20040465.pdfr
E RECEIVEIIZ
PERMIT EXPIRES
L I F
X
4 L /
,
CITY OF EDMONDS
I
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS -I—X
0)� NER NAMEINAME
, OF BUSINESS
C 4,�3t,_ (
117r
LLVAL_L�
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
U3
a:
W
—,--%
MAILING ADDRESS
LID FEE $
z
0
4o�, �L),i
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TF.SCP Approved E3
RW Permit Required 13
Street Use Permit Roq'd 0
CITY ZI . P TELEPHONE
EXISTING — PROPOSED
inspection Required 0
Sidemalk Required E3
REQUIRED DEDICATION— FT
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
I
L)
12(
I
YES NO
z
Cr
W
LU
t=
ADDRESS Ii
REMARKS
z
z
-7 4514;;',
OWNER/CCIN TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
W
Ir
L�4 -1
CITY ZIP
TELEPHONE
T
L
r
NAME
CBL#
lk-c a e cc
Co'�)'Zw
BY
z_
ENGINEERING REVIEWED DATE
ADDRESS
0
T�
A(
FIRE REVIEWED BY DATE
W
CITY ZIP
TELEPHONE
E
LL
i
VARIANCE OR Cu
SHORELINEORADB#
INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
1E
DYES ONO
S
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
Uj
17 ;'X�p ec)n
,
,
,
_j
-n In
EXP
NEW RESIDENTIAL 2__�PLUMBING MECH
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
z
E
z
PARKING
REQ'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN
I
GRADING o FENCE
REPAIR r Y ns ( — X —FT)
REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
FIRE ALARM
z
CARPORT ROCKERY
(TYPE OF USE, %USINESS 02R ACTJ�ITY) EXPLAIN:
It
( eel?
CHECKED BY
'�(PE OF CONSTRUCTION
CODE
1
OCCUPANT
GROUP
;6
C3
_.j
1
OZ9
NUMBER
OF
N 13ER OF
U1
U M
To ELLING
W
W
CRITICAL
C
AREAS
FNII
W
W
-
SPECIAL INSPECTION
JAREA
OCCUPANT
0
STORIES
UNI
MBER
REQUIRED [] YES
LOAD
DESCRIBE WORK TO BE DONE
--r4s;4::z,4;0 V Gr--,�v :E4_z!�r_-Lr-
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
®r
W
VALUATION
Description
FEE
Description
FEE
Plan Check
I
I
State Surcharge
/
HEAT SOURCE
GLAZING %
LOT SLOPE %
I __/
Building Permit City Surcharge
I L. 72" L a
PLAN CHEIQK NO: VESTED DATE Plumbing Base Fee
0 LLzi Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
W
PERMIT APPLICATION: 180 DAYS
EL
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
—
in
U)
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
/
Lu
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
1
_j
2
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
eov
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
X1
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 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or hisitier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
/,j receipt is c nowledged in space provided.
WORKMEN'S (��MPENSATION INSURANCE AND RCW 18.27.
OFF LALS SIGNATURE DATE
GNAT WNq , R OR AGENT)
----------------
DATE SIGNED
(425
771-0220
, /
RELEASED BY /6ATE'
NTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPRUVAL UH A UEH I IFI- 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
z
0
i
0
M
--i -n
M
C
M 0
0
10
0 C
-i K
X M
M Z
10 --A
C
0 -n
>
M M
0
0
0 M
C cl)
F, Cn
M 0
Z
71
z
CD
z
0
M
im
I
CITY OF EDMONDS
..............
Grease Removal Equipment Application
Business Name: Date Submitted: A_,?(0 .0d,—
Address: Suite No.:
�5 cpm
Business Owner: "Mott-, Mailing Add & 40_t;_�
Contact Personffitle:'��4 A�Q CLLk�_,�� -Plione:20CP '550 7 5LS
Days/Hours of Operation: 9:::
Total Number of Meals Served Per Peak Hour (assume all seats filled):
Number of Seats: Dining: Lounge/Bar: —Banquet Rooms: Deck/Patio: 15
Building occupancy Permit Capacity: Health Dept. Permit Capacity
Inventory of Kitchen Equipment and Plumbing Fixtures for this Establishment: (Grills,
burners, ovens, hoods, deep fat fryers, wok stations, soup kettles, sinks, pre -wash sinks,
dishwashers, disposers, mop sinks, floor drains, etc.) —:5poP WAf(U_c,,eA pa';e u_"q&14
0 (0
What proportion, if any, of the dishware used is of the disposable type? _+0
How is waste oil/grease handled, stored, and recycled/d is posed?
�22 i la 0>�=,j 4-_-o-dub Qci-_qr
k
Estimate gallons of waste oil/grease prod need per month:
If recycled, by which company? zb
How are vent hoods cleaned and where does the cleaning waste go? .51kr_ e(4_. 1,�p
C A-60 �U Rsi C I A-i_-o
Contact the Pretreatment Technician at 425-672-5755 to (fisciiss the type and size
of equipment you must install, and then complete the appropriate accompanying
worksheetfor either a Grease Interceptor or a Grease Trap.
( rry op",,7"
C., IL . I
z
0
4
0
M
Grease Trap Sizing Worksheet
Facility Name:
Address: Aye— -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 oil
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 x1rX-n6---Df4inks)
Fixture Capacity
in Gallons
(Cu. In. — 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for a
2-Minute
Drain Period
in
was V_ c) n
Pre�, i.
—231 = gal.
x .75 = gal.
2
2.) 1 = gal.
x .75 = gal.
2 gpm
#3
X X X c.i.
231 = gal.
x .7 5 = gal.
2 gpM
X X X c.i.
231 = gat.
x.75 = gal.
2 gpm
-#4
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures
gpm
#1
X X X C.1.
231 = gal.
x .75 = gal.
2= gpM
#2
X X X CA.
231 = gal.
x.75 = gal.
2 = gpm
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 #2 — Total drainage flows from maximum of 4 fixtures
gpm
MINMUM SIZE OF GREASE TRAP(S) REQUIRED
gpm
Number of Fixtures Connected to a Grease Tra
2
3
:4�
Grease Trap Size (in gpm)
25
35
50�
Upsize for factors such as high volume dishwashing, high oil/grease content on tnenu, etc.
-------------------------------------- (For City use only below this line)
Remarks:
Date: 2-
Size Approved: '2_0 gpm Approved by: �J�i
Pretreatmery Technician
Z
0
4
0
M
r
FINAL PROJECT XPPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PRETREATMENT PLANT DATE 05
PLEASE Sl(;NV
z
0
PROJECT Re, L L C-
0
rp
SITE ADDRESS 7 S "q Vc. S
=-n
0
M
PERMIT # 2-00'q O'q 65 ADB#___----DATE[NSPECTED 12-0-WI
M 0
--10
0 C:
--i
DESCRIPTION OF WORK TO BE INSPECTED i a n (3T r e- o,, S e-,
K
T- M
MZ
A field inspection was conducted to determine compliance with approved plans. Final approval
Cz z
>
denotes that there are no objections from the above signed Department to the release of
--4
r x
Cn
PERFORMANCE BONDS and the granting of:
0 -n
-n ;d
GRANT FINAL PROJECT APPROVAL
M M
0
0 M
9 Cl)
M C-)
Z
M
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
z
I
Cn
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
z
0
i
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
0
M
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
uvrEM ll\BUILDING\FOIZMS,�IIIZEI'REAI'M ENTAPPROVALMOC 1/4/2005
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch .................
0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
0 M
Underground .............
C
M 0
0
Rough -In ...................
0
0
—4
Commercial Final ......
x M
M z
HEATING:
C z
GasTest ....................
0)
Gas Piping .................
0 -n
Equipment
n
.................
Commercial Final .......
M M
0
EXTERIOR SHEATHING
0
0 M
NAILING ..........................
C: CD
FRAMING........................
M 0
FIRST FLOOR FRAMING ...
INSULATION ...................
x
Floor Insulation .........
z
_q
Wall Insulation ...........
x
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
171
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
f4up