228 5TH AVE S.PDF111111111111
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228 5TH AVE S
Block_ Parcel No
ATC-20 Rapid Evaluation Safety Assessment Form
Lis
Ms
No. of stories: CAC
Basement: Yes E] No Unknown F1
Primary Occupancy: Dwelling [I
Other Residential E] Commercial Office El
Industrial D Public Assembly El S&ool El
Government E] Emer. Serv. E] Historic 0
Other
OVERAIL RATING: (Check One)
INSPECTED (Green)
Exterior only
Exterior and Interior
11MMD ENTRY (Yellow) El
UNSAFE (Red) 14
INSPECTOR:
Inspector ID jf-5�, —ii�-rAjeyz?)V�
Affiliation 4/7-1 V7>/rIOK;1�6
INSPEMON DATIF:
Mo/day/yeai�--
Time— 1AfA,#u,14 am prn
Instructions: Review structure for the conditions listed below. A "yes" answer to 1, 2, 3, or 5 is
grounds for posting entire structure UNSAFE. If more review is needed, post LDAMD ENTRY.
A "yes" answer to 4 requires posting AREA UNSAFE and/or barricading around the hazard.
Hazards such as a toxic spill or an asbestos release are covered by 6 and are to be posted and/or
barricaded to indicate AREA UNSAFE.
More
Review
Condition Yes No Needed
1.
Collapse, partial collapse, or building off foundation
2.
Building or story noticeably leaning
El
3.
Severe racking of wal1s, obvious severe damage and distress
El
1:1
4.
Chimney, parapet or other falling hazard
El
0'.
5.
Severe ground or slope movement present
El
6.
Other hazard present
El
0
Recommendations:
'No further acti6h required
Detailed Evaluation required (circle one) (S-i;�c�tur Geotechnical
Other
F1 Barricades needed in the following areas-
C] Other
Posted at this Assessment C1 Yes O<No
Cor
130 Appendix C ATC-20
ATC-20 Detcdled Ewduation Scdety Assessment Form (Continued)
-Instructions: Examine the building to determine if any hazardous conditions exist. A "Yes"
answer in categories 1, 2, or 4 is grounds for posting building UNSAFE. If condition is suspected
to be unsafe and more review is needed, check appropriate Unknown box(es) and post LRarED
ENTRY. A "Yes" answer in category 3requires posting and/or barricading to indicate AREA
UNSAFE. Explain "Yee, "Unknown" findings and extent of damage under "Comments.,,
Hazardous Condition Exists
fondition Yes -No Unknown Comments
1. Structure Hazardous Overall
Colla se/partial collapse 0. 0
Buflzg or story leaning �9 El
Oth El '00— f_1
0 0 El
2. Hazardous Structural Ejeme:nts
Foundations 1:1 D
Roof/floors (vertical loads)
Columns/pflasters/corbels E01
Di'2ahragms/hotizontal bracing El [I
W shertical bracing El El #
Moment fi-ames El D F1
Precast connections El D El
Oth El 0 D
El El 0
3. Nonstructural Hazards
Parapets/ornarnentation EJ El El
Cladding/glazing El El El
Ceilings/light fixtures n El D
Interior walls/partitions 11 El El 4=
Elevators 0 F-1 D tqu I AZ
Stairs/exits 1:1 El El � I -
Electric/gas 1:1 El El X-N
.Other n 1:1 El
0 Fi D
4. Geotechnical Hazards
ope re/debris El
ro d movement, fissures El El
Other 0 El E1.
0 0 0
SKETCH: . . . . . . . . . . . . . . . . ... . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Sheet — of-
132 Appendix C ATC-20
U
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
1 S C) 11 Manning * Budding , Eng neer ng
January 25, 2002
Wilcox Construction
1234 1h Avenue N
Edmonds, WA 98020
Dear Mr. Wilcox:
Re: Address Change
This letter is to infonn you that your request for an address change has been granted. The
previous address at 228 5'h Avenue S has been changed to 234 5 th Avenue S. I will
inform all City Divisions including Fire, Police, Utility Billing, Public Works and
Building.
It is your responsibility to inform the Post Office, the Phone Company for Enhanced 911
emergency purposes and all other interested parties of this correction.
Sincerely,
Marie Harrison
Permit Coordinator
Cc: Fire Department
Police Department
Utility Billing
Public Works
Building Official/Street File
U'rempOST'sWaster Letters\Address Change
Incorporated August 11, 1890
Sister Citv - Hekinan. Jaoan
LA-ul�-A
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Permit No: 4 i�
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT, Issue D i ate:
A. Address or Vicinity of Construction:
B. Type of Work (be specific): �Aqo*4r-isr
C. Contractor: WIC-1r, O.NJ
Mailing Address:
StateLicense#:_
D. Building Permit #(if applicable)__M//—eg��
Contact:
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. Commercial n S, ubdivision El City Project 0 EUC (PUD, VERIZON, PSE,'AT& T, OVWD)
Multi -Family E] Single Family El Other
INSPECTOR: CXILOVxZ
F. PAVEMENT CUT: 0 YES El NO
CONCRETE CUT: []YES El NO
G. SIZE OF CUT _X _.
INDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLORING THE, FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES HILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WiLL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public, safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession. f �
* Restoration. is to be in accordance with, City codes. All street -tut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
I HA VE RE,4D
THATINMT
Signature:_�
DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
P_'THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS -
(Contractor or. Agent)
Date: zv — 6
FOR CITY USE ONLY
f.04
Approved by: Right-of-way Fee:-110 4'r; -Ala,
Time Authorized: Void After lFiAIM5 Lu�rallqx Disruption Fee/Fund 111:
Special Conditions:
*At #-A I PJ -P otJ
f- WE
1:�am
,14 TP EC tKE7.XUM R;7
Restoration Fee:
19
Total Fee:
Receipt No:
Issued by:.
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERMITTED WORK. DATE-:0/4
Inspector's Signature
For inspection requirements see Engineering Inspection Information. handout.
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