20050657.pdfOi4WIV&� DATE RECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN %T-/NAME OF BUSINESS
w MAILING ADDRESS
ol �IVOO 7ZV 4,,a
I GIT-Y_ ZIP I TELEPHONE
TELEPHONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRES�S
PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved [3
0
RW Permit Required
Street use Permit Required E3
EXISTING PROPOSED
inspection Required 1:1
Sidewalk Required 13
REQUIRED DEDICATION FT
Underground 0
I
- -
Winne requited E3
METER SIZE
LINE SIZE
NO. OF FI XTUJFRWS
P13V REQUIRED
I
.
YES 1:1 NO13
CD
z
-
R
REMARKS
U1
W
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
0
z
uj
1111vf�
UtJL
ENGINEERING REVIEWED BY DATE
E N
ADDRESS
6 �79)
�L _�alt 7eq
0:
R
U
FIRE REVIEWED BY DATE
.IR
F
Lu
a:
z
0
U
CITY ZIP
4
V1;f1f1?A6j
TELEPHONE
V
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REQ'D
13 YES 13 NO
SEPA
COMPLETED EXEMPT
STArEj MBER EXPIR
�CENSE NU ATION DATE
C ED Y
I
4OR
CAN
WAIVER 13
. A
I
STUDY 0
ZONE
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED I PROPOSED
_j
_j
PROPERTY TAX AC COUNT PARCEL NO.
7 4z0z�'e:4-9L 1511
z
z
5
IL
____
NEW RESIDENTIAL UMBING MECH
COMMERCIAL 0
ADDITION COMPLIANCE
MIXED USE E] CHANGE OF USE
REMODEL ULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
PARKING
REQ' D PROVIDED
LOTAREA
PLANNING REVIEWED BY DATE
GRADING FENCE
REPAIR CYDS x FT.)
REMARKS
1:1 DEMOLISH E] TANK OTHER
0
I=
EDGARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF BUSINESS OR
TYPP
�OS T R T,
1 � W/
I
OCCUPANT
GROUP,
.1
0
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED MYES
CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
z
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ui
9L
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
Engr. Inspection
UU)) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
Lu
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M 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 Landscapeinsp. Total Amt. Due
21 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION., - . /1/1 7 S
--- Recording Fee Receipt # �& az
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVALf
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 application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or hisihot Deputy: and Fees are paid, and
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 11:27,
OFFICIALS SIGNATURE DATE
N NT DATE SIGNED (425)
<1* A/
P epi� W )10�
771-0220 REL SE Y DAY
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- ORIGINAL Fir F 9Y SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110. PINK - OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
z
0
1
0
M
--i -n
M
C
M
0
0
0 C
M
M Z
C —Z
CO)
0 _n
n
--I
3:9
MITI
0
0
0 M
C cl)
F. co
M 0
Z
z
__q
X
U5
z
0
i
0
M
t
CIT Y-OF-EDMONDS
Grease Removal Equipment Application
-04
kV1Jj,%, "ate Submitted: IiI3—
_Oek�l'
Bus�ness Name:
p
11LAbO D& Suite No.:
Address-
z
0
Business owner. aill.ng-Address--Mt wcl:-,�ele- - W1,
Fmcz
ho -12
Person/Title:-jor.-tv�K rte q I q LA- — O—W-6k, S 49
M
Contact
Dnys/Hours of Operation:—
)
V 3:
M
C
Total Number or Meals Served.Per Peak Hour, (assuine all seats filled):—JiL->—
M 0
0
1.
Number of Seats- Dinink-P. LOU anquet Rooins: DecklPatio:?�Lvi
age/Bar: N/A 113 Ad —A
0 C
X M
Building Occupanc y Permit Capacity: ___Health DepL Permit Capacity
M.Z
C
>
-mbine, Fixtu res ror this Establishment. (Grills,
Inventory. of Kitchen Equipment and Plu t7
Cn
Soup e-wash sinks,
ovens, hoods, deep fat fryers, wok stations,. sinks,.Pr
burners, sjrec,- e-r
clovlo A �Icl Lx��
0 -n
dishwashers, disposers, mop sinks, floor drains, etc.) �-
MM
10 �10x- �m
0
0 M
C 0) L
th
What proportion, if any, of the dishware used is of e disposable type.
M Cn
M 0
Z
ispose rs'lt�e- -eAt=-2
Flow is waste oil/grease handli ed, stared, and recycled/d d? 01
X
CA 5-0 is CIPM ei"A el 1,4-o 5
>
Rec---4c- eA 62' rov'N LS —D&�A
Z.
Estimate gallons of waste oil/grease produced per.month:
If recycled, by which company-?
z
01
ds Cl L ned and where does the cleaning waste go9._2_ CN. r
How ar Vent hoo ea
0
M
got)l ga."� Oki-g 10oc'-p- 31
Contact the Pretreatment Technician of 425-672-5.755 to discuss the type and
siZe equipm ent you must install, and then complete the qppropriale
Of
accompanying worksheei for either a Grease Interceptor or a Grease Trap.
n
F1 6 AJ
-TID
m
>
&FWjer*(_LE:V
tx N K it TI&I
Z
qq2
BUILDING R
--A Ali E N,
WORI< c-wu(z5c T)Aky
A D D 4 4CO - I
OWNi-I'Adero-
"A p
.4PPR0,,,,Ei" E:
Z"
F
IVART NUMEFE
V�
05-l"
am
c
m o'
2003 EDITION UPC
0 O�
c
W/WAC AMENDMENTS
M
AND APPENDICES AjBlGlI
2003 EDITION IB c
0 -n
W/WAC, AMMENDMENTS
om
co"
K OY
CITY 'COPY
m0�
Z
z!
-4
M.:
z
RECEIVED
0:
M
OCT 19 2004
BUILDING QEPA�
UTY OF E[)Mo(qDv;
Grease Interceptor Sizing Worksheet
Facility Natne: Airley-cre-Si Hecdt� Y-- Re-ka—ce
-n LP-V
Address: 2-Noo Avf,. �,po2G Suite No.:
A Grease Interceptor perinit.is required ($365.00 fee). Contact the Pretreatment Technician
(425-672-5755) if you have any questions and also to get signature approval on this forin.
Per Edmonds City Code the minimum sized Grease Interceptor pennitted is 500 gallons.
-Mbftumsizd�d uhit is 4,000 gallons.
Z
NUMBER OF MEALS SERVED AT PEAK HOUR- A
0
M
ge time per meat
Based on she total number of seats and avera,,
Lounge and bar seating is counted x 20%.
CO)
WASTE FLOW RATE (Choose one) B= G
M
With Dishwashing Machine ...................... 6 gallon. flow
MO
0
0
Without Dishwashing Machine ................ 5 gagon flow
Single Service Kitchen;' . ............................. 2 gallon flow,
M M
Z
(Food Waste Disposer ....................... add I gallon flow)
Z
RETENTION TIMES (Choose one) C 2—
Commercial Kitchen Dishwasher ............. 2.5 hours
0-n
Single Service Kitchen,' . .......................... 1.5 hours
STORAGE FACTORS (Choose one) D
M M
Puff Service Kitchen 0-12 hour operAtion: .......... I
0
Full Service Kitchen 12-20 hour operation: ........ 2
0 M
C 0)
Full Service Xitchen 24 hour operation: ............. 3
K CD
M 0
SingleService Kitchen**: ........................ ............. 1.5
Z r
(Alternate factor for occasional use kitchen .........
;U
Minirourn Interceptor Size (liquid capaci!y) A x B x C x D /740
Z
*A single service kitchen refers to a restaurant where disposable dishware is used and
Z
dishwashing operations are therefore greatly reduced.
(For City use only below this line) — ---------
M
Remarks: Be-c,,yr,- j ±A.- mcjtxr-e of j.h; r 6-f " e. '4 -F -fht'� f-be- -:Emf- t1al
J1
0 Q.C-i I r LJ4 6, LLn r CL
:�--r QA P-Y-i SLiy , f
-%C floo n 1'qf'0y-'
d
q2 C:)
C-4
1A V eL, 14
nm MON
Size Approyed.�9 /700 gal. Approved by: Wka.4a, Date: 5 - 2� - 04
flretreaty#nt Technician
5-
[Rev. Feb. 2004)
CITY COPY
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
-Pier/Porch .................
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
-4
Underground .............
M
C
Rough
M 0
0
-in ...................
-4 0
C
Commercial Final ......
-4
ITI
HEATING:
171 z
10
GasTest ....................
z
*Gas
r
Piping .................
0
Equipment ................. I
Commercial Final .......
ITI ITI
Co
EXTERIOR SHEATHING
0
NAILING ..........................
0 M
C (j)
FRAMING ................... ...... .
M 0
FIRST FLOOR FRAMING...
z r
INSULATION ...................
Floor Insulation .........
>
Z.
Wall Insulation ...........
3:
Ceiling Insulation .......
Z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
ITI
MISCELLANEOUS .........
FINAL APPROVAL FOR
J\As
OCCUPANCY ..................
c*157