20040372.pdfN
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
E[I NAME/NAME OF BUSINESS
MAILING ADDRESS
NAME
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CL/ I I PERMIT EXPIRES
SE I PERMIT _VZ"
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PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
Rim Pormil Required CI
Street use Permit lli)q*(j 13
1
EXIST ING - PROPOSED
Inspection Required 13
Sidewalk Required 13
RFOUIRED DEDICATION- F1
Undef0fOUnd
wiring required 13
MEIER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
1
1
YES 0 NO 1:1
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REMARKS z
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OWNERICONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE F5
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EERING REVIEWED BY DATE
FIRE REVIEWED BY DATE LU
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- VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND
CHECKM REO'D POSTED
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__ j3MECH
E] ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
SIGN
El REPAIR
GRADING
rynq
FENCE
( X FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
E:i RETAINING WALL
FIRE SPRINKLER
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FIRE ALARM
(TYPE OF USE, BU
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NUMBER
NUMBER OF
CRITICAL
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO
BE DONE 19
I I HEAT SOURCF_'_T GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
/97 j jT
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Uj PERMIT APPLICATION: IGODAYS
CL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, �ASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECILY Oil INDIRECILY
FROM IHE ISSUANCE OF THIS PERMIT ISSUANCE OF 1111S PERMIT SHALL NOT BE
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_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI IY ORDINANCE
= 01 NOR LIMIT IN ANY WAY THE CITN'S ABILITY TO ENFORCE ANY OHDINANCE PROVISION *
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION, AND IN DOIN9,TkIE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOCAT40N OF fIIE 'LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'P C044INISATIOtT INSURANCE AND RCW 10 27,
OGN T7U
E R GEN DATE SIGNED
SEPA REVIEW
COMPLETE , EXEMPT
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LOT COVERAGE
NLLOWED PROPOSED
PARKING
REO'D I PROVIDED
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SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR I FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
SPECIAL INSPECTION JAREA
REQUIRED 0 YES
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
EMARKS 0
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IROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-022'0
EXT 133
FEE
Description
FEE
State Surcharge
City Surcharge
10
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due (P-5
Receipt #
APPLICATION APPROVAL
This application is riot a perinit until signed by the
Building Official or hisitter Deputy. and Fees are paid, and
receipt is acknowledged in space provided
_FIQ I, A411F DA I E
7"_S�Q_ fly Ili DATE
IT IS UWAWFUL 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
0903 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW INSPECTOR
PINK - OWNER COLD - ASSESSOR
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City of Edmonds PEIII NO: 9 8 4 7,
PERMIT EXPIRES A 1<�_)OL/
SIDE SEWER PERMIT
Address of Construction: ZOO :kh� U LTD
Property Tax Account Parcel No.
Attach copies of all accessAnd utility easements Verified and Approved by
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Owner and/or Contractm.
Contractor License M 65121- 3 4 M Building Permit #:,200-6372 PI-ff/
C&#=116(b
Fj Single Family Invasion into City *Right -of Way: 0 Yes No
Fj Multi -Family (No. of Units *RW Construction Permit #
VCommerci *_(No. of Units Cross other "Private Property: El Yes No
nP bl' "Attach legal description and copy of recorded easement.
OY—A OwnerXontract
Own4r/or cC1'h'tr�ci`o_Uignatureand acknowledgement statement: Date
By si�ning �o�this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
W CALL DIAL -A -DIG (1-800-4214-5555) BEFORE ANY EXCAVATION W
W FOR INSPECTION CALL 425-771-0220 extension 13.%W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
Permit Fee $ 150 94WFe4e^$' 15;�D Issued (x Lo I vll�_�
Date Issued:
Assessment Fee $ Receipt No: -a4l i�D
City Permit Surcharge Fee 15.00 Total Fees Pai.d $ i25(055
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES, A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO —Date: Initial:
Partial Inspection: —Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: Initial: As -built to Street File: E]
'rz- PERMIT MUST BE POSTED ON JOB SITE t�
While Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY &QXYnterce' pfor Sizing Worksheet PZCJ�71V4�,o
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Facility Name: Ja C-� Y)
Address: 2113 —Suite No.:
• A Grease Interceptor permit is required ($365.00 fee). Contact the Pretreatment Technician
(425-672-5755) if you have any questions and also to get signature approval oil this form.
• Per City Ordinance 3 )401 the minimum sized Grease Interceptor permitted is 500 gallons.
Maximum sized unit is 4,000 gallons.
NUMBER OF MEALS SERVED AT PEAK HOUR
Based on the total number qf seats and average titne per ineah
Lounge and bar seating is counted at 20%.
WASTE FLOW RATE (Choose one)
• With Dishwashing Machine ...................... 6 gallon flow
• Without Dishwashing Machine ................ 5 gallon flow
• Single Service Kitchen* ............................. 2 gallon flow
• (Food Waste Disposer ....................... add i gallon now)
RETENTION TIMES (Choose one)
• Commercial Kitchen Dishwasher ............. 2.5 hours
• Single Service Kitchen* ............................. 1.5 hours
STORAGE FACTORS (Choose one)
• Full Service Kitchen 0-12 hour operation: .......... I
• Full Service Kitchen 12-20 hour operation: ........ 2
• Full Service Kitchen 24 hour operation: ............. 3
• Single Service Kitchen*: ...................................... 1.5
• (Alternate factor for occasional use kitchen ......... --j
A
B = 2-
C= 1.5
D = /.S
Minimum Interceptor Size (liquid capacity) A x B x C x D = (70--)
*A single service kitchen refers to a restaurant where disposable dishware is used and
dishwashing operations are therefore greatly reduced.
-------------------------------------- (For City use only below this line)
Remarks:
. gal. Approved by: at��
SizeApproved: 0i00' qMU,4-., Date: 3-.2'�-04
PretreatniVn-t Technician
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Per m i #2-004 - 0372- P�M
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MEMOTO:
FROM:
FINAL PROJECT APPROVAL FORM
TO:
PERMIT COORDINATOR, BUILDING DIVISION
PRETREAV�
PLEASE SIG�r
DATE:
DATE 7-16-0�
-ENGINEERING DIVISION DATE —
PLEASE SIGN
—PLANNING DIVISION DATE—
PLIASE SIGN
PROJEC PDX
SITE ADDRESS 2-1130 kll*�A'wail
PERMIT 2 o0,4 - 0 3 7 2- PktA ADB#_________jDATE INSPECTED q- /6- - 04
(,Igo 0 pl
DESCRIPTION OF WORK TO BE INSPECTED _YnSLOM Y-_4_
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
PERFORMANCE BONDS and the granting of :
GRANT FINAL PROJECT APPROVAL
GIANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocaprv1 3/25/04
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RECORD OF INSPECTIONS