20040360.pdfDATE RECEIVED L L
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U F PERMIT
CITY OF EDMONDS Z014E NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LID NO,
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LID FEE S
UM MAILING ADDRFSS �13
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REQUIRED DEDICATION— FT vv,,,omq,,ted 13
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METER SIZE NO. OF FIXTURES PRV REQUIRED 0
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NAME
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ENGINEERING REVIEWED BY DATE
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FRONT LjR SIDE REAR
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REMARKS
DEMOLISH TANK El OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
El FIRE ALARM
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
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NUMBER OF,
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AR AS
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JAREA I
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VALUATION
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Description
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Base Fee
VESTED DATE
rpaN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180DAYS
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PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. InspecItionEEE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
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'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Inspection
Receipt
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHING1 ON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERM11 SHALL NOT BE
Lan dscapeinsp.
Total Amt. Due
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DEEMED 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Receipt #
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NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: ancl Fees ate paid, and
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowILdged in space provided.
THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ,-\
IN VIOLATION OF THE LABOR CODE OF
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27. 0 S SIGNATUR�/ ..�D
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NER OR ENT) DATE SIGNED (4251
SIGNATL (OW "I-",
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771-02 1EASED BY I DATE
EXT 1333
ATTENTION
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 - OWNER GOLD - ASSESSOR
PRESS HARD -YOU ARE MAKING 4 COPIES
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CITY OF EDMONDS,
rease Removal Equipment Application
Business Name: t4 CA 1.� r-2 /_J"91UJ Date Submitted:
Address: �-3a _s-j AL)-e � Suite No.:
'ZY M e% M -1) e 114,el
Business Owner: ailingAddress: N-001-
Contact Person/Title: /A'r/zY bi -e 6/",*- Otvro-ev Phon,,� C12-S 77
Days/Hours of Operation: 24 h, S 14'
Total Number of Meals Served Per Peak Hour (assume all seats filled):
Number of Seats: Dining: Lounge/Bar: X_ Banquet Rooms44 r Deck/Patio:
Building Occupancy Permit Capacity: 3 0 Health Dept. Permit Capacity 0
Inventory of Kitchen Equipment and Plumbing Fixtures for this Establishment: (Grills,
burners, ovens sinks,
hoods, deep fat fryers, wok stations, soup kettles, sinks, pre -wash
dishwashers, disposers, mop sinks, floor drains, etc.) 3 I�W' //S , z 6 U'Z'v��_-s
6 Ue j�j 1400 -e ega, I-Jd� jo Ct, Q i e-
h7o,�J�W14 FIVOX _24411Z
What proportion, if any, of the dishware used is of the disposable type? I�OH)C_
How is waste oillgrease handled, stored, and recycled/disposed? —
5-rot F.0 I 'kj c i_ VIC 9 -t-e d �=Z .6 a k,66?-r
tT u 1h jfer-h
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Estimate gallons of waste oil/grease produced per month:
If recycled, by which company? tq'a V_ -6"1_J 0 0 ^-1 Ph 0
How are vent hoods cleaned and where does the cleaning wTte go? 0- keq-�J ed
Li Ve.,,f--r Sqr4-Qt,-n //\Ao wAste- Y M 92
Contact the Pretreatment Technician at 425-672-5755 to discuss the type and
size of equipmentyou must install, and then complete the appropriate
accompanying worksheetfor either a Grease Interceptor or a Grease Trap.
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Grease Trap Sizing Worksheet
Facility Name: Pancake- Naus
Address: .5-3 o St� A ve, - -S Suite No.:
0 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.
0 Dishwashers are not allowed to be connected to a Grease Trap.
0 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
(L x W x D x no. of sinks)
Fixture Capacity
in Gallons
(Cu. In. + 231)
Drainage Load
(75 % of Total
Capacity)
Flow Rate for
a 2-Minute
Drain Period
#1
J;k, x I)., x q x I = c.i.
23 1 = A,q,9 gal.
x .75 gal.
+ 2 = IT 3 gpm
#2
-1_7, x -1, x q x I = S-2- 9 c-i.
+ 231 = 2.- 2- 9 gal.
x.75=/,,7/ gal.
+ 2 =
#3
x x X c.i.
+ 231 = _gal-
x.75 = gal.
2= gpm
#4
x x X c.i.
+ 231 = gal.
I x.75 = gal.
2 gpm
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures
1:7 F, gpm
#1
/-1 x,?,l x,2-x_3 =/2-31-7-6.
231 =5!;4 3 gal.
x .75 = t4l,,72- gal.
2 ='20- q 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.
I x.75= gal.
-- 2 = gpm
Grease Trap #2 — Total drainage flows from maximum of 4 fixtures
2 b,.—� gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
gpM
Number of Fixtures Connected to a Grease Trap
1 1
2
3
1 4
Grease Trap Size (in gpm)
20
1 25
35
1 50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
........................................ (For City use only below this line) -----------------------------------------------
Remarks: Existina 20 ,Dm G'T w;J1 serva the. ny-p--wo.A- 4 iAe- di.r(20re-ly- wi)l
Size Approved: 9pm Approved by: /J�� 91L�— — Date: 5- 14 - 04
PretreatmeOt Technician
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RECORD OF INSPECTIONS
INSPECTOR
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL-FOW-
Ei4L;'i5-,t:J19A*Nt'Y ..................
DATE APPROVED
Readwin, Jennifer
Yokers, Tim
From: 21, 2004 1:56 PM
Sent: Friday, May
To: Readwin, Jennifer
Subject' GT inspection for Pancake Haus
Jennifer, #2004-0360.
1 inspected the GT installation at the Pancake Haus on Thursday - looks good. it is permit
Tim Yokers
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