20040847.pdfDATE RECEIVED
1 3104
PERMIT EXPIRES
USE' PERMIT -7
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CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUIHE/�PT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
LID NO.
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PLAT NAME/SUBDIVISION NO. LOT NO.
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LID FEE S
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MAILING ADDRESS
jr.SCV Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Fjvv permit Required
street use Permit Rart'd
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EXISTING — PROPOSED
inspection florlinted C3
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TELEPHONE
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REQUIRFD DEDICATION — FT
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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NAME
YES NO
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REMARKS
OWPER/COIATRACTOIJI RESPONSIBLE FOR EROSION COWOL/DRAINAGE
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FIRE REVIEWED BY DATE
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NEW RESIDENTIAL El PLUMBING MECH
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REQUIRED SETBACKS (Fr.)
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PROPOSED SETBACKS (Fr[)
FRONT L/R SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REMODEL MULTIFAMILY SIGN
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GRADING FENCE
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REMARKS
El DEMOLISH TANK
GARAGE RETAINING WALL FI SPRINKLER
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CARPORT ROCKERY LARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I 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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
A PERMIT APPLICATION: 180 DAYS
[L PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
9 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 #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due
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.0
Recording Fee Receipt #
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a POrmit until signed by the
T I JVI; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or his/her Depuly� and Fees are paid, and
IN 10 ION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknR
LAT FOR INSPECTION , virledged in space provided.
W RKMEN'S �QMK-NISA�ON INSURANCE AND RCW 18.27.
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AT U��EN �AGEN DATE SIGNED (425) vc,
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p 7 -0220 ECEASED 13Y
AT�ENTI N EXT 1333
kTIS VNLAWFU9LTFO USE 0(90CUPYABUILDING OR STRUCTURE UNTILAFINAL
lk��CTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Grease Trap Sizing Worksheet
Facility Name:
Address: 72-1-2- 2_2_�N Suite No.:
A Grease Trap plumbing permit is required ($ 1_65.00 fee). Contact the Pretreatment
Technician (425-672-5755) if you have any questions and also to get signature approval on
this form. allowed to be connected to a Grease Trap.
Dishwashers are not rved by a Grease Trap and must be disabled or
Food disposers are not allowed in a facility se olid waste container.
removed. Solids must be screened out and placed in the s
Fixture Capacity in Cubic Fixture Capacity Drainage Load Flow Rate for
in Gallons (75% of Total a 2-Minute
inches * 23 1) Capacit Drain Perio
(LxWxDxno-ofsin (Cu. In. .
, i., -) al. x .75 = -7. al. + 2 = Wm
#1 20 x 2_0 X (- X c.i. -. 231 = al. x.75 = al. 2 = m
c.i. + 231 =
#2 x x x c.i. + 231 = gal. X.75 = al. 2 = rn
#3 X x x 231 = gal. x.75 = al. + 2 = gnm
x X x RPM
rease Trap #1 -Total drainage flows from maximum of 4 fixtures
x x c.i. 231 = al. x.75 = al.
#2 X X x c.i. 231 = al. x.75 = al.
#3 X x X c.i. 23 � = al. x.75 = al. + 2
#4 x x - X c.i. 231 = x.75 = al. gpm
Grease rap #2 - Total drainage flows from maximum of 4 fixtures gpm.
MINIMUM SIZE OF GREASE TRAWS) REQUIRE D
2 3 4
Number of Fixtures Con"""tot' t2 a 25 35 50
Grease Tra Size (in in)
Upsize for . factors such as high volume dishwashing, high oil/grease content on menu, etc.
---------------------------------------- (For City use only below this line) -----------------------------------------------
Remarks:
Approved by: Date: 5- 2X-01
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Size Approved: 9Pm
,tl 1creamician
,V. 17-el). 20041
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FINAL PROJECT APPROVAL FORM
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM- 10-4AX-----'PRETREATM ENT PLANT DATE
PLEASESIGN
PROJECT Fu n t o,,,- 1. 01
SITE ADDRESS- 72-12- .-IZO-64 St.
PERMIT# 2-004 - 0-F# Z ADB#- DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED Grease- �-ra I g I�Skodlation
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
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
LvrEM I'M ILDINGTORMPREFREATM ENTAPPROVAL-DOC 1 /4/2005
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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
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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