20040403.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
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CITY ZIP ITELEPHONE
NAMW CBLO
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ADDRESS
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CITY ZIP
TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
11 NEW
E] RESIDENTIAL
PLUMBING / MECH
11 ADDITION
;5RC—COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
El REPAIR
GRADING
CYOS
FENCE
( x . Fr)
DEMOLISH
TANK
!Tb�- I
GARAGE
RETAINING WALL
FIRE SPRINKLER
z CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
(; Pro, -T- G
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uj NUMBER
NUMBER OF
CRITICAL
OF
DWELLIN
AREAS
STORIES
01
UNITS
NUMBER
—3
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
4 USE
1ON F
PERMITEXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO,
LID FEE $
TIESCP Approved 11
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Pernia Required 0
street use Permit Flori'd 13
EXISTING - PROPOSED
inspection floquired E3
sidewalk Floquired [3
HFOUIRFD DEDICATION- FT
underground 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO
W
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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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.
Uj PERMIT APPLICATION: 1BODAYS
PERMIT LIMIT I 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 TO INDEMNIFY, DEFEND AND HOLD HARMLESS T-HE CITY OF
M EDMONDS. ikASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIM THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENr OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
ONER 0 GEN DATE.SIGNED
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
SHORELINE OR ADB#
DATE
DATE
INSPECTION
REO'D
OYES ONO IS
SIGN AREA I
ALLOWED - PROPOSED I ALLOWED
BOND
POSTED
HT
PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR I FRONT L/R SIDE REAR
LOT AREA I PLANNING REVIEWED 13Y DATE
7
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CHECKED BY PTE OF CONSTRVCLTION E OCCUPANT
or
I A 1)") 1 CT-1 GROUP
IS
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED C] YES LOAD
REMARKS z
PROJGRESS INSPECTIONS PEFVUBC 108/FINAL INSPECTION REaD
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FEE
Description
FEE
State Surcharge
cc)
City Surcharge
Base Fee
FOR INSPECTION
(425) //"�
771-0226-
Plan Chk. Deposit
Receipt
Total Amt. Due
Receip
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building official or his/tier Deputy: and Fees are paid. and
receipt is acknowledged in space provided
7,SIGNATURE D, At
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ATTENTION tX I I 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
/ C --,- �,-
BY / DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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Grease Trap Sizing Worksheet
FacilityName: /1111/4 &
Address: 2- Y 0 0 1 14i,-� a T-1 —Suite No.:
• A Grease Trap plumbing permit is required ($165.00 fee). Contact the Pretreatment
Technician (425-672-5755) ifyou have any questions and also to get signature approval oil
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
x W x D x no. of sinks)
Fixture Capacity
in Gallons
(Cu. In. -- 231)
Drainage Load
(750/0 of Total
Capacity)
Flow Rate for a
2-Minute
Drain Period
01
X X X c. i.
-1-- 231 = aal.
n
x .75 = gal.
—
' 2 = gpM
#2
x x x c.i.
23 1 = gal.
x .75 = gal.
2 = gpm
X X X c.i.
= 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.
2 3 1 �al.
x.75 = gal.
2 = gpM
#2
X X X c. i.
23' 1 �al.
x .75 = gal.
2 = gpM
#3
X X X c.i.
—2�1
a ..., gal,
x .75 = cyal.
2 = gpM
#4
, X X X C.
I gal.
2_= gpM
Grease Trap #2 — Total drainage flows from maximum of 4 fixtures
gpm
MINIMUM SIZE OF GREASE TRAP(S)REQUIRED
— gpmj
Number of Fixtures Connected to a Grease Trap
2
3
4
Grease Trap Size (in gpm) 20
25
3
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
-------------------------------------- (For City use only helow this line)
Remarks:
/-71
Size Approved: 20 gpm Approved by: Date: 3 -7- 01/
Pretreatmo t Technician
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RF—CE.IVED FINAL PROJECT APPROVAL FORM
A!"IC, 11 2004 TO:
DEVELOPMENT SERVICES CTR.
CITY Or- EDNAONDS DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
Pr e- f, r e o--L m e- nt
Uri, DATE A>-6-oq
FROM:
PLEASE 1IGNU
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT ZV1 i c, k'
SITE ADDRESS 9
PERMIT # —ADB# DATE INSPECTED 6 -
DESCRIPTION OF WORK TO BE INSPECTED ZO. rr.
A field inspection was conducted to determine compliance with -approved plans. Final appr val
denotes that there are no objections from the above signed Department to the releas of
PERFORMANCE BONDS and the granting of:
OK GRANT FINAL PROJECT APPROVAL
GRANT 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:ten1p:b1dg:fbnns: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 ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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