20040974.pdfI
DATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
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ADDRESS
CITY ZIP TELEPHONE
NAME 4CBILr'>
¢O ADDRESS
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CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE C iECKED BY
J¢ PROPERTY TAX ACCOUNT PARCEL NO.
❑ NEW ❑ RESIDENTIAL PLUMBING ECH
❑ ADDITION COMMERCIAL COMPLIANCE OR
❑ CHANGE OF USE
REMODEL ❑ MULTIFAMILY ❑ SIGN
❑ REPAIR ❑ GRADING ❑ l ENCE X FT)
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
PI (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER J I NUMBER OF
OF / DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
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�/A�JO �LA�sN�r�ci s
HEAT SOURCE
GLAZING %
CRITICAL
AREAS
NUMBER
W INS
LOT SLOPE %
PLAN CHECK N 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 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR VIER 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE. ANY ORDINANCE PROVISION •
1 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 COMPENSATION INSURANCE AND RCW 10.27.
SIGNATU . (OWNE OR AGENT) DATE SIGNED
ZONE NUMBER 1'
L�
JOB SUITE 41
ADDRESS r•� r -' f7 %/�'7 %
PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
LID FEE $
CP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit
❑
rma Roquood ❑
Street Use Permit Roq'd ❑
EXISTING PROPOSED Inspection Required ❑
Sidewalk Required ❑
REQUIRED DEDICATION FT wiringUndergroundrequired
Winne roquvotl ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES ❑ NO z
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE W
SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
OYES ONO S
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SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT) I
FRONT SIDE REAR FRONT UR SIDE REAR 99
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PARKING LOT AREA PLANNING REVIEWED BY DATE g
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE.TONST UCTION COD OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
YES
REMARKS Z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
VALUATION
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Description
Plan Check I
Building Permit I
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description FEE
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State Surcharge !Gi
C City Surcharge
IF
CALL
FOR INSPECTION
(425)
771 0220
Plan Chk. Deposit �l
`- Receipt #�(`Jvl
Total Amt. Due
Receipt # 4 i 5[/ 4!�
APPLICATION APPROVAL
1 his application is not a permit until signed by the
Huilding Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
)FFICI�I_S.iSIGNATUU E DATE
RELEASED BY '
ATTENTION EXT 1333 '
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 4 /
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGi
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINI
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
FILE YELLOW IINSPECTO
iWNER GOLD -ASSESSOR
GREEN -ACCOUNTING
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Grease Trap Sizing Worksheet
Facility Name: %L(< f roi�'s !)�or���r�"►� rkeL
Address. 7 S 3 3 �lu in0 i �' �l ' N) pr Suite No.:
• 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.
• 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 Fixture Capacity Drainage Load Flow Rate for a
Inches in Gallons (750% of Total 2-M1nute
L x W x D x no. of sinks Cu. In. _ 231 Capacity) Drain Period
#1 Z�x 1`� x /2 x 3 = r c2c.i. - 231 = �'T al. x .75 = �o _ >al. _ 2 = 2514 m
#2 /6 x 16 x lD x 3 = Sc� c.i. _ 23 I =��, ral. x .75 = gal. _ 2 = /2, 7 m
#3 x x x = c.i. _ 231 = gal. x .75 = al. _ 2 = �T m
#4 x x x = c.i. _ 231 — al. x .75 = gal. _ 2 = m
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures 3 8 gpm
x x x c.i. 231 gal. x .75 = al. 2 = gpm
r#2ci. 231 gal. x.75 gal. 2 = gpm 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 gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
5 O gpm
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
-------------------------------------- (For City use only belowthis line)
Remarks.
Size Approved: 0 0 gpm Approved by: Date: 0�
Pretreatin t Technician
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Business Name:
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Address:
CITY OF EDMONDS
Grease Removal Equipment Application
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Date Submitted: — ' 0
uite No..
Business Owner: `/ Mailing Address: 1-/l� �A�
Contact Person/Title:
Days/Hours of Operation:
Total Number of Meals Served Per Peak Hour (assume all seats filled):
Number of Seats: Dining: Lounge/Bar:
Building Occupancy Permit Capacity:
Banquet Rooms: Deck/Patio:
Health Dept. Permit Capacity
Inventory of Kitchen Equipment and Plumbing Fixtures for this Establishment: (Grills,
burners, ovens, hoods, deep fat fryers, wok stations, soup kettles, sinks, pre -wash sinks,
dishwashers, disposers, mop sinks, floor drains, etc.)
What proportion, if any, of the dishware used is of the disposable type? A ; --QM
How is waste oil/grease handled, stored, and recycled/disposed?
Estimate gallons of waste oil/grease produced per month.
If recycled, by which company?
How are vent hoods cleaned and where does the cleaning waste go?
Contact the Pretreatment Technician at 425-672-5755 to discuss the type and size
of equipment you must install, and then complete the appropriate accompanying
worksheet for either a Grease Interceptor or a Grease Trap.
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MEMO TO:
FROM:
PROJECT
OJECT
)VAL FOP
TO:
DATE.
PERMIT COORDINATOR, BUILDING DIVISION
SITE ADDRESS
DEPARTMENT DATE L(— 7 —Q L(
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PERMIT # '10 r �7 ADB# DATE INSPECTED
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 :
4. GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS, given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
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1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date
l:temp:bldg: forms:ocaprvl 3/25/04
Signature
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
Footing
Wall .................... .
Z
Pier/Porch ......... .. .. O
Retaining Wall
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Slab Insulation ..........
PLUMBING: fA
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Underground ............. C
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Commercial Final ..... � M
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HEATING: I[)
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Gas Test
Gas Piping ........ ...... fA
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Equipment
Commercial Final.....,. rn rn
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EXTERIOR SHEATHING rn
NAILING C
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FRAMING Z (�.
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FIRST FLOOR FRAMING", D
INSULATION --i
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Floor Insulation ......... Z
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Wall InsulationCn
........... 2
Ceiling Insulation Z
SHEETROCK NAILING ... n
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SPECIAL INSPECTION ...
MISCELLANEOUS
FINAL APPROVAL FOR�-
OCCUPANCY
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