21110 80TH PL W.PDF111111111111
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21110 80TH PL W
ADDRESS: c:�/)/ ILI) /2t
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: F� Conditional Waiver Study Required E] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS(OTHER): [7UI-7 I—IffN—
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: SIDE SEWE R PERMIT(S) #:
SOILS REPORT DA
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Forms\Street File Checklist.doc
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F08TED ON KROLL M,*,P N1
BUILDING DEPARTMENT Ap,U=t MI
PERMIT APPLICATION Inside Heavy Lines JUB ADDRESS
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SIDO YARD 1117111AUR ST!
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i A�XA VARULNCF. NUMBER 16
E a; 47STREL'r R/W DrXICIENCY THIS PROP ERTY
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TYPE CONNECTION
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REMARKS
Ale
El 0SIDEN-1, 0
NON-RESIDENT]AL
GAS
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0 YES )s NO
PLAN
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1 AINING
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ALTER
REPAIR
EXCAVAT
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ED
]PENCE
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�UMBEROF M-11129 I NUMBER OF
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U14ITS
72-/ Plea, Chmk No...
BUILDING
PVO, PLUMBING
BEAT 11 GAS LINE
PENCE
'IN
RFTAINING WALL
SWIMMING POOL
N
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PRE.MOVE rNSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
led .......
I �enby ackn ,j_ .. .. inat the im'
tontion given Is Correct; Md tn&t I — the wn,r. .1 the ditty atithor'
lzed z ent or �o owner. I &irree to comply With city and state laws �gu_
ATTENTION
lat�ng Wn'tmetion: and I. doing the work autbotl..d thereby. .. V
wit be employed In vtol-ti-n Of the Labor Cod. of the State of Washingtoo,
Tins PEn3irr
yelaticl: to Workmen'. C..p.t1cm I—ranoe.
AUT110111ZES
NOTIE: Permit Limit One Year (E—pt DEMOTITIONS --htlh
ONLY THE
WORK NOTED
.hall b, C.mpl.td In ol-ty day.: MOVED4N BUILDINGS bl: be
pletm !u oix months.)
INSPECTION
DEPARTMENT
� AG
ji—G—NA:-;�RX (OWNEit Ol� AG DATE SIGNED
�:AE 1�/- —6— 6
CITY OF
��AM -7—
ED31ONDS
Subjert to Plan Chrch Fee
NOTE: APPlicallt
Pit 6-Im
_;T_ ro�rt, ONLY.
This r,_,, __ wo, in �',, no on ,jt. I,
Anr on tho publie domain (curbs, .1d,..Ike. drl—as.,
w., ".I rd.- --an.
I : ., I I - ; .
lid
IT11
[3 YES (3 NO
OCCUPANCY UAVU-
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Val tino, Fee
;77
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APPLICATION APPROVAL
This application is not a pernilt until
ned by the Building Official or his Dep-
and fees are pail, and receipt Is ItC-
Dwledged In space provided.
EcTO.Va HIGNATURIC
mix
ILE
STREET-f
APPLICATION BUILDING PERMIT Appl. No.
A" 1�
Permit lirnit� on�i.,Yea�
CITY OF - EDMONDS Building Department
APPLICATION is hereby made for a permit to construct the following work, in accordance,with the'a
ts are submitted herewith for approval.
panying plans and specifications. Two se q
Off'St.
new alter _'Parking'_.� ............
.... .............. .... .... ........... .......
Work addn repair .......... ...................... ..........
onst, t Use zone .....
f . Fire zone"..- ..... ......
y 4e-_,,,, ................ ............ ....
Occsua,ncy ..................... ....... r�r_
Lot ... .................. AddrL, .... ...........
... BIL .....
Address...
............................................ Septic tank ..... ..... . . . .................. ........
Lot frontage.. ..... ...... ...................... Area 40
1. side .............................. rear ...............................
Bldg. set -backs front...... ...................... r. sloe ....................
........ .... ... .......... ........ . . . .......... r ...
0 ..............
11�ller_
Address.................................................... Tel. No .............................
Builder................ ............ .............................
Plansby .................................................................. Address ........... Z.: ............ . ............... Tel. No ...............................
Remarks.4':4,/4,"�` ... :5� ....................................................... ............ - ................................ 3 .
The above is a corma statement, and I agree to comply with all applicable Codes and State laws regulating. this,
work.
Date-
ress.................... .......
Signed Owner/Agent2
........................
PERMIT for the above work is hereby approved, subject to the above c6nditions.�,and to compliance with thi ap-
proved plans and specifications, and Building Department notations thereon.
............ Reed. by
Valuation
........... permit fee..
Building Department, By ............................... . . .. . . ................... 7-.;
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK ...................... ..........
final, OF . ................. ...
........ .. .....
This Pemit does not cover Plurribing, Sewer or Electrical installations-
q
SURIEET FILE
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PLANNING DATA
New Commercial I Multi -Family Projects
Name: PrIAI(A
Date: 10 -7
Plan Check'#: BLD - Zd I y — 016,(
Site Address.-
Project Description: AmdrCoa Yo 95�A �(_CVP hWlAt, Ul��
Use(s) Proposed.
Allowed Use
CUP File Number:
To Allow What Uses:
Legal Nonconforming Land Use Determination Issued: (YES I
Reduced Site Plan Provided: (YES I qP
Zoning: 4
Map Page:
Comp Plan Designation-.
Comer Lot: (YES 1?90
Flag Lot: (YES i
ADB File Number (date waived): IV�4_
Lot Area: 17 563
Plans Match ADB Approved: (YES / NO) 14
Sho eline Required: (YES I to
Critical Areas Determination #:
[I Study Required
El Waiver
SEPA Determination:
0,rxempt
El Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form)-
-ec
Requii f$&bqcks
Street:
Side-
Side: /0
Re
IV
Street:
Side: /0
Side:
Rear:
Lot CoverageffiVifrRequired:
Lot Coverage/tW Provided:
Lot Coverage/FXP?Calculations:
30YO W 3 W, 3d ff 7
Buddif 7g Hqi�yh
Datum Point:
ZIA
9�turn Elevat�*W-,o
Maximum Height:
VLf L
Actual
oe
Subdivision:
Lot Aggregation Required:
LandsOaping-'
Landscaping Matches ADB Approved: A / /-I —
Landscaping Bid Provided: (YES / NO) / V �
I dond Amount (100% Bid):
Plan Review By: clt,7
PLANNING DATA F =ILE
New Commercial I Multi -Family Projects
G&MmerchilpdikifigA��,
Business Name Type/Use Parking Tenant Required
Ratio Area Parking
Total Parking Required.
Total Parking Pro vided_-
# Bedrooms per Dwelling Unit
Parking Ratio
# Units
Required
Parking
Studio
1-21D.U.
1 Bedroom
1-51D.U.
2 Bedrooms
1-8/D.U.
3 + Bedrooms
2.0ID_U_
Total Parking Required.
Total Parking Pro vided.-
PArqW Vffe_5 5iPIP_J," Y�t#ctc 11L A440— —C_-Jl�r,47
V� M6Y 60,A 57A e
oo
41
T,(44 � >
Tep ((J r Al 9'0
r 0' lq 1c4,7nLx4_J,,
(e A
IZ)
Plan Review By: A, C(C,7 K.=,,
License Number: BH 453
Pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services, a license is hereby granted to
EDMONDS GROUP HOME
operated by NORTHWESTERN FAMILY HOMES INC
rov -
to conduct - and maintain at 21110 80TH PL W BUILDING DCEPT.
City of EDMONDS, Zip Code 98020 County of SNOHOMISH State of Washington
a facility for the.board and domiciliary care of 15 adults
This license shall be in force from the Ist day of April, 2002 through the 31st day of March,'2003 subject to revocation for due cause.
This facility meets the DSHS contract requirements to provide Adult Residential Care Enhanced Adult Residential Care
Conditions on License, if any: No resident shall be.allowed to work on "kitchen crew3� until proof of valid food and beverage
service worker permit or limited duty food worker card is provided to the department. After card(s) have been obtained,
"kitchen crew" tasks shall be limited to the scope of the card(s). Lf —
NOTE: The department renewal of a license does not preclude the
license Is not transferable, and Is valid only for use by the corporation,
Licensing Authority
taking any action under RCW 18.20.115,, based on inspection.
p or IndIvIdual(s) to whom It Is issued and at the location above
Issued by Authority of Chapter RCW 18.20
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jOARDWEi HOME--,-, 1JCE-N1S---)-E---1-,
BBUILDING
License Number: BH 453
Pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services, a license is hereby granted to
EDMONDS GROUP HOME
operated by NORTHWESTERN FAMILY HOMES INC
to conduct and maintain at 21110 80TH PL W
City of EDMONDS, Zip Code 98020 County of SNOHOMISH State of Washington
a ficility for the board and domiciliary care of 15 adults
Tfi�s license shall be in force from the Ist day of April, 2001 through the 31st day of March, 2002 subject to revocation for due cause.
This facility meets the DS.HS contract requirements to provide Adult Residential Care Enhanced Adult Residential Care
Conditions on License, if any:
Licensing Authority
tak
NOTE: The department renewal of a license does not preclude the dep ent r ing any acttoshftffidffi6aa� 18.20.115, based on inspection.
der
This license Is not transferable, and is valid only for use by the corporation, p2i or Individual(s) to whom It is Issued and at the location. above described.
Issued by Authority of Chapter RCW 18.20
D
D.
STREET FILE
Graf, Jeannine STROW FILE
From: Westfall, John
sent: Friday, October 25, 2002 10:47 AM
To: Graf, Jeannine
Subject: RE: Edmonds Group Home @ 21110 80th Place West
Jeannine: Alok . 06 e&VJ /d�v Ala 4,-Y 1-,6 /SMt0?4Vr A�t�
The sprinkler system (UBC� Standard 9-3) is being installed by a grant from the State Fire Marshal's Office. They are a
nine -person (R-4/1-C) boarding home that has a valid City BL since 1974 as well as state license for (approved by BO
Whitcutt "subject to state licensing" on 2/26/74). 1 believe they currently have 9 residents. The last document of FID inspect
is Feb 01, last FA system confidence test is Mar 02.
John
Ar os--dn Ae. Af Ar;%e zXe.
----- Original Message -----
From: Graf, Jeannine
Sent: Tuesday, October 15, 2002 11:19 AM
To: Chave, Rob; Smith, Mike; Westfall, John
Cc: DST
Subject: Edmonds Group Home @ 21110 80th Place West
Seeking your assistance and historical information.
A fire sprinkler permit application was received today for the subject building. The application describes the building as
a Group Home with 12 beds. In researching our permit files we found that in 1960 an existing single family dwelling
was converted into apartment units at this site (total number of apartment units unknown but 6 parking spaces were
required to be provided). We also found a permit for a new exterior stair and landing issued in 1994 to Northwest
Group Homes. Please provide any historical or City approval information on this building. Also, Rob what Planning
approvals would be required to convert from an apartment to a Group Home? I will be checking with the State to see
what kind of approvals they have granted to this facility. Thanks JLGraf
Jeannine L. Graf
Building Official
City of Edmonds
1
APPLICATION
for
The City of Eclm
onds SEDE SEWER PERMIT EASEMENT No . .......................................
NEW CONSTRUCTION 0 REPAIRS E]
321-02500
OWNER........... Me.lb.a..Her-ring .............................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... ?1.1.1.0 ... 8O.t.h ... Pla.c.e ... W ................................................... LEGAL DESCRIPTION: LOT No . .............................................. BL40CK No . ............................................
. .. ..... .. ..
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer
Approved:
DATE................................................ By ......................................................................
L4 w tJ
_L7�
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1;N -h4
SITE PLAN.- ph�'dle�t 14.00560RO 660Z_b0
S(�,ALE 1" 10 FT -r 2-
L
NORTH
WhWED AS IAOTED
General Scope: Restore apartments that had been converted to Personal Care Units. Al
-2, C s u General Notes: ly
Occupany. R on tr ction VA
.6 E �.NEERI C
Insulate all wall cavities exposed during construction to the maximum allowable
Scope Specific: a: based on cavity depth, without compression to the insulation. e) hA
1 . Re -install a kitchen in.each unit. Make small structural modifications to Project Are UP,
kitchens in second floor units. Gross Sq Ft 2x4 stud cavities to receive R-15 batts, and 2x6 stud cavities to receive R-21.
—0V
New Washer/Dryer in lower units and common Washer/Dryer, in Wil . ity First Floor 3058 Exhaust fans, clothes dryers and kitchen hoods shall be smooth, rigid ducted to trio Jr&
Second Floor 880 17
room for second floor units.
Total 3938 the exterior and provided with back draft dampers.
3. Replace all bath fixtures.
I AJ' �u r
4. Replace all windows and Tesize to provide egress from all bedrooms. fV 1) n eW I Y P��V
6 Apartment Units Apartment entry doors to have Y2" throw dead bolts with locks operable without &ML
5. Replace interior and exterior doors. special knowledge or keys or effort. Observation viewport to be provided at 54" to
No. 1 743 Sq Ft
N
6. Encapsulate acoustical spray ceilings (asbestos) with gypsum wall board. 66" off floor.
7 Add exhaust fans where necessary. No. 2 743 Sq Ft
No. 3 692 Sq Ft
8. Relocate hot water tanks to central location in attic.
No. 4., 762 Sq Ft All walls receiving gypsum wall board shall be 5/8" Type 'x'
No. 5 402 Sq Ft 2x4 Party walls between units shall have R-15 batts, double 5/8" GWB type'xJ RPXD B _PLANNINP"
No. 6 415 So Ft
on each side, joints staggered and electrical outlets staggered for STC rating of
LE
50+
DESIGN CODES: Provide a carbon monoxide detector in each unit outside and adjacent to the
2012 EDITION OF THE.1UBQ AND sleeping areas.
ENERGY CODE WITH WA STATE �6o?olyo?OSTREET FILE
AMENDMENTS Provide flow restrictors for showers of 2.5 GPM and 1.6 Gal flush for toilets.
Nothing in this permit approval shall be interpreted as
allowing or permitting the maintenance of any currently " �eM Com, er Flag —
existing illegal, nonconforming or unpermitted building, Setb
F
acks Re uired
structure or site condition which is outside of the scope
Scanned of the permit application, regardless of whether such Front L
building, structure or condition is shown on the site plan
L4 or drawing. Such building, structure or condition my be Sidesp/5 10 10 C 0'�' 9EP 2 5 201
the subject of a separate enforcement action.
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REVISIONS31
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