20040324.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY TELEPHONE
ZIP
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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ADDRESS
CITY
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STATE LICENSE NUMBER
CBL #
ZIP TELEPHONE
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EXPIRATION DATE I
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
M RESIDENTIAL
13
ADDITION
53_�COMMERCIAL
1:1
REMODEL
MULTIFAMILY
1:1
REPAIR
GRADING CYDS
11
DEMOLISH
TANK
IGARAGE
I
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CL
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5'"k)
NUMBER
NUMBER OF
OF
DWEI ' LING
STORIES
I
UNITS
DESCRIBE WORK TO BE DONE
tvd
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
USE '
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LOT NO.
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO�
LID FEE $
TESCP Approved
13
RW Pernnit Requirpt!
0
Street Use Permit Roq'd
13
Inspection Required
13
Sidewalk Hequired
E3
Underground
Witing required
13
PRV REQUIRED
YES 13 NO 1:1
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE
--I r VARIANCE OR CU
By
0
154 PLUMBING / MECH
COMPLIANCE OR
11 CHANGE OF USE
1:1 SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER P/A
LOT SLOPE %
VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION *
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
FIEQ'D I PROVIDED
REMARKS
iii-IORELINE OR ADBN INSPECTION BOND
REQ*D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS FT.)
FRONT SIDE HEAR FRONT URSIDE 4A(R
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LOT AREA I PLANNING REVIEWED BY DATE CL
CHECKED BY 4RE OF CONSTRUCTION CODE OCCUPANT
�j I GROUP
SPECIAL INSPEC)1-Otr- XR A OCCUPANT
REQUIRED [3 YES LOAD
REMARKS z
I PROGRESS INSPECTIONS PER I)BC 1 OB/FINAL,!NOECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAI THE INFORMATION
H ORMAT'ON
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
C
ONJSTR
T IV _ U
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
THE OWNER. E MPLOY ED
H
T
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I 1 10 V RELATING TO
N ViCiLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WWOFKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0
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SIGNATURE (OWNER OR, T) DAI ION E �D
FEE
o
CALL
FOR INSPECTION
If
(4 2. 5)
771-0220
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # -2
1 1101,62
APPLICATION APPROVAL
I tits application is not a perinit until signed by the
Building officiai of hiSiher Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
FFiV*l S SIGNATUFJE I / DATf
EASED BY I CATE
ATT ENTION MA 1 1 JJJ
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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Grease Trap Sizing Worksheet
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Facility Name: 'Z�
Address: -J, Suite No.:
• 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 o
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 4,�ged
removed. Solids must be screened out and placed in the solid waste container.
Fixture Capacity in Cubic --
Inches
(L x W x D x no. of sinks)
Fixture Capacity
in Gallons
(Cu. In. - 231)
Drainage Load
(75% of Total
Capacity)
Flow Rat�*r
a 2-Minute
Drain Period
#1
;z.�(x 2q x // 1-x _3 2--ejo) 2_ c.i.
231 = 10_,q gal.
x .75 = 7L aI.
2 = 39 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 1Z x rlqoj c.i.
+ 231 = -1/ / __gal.
x .75 = gal.
�3
+ 2 = /,9- gpm
#2
x x c.i.
231 = gal.
x .75 = gal.
2 = gpM
X X x c.i.
231 = gral.
x .75 = ___9�a—l-
2. = gpm
�3
#4
#
x X x c.�
gal.
x .75 = gal.
2 gpm
Grease Trap #2 - Total drainage flows from maximum of 4 fixtures
MINIMUM SIZE OF GREASE TRAP(S) REQUIRE, D So
gpm
270 gpm I
Number of Fixtures Connected to a Grease Trap
2
3
4
Grease Trap Size (in gpm)
20
25
25
355
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
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---------------------------------------- (For City use only below this line) -----------------------------------------------
Remarks:
:y 2�, Date: 5- 3-
Size Approved:2 26 gpm Approved by: j0".1
PretreatmeNt Technician
I Rev. Feb. 20041
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RECEIVED FINAL PROJECT APPROVAL FORM
';L�P -- 2 2004 TO:
DEVELOPMENT SUAVICES CTR.
CITY OF EDMO14DS
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
PRETREATMEN
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FROM: DATE-1—LI—�_
ENGINEERING DIVISION DATE—.
PLEASE S1
PLANNING DIVISION DATE--,
PROJEC 4�1-51J
LobnorAs Wal)
SITEADDRESS __1903- ADB# DATEINSPECTED q-1-24 (Pi
PERMIT I
DESCRIPTION OF WORK TO BE INSPECTED SO pi �ALe_ 0
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFO NCE BONDS and the granting of
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDIN ' GISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
PQ
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
-----------
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. ----------
Retaining Wall ...........
Slab insulation .......... ----------
PLUMBING:
-----------
Underground .............
Rough -In ...................
-----------
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
----------
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... ----------
Ceiling Insulation ....... ------------
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
t
FINAL APPROVAL FOR
OCCUPANCY ..................
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