20050042.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEtNAME OF BUSINESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
CH CKED BY
X/0
PROPERTY TAX ACCOUNT PARCEL NO
NEW
RESIDENTIAL
PLUMBING MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
El
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
El
FENCE
( X
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
NUMBER
OF
NUMBER OF Lk
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEATSOURCE I LOTSLOPE% I VESTED DATE
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APTH
ADDRESS
Z2
PLAT NAME/SUBDIVISION NO
LOT NO
I
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP
TESCPApproved 0
RW Permit Required 0
street use Permit Required 13
EXISTING PROPOSED
Inspection Requited 0
Sidewalk Required E3
REQUIRED DEDICATION FT
Underground [3
Witinq required
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
YESM NO E3
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REMARKS
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OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBI I iNSPEC to SEPA
REOTD'o COPAPILETEID I EXEtAPT
13YES 13NOI
CA# ZONE SIGN AREA HEIGHT
WAIVER13 ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 0 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ*D . PROVIDED I I
FT.) 0 REMARKS
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 BE
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. -
OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 0 YES I I LOAD I
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description
State Surcharge
25i City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
FEE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
" I APPLICATION APPROVAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
R N C ST This application is not a punlit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
M PL Y CALL Building Official or hisihor Deputy and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 118:27. 1
F 1�IALS srGOATURE DATE
I - I DATE SIGNED
SIGNATUFlr�WNER R AGENT) (425)
771-0220 RfL?AS1I
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110.
iW04 PRESS HARD - YOU ARE MAKING 4 COPIES
I
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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Grease Trap Sizing Worksheet
Facility Name: I'lair, Sb.rt?'tb Dine-r-
Address: Irinsn St. -Suite Nb.:
• A Grease Trap plumbing permit is req uired ($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
Inches
(L x W x D x no. of sinks)
Capacity
in Gallons
(Cu. In. - 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for a
2-Minute
Drain Period
0 x / 7x 12- x 3 /QqO4�-i-
231 = gal.
x .7 5 = 34 -gal.
2= /7 gpm
42
X X X c.i.
231 = _gal.
x .75 = gal.
2 = _ gpm
#3
X X X c.i.
231 = �al.
x .75 = gal.
2 =
#4
X X X c.i.
231 = gal.
x.75 = gal. 1
2 = gpm
Grease Trap #1 - Total drainage flows from maximum of 4 fixtures
-gpm
#1
X 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 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
2pM
MIMMUM SIZE OF GREASE TRAP(S) REQUIRED
20 2I)m
Number of Fixtures Connected to a Grease Trap
2
3
Grease Trap Size (in gpm)
1 201
1
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:-20 gpm Approved by: S62�'�� Date: //-5, OY
Pretrentindfit Technician
[Rev.reb.20041
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City of Edmonds PERMIT#:
ISSUEDATE:
Grease Trap / Grease Interceptor
Installation Record
THIS CARD MUST BE POSTED ON SITE AND AVAILABLE TO THE INSPECTOR
Owner: D' Y\'; unitl�pe: Map
Site Address: L4 1�"� C�'-'\ V-) A--y- J�— -iI-
-p A CLV`�—
Business Name: _j
Size: 136C-1 Pho
Location:
Grease Interceptor Installation
CALL ENGINEERING FOR INSPECTION
(425)771-0220xI326 Mol)iliz�ition/Erc)sioilCoiltroI
Pipe histallation / Test
Vault Orientation / histallatim
Sarn Vault
ling
Approved
Date
Note plumbitig fixtures connected
- - - - - --
1ZW Permit #
Mimi Approval
Grease Trap Installation
CALL BUILDING FOR INSPEcuON Approved Date Note plumbilig jLvitres comiected
(425) 771-0220 x1333
lzough-ili 42
Fhial Approval 12.- 1 3 4v-,-
FOR GREASE TRAP INSPECTIONS CALL (425) 771-0220 x1333
FOR GREASE INTERCEPTOR INSPECTIONS CALL (425) 771-0220 x1326
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PRETREATMENT PLANT DATE E>
PROJECT
SITE ADDRESS Lk 4�% A S4-,
TED
PERMIT # ADB#_DATE INSPEC
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
1:1 Copy of CONDITIONS given to owner/con tractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
L:\I'EMII\BUII-DINC,\I:OltMS\I'ItUl�ItEAI'MEN�rAPPIZOVAL.I)OCl/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 ..................
av501' 1)Ad.9 k00000",*
(0001v 1 410w
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