20050564.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAMECF-?YySINASS A
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NAME
NAME
ADDRESS
CITY
STATE
PROPERTYTAX
NEW
ADDITION
E REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, E
ZIP TELEPHONE
ZIP TELEPHONE
EL NO.
60 1 0
RESIDENTIAL
>_4: OMMERCIAL
M
MIXED USE
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
[ON
CHECKED BY
UMBING MECH
IANC
IANCE OR
CHANGE OF USE
SIGN
FENCE
I X FT.)
OTHER
ElFIRE
SPRINKLER
FIREALARM
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
e
HEAT SOURCE LOTSLOPE%
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
IPERMIT
NUMBER
JOB SuITE�APT#:
ADDRESS L. t C! t 7��
f _� y 0
PLAT NAMEISUBDIVISION NO LOT NO LID NO
I Lit) FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP E SCP A,,Iao�ej
ke, il ....... I kf.jwft�j
tO,00 jv, 61w,"Ll
EXISTING PROPOSED.. 1r%j.!wn Hwj,�Fw,
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REQUIRED DEDICATION FT
METER SIZE LINE SIZE NO OF FIXTURES PliV REQUIRED
Yis NO 13
*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.'
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 0 E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S NCE AND RCW 18:27.
SIGN RE 0 A
)r: DATE7GNED
0 P?
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
CA#
WAIVER 0
STUDY 13 1
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D . PROVIDED
REMARKS
SPECIAL INSPECTION
REQUIRE
REMARKS
I GEOTECH REPORT
V BY:
STRUCTURAL DESIGN
Ely:
Y�
V
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
SHORELINE OR ADBI$ INSPECTION SEPA
REO'D COMPOTED FAFMPI
10YES I I 1
SIGN AREA HEIGHT
ALLMVED , PROPOSED ALLONED . PROPOSED
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REQUIRED SETBACKS (FT) I PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT URSIDE REAR
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LOT AREA PLANNING REVIEWED BY DATE 5
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CODE OC UPANTM
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GROUP
CONSULTANT OCCU15ANT
LOAD
FEE Description FEE
5DState Surcharge
City Surcharge
CALL
FOR INSPECTION
(425)
771-0220
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a peram until signed by the
Building Official or his/her Deputy. and Feesare paid, and
receipt is acknowledged in space provided
OFFICIALS SJGNATURE DATE
211 17)
RELEASED BY DATE
ATTENTIOW 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. UBC109 / IBC110 / IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK -OWNER - GOLD - ASSESSOR
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Grease Trap Sizing Worksheet
Facility Name:
�5�0 Ave'. --grill Lowpt,
Address: 6 /&— -f *4 Ave, - 1, - 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. isabled or
• Food disposers are not allowed in a facility served by a Grease Trap and must be d
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
PMW C'x X JK c.i.
-- 231 = gal.
x .75 = gal.
+ 2 = Rpm-
#2
-x
x x x c.i.
+ 231 = _gal.
_x.75 = gal.
L.2 =___2m
#3
x X x c.i.
-- 231 = _Sa�l.
x .75 = gal.
- + q���nl
#4
x X x c.i.
I + 231 gal.
. x .75 = gal.
-- 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
x X x c.i.
+ 231 = gal.
x .75 = gal.
#3
x x x c.i.
+ 231 = gal.
x.75 = gal.
#4
x X x c.i.
+ 231 = gal.
x .75 = gal.
_Zf ----Ap"n
Grease Trap #2 - Total drainage flows from maximum of 4 fixtures
gpm
MINIMUM SIZE OF GREASE TRAP(S) RE, QUIRE, D
—gpm
f Fixtures Connected to a Grease Trap 2 3
Grease Trap Size (in gpm) 25 �3 �5
Upsize for factors such as high volume dishwashing, high oil/grease content on rnenu, etc.
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---------------------------------------- (For City use only ulow this line) -----------------------------------------------
Remarks:
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Size Approved: 10 gnm Approved by: L� Date:
Pretreatif—ffechnician
[Rev. Feb. 2004]
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PLANT DATE
----PRETREATMENT
PLEASE SIGN
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PROJECT �7-6� AVe,. 6-i-rdl
SITEADDRESS- (610 54 Ave.. 5.
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PERMIT # 2-005 - 0 SO ADB# DATEINSPECTED 7-2LOS..
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DESCRIPTION OF WORK TO BE INSPECTED rap
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A field inspection was conducted to determine compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
LVITM P\BUII-DINCj\l-'OIZMS\Illtr-.'I'IZEATM ENTAPPROVALDOC 1/4/2005
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Stab 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 ..................
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