20040968.pdfx
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DATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
P NAME/NAME OF BUSINESS
MAILING ADDRESS
1,*0
CITY ZIP TELEPHONE
NAME
CITY ZIP I TELEPHONE
NAME CEIL #
.ft6rf M010 J��V 1 te;7r. )A1 L
ADDRESS
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CITY z P TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE ---tHECKKDj
PR
,�P.�R`17 TAX ACCOUNT PARCEL NO.
I ^ . V� A
1:1
NEW
1:1
RESIDENTIAL
El
ADDITION
COMMERCIAL
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EWREMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TY�E OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
0 OF JA DWELLING
M
0 STORIES UNITS
I DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
FT)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 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 TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIL ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
GROUP
SPECIAL INSPECTION JAREA OCCUPANI
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 / IBC109 / IRC1 09 FINAL INSPEC ONREQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
�Landscapelnsp.
IRecording Fee
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 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS�. UJANCE AND RCW 18.27.
SIAATURE (OWNER R GE — rDATE SIGNED
I I
/A%� JA A^ I I - 6 A- I
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUM13ER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION-- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
Ci(l 67
S APT#
LID NO.
LID FEE S
I ESCP Approved
C3
RW Permit Required
Street Use Permit Floq'd
Inspection Required
Sidewalk Required
C
Undefgmund
Wiring required
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
IN
DATE
DATE
SHORELINE OR ADBI I INSPECTION
REO'D
EIYES ONO S
SIGN AREA 1-
FAILLOWED . PROPOSED I ALLOWED
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POSTED i
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PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR a
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PARKING LOT AREA PLANNING REVIEWED BY D E -1
REO'D I PROVIDED I I CL
REMARKS
CHECKED BY
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
0
(425)
771-0220
ATTENTION LAI 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Chk. Deposit
Receipt #
Total ALmt. DLueL
f`7
Receipt #
PPLICATION APPROVAL
application is not a permit until signed by the
Official or his/her Deputy: and Fees are paid, and
accipt jst�clrovvledgecl in space provided.
S E
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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Grease Trap Sizing Worksheet
Facility Name: PI-Qvino-es ATian PeAaurant 'v acl,r
Address: 201 54 Ave— S- Suite No.:
9 A Grease Trap plumbing permit is required ($165.00 fee). Contact the Pretreatment
and also to get signature approval on
Technician (425-672-5755) if you have any questions
this form.
9 Dishwashers are not allowed to be connected to a Grease Trap.
9 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
/7 x 2.qx 13 x q12- c.i.
231 = 69 al.
x.75 = 52 gal.
— 2 gpm
#2
K—
PrV& X — c.i.
231 = gal.
x.75 = - gal.
-2= g-PM
#3
X jr
WO Q 776 r\ trou aln
"41 c.i.
.
—231 = gal.
x.75 = gal.
-. 2 gpm
#4
X X X c.i.
I — 231 = gal.
I x.75 =
2 = g'DM
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures
gpm
X X X c.i.
— 231 = _gal.
x .75 = gal.
2 = gpM
V2
X X X c.i.
— 231 = _gal.
x.75 = gal.
2 = gpM
#
g#4'
X X X c.i.
— 231 = _gal.
x.75 = gal.
2 = gpm.
X X X C. 17
T. 2 3 1 = _gal.
x.75 = gal.
2_= gpm.
Grease Trap #2 — Total drainage flows from maximum of 4 fixtures
gpm
MMMUM SIZE OF GREASE TRAP(S) REQUIRED
Number of Fixtures Connected to a Grease Trap
1
1 2..
3-
-4�
Grease Trap Size (in gpm)
20
1_ 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:
Size Approved: gpm Approved by: �� Date:
Pretreatineit Technician
[Rev. Feb. 2004]
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FIN Al, PROJECT APPROV-A-L FO
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
A"__\ PRETREATMENT E
FROM: �DAT
ENGINEERING DIVISION DATE_�
PLEMESIGN
PLANNING DIVISION DATE___�
PLUSE SIGN
PROJEC
SITE ADDRESS- 21
ADB#
PERNITF _________pATE INSPECTED 2—
DESCRIPTION OF WORK TO BE INSPECTED _LiStcd(0,tiQn-_�0_
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 BON 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
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
1. RECEIVED
2. DEC 2 2 2004
3. PERMIT COUNTEP
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis: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:
GasTest ....................
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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