20050484.pdfDATERECEIV@D@D
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
PERMIT EXPIRES
PERMIT
NUMBER �,7/
JOB / SUITEJAPT#
ADDRESS �!�)
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO,
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 17
RW Permd Required 17
Sheer Use Permd Required E3
EXISTING PROPOSED Inspection Requited 17.
Sidowatk Required 13
REQUIRED DEDICATION FT Underground 17
Wifinq required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 17 NO13 2
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REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTRO DRAINAGE
.d /i 1 /•/
ie P6 Lokm ' ENGINEERING EVIEWEDBY DATE
ADDRESS
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE Of
NUMBER
RTY TAX
❑ NEW
❑ ADDITION'
❑ REMODEL
REPAIR
❑ DEMOLISH
❑GARAGE
CARPORT
(TYPE OF USE, E
EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED EXEMPT
OYES ONO
CA# ZONE SIGN AREA HEIGHT
PARCEL NO.
,WAIVER E3 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY. D
❑ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
Y ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMMERCIAL COMPLIANCE OR _
❑ MIXED USE ❑ CHANGE OF USE z
PARK114G LOT AREA PLANNING REVIEWED BY DATE 5
❑ MULTIFAMILY ❑ SIGN REQ'D PROVIDED
❑GRADING FENCE
CYDS ❑ ( X FT.) REMARKS
❑ TANK ❑ OTHER
❑RETAINING WALL FIRE SPRINKLER
ROCKERY ❑ FIRE ALARM
OR ACTIVITY) EXPLAIN:
OCCUPANT �J
GROUP
G
NUMBER NUMBER OF — ' " - I
m OF DWELLING SPECIAL INSPECTION CONSUL LOAD O STORIES UNITS REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS z
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GEO7ECH REPORT �
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t S CAAl0 1 STRUCTURAL DESIGN .
BY:
VALUATION
$
[description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPEW. 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
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
11 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION,
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19,00,005(A)(5)
4 L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
*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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' y ��
Recording Fee Receipt #
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 This application Is not a permit until signed by the
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her 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 COMPENSATIO INSURANCE AND RCW 16:27, F MALS SIG AT I F;E DATE
L
NATU OR GE T) DATE SIGNED (425) /v ! ` / r `
X13 771-0220 RELEASED BY I DAT
A ON 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- ORIGINAL - FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
Number of Fixtures Connected to a Grease Trap 1 2 3 4
Grease Tra Size in m 20 25 35 50
1WEEM
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Fixture Capacity
in Cubic.
Fixture Capacity
Drainage Load
Flow Rate
for a
Inches
in Gallons
(75% of Total
2 -Minute
x W x
D x no.
of sinks
Cu. In. _ 231
Capacity)
Drain Period
#1
2#x /I x 1
x =
/6 Rilt c.i.
-
231 = 73
al.
x .75 = S
al.`
= 2= 2?
m
#2
/7x/7x !2 x 1 _
X68 c.i.
@
231 = gal.
x.75= l
al.
- 2. 6
gpM
#3
x x
x —
c.i.
=
231 =
al.
x.75 =
al.
— 2=
m
#4
x x
x =
c.i.
_
231 gal.
x .75
gal.
= 2.=
gPM
Grease Trap #1-
Total
drainage flows
from maximum
of
4 fixtures
3.3
gpm
#1
x x
x =
c.i.
-
231 gal.
x.75
gal.
= 2
9PM.
#2
x x
x =
c.i.
:231
=
al.
k.75=
al.
_ 2 =
m
#3
x x
x =
c.i.
_
231
gal..
x .75
gal.
= 2
gpm
#4
x x
x =
c.i.
=
231 =
al.
x .7S =
al.
_ 2 =
m
Grease Trap #2
— Total
drainage flows
from maximum
of 4 fixtures
gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
JS
gpm
Number of Fixtures Connected to a Grease Trap 1 2 3 4
Grease Tra Size in m 20 25 35 50
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