20040605.pdfDATE RECEIVED -7 //,-64(d I I PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN�Pl
.rAMEINAMEI OF BU"%TSS
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MAILING ADDRESS
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C`ITY ZIP TELEPHONE
PC C-7-1vt ro �,, C
1"36 1-// 3,?
NAME
ADDRESS
CITY
NAME
ZIP I TELEPHONE
ESS
ADDR C T)y tIf YL/ ol
CTI T I ZIP I TELEPHONE
STATE LICENSE NUMBER
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
CBL Ir
USE PERMIT
ZONE
NUMBER
ADDRESS 15
JOB H_IL
) ( - SUITE!APT#
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Required Q
Street Use Permit Roq'd 13
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Underground
Weing required 0
METER SIZE
LINE SIZE
I
NO. OF
FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REV]
FIRE REVIEWED BY
EXPIRATION DATE I CHECKED BY I VARIANCE OR CU
SEPA REVIEW
NO. COMPLETE , EXEMPT
0 0 91M
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
E]
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN:
Lu NUMBER BER OF
0 OF ELLING
M
o STORIES T-DNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
SPRINKLER
EFIRE
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1130 DAYS
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL No I BE
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."
I HEREBY ACKNOWLEDGE THAT I HAVE READ IHIS 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 VI*6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATUR, DATE SIGNED
,�,121 El 0 A/,
M
DATE
DATE
SHORELINE OR ADEII I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SIGN AREA HEIGHT
F—ALLOWED , PROPOSED I ALLOWED . PROPOSED
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T LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE I
REO'D I PROVIDED I I IL
REMARKS
CHECKED BY
jTYK`9F
I
N E
OCCUPANT
GROUP
ml?[/N
/W
SPECIAL INSPECTION
AREA
-7
OCCUPANT
REQUIRED [] YES
IPR04ESS
LOAD
REMARKS
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INSPECTIONS
PER UBC 122/IBC109/IRC109
FINAL INSPECTION REO'D
M
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE
Description
c:_s 0
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt # 1 0 5
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/tier DLputy: and Fees are paid. and
receipt is acknowledged in space prov,ided.
)FF16 Ls SIGNATUiy DATE/
�W_r_'1111611f.li( 7/__6)
RELEASED BY
ATTENTION EXT 1333
IT IS U N LAWFUL TO US E OR OCCU PY A B U I LDI NIS OR STR UCTU R E U NT I L A FI NAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC10911BC110/IRC110.
CALL
FOR INSPECTIO
(425)
771-0220
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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Facility Name:
Grease Trap Sizing Worksheet
r- 1 1) - - 1, LL — - �# C
Address: 2-972-5 /
Iwo 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 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.
ure 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
#I
2Z x I x 4 x 2- 3 W, C.i. L
__t 231 = 34 gal.
Pp
x.75= 2-G gal.__+2=
/,3--,gPm
#2
22- x le x A/ x c-i
231 = gal.
x .75 = gal.
+ 2 = gpm
#3
x x x CA.
231 = gal.
x .75 = gal.
-_ + 2 = gpm
#4
x x x CA.
+ 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.
231 = gal.
x .75 = gal..
2 E2m
r#2
x X x c.i.
231. = gal.
x .75 = gal.
2 gpm.
#
x X x CA.
231 = gal.
x.75 = gal.
I
+ 2 gpm
#4]
:�3
x x x -c.i.
231 = gal.
x .75 = gal.
2��m
Trap #2 — Total drainage flows from maximum of 4 fixtures—
gpm
—
I _gpm
-Grease
MINIMUM SIZE OF GREASE TRAP(S) REQUIRE D
Number of Fixtures Connected to a Grease Tra
2
3
4
-Grease Trap Size (in gpm)
25
55
35+
50
Upsize for factors such as high volume dishwashing, hig h oil/grease content on menu, etc.
---------------------------------------- (For City use only below this line) -----------------------------------------------
Remarks: Min;mwm 2-09pm �kt (ecomma,nd 25rpim aosrille,-
jr V. r
Size Approved: 20 -� gpm Approved by: Date: 3-12- Oq
1'retreaMptTechnician
[Rev. Feb. 20041
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Address: o�- -3 '2 al -
0 V71- 5 / 1/ 00/ 0 &)V
CITY OF EDMONDS
Grease Removal Equipment Application
Business Name: FA- v4' I- Y P4/i c /4 lee- /'(0'
Date Submitted: ? ,:?- 6 -OC/'
1�1
ite No.:
Business Owner:F/4," —Mailing Address:-*3 37/ e_�A-y
Contact Person/Title: &_)h I'lh 7_8 LJ/4--- A /_�' Phone: Y2 '/ W 3_��
Days/Hours of Operation: .5—., - ),I — R 117
Total Number of Meals Served Per Peak Hour (assume all seats filled):
Number of Seats: Dining: 4Y__2_cbunge/Bar: _ Banquet Rooms: Deck/Patio:
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, _wzk-4tafions, squp-keftles, sinks, pre -wash sinks,
dishwashers, digmsers, mop sinks, floor drains, ete.)
What proportion, if any, of the dishware used is of the disposable type?
How is waste oil/grease handled, stored, and recycled/diSPIDsed? 44W -f-
Estimate gallons of waste oil/grease produced per month: 36---Z-5
If recycled, by which company?
How are vent hoods cle ned and where does the cleaning waste go?
-7.1
-.'e— �'� —
Contact the Pretreatment Technician at 425-672-5755 to discuss tile type and
size of equipmentyou must install, and then complete the appropriate
accompanying worksheetfor either a Grease Interceptor or a Grease Trap.
[Rev. Feb. 20041
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REC-E:1VF_D
FINAL PROJECT APPiOVAL FORM
AUG 2 6 2001, TO:
OEVELOPMENT SERVICES CTR
CITy OF EDMONDC' DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
PRETREATMEN 0
FROM: �2 DATE —
PLEASE S11 9
ENGINEERING DIVISION DATE —
PLEASE SIGN
PLANNING DIVISION DATE,
_7LEASE SIGN
PROJEC Czyke— 140(A.SQ,
G
SITEADDRESS 2_372�5 *'�Aw)(-,,q LI
v 'i
PERM1T#_200A/_(3GDS —ADB#-----------PATE INSPECTED 0
DESCRIPTION OF WORK TO BE INSPECTED G - c _
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 release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
PA
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbmis: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 ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL-FeK
.04;cvw;"Cy ..................
700 0 (P 0so,
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