20040601.pdfM
1 DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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ADDRESS
CITY ZIP IIELEPHONE
PERIMITEXPIRES
USE
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PERMIT
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NUMBER
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SUITE/APT#
ADDRESS
PLAT NAME/SUD DIVISION NO
LOT NO.
LID NO,
LID FEE $
TESCP Approved (3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Required 13
Street Use poorrut Roni'd 13
EXISTING - PROPOSED inspection Required 13
Sidewalk Required (3
REQUIRED DEDICATION- FT Undruaro,und
I Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I I YES 0 NO 1:1 1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME CBL #
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ENGINEERING REVIEWED BY
DATE
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ADDRESS
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FIRE REVIEWED BY
DATE
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CITY ZIP TELEPHONE
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0
BOND
VARIANCE OR CU SHORELIN
IE OR AIIIII INSPECTION
STATE LICENSE NUMBER EXPIRATION DATE BY
REO'D POSTED
DYES ONO IS
4—.-
SEPA REVIEW
SIGN AREA HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO,
COMPLETE EXE MPT
ALLOWED ALLOWED PROPOSED
PROPOSED
nc. �2-
EXP ,
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NEW RESIDENTIAL 'fQ.,PtUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS tFT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LIFISIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL E] MULTIFAMILY SIGN
REQ'D PROVIDED
GRADING FENCE
REPAIR CYDS x Fr)
REMARKS
OTHER
DEMOLISH TANK El
GARAGE RETAINING WALL FIRE SPRINKLER
El FIRE ALARM
z CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY OCCUPANT
GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
M I I /\ JI/1--
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
0 STORIES UNITS NUMBER
REQUIRED [3 Y
DESCRIBE WORK TO BE DONE f
REMARKS
PROGRESS INSPECTIONS
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PER UBC 108/ IBC1091IRC109 FINAL INSPECTION REQ'D —9
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VALUATION
$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge ki
ECK NO: VESTED DATE
Plumbing
BaseFee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
2
PERMIT APPLICATION: 160DAYS
a. PERMIT LIMIT. 1 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 SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt
Ir
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF '[HIS PERMIT SHALL NOT BE
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Total Amt. Due
91 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.'
Receipt #
Recording Fee
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
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Official or his/tier Deputy: and Fees are paid, arid
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
FOR INSPECTION receipt is acknowledged in space provided.
WORKM�N'S COMPI�-NSAT20ANSURANCE AND RCW 10.27.
OFFICI S S6 URE DATE
S
Slot URE 4OW: kGE NT) DATE SIGNED
(425)
71L /,/
771-0220
I
FL D T
ATTENTION
EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC 109 / IBC1 10 / IRC1 10.
PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU
ARE MAKING 4 COPIES
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Grease Trap Sizing Worksheet
Facility Name: --Fa'co -T ry, e,
Address: oq Hvi V Suite No.:
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• A Grease Trap plumbing, pert -nit is required ($165.00 fee). Contact the Pretreatment
Technician (425-672-5755) if you have any questions and also to gget 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 tile solid waste container.
Fixture Capacity in Cubic
Inches
(L x NV x D x no. of' sinks)
Fixture Capacity
in Gallons
(Cu. In.--- 230
Drainage Load.
(75% of Total
Capacity)
Flow Rate for
a 2-Minute
Drain Period
#1
2-o x �_, 2 x j I x _3 I�IS2 0 c.i.
23t = 63 - gal.
x .75 = 4 7 gy a 1.
2 = 24 gpin
#2
x x x c.i.
+ 2 3 *1 = gal.
x .75 = �21 I L
2 = gpill
#3
x x ca.
-. 231 = gal.
x .75 = gal.
2 = gpill
#4
_x
x x x c.i.
+ 231 = gal.
x .75 = gal.
2 = gpni
Grease Trap #1 - Total drainage flows from maximuni-of 4 fixtures
241 gpin
At
x x x c.i.
+ 2 3 1. = gal.
x .75 = gal.
+ 2 = gpill
A2
x x x CA.
+ 2 3 1. = gal.
x .75 = gal.
2 = gpill
#3
x x x c.i.
- 231 = gal.
x .75 = gal
2 = -pill
#4
x x x C
211 = gal.
x .75 = gal.
2 = gpm
Trap #2 - Total drainage flows from maximum of 4 fixtures
gpm
-Grease
-MINIMUM SIZE OF GRE ASE TRAP(S) RE, QUIRED
gpm
of Fixtures Connected to a Grease Trap
2
3
1 4
-Number
-Grease Trap Size (in gpin)
1 20
25
35
1 50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
---------------------------------------- (For City use only below this line) -----------------------------------------------
Remarks:
SizeApproved: 225 gpm Approvedby: Date: z'_7-17-o�
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FINAL PROJECT APPROVAL FORM
R E C E I V ET-)
AUG 2 5 2004 TO:
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
P r et Y- e- ojt, ro, e,At
DATE
FROM: 4: e-Z 3
PLEASE S16N
-ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT laeo L'me,
SITE ADDRESS 2— 3 9 0 q Lun,
V 'i
PERMIT 2-004 - 0G01 —ADB# DATEINSPECTED 9-20-2-004'
DESCRIPTION OF WORK TO BE INSPECTED i')I,�tallcu�jon
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 rele ase of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
11 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fom1s: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 ...
OUS ..........
MISCELLANE
FINAL APPROVAL FZR'
_oCe"4PANeY .................. - rr4
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