20040257.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP
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NAME
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ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATIO DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPA IR
o
FENCE
( X_
GRADING
CYDS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TE9CP App(oved 13
RW Permit Roquiled 13
street use Ilennit Fioq'd 13
inspection Heipmed Q
Sidewalk Requtred E3
underground
Witing roqtjirod C3
PRV REQUIRED
YES 11 NO IJ
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
UJI
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FIRE REVIEWED BY DATE uj
VARIANCE OR CU SHORELINE OR ADB#_ I ]INSPECTION BOND
REO'D POSTED
YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA _F�NNING REVIEWED BY DATE
REO'D I PROVIDED I
FT) I REMARKS
(TYPE OF USE,,aYSINESS OR ACTIVITY) EXPLAft-, 14-011 f1l ZAC2
CHECKED 13Y 17D�WOF CONSTRUCTION COWE OCCUPANT
7 GROUP
,a
U) NUMBER OF
NUMBER CRITICAL
SPECIAL INSPECTION JAREA OCCUPANT
M OF DWELLING AREAS I
to STORIES UNITS NUMBER REQUIRED 0 YESI LOAD
DESCRIBE WORK 10 HE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REQ'D Ei
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Of
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
I - I /
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
UJI PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
in
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, 11S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt ft
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIREC MY
FROM 114E ISSUANCE OF THIS PERMH. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE e
0 NOR LIMIT IN ANY WAY I HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
xi - Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY Willi CITY AND STATE LAWS REGULA:rING CONSTRUC- CALL I his application is not a perinit until Signed by the
TION ' AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED FOR INSPECTION Buildin g ollicial or hisitier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO teceirit is acknowledged in space provided.
WORKMEN'S COMPENSATION�,PO'U�ANCE AND RCW 18.27. OF Ci,��)Il S,,SiGNATU r DATE
SIGNATURjOWNER OR A �NT) DATE SIGNED (4215) 4.
77 -0220 E
L 2 nFl EASE[) 11Y
ATTENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK-OVVNER GOLD -ASSESSOR
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Facility Name:
Grease Trap Sizing Worksheet
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Address: 23632- Hw� 5� 1� t4 Suite No.:
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• A Grease Trap plumbing permit is required ($165-00 fee). Contact the Pretreatment
Technician (425-672-5755) if you have any questions and also to get signature approval on
this form.
• Dishwashers are not allowed to be connected to a Grease Trap.
• Food disposers are not allowed in a facility served by a Grease Trap and must be disabled or
removed. Solids must be screened out and placed in the solid waste container.
Fixture Capacity in Cubic
Inches
xWxD xno. of sinks)
Fixture Capacity
in Gallons
(Cu. In. + 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for a
2-Minute
Drain Period
#1
17 �,J.
231 = gal.
x.75 = 216 gal.
2 = ;-23 gpm
#2
X X X c.i.
231 = gal.
x.75 = gal.
2 = - gpm
#3
X X X c.i.
231 = _gal.
x.75 = gal.
2 = - gpm
#4
X _X X c.i.
231 = __gal.
x.75 = gal.
2 = gpm
Grease Trap #1 — Total drainage flows from maximum of
4 fixtures
gpm
#1
X
X X c.i.
231 = gal.
x.75 = gal.
2 gpm
#2
X X c.i.
231 = gal.
x.75 = gal.
—2 gpm
#3
_X_
X X X c.i.
231 = gal.
x.75 = gal.
2= gpm
#4
J x x x c-i-
231 = gal.
I x.75 = g al.
+ 2 gpm
Grease Trap #2 — Total drainage flows from maximum of 4 rktures
gpin
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
gpm
Number nf Fixtures Connected to a Grease Trap
I J
2
3
4
Grease Tra
20
25
35
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
-------------------- — ---------------- (For City use only below this line)
Remarks:
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Size Approved: 2 gpm Approved by: �� —Date: 21- 7- 04
Pretreatmeifft Technician
[Rev.Feb.2004]
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
ITI
Slab Insulation ..........
PLUMBING: =n-
Underground ............. 0 ITI
-In ................... M
Rough 0
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0
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Commercial Final ...... --I ?.
3: M
HEATING: M Z
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Gas Test .................... > z
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Gas Piping .................
Equipment ................. 0 -n
n
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Commercial Final ....... M
M M
EXTERIOR SHEATHING 055
NAILING .......................... 0 r-
0 M
C (D
FRAMING ........................ F. C/)
ITI 0
Z
FIRST FLOOR FRAMING ... --I
INSULATION ................... X
3:
Floor Insulation ......... >
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Wall Insulation ...........
Ceiling Insulation ....... C/)
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SHEETROCK NAILING I
PECTION
SPECIAL INS M
VALUATION , 41
MISCELLANEOUS ........ $
0
FINAL APPROVAL FOR
pDoscription -,,FEE Description FEE
OCCUPANCY ................