20040944.pdf6
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF 13USINESS
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CITY ZIP TELEPHON9
NAME
PE RMIT EXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO tOT NO 1,40
LID FEE $
I I SCP Appwvorl 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Mw Frni.t Hnqwrod 13
stmot us" Parmit Hon'd 0
EXISTING - pROpOSFo inspection HocItiand 13
Sule*a1k flar,"und
REQUIRED DEDICATION- FI UmsevUrmnd
Wiftng i0quir"d E3
METER SIZE LINE SI qE NO OF F1XIURrS PRV REQUIRED
YES 0 NO 0
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ADDRESS
REMARKS
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OWNER/CONIFACTOR RESPONSIBiF FOR FROSION CONIROI/DRAINAGE
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CITY ZIP TELEPHONE
NAME CBL
�ZLE PL cl m a i �d i iq c
ENGINEERING REVIEWED BY DATE
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ADDRESS t
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CITY
FIRE REVIEWED 13Y
DATE
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ZIP TELEPHONE(Z:--) rjR-et33(
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STATE LICENSE NUMBER E71RATIN DATE BY
VARIANCE OR CU
SHORELINE OR ADBN INSPECTION B7ND
REQ D POSTED
P,
10 1 PIA_
13YES EINOIS
SEPA REVIEW
SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
3
COMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
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2--1 o 24s-0 0 C)
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Eyp
NEW RESIDENTIAL Eg(�E��CH
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
F� ADDITION r-A COMMERCIAL
OF USE
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CHANGE
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REMODEL MULTIFAMILY
PARKING
REQ'D
LOT AREA PLANNING REVIEWED BY DATE
5
CL
SIGN
I PROVIDED
GRADING E:i FENCE
1:1 REPAIR E] CYDS X Fr)
REMARKS
E] DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
El 13
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, B SS OR ACTIVI XPLAIN:
CHECKED 13Y
CORE,,- OCCUPANT
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GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
Pr
SPECIAL INSPECTION
L OCCUPANT
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STORIES . . ......... . UNITS NUMBER
JAREA
REQUIRED [] YE
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC1G8/IBC109/IFIC109 FINAL INSPECTION REO'D
VALUATION
$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT 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
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2
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: ISO DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'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 CIT-Y OF
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
MI
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee
Receipt N
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 WITH CITY AND STATE LAWS REGULATING CONSTRUC.
AGREE TOeMP_'Y
CALL
This application is not a pefinit until signed by the
TION; AND IN DOING TH."ORK) THORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy� and Fees are paid, and
IN VIOLATION OF THE �Dan CO E OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENjk11_0N INSU NCE AND RCW 18.27.
OFDJaIAL� SIGNAT)4RE DATE
1
SIGNAf E (OWNER GENT) DATE SIGNED
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(425)
11
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771-0220
nommoommo�
RELEASED BY DATV--"--
7.
ATTENTION
EXT 1333
IT
IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
PINK -OWNER GOLD -ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
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Grease Trap Sizing Worksheet
Facility Name: Romia,A rjl*z,.-.rk -t NuLcj,
Address:- 630 iUi)o6nd.r -WrIj4 Suite No.:
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A Grease Trap plumbing permit is required ($165.00 fee). Contact the.Pretreatnient
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.
Fixture 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
#1
/?1 x /,7jx 111.x .3 1:3,119 c.i.
231 = r) gal.
x .75 = gal.
+ 2 = 2- 1 gpm
#2
Pre-waik siak (4�k�cdl)
x x c.i.
231 = __gal.
x .75 = gal.
+ 2 = — _5 g P m
#3
x x c.i.
+ 231 = gal.
_ x .7 = gal.
2= gpm
#4
_x
x x X c. 1.
231 = _gal.
Ix.75 = gal.
2= gpm
Grease Trap #1 - Total drainage flows from maximum of 4 fixtures
9pm
#1
x x c.i.
231. = gal.
x .75 = gal.
+ 2 = gpm
#2
_x
x x c.i.
231 = gal.
x.75 = gal.
+ 2 = gpm
#3
_x
x x x C.I.
231 = gal.
x .75 = Yal.
9
-. 2 = gpm
#4
x x x c.i.
+ 231 = gal.
x .75 = _____Kai
+ 2 = gpm
Grease Trap #2 - Total drainage flows from maximum of 4 fixtures
9pm
MINIMUM SIZE OF GRE ASE TRAP(S) RE, QUIRED
91PM
Number of Fixtures Connected to a Grease Trap
2
j 3
-Grease Trap Size (in gpm)
20
25
35
Upsize for factors such as higli volume dishwashing, higli oil/grease content on menu, etc.
------------- -------------------------- (For City use only below this line) -----------------------------------------------
Remarks:
Size Approved: 3 5 gpin Approved by: -44u
��_ Date: /OAVO�
Pretreati#f ni Teclinician I
[Rev. reb. 2004]
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
PRETREATMEN.
FROM: DATE —
PLEASE SnItL
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE —
PLEASE SIGN
PROJEC
SITEADDRESS 630
DATE INSPECTED
PERMIT #__:2- �o 05 1414 ADB# 2_0D4
DESCRIPTION OF WORK TO BE INSPECTED—LL �35 � �22 �(a' �r,
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
X 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 .
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvi 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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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