20040396.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
7 vqRj Idd,
MAILING ADDRESS
C"C' C? -(J 1
_12ZL?_
CITY ZIP TELEPHONE
_Sgi7ec) 7 6.5
NAME
�_ U _'Z�DRESS
CITY
NAME
e�ve_w- � 74
ADDRESS
P,3 - 'V,
66:04i�>
CITY
ZIP TELEPHONE
CBL
TELEPHONE
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STATE LICENSE NtIMBER EXPIRATION DATE I -CHeCtiED 13Y
e-1;%j; 1jr;&
PROPERTY TAX ACCOUNT PARCEL NO.
�2 7() 93 6; o o
11 NEW RESIDENTIAL
1:1 ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIViTY) EXPLAIN:
/ . 6/z,�WJ*AF
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESC E IN RKTO BE DONE
0441c_-f 77-677 e:>`;,
6 -7�
LIT EXPIRES
PERm
USE PERMIT
ZONE NUMBER, q
JOB SUITE/APT#
ADDF1ESSZ,7/,,
PLAT NAMEISUBDIVISION NO LOT NO� LID NO.
LID FEE $
1 ES(7 �APPMVOd[3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Ponnit Required [3
street Use Permit Roq'd 13
EXISTING - PROPOSED inspection Requitod [3
Sidewalk Required 0
REQUIRE[) DEDICATION- FT Underground
wiring requitud [3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 0 NO IJ
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
(0 1
I ENGINEERING REVIEWED BY DATE
15
ZIP
0 U
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
F� SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
:'f7WU e7/j k_? -t—
S, � ae
CRITICAL
AREAS
NUMBER
r_,L)
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR I FRONT UR SIDE REAR
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PARKING LOT 7FA P �NNING REVIFWED BY DATE 5
REO'D I PROVIDED I IL
REMARKS
CHECKED BY ITYPENONST CTION CODE OCCUPANT
i V. : W149 GROUP
RA
SPECIAL INSPECTIOd AREA -FOCCUPANT
REQUIREDE] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D F5
M
VALUATION
Description FEE Description FEE
State Surcharge
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit 0 City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Giading
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
i Engr. Review
M
W PERMIT APPLICATION: 180 DAYS
Ix PERMIT LIMIM 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 SUCCESOFIS Fire Review Plan Chk. Deposit
U)
!4 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
W
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE cLrYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION' 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 AGRI�E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
1� [his application is not a pormil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO I�NSPEC I receipt is acknowledged in space provided.
WORKMEN'S COMPENSATP��
:ER O+PEN��P) _�ANCE AND RCW 18 27. DATE SIGNED (425 OFFICIAL§ SIGNOTURE ATE
1�
SIC �IJRE (OWN (425) O'l
rl 0
�t la7w:� 10;11
771-0220 RrLEASFD BY' DATE
ATTENTION J;flle /-;VZ�� EXT 1'1'13/
IT IS UNLAWFUL TO USE OR OCCUKY A BUILDING OR STRUCTURE UNT11
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
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Grease Trap Sizing Worksheet
Facility Name:
'10 Suite No.:
Address: W,,-LLI
J
• A Grease Trap plumbing pern-fit 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
(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
91
JR /( N 13 x 3 Z LIS -c-i-
231 = 53 _gal.
x.75 = 40 gal.
2 = 2f-) gpm
#2
X X X c.i.
231 = gal.
x.75 = ___gal.
2 = gpm-
43
C.
X X X i.
231 = gal.
x.75 = gal.
2 = gpM
#4
P-GreEaseTrap
X X X c.i.
231 = gal.
x.75 =
2 = gpm
91 - Total drainage flows from maximum of 4 fixtures
--�Lc—) gpm
#1
X X X c.i.
231 = gal.
x.75 =
2 = gpm
#2
X X X c.i.
231 = gal.
x.75 = gal.
2 = _ gpm
#3
X X c.i.
231 = gal.
x.75 =
2 = gpm
#4
-X
X X X c.i.
231 = _gal.
x .75 = gal.
2 = _ gpm
Grease Trap #2 - Total drainage flows from maximum of 4 fixtures
gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
gpm
Number of Fixtures Connected to a Grease Trap
/1
3
�35
4
Grease Trap Size (in gpm)
20 /
'25
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
-------------------------------------- (For City use only below this line) --------------------------------------------
Remarks:
Size Approved: 2-0 gpm Approved by: Date: 5 - 2A - O.q
Pretreatme 11 Technician
[Rev. Feb. 20041
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INSPECTOR
DATE APPROVED
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 POFP
...............
Umbaugh, Theresa ......
From: Yokers, Tim
Sent: Wednesday, June 02, 2004 9:53 AM &=570
To: Umbaugh, Theresa
Subject: lvar's GT
Hi Theresa,
1 inspected the GT installation at lvar's - looks good. I'll put a signed off copy of the permit in the street file.
Tim
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