20040690.pdfDATE RECEIVED
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USE PERMIT
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CITY OF EDMONDS NUMBER 1&7D_
CONSTRUCTION PERMIT APPLICATION JOB SUI,E/APT#
ADDRESS C D (j
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OWNEPNAME/NAME OF BUSINESS
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MAILING ADDRESS LID FEE S
z — TESCP Approved 0
I,* PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP fAW Permit Required 13
3. Ave Street Use Permit Roq*d 0
0 15
CITY inspection Required C3
ZIP TELEPHONE EXISTING — PROPOSED Sidewalk Required 13
REQUIRED DEDICATION— IFT Underground
F_ fe�_ vi�b 1 wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES C3 No 1:1
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t ADDRESS REMARKS z
x OWNEACONTRACJ(:�R RESPONSIBLE FOR E40SION CONTROLIDRAINAGE
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CITY TELEPHONE �2 #L 1/ 0 AL5
NAME CBL
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35 V Ave NF,
FIRE REVIEWED BY DATE
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C TY �Ip TELEPHONE
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5 2Y3 � i Ll VARIANCE OR CU HORELINEORADBI INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHEC ED BY REO'D POSTED
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1 79/ NA SEPA REVIEW SIGN AREA OYES ONO IS HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
'�-70 3�119 0 0 / 3 �,tl EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED FRONT SIDE REAR FRONT UR SIDE REAR
PROPOSED
COMPLIANCE OR
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING ;�rT AREA I PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROW
REPAIR GRADING FENCE
CYDS ( X F7) REMARKS
DEMOLISH TANK OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
3 CARPORT ROCKERY FIRE ALARM
(rYPE OF USE, BUSINESVO� ACTIVITY) EXPLAIN:
CHECKED BY TYrF CONSTRUCTIOML. ICODE OCCUPANT
6T2- ) GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTIO9 AREA OCCUPANT
LOAD
cr STORIES UNITS NUMBER REQUIRED [I YES
DESCRIBE WO'kK ONE
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j 0 PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINALINSPECTION REO'D
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$
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Description FEE Description FEE
Plan Check State Surcharge
HE SOURdE GLAZING % OT SLOPE % Building Permit
city Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: IBODAYS
LU
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION i
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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt it
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
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 AGENI OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY Wilif CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a perind until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Olficial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF CI � SIGNATURE DATE
SIGNATURE PWNEROAG:�EN�l DATE SIGNED (425)
�./ 'I/ -, - I V(9(411001k
0� . j -
I,= 6� �, 771-0220 A§FD BY DAV
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR ACERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/1BC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Grease Trap Sizing Worksheet
Facility Name:
557C)
Address: j Suite No.:
0 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.
0 Dishwashers are not allowed to be connected to a Grease Trap. Z
ot allowed in a facility served by a Grease Trap and must be disabled or 0
0 Food disposers are n 1 1
removed. Solids must be screened out and placed in the solid waste container. 0
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Fixtl:ur:ee :Capacity in Cubic
Inches
(LxWxDxno-ofsinks
Fixture Capacity
in Gallons
(Cu. In. 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for a
2-Minute
Drain Period
#1
.23 x 17 x /2 x 3 1110 76- c.i.
231 = gal.
1
x .75 -16 ga.
2 3 gpm
#2
X X X c.i.
231 = gal.
x.75 = gal.
2 gpm
#3
X X X c.i.
231 = _gal.
x .75 = gal.
2 gpm
#4
x x x c.i.
231 = _gal.
1 x.75= gal.
2 gpm
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures
gpm
#1
.2-0 X-1 � x 12. x 2o /6o c.i.
231 = __gal.
x .75 = gal.
2 = 3Z - gpm
#2
X X X c.i.
231 = _ gal.
x.75 = gal.
+ 2 = gpm
#3
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
-- gp1n
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
.2— 5'
� �35 gpm
Number of Fixtures Connected to a Grease Trap
2
1 .3 :T—�
4
Grease Trap Size (in gpm)
20
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:
2-5-)-
Size Approved: ?5 gpm Approved by: qhk::jL Date: /7 - 0 -1
Pretreatmefit Technician
[Rev.Feb.2004]
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R E. C E. I V E D FINAL PROJECT APPROVAL FORM
2 2004 TO:
DEVELOPMEN'i SERVICES CTri'
CITY OF EDMONDS DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
PRETREATMEML
FROM: DAT
PLWF S1
ENGINEERING DIVISION DATE-
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PLEASE SIGN
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PLANNING DIVISION DATE--,
F�
I -LEASE SIGN
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PROJECT
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SITE ADDRESS____E�Q 5 Ave. 1
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INSPECTED 11--2--0
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PERM IT # 2-0014 - 0690 ADB#________PATE
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DESCRIPTION OF WORK TO BE INSPECTED r
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE -BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocapi-0 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... 0
-4
0
Slab Insulation ..........
R!
PLUMBING:
Underground ............. -4
x
0 rn
Rough -in ................... C
M 0
0
Commercial Final ...... 0
0
HEATING: —4
= M
M z
Gas Test ....................
C z
Gas Piping .................
Equipment .................
0 _n
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Commercial Final .......
x
EXTERIOR SHEATHING M M
NAILING .......................... 0
0
0 rTj
FRAMING ........................
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FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
X
Floor Insulation ......... —4
:E
Wall Insulation ........... z
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Ceiling Insulation ....... x
SHEETROCK NAILING ... z
0
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................