20040734.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
'-IA. AiA Nh Lr�Fliil
MAILING ADDRESS
-�75cE,c-L 2.C,,*Iq AVC� S
CITY ZIP TELEPHONE
YW-1
4Y , I rt o3 3 z o L-r ) z ZI-) -
NAME
Ly
XkVA
NAME 6 f
ADDRESS
CITY
;TA�E LICENSE NUMBER
�5_0 4
L_� 1�_ yc- IQ
ZIP TELEPHONE
CBL
/zip TEL�PHONE
EIPI�R&10% 97-E CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
1)n -7
NEW E] RESIDENTIAL RI, �UMBIV/MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS I X FT
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Rr:-_,:iT-A wk ANT-/ K-A-P-A04�-e-
NUMBER NUMBER OF CRITICAL.
OF DWELLING AREAS
STORIES UNITS I NUMBER
DESCRIBE WORK TO BE DONE
�j N01z 5 H I
ILI K1AI`1A*r_
-1 � J, KI 0
0 (1
r SE
ZONE
JOB
ADDRESS
PERMIT EXPIRES
---
PERMIT
NUMBER
(17
SUITE/APT#
1 2 i
LAT NAME/SUBDIVISION NO.
P PLAT
1_01 NO.
LID NO.
LID FEE $
TESCP Approved
13
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
U Ll'
RW Permit Required
E3
Street Use Permit Req'd
0
E 1 S
X T
XISTING — PROPOSE[)
Inspection Required
13
Sidewalk Required
[3
REQUIRED DEDICATION—
Q U
FT
Underground
Wiring required
[3
M T
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO
z
Fx
z
HEAT SOURCE I GLAZING % LOT SLOPE %
r_-xv�F. HEATr*14P —
PLAN CHECK NO:' VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORiCNOTED. 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: 100 DAYS
W
PERMIT LIMIT.''! YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 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 T14E 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 LA130H CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S 06M—ftVSATION INSURANCE AND RCW 18.27.
SIWTUjiE (jWNE,R �RIkGfN DATE SIGPED
REMARKS z
OWNER/CONTRACFOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE � 0
z
Lu
EN—GINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE III
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
[]Y REOR of POSTED
I ES NNO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE E7PT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I A/0 1b e_ —t—
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
z
It
PARKING LOT AREA N I N G WAD/jY DATE IL
REO'D I PROVIDED
10 10
REMARKS
CHECKED BY ITYPE
CODE OCCUPANT
;W3 GROUP A -2—
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED :;j LOAD
Z-4
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 IBC109 IRC109 FINAL INSPECTION REO'D
A k I A. A
VALUATION
$
Description
FEE
Plan Check
i9- 7 (jr
Building Permit
> C-5
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Description FEE
State Surcharge It -
City Surcharge
Base Fee
Fire Review 60 Plan Chk. Deposit Fl/
--7 --) v>.
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee I Receipt j:2494
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFIC ALS S1 LIFE DATE
(425)
I -IL I / 4 �" __ 4; 1 1 1 —Ue_e.V RE E D BY /AT
__V
ATTENTION E)ff 1333 9
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - IINSPAOR
PANCY HAS BEEN GRANTED, UBC109/IBC110/IRC110. PINK - OWNER GOLD ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
V
z
0
i
0
1711
—i -n
OM
C
M0
0
--I ()
0 C
--j K
X M
M Z
10 -1
Cn
0 _n
n
M M
0 C—n
of-
0 M
C Cn
9 Cn
Q 0
Z
7-1
z
-i
a:
Cn
z
0
i
0
IT!
1994 Washington State Nonresidential Energy Code Compliance Form
g t n Su": Mary
1994 Wa5hington State Nonrosiderdiall Energy Code Compliance Forms
Second Edition - June 1995
Project Info
Project Address A - NA-
Date
0 k)y 1) b F, LA I TE- I Z-11
For Building Department Use
V1,
V.1A '51
V6
Applicant Name: IJ
Applicant Address: D�-xrz--/z A1JG:.. �A 5��A-,-'T-L-& V-
lc�
Applicant Phone:
-i e, 1; -7 931-)9
1
004 0. -A W- -V
U,
Project DStS1!E!j2n, Now Building U Addition PGAfteration
compliance Option L3 Prescriptive U Ughting Power Aliowance -bu-Systems Analysis
I (See Qualification Checklist (over). Indicate Prescriptive & LPA spaces cieady on plans.)
Alteration Exceptions
(check appropriate box)
No changes are being made to the lighting
Less than 60% of the fixtures are new, and Installed lighting wattage Is not being Increased
AN A11r%vvck&q T.;cr164-;inrr Wnffncrp (Tinforinrl
Location
(floor/room no.)
Occupancy Description
Allowed
Wafts per fe
Area In fe
I-JALL,-
— Mlo worllc( K10 Z)JAQ6r--.�
-Pl�,JJN16
A P- A
A-z P `�ILOIQL 08-JL4LiQG
5,2 1+
From Table 15-1 (over) - document all exceptions taken from footnotes Total Allowed Watts
Proposed Lighting Wattage (Interior) (may not exceed Total Allowed Watts for Interior)
Location Number of
(floor/room no.)
Fixture Description
Fixtures
Watts/
Fixture
Watts
Proposed
06
(-,H A N1
KAA-A o r-C- �J
P L- 0 ULF- S ( ELI 'r
4-
W CAN DF-,�
Total Proposed Watt§/may nqt exceed Total Allowed Watts for Interior Total Proposed Watts
Maximum Allowed
Lighting Wattage (Exterior) \ 1�
Location
Description
Allowed Watts
per ft' or per if
Area In f?
(or If for pedme
Allowed Watts
x fe (or x 0)
Covered Parking
0.2 We
Open Parking
0.2 We
-1
Outdoor Areas
0.2 We
Bldg. (by facade)
0.25 We
Bldg. (by perim)
7.5 WAf
Note: for building exterior, choose either the facade area or the perimeter method, but not both) Total Allowed Watts
T "Ikf-iincy Wi2f4mern 11P-vf-g%v4nA IMAv not exceed Total Allowed Watts for Exterior)
Location
C'
Fixture Description
Number of
Fixtures
Watts/
Fixture
Watts
Proposed
Total Proposed Watts may not exceed Total Allowed Watts for Exterior Total Proposed Wattsl
z
0
4
0
M
-n
X
C M
M 0
0
0
0 C:
M
M Z
C
M
Fn
0 -n
M M
0
0 M
C: cn
9 Cn
M 0
Z
z
z
0
1
0
M
NOT ICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE To THE QUALITY OF THE DOCUMENT.
qnv
003; U�dalll ISW3
Z-K' r4
irwev" L33N 9 ma"
.0-3 :317�9
Lz"- "rowa
NV 1cl A 1 IG
0
C,
';0�5 kN
x, rwoiing
co
c>
tA C)
QJ
0
tzj
U)
W—t
'is L.Ka -'WL3d Y-VY W�
n.
Is ars
A'M
,.am
.1 '%�
'N 1w.
0 lfvv
3�"t"3 %4LSIX3
ltwNcuH 1SW3
M IVZIIN2�
EiNIKNVld
gNim Hinog
j
�f4
-199
.9a
I
At:
.:.*,. :M-'.
��V' QkV
E., ME
S
,oAdhop A F go r
aln 00"
my
DEPARTMENT OF BUILDINGS
PER INTERNATIONAL BUILDING CODE SECTION 110
23830 Hiqhway 99, Suite #121
Building -,Permit # 2004-0734
Occupancy established by this ceqificate:
, I , I Dwelling Units: **N/A*** No. Stories: 1
A2
Type of;Construction: VB Basement: No
Maximum occu tR oad� ***74*** (Per IBC 1001)
p lag
Room, capacity ssigns,W" U -4tiust remaln posted at all times.
i '' — , IN
0"Highw6y 99, S*�ite #121
Owner of Building Seoul PIna Addr'e S:-:�" '2"��' 1
The Nana Restaurant has beeh1nspe6ted and aporoyed: as'.'complyingmith -the requirements of the 2003 Edition
an Ivisiori of occupancy and the
of the International Building Code as adopted-'b,;i,t e City for th-6-grou"'I':7
use for which the proposed
occupancy is classified.
Issued this Ist . day of December 2004
Q.I;I4EF BUILDING OFFICIAL
BY:
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
as assess assess Soso& ease ease a.
(1) (T) (1) (1) (T) (1) (1) 4) (1) (T) (T) (1) (1) (T) (1) (1)
a
(T) (1) (T) T(T) (TV q/ T kv
TTT \V 4111' It -
BACKFLOW PREVENTlION ASSEMBLY TEST REPORT
OLYMPIC VIEW WATER & SEWER
23725 Edmonds Way
Edmonds, WA 98026-8981
(425)77407769
Fax (425) 670-1856
ACCOUNT#
9/commercial 0 Residential
NAME OF PREMISE WIN 1,10k
Z I P
SERVICEADDRESS CITY6ALQ_�'- �A �
FAX(
CONTACT PERSON C U - PHONE (4
LOCATION OF ASSEMBLY k*'-' IcA, C:
DCVA RPBA D PVBA 0 Other
DOWNSTREAM PROCESS TCL
REPLACEMENT OLD SER. # D PROPER INSTALLATION? YES NO
NEW INSTALL El EXISTING
1
MAKE . OF ASSEMBLY MODEL QQq 0 SERIAL NOL��520 SIZE
DCVA/RPBA DCVA/RPBA RPBA PVBAlSVBA
AIR INLET
INITIAL CHECK VALVE NO. 1 CHECK VALVE NO. 2 PV
TEST O'PENAT 3-7, PSID
/ 11 [1 LEAKED LEAKED #1 CHECK - PSID OPEN AT _ PSID
PASSED PSID Clr/,_U;__I Lc I PSID eIR GAP OK? El DID NOT OPEN
FAILED
CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE
HELD AT - PSID
El El
NEW El 0 11 El
P P ��S EILEAKED
ARTS El El
AND El El 11 0
REPAIRS 0 11 El 0 D ED CLEANED
El El El El D REPAIRED
R
N
E
A
A
P
E
R
W
N
A
T
D
S
IRS
CHECK VALVE
T P]
:LD A - SID
LEAKED
----------
ST
TEST AFTER
I
R OPE
, EPAIRS LEAKED El LEAKED FN AT -PSI I D AIR INLET- PSID
EIPASSED #1 C C K� PSID PSID
IL 0 HE
FAILED PSID PSID #1 CHECK PSID I CHKVALVE_
Detector Meter Reading ------
AIR GAP INSPECTION: Required minim'um air gap separation provided? El Yes No
REMARKS: Tu LINE PRESSURE __'4t_Q PSI
CONFINED SPACE?
DATE
TESTERS SIGNATURE CERT NO.
�-J 6�
TESTERS PHONE # (q�L5 C/
TESTERS NAME PRINTEDLt�,l �'
DATE
REPAIRED BY
I NAL TEST BY CERT. NO. DATE
w lal_� RED? 12 YES D NO
CALIBRATION DATE Q I / 05 GAUGE # MODEL SERVICE RESTO
certify that this report is accurate, and I have used WAC 246-290-490 approved test methods and test equipment.
WHITE - WATER SYSTEM PINK - CUSTOMER YELLOW - TESTER OV 016 (REV. 2/04)
z
0
'I
0
!'P
zi --fi
0 M
C
M 0
0
0 C
--I K
X M
M Z
_z
C0
0 -ri
n
M M
0
0
IC) M
C (/)
90
Q 0
Z
z
--I
Cl)
z
0
i
0
M
I
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM. FIRE DEPARTMENT DATE
PIXASE SIGN
ENGINEERING DIVISION DATE
PLEASP SIGN
PLANNING DIVISION DATE
PLEASF SIGN
PROJECTIN&-/L/A
SITE ADDRESS 2- 3 !Z 2�
12 ED
DATE INSPECT
PERMIT # D2 _ADB#
DESCRIPTION OF WORK TO BE INSPECTED
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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of COFLRECTION NOTICE given to owner/co n tractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUE, S - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
z
0
M
U)
M
M 0
0
--I C)
0 C::
M
M Z
JD --i
C: —Z
U)
0 -n
n
M M
0 Fn
0 r-
0 M
C Cn
K Cn
M C-)
Z r-
M
;u
-1
r
z
--I
X
U)
z
0
i
0
M
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 ...
yvi
<�
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
1
0
M
r
M
0
0
__10
0 C
M
ITI Z
o -n
n
M M
0
0
0 M
C Cn
r. Cn
Q 0
Z
>
z
C/)
z
0
1
0
M