20050043.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
� r� !
i
i
MAILING ADDRESS �. f
CITY 1 / (ZIP TELEPHONE
•�_ I` i it�� �\.1' �" CI
NAME
%r
[PERMIT EXPIRES
PERMIT _
NUMBER
JOB SUITEIAPT#
ADDRESS 55
c
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved O
RW Permit Required 113
Street use Permd Requited
EXISTING PROPOSED__ inspection Required O
- I Sidewalk Requited E3
REQUIRED DEDICATION FT Underground O
Weinrequired 13
METER SIZE LINE S17 NO OF FIXTURES I PRV REQUIRED
YES O NO O Z
W
REMARKS W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
w
1•f•IVIL IrOLH
��((J I i 1�) i 'tel) T1 b I l ENGINEERING REVIEWED BY DATE
tY ADDRESS
9 V �) r 01) 0 `4 6 y FIRE REVIEWED BY DATE
y CITY ZIP TELEPHONE x
STATE LICENSE NUMBER EXPIRATION PATE C CKED B VARIANCE OR CU SHORELINE OR ADBN INSPECTION SEPA
L ' REQ'D COMPLETED EXEMPT
�L� L1 I y- ti L P 11 9JL' ��� 13 YES ONO
a PROPERTY TAX ACCOUNT PARCEL NO. CAN ZONE SIGN AREA HEIGHT
W Q �� `� ?� r �� (� �� C ^. ��/ WAIVER o. ALLOWED PROPOSED ALLOWED PROPOSED
W `j l ' STUDY O
RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
❑ NEW ❑ PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
;N`COMMERCIAL C MPLIANCE OR z
❑ ADDITION MIXED USE ❑ CHANGE OF USE z
PARKING LOTAREA PLANNING REVIEWED BY DATE S
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑
REPAIR ElGRADING CYDS ❑ FENCE X FT.) . REMARKS
DEMOLISH ❑ TANK ❑ OTHER
GARAGE Z ❑ CARPORT ❑ ROCKERY NING WALL ❑ FIRE A ARM FIRE LER
O
IL (TYPE OF USE, BUSINESS ZACVI Y) EXPLAIN:
UF.CONSTRU ON E OCCUPANT
C,C/) GROUP
Lu NUMBER NU BER OF
m OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
O STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE REQUIRED YES
REMARKS 0
Z
GEOTECH REPORT O
BY: m
STRUCTURAL DESIGN
BY:
VALUATION .
Description FEE Description FEE
Plan Check '"y Stale Surcharge
HEAT SOURCE LOT SLOPE % VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
3 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapo Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt # f -
1 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• This Oficial or h is not o punnd unto signed by id,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or knowl dgeaDopuin and Foos aro paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION roLdipl is acknowind{pnl ut spare prowdod
WORKMEN'S COMPENSATION INSURANCE AND RCW 16:27.
OF LS SIGN f IRF. DTC:
SI NATURE (OWNER OR AGENT): DATE SIGNED (425) ��, fy ;) �.'
• ���.) � ` -��A.. l l �t � � li_ '. 1 tti i. � 771-0220 r, AAn lY 1b//VV'
D E
i
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-
014
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC1091 IBC110 1 IRC110, oiPINK-.( Fur n I11)W SSF"o oINSPIli
PINK •• OWNCH Ci1J1 D A`.iCiC;iSCIit
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
Number of Fixtures Connected to a Grease Trap
Fixture Capacity
in Cubic
Fixture Capacity
4
Drainage Load
Flow Rate
for a
35
.50
Inches
in Gallons
(75% of Total
2-Minute
x W x
D x no.
of sinks
Cu. In. _ 231
Capacity)
Drain Period
#1
2q x 4X//ix
=Z&
72 c.i.
=
231 eGgal.
x.75
gal.
= 2 = 2
m
#2
x
x
x _
6._
231 =
al.
x
.75 =
al.
_ 2 _
m
#3
x
x
x =
c.i.
_
231 =
al.
x
.75 =
al.
_ 2 =
m
#4
x
x
x =
ed.
—
231 =
al.
x
.75
gal.
— 2
9PM
Grease Trap
#1-
Total
drainage flows
from maximum
of
4
fixtures
32L
gpm
#1
x
x
x =
6.-
231 gal.
x.75
=
al.
- 2
gPM.
#Z
x
x
x =
c,i.
_
231 =
al.
x.75=
al.
- 2 =
m
#3
x
x
x =
c.i.
=
231. gal.
x.75
=
Tal.
= 2
gpm
#4
x
x
x =
c.i.
_
231 gal.
x.75
gal.
_ 2
apm
Grease Trap
#2
— Total
drainage flows
from maximum
of 4
fixtures
35
gpm
MINIMUM
SIZE OF GREASE TRAP(S) REQUIRED
gpM
Number of Fixtures Connected to a Grease Trap
1
.2
3
4
Grease Tra .Size m m
20
25
35
.50
r ;
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