20040474.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
*�FTT&CtL KI
MAILING ADDRESS
CITY, ZIP TELEPHONE
NAME
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ADDRESS
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CITY ZIP ITELEPHONE
NAME C L rl
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ADT)PPO"� A -
CITY ZIP TELEPHONE
U,QRYD(7__ 9.8a.7 1,2r)& 4-06c
STATE LICENSE NUMBER EX7PATI N DATE
2 1 r:`
PROPERTY TAX ACCOUNT PARCEL NO.
10 2 6?61 - 0 - Z,
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE -OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
UP
Lu NUMBER NUMBER OF
0 OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
6��
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
1:1 PLUMBING/ MECH
COMPLIANCE 08
CHANGE OF USE
SIGN
FENCE
( — X_
OT ER e-
Q
Ab IA1
F Sp I�
IRE SP INKL&
FIRE ALARM
CRITICAL
AREAS
NUMBER
r�
LOT SLOPE %
VESTED DATE
/W I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SU ITE/APT#
ADDRESS tfj (
S*
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
[3
, treat use Permit Roq'd
S
El
EXISTING — PROPOSED
inspection Required
Sidewalk Required
13
E3
REQUIRED DEDICATION— FT
Underground
W,nng required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
YES 13 NO
3
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REMARKS
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OWNER/CONTRAcTOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
BOND
REO'D
I
POSTED
I
OYES ONO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEM13T
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
I
I —
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
LOT AREA -[PLANNING
REVIEWED BY DATE IL
REO'D I PROVIDED
FT) I REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I 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 THE CITY OF
N EDMONDS, WASHINGTON, 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE 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 DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'=ENSATION INSURANCE AND RCW 18.27.
SIGNATP
_A(OWNE�)OR AGP DATE)IGNED
CHECKED BY
F ONS RUIICTION.
C4DE
OCCUPANT
RA10
141—
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED 0 YES
JAREA
LOAD
REMARKS
PROGRESS INSPE9TIONS PER UBCdO8/IBC109/IRC109 FINALINSPECTION REQ'D
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTIO
(425)
771-0220
FEE
Description
60
State Surcharge
(10
City Surcharge
Base Fee
SY
FEE
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
`1 receipt is acknowledged in space pro�ded.
OFF)Cl4nS SIGNATURE/ I j DATE/
AELCA'SED BY
ATTENTION RZI& I I jjj [
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 2�
INSPECTION HAS BEEN MADE ANDAPPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PiNK - OWNER GOLD - ASSESSOR
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Grease Trap Sizing Worksheet
Facility Name: (fl'el-o B�Xlio�
Address: 5* A-,, Suite No.:
0 A Grease Trap plumbing permit is required ($165.00 fee). Contact the Pretreatment I on
Technician (425-672-5755) if you have any questions and also to get signature approva
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
X W x D *4m-.-of,5i nks)
Fixture Capacity
in Gallons
Cu. In. 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for
a 2-Minute
Drain Period
#1
.2-o x 2-o x
i��41114 4) c.i.
gal.
x .75 = gal.
+ 2 RPM
I—
#2
x X X c.i.
231 =
x.75 = gal.
2
#3
x x x c.i
231 = aal.
x .75 = gal.
2 QDM
#4
X x x c.i.
231 = gal.
x.75 = gal.
— + 2 !���M
Grease Trap #1 — Total di-ainagenowsfrommaximumof4rixtures
gpm
#1
x x x c.i.
231 = gal.
x .75 = gal.
2 g2M
#2
x x X c.i.
231 = gal.
x.75 = gal.
+ 2 7_��m
#3
X x X c.i.
231 = gal.
x.75 = gal.
2 m
#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—
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
gpM
Number of Fixtures Connected to a Grease Trap
2
3
4
Grease Trap Si re (in gpm)
25
35
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
........................................ (For City use only below this line) -----------------------------------------------
Remarks: /&rOmIr e 'tr
qa
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Size Approved: 20 gpm Approved by: �Z- Date:
llretreatnV'Fechnician
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FINAL PROJECT APPROVAL FORM
JUL 1 3 20A TO:
DEVELOPMENT SERVICES CTR. DATE:
CITY OF EDMONDS
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
PRETREATMENT
FROM: — J(:Z_1 DATE_L-. 2- - 0
PLWE SI'tl
ENGINEERING DIVISION DATE
PLWE SIGN
PLANNING DIVISION DATE—
PLEASESIGN
PROJEC 191:.�' ko ro, A Iz,
SITEADDRESS 5-//G 5), Ave,, J.
PERMIT # 2 0 0,q - Oq 72/ ADB#______-----PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED 2-0�4o,22 Trrll) i'AS�adlct,�'iofl
V,
A field inspection was conducted to determine compliance with -approved plans. Final approval
s from the above signed Department to the release of
denotes that there are no objection
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
E] Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El 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:fbrms:ocaprv1 3/25/04
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RECORD UF Miljtk; I IlUr4t)
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
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Stab Insulation ..........
PLUMBING:
Underground .............
C: ITI
M 0
Rough -In ................... 0
Commercial Final ...... 0 C
M
HEATING: M z
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Gas Test .................... C
3: Gas Piping .................
Equipment ................. o -n
n
Commercial Final ....... x
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
C
FRAMING ........................ Cl)
ITI 0
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FIRST FLOOR FRAMING...
INSULATION ................... ;U
Floor Insulation ......... >
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Wall Insulation ........... --I
Ceiling Insulation ....... Cn
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0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... 1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. IF It faw 00 Ah
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