24017 104TH AVE W.PDFiiiiii lill
264
24017 104TH AVE W
Ilk
ADDRESS: �w/ -? ld,�l
TAX ACCOUNT/PARCEL NUM[BER:-
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: Q-DETERMINATION: E] Conditional Waiver [] Study Required 2Caiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DA
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMp\DSrs\Fonns\Sftwt File Checklist.doc
i4e.411
� N 00 DEG. 53' 11" E
C
ASSUMED 300.00'
DATUM TOP MON IN MON CASE
DRAINAGE SYSTEM STANDARD DESIGN 14' ROOF O.H.
DRIVEWAY:
835 &f.
ACCEPT
OPEN PATH:
261 &f.
GARAGE ROOF:
1,412 s.f.
SDR 35
HOUSE ROOF:
2.131 Lt.
SCH 40
OPEN DECK:
218 &f.
TOTAL:
4,923 Lt. &v
N - 12
F81 0 HAI
IMPERMEABLE AREA: 4,923 &f.
REQUIRED VOL
CU.FT.: 125 c.f.
PIPE DIAMETER:
30"; 25' LONG
OUTLET ORIFICE DIA: 1/8"
CATCH BASIN: TYPE IL, CB JWATER
lWiPECTION%c
RESIDENCE
A=304.0
B=304.0
C=304.0
D=303.0
AVE GRADE=303.15'
ACTUAL=328.08'
MAXIMUM=328.15'
GARAGE GRADE
AT CORNERS
305.0
AVE GR=305.0'
ACTUAL=319.3'
MAXIMUM=320.0'
NOTE:
CONTRACTOR TO VERIFY TO BE�
GRADE POINTS USING TRANWENI
PER CITY OF EDMONDS PRIOR
TO START OF CONSTRUCTION
LOT COVERAGE CALCULATION IDONT
SITE AREA: 8.444 S_F_ WATE
35% OF SITE = 3.025 S.F. rax
RESIDENCE AND PORCHES: 1.150 S.F.
TERIAL
REQ'D.
0 EXT. I
+304 U�/
Fil P_ M
',,,RESIDENCE
P". 328.0e
--------------
BSMT: b*f.
IST M: t470sl
UPPER FLR. '935sf.
FIRST R.R. REV", 304.
BWT ' ELEV- 2,
L
FTG D TH: 29 )gf
CRAV&'
FTG D�
FIR E
A4304
a
INTO
SYSTEM
8 TOFU
W A TM
SPREADER
SYSTEM
TRE
10'LONG.
co
OLYMPIC VIEW
WER DISTRIM16
Sir- lgsp&.,-.Ctdt-J
GARAGE AVERAGE
r.PAnt= 'AAC Al'
. %w
*2.25
4 411' w w I
4 B 4304.0
V-04 WIDE -
ASPHALT
4b WALKWAY
8 'l 8 —8 -
-----------------------
y
523 S H 0 rP�.�"
-------- ---
25'
2-CAR b
0 GARAGE:
:r : oll
GARAGE SHOP: 1,123 S.F. RR ai"o
;z FM DEP
16'
IV I AL K00r AK=A: a 1.� 0.r.
LEGEND OF SYMBOLS TEMPORARY CONST I RUCTIOC td
JgE.�RUIRED
STORK WATER T E
IGHTLINE T-W A
W W WATER PIPE NOTE:
98-98— SANITARY SEWER PIPE ALL EXISTING TREES
ON SITE TO BE REMOVED �:A r**._,-"
—6-6— GAS PIPE
TALV 1
RIGHT-oF.WAy 01 DEG 11' 21" F 16,
APPROVED AS NOTED CONSTR N :4 1:
EERING AND INSPECDON MVION PERMIT.,3OS75'
REQUIRED
_51TE PLAN 7:
0 12M4
=ALE: I' = 20'
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"qql RHENE JOHNS PLAN, NORTH &PPROV D FL.' (A46
24017 104TH AVE NW BY PLAN INb
A R C H I T E C T PROJECT ADDRESS. EDMONDS, WA iloq I
c9
7310 R Skyvlew PL #8RE C E oo5e4gooloo3ol 14
Tacoma, Washington 98406 OZIS: EVAN PIERCE AND SUSAN BLAND G
Phone/Fax (253) 565-e27APR I - 0 4 2708 E. PIKE ST. N 01 DEG _11'_ 21" E
SEATTLE. WA 98122 _w
PERMIT COUNTER k(QL-py
ST @fff
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
STRL
owt=
"Dp". 2-/,P/'7. /,pf pHOML. 204 32.Z: 9,7?.
D4%
*DESIGN DA TA
CE
ORIR
IMPERVIOUS AREW PiPENA. PIPE LG
-7
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How"
W
COIC IN am
T umw% . .
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CONI
UPPER.CATCH BASIN
CONTROL CATCH BASIN
R-ECMVED
ARK) 6 2004
SYSTEM.CROSS SECTION
AM 4-61 SPNA.S OR ECUAL
FR13N CONTROL C9 L,*X VX 3..MXP, 3/4' CRUSHED'ROCK ISTING GRAK ST25W
CONTROL
pff "ppc.T% a
POW ME V/ 012
WPAP OUrUr
RUNOFF SPREADER. TRENCH
F0077NG DRAINS $HALL NOT -RE CONNEMD -TO DEMMONSYSTEM.
NOTM:
W Ea&w&g DivWan (M-WO) for a fightline and &ftnfion systm inspection'
'ST 'No 0
Gym
-X -X 31 3/4' �70 1
rW
Lr
W= WcVdft and hr finA inVactions.
",PR0VM,61r
2, Rmpo='bffity for opuation and mintecunce of &ainap qdem on pfivift pwpody is 60 U04
6
respom-bility of tho property owner ' MaterW accumulated in die -storage pipe natst be 5liel .
nut and removed from the vatch basins, to allow vrooer coeradon. Mw outlet vontrol onfiame DAIN
'KA2.
OZ5 I,, -
I
pf PC
C-a-16
W',e&xoc A/ A�-:
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1-22-04
City of Edmonds
Development Services Department
Engineering Division
1215' Ave N.
Edmonds, WA. 98020.
To Whom it Concem's,
The purpose of this letter is to attest to the location of drainage test pits which were
conducted at the time of my short plat. Mr. Pierce recently contacted me to inquire as to
the whereabouts of the test pit locations. I met Mr. Pierce at the property and we mapped
the pit locations as they are represented on the enclosed map.
I hope this is sufficient enough to satisfy the pit location need in conjunction with the
drainage date submitted at the time of my short plat. Please feel free to call if any
questions arise.
Sincerell
A 'Ir
ry ize
2063490733
SION
�AOTAR'y �P-
of :0 M.
oo
PUBLIC
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+304.0,
N 00 DEG. 53' 11" E 98.41'
j4o�—i jo4o+�,- Av4t,,IJ
1125
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PLAN
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N 01 DEG 11' 21"
N 01 DEG 11' 21" E C, IOITH AVE. WEST
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Rece-1ved: 1/26/01 12:52, WINDERMERE REAL ESTATE Page 2
`26
M, -2001 FRI 12:53 P*E REAL ESTATE GROUP FAX NOI&253477246
IGGEL F.NGD*MWG ASSOQATES, INC.
9900 EVERGREEN WAY
EVMTr, WA. 99204
PHONE: (425) 353-1119 OR (206) 775-5424
Fax (425) 353-7149
March 21, 2000
Karissa Kawawto
Pknning Department
City of Edmonds
12156 Aveme N.
Edmonds, WA 98020
RE: The Bryan Mize Short Plat -drainage plan (S-99-132)
Dew M& Kawamoto
P. 02
RECF.IVF-D
MAR 2 8 2000
KANitnva DEPT.
Attached please had a copy of a Preliminary Drainage Plan prepared by Bryan Mize as
part of a Short Plat application. Mr. Mize submitted this pin to the City of Edmoi3U but
was told that the drainage Plan Would require the signature and seal of a professional
engineer. hi order to meet the City's requirements W. M= colltracted with our firm to
review and sign his Preliminary Drainage Plan.
After a site inspection and a review ofthe calculations provided by Nft. Mize, we fmd
these calculations to be consistent with the City,s requirements and-commn engineering
Practice. 77'e results of the soil tests were consistent with the conditions observed on the
site, and the final trench size is reasonable relative to others desWW in this wv&
Therefor, please accept this letter and attached Pmliminary Drainage Plan as fiffillmerA
of your requirement for drainage plan signed by a professional engineer. If you have any
questions or comments please contact us at (425) 353-1119.
Sincerely,
R.
W
Erik Enw.wn. Eff
RevieuvA and Approved By
980
4mwid Ycgc P.E. L
EXPIRES
m,�;—..ea: lleolul le:0.3; "4NU=KM=nt-- "=AkL =01AkIM eage 4
n-2001 FR 1 12: 54 PM REAL ESTATE GROUP FAX NO. 03477246
2 P. 03
a
a
R F. C"� E I V E 1)
110 Mize's MAR 2 8 2000
10413 2400'Place SW
Edmonds, WA 98020 iimd DVT.
RAM
Preliminaa Drainage Plan
The tests and were performed, and the measurements achieved according to the
guidelines presented in the King County Surface water Design ManuaL Hydraulics
engineer,. Don Fiene at the city Planner's office (Edmonds), recommended these
gWdelines for the aiia under question, The recommended test for this area is the Sub -
Surface Maximum Infiltration Test� spelled out in section 4.5.2 of the, Design Manual.
Four complete infiltration tests wereconducted, yielding the following times:
Seconds bich 1
Seconds inch 2
'c h 2
Seconds hich 3
Seconds inch 4
Ich 4
Seconds inch 5
Secon ch
ds inch 6
Average time
e
1, -Aec.
.:05 sec'
105 see
11
105 sec
1
110 sec
I
115 see
101,
101 see/ inch
I lest #2
75.sec
90 sec
80 sec
80 sec
75 sec
80 see
80 sec / inch
I -
1 Test #3
70 sec.
80 sec-
1 85 sec
90 sec
90 sec
90 sec
# 84 sec / inch
Test #4
55
70 sec*
80 sec
85 sec
.80-sec
80 sec
75 see / inch
. The above data led to the use of the maximum infiltration rate of coarse sand or
cobbles for the purposes of the calculation Of the sizing of the trench.
Calculation values;
Roof area 3006 square feet
Soil texture .333 inches/min
I 00yr storm precip— 3.0 inches
Aj= (0-054P,00AR)/10Im= (0.054 * 3 * 3000)/((10)(.333)) - 145*.95
K = 146/4 --- 36.5'
Minimum Trench Length = 37 Feet
Please find attached a general drawing (not to scale) of the type of drainage plan
Proposed. Please note that only 6" perf-pipe is to be allowed on premises. Scale
drawings and detailed final plan to be submitted vvhen applying for development permit.
Bryan D. Mize, ovmm
0 . 0
Thomas F. McDonough
Attorney at Law
510 BOB Street
Edmonds, WA 98020 �2(
DOCUMENT TITLE:
SANITARY SEWER EASEMENT AND JOINT SIDE SEWER AGREEMENT
REFERENCE/RECORDING NUMBERS OF
DOCUMENTS ASSIGNED OR RELEASED:
(if applicable)
NAMES OF GRANTORS; (last name, first,middle)
BRYAN D. MlZE and REBECCA C. MIZE
AND GRANTEES:
EVAN PIERCE and SUSAN BLAND
PAGES WEMRE ADDITIONAL NAMES ARE LOCATED: N/A
ABBREVIATED LEGAL DESCRnMON
(additional legal Is attached to the document)
Lot 1, City of Edmonds Short Plats 99-132, Block 1, Vol. 15, Page 25
ASSESSOR'S PROPERTY TAX PARCEL NUM[BER
OR ACCOUNT NUMIDER:
REr,EIVIED
To be assigned by Snohomish County APRI ' 6 2004
PERMIT COUNTER
After recording return tog
Thomas F. McDonough
Attorney at Law
510 Boll Street
Edmonds, wA 98020
SANITARY SVMR EKSBNZW Am i0IXT SIDX BXWZR AaRZX)m=
THIS SANITARy SEWER EASEMENT (this "Easement") is made by
and between BRYAN D. MIZE and REBECCA C. MIZE, husband and
wife, ("Mize") and EVAN PIERCE and SUSAN BIJM, husband and
wife ("Pierce-) .
WHEREAS, Mize and Pierce have entered into a Purchase and
Sale Agreement whereby Pierce is purchasing property from
Mize. Said transaction is scheduled to Close on or about
March 15, 2001;
WHEREAS, Pierce intends to acquire the subject property
and any subsequent reference to Pierce as Owner is in
furtherance of this intent even though at the time this
document is executed Pierce will not actually own said
property. Notwithstanding, Pierce makes such representation
as if he in the owner of the property he intends to acquire;
WHEREAS, Pierce has requested that Mize allow Pierce to
� I -
0 0
Construct and extend a sanitary sewer line through the
property owned by Mize so it will serve property owned by
Pierce as well as the Mize property;
WHEREAS, Mize is Willing to grant Pierce an easement
subject to certain condi�ions which are deemed satisfied upon
execution of this Agreement;
WHEREAS the Pierce property, which is to be benefitted by
the easement to which sanitary sewer will be extended, in
legally described in fthibit A, which is attached hereto and
incorporated by this reference;
WHEREAS, Mize is the owner of certain property which is
legally described in Exhibit 3 which is attached hereto and
incorporated by this reference;
WHEREAS, Pierce will be responsible for the construction
and all costs of said sanitary sewer and, in order to
construct said sanitary sewer line, Pierce will need a
temporary construction easement;
NOW, THEREFORE, for and in consideraLtion of the covenants
and other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties
agree as follows;
.2-
1. —GRANT OF-FAMM: Mize hereby grants to Pierce a
perpetual, non-exclusive easement over, under and across the
five (5) foot sanitary sewer easement identified in the plat
map which is attached hereto, marked Tzhibit C and
incorporated by this reference for the purposes of
constructing, reconstructing, installing, maIntaining and
repairing a sanitary sewer line. The location of the easement
on Exhibit c is for illustrative purposes and the precise
location will be fixed upon construction, at which time the
parties may amend this document to fix the precise location of
the easement. while the actual easement is limited to a five
(5) foot width, it is understood and agreed that equipment,
personnel and material may be temporarily placed upon areas of
the Mize property beyond the five (5) foot width of the
easement during construction, installation, repair and
maintenance of the easement. For the purposes of constructing
the sanitary sewer line, Mize hereby grants to Pierce a
temporary construction easement. Said temporary construction
easement is located on the same above described lands. Said
temporary construction easement terminates and said sanitary
sewer easement vests in Pierce upon the earlier of completion
-3-
0
_V
AI�Ikl *
Mize hereby grants to Pierce a
perpetual, non-exclusive easement over, under and across the
five (5) foot sanitary sewer easement identified in the plat
map which is attached hereto, marked Exhibit C and
incorporated by this reference for the purposes of
constructing, reconstructing, installing, maintaining arid
repairing a sanitary sewer line. The location of the easement
on Exhibit C is for illustrative purposes and the precise
location will be fixed upon construction, at which time the
parties may amend this document to fix the precise location of
See AddenduM On P&9B 9
the easement4 While the actual easement is limited to a five
(5) foot width, it is understood and agreed that equipment,
personnel and material may be temporarily placed upon areas of
the Mize property beyond the five (5) foot width of the
easement during construction, installation, repair and
maintenance of the easement, For the purposes of constructing
the sanitary sewer line, Mize hereby grants to Pierce a
temporary construction easement. Said temporary construction
easement is located on the same above described lands. Said
temporary construction easement terminates and said sanitary
sewer eas�TeStB in Pierce upon the earli ompletion
t.s -3- Z
0 0
GgANT OF EASEMENT: Mize hereby grants to Pierce a
perpetual, non-exclusive easement over, under and across the
five (5) toot sanitary sewer easement identified in the plat
map which is attached hereto, marked RxbLibit C and
incorporated by this reference for the purposes of
constructing, reconstructing, installing, maintaining and
repairing a sanitary sewer line, The location of the easement
on Exhibit C is for illustrative purposes and the precise
location will be fixed upon construction, at which time the
parties may amend this document to fix the precise location of
See Addendum on Page 9
the easement/. While the actual easement is limited to a five
(5) foot width, it is understood and agreed that equipment,
personnel and material may -be temporarily placed upon areas of
the Mize property beyond the five (5) foot width of the
easement during construction, installation, repair and
maintenance of the easement. For the purposes of constructing
the sanitary sewer line, Mize hereby grants to Pierce a
temporary construction easement. Said temporary construction
easement is located on the same above described lands. Said
temporary construction easement terminates and said sanitary
sewer easeiViests in Pierce upon the earli o completion
us
of construction of the sanitary sewer line and regulatory
approval of construction of the sanitary sewer line or six
months from the date construction in commenced.
2. CHARACTER OF EASRWT: This easement shall be
appurtenant to the Pierce property legally described in
Exhibit A and shall touch, concern and run with the land
described in Exhibits A and B, being binding on the successors
and assigns Of Mize and Pierce.
3. REPRESENTATIONS OF THE pAgTjgS. Each of the
parties who affix their signature to this Easement represent
and warrant that they hold good and marketable title to the
respective properties identified herein, free and clear of
encumbrances, except for those encumbrances listed on the
Exhibits, Further, each of the parties are duly authorized to
grant and convey the Easement referenced herein and to make
the other representations and covenants herein.
4. MIZE USE—QE- = EMENT N&L&L Mize shall be entitled
to use the area within the easement and over the easement as
long as such use.does not unreasonably interfere with Pierce's
utilization of the easement along the five (5) foot sanitary
sewer easement depicted in Exhibit C of the real -property
�. 4 -
0 0
described in Exhibit B for the easement purposes and locating
A sanitary sewer line therein. This conveyance is conditioned
upon Pierce's obligation to replace any fences, lawn, shrub-
ery or land contours that are disturbed in connection with the
exercise of Pierce's rights hereunder in as good condition as
Ehe same were immediately before the property was entered upon
by Pierce oK i�s contractor., Pierce shall construct the sew,,�r
6.A.-
Ine with six (6) inch pipe by means of employing a licensed-*,:
insured and registered contractor and shall undertake all work
related to construction of the sewer line in a professional
manner and in material compliance with all applicable laws,
rules and regulations, including but not limited to, zoning
regulations and construction permit requirements.
5. MAINTENANrp.: The cost Of maintenance, repair or
reconstruction of any portion of the sewer line used in common.
shall be borne equally by Pierce and Mize. Pierce shall be
fully responsible for all blockages, cleaning and repairs to
said side sewer on that portion of the side sewer that is not
used in common.
INDEMNIFICATIONt Pierce shall indemnity and hold
Mize harmless from any and all costs, damages, expenses,
* Ro__,�-I S D i-I b � P < be- c 6 c- c k", i 7- e- 'v� -, s A44ctvmj tv\
0 0
losses, coats and/or attorney fees caused by Pierce's
construction activities, breach of the terms and conditions
herein or damages caused by blockages, cleaning or repairs to
said side sewer.
7. NOTI!gES: Any notices or demands permitted or
reguired hereunder shall be in writing and delivered either
personally or by certified or registered mail addressed to the
address set forth on the signature page or such other address
as the parties may designate in writing, All notices shall
be deemed received on the date the postmark is affixed by the
United States Postal Service.
GOVERNINO. IM-e- This agreement shall be
interpreted, construed, and enforced in accordance with the
laws of the state of Washington.
9. ArrORNEY nrhs-:- in the event it becomes necessary
for either or both of the parties to retain an attorney to
undertake action to induce or enforce performance of the
obligation of the other &rising out of this agreement, or
defend a claim brought by the other, then reasonable costs and
attorney fees incurred by the prevailing party shall become
the Obligation of the other party, whether or not suit is
instituted.
-6-
0
11
This agreement represents the
entire agreement of the parties with respect to its subject
matter. There are no other prior or contemporaneous
agreements, either written or oral, between the parties with
respect to this subject. No provision of this agreement may
be modified in any way without the written consent of each
party.
11- INDEPENDENT COUNSEla This document has been
prepared b.y Thomas F. McDonough, attorney for Mize. Pierce
has been advised of his right to independent counsel and has
retained the services of James Jameson for review,
consultation and approval of this legally binding document.
Pierce ack.Tiowledges the fact that counsel for Mize who hag
pr spared this document creates no attorney client relationship
between McDonough and Pierce, who is* represented by James
Jameson.
IN WITNESS WHEREOF, each party to this Agreement has
caused it to be executed on the dated indicated below.
IL
Y �DMIZE���� REBECCA C. MIZE L' I?
Address:
4420 - 154th Place SW
Lynnwood, WA 98037
"7,
0 0
EVAN PIERCE SUSAN L.-BLAND
Address:
STATE OF WASHINGTON
I
COUNTY OF SNOHOMISH)
. �4 ".
On this day of March, 2001, before me the under-
signed, a Notary Public in and for the state Of Washington,
duly Commissioned and sworn, personally appeared BRYAN D. MIZE
and REBECCA C. MIZE, husband and wife, to me known to be the
individuals described in and who executed the within and
foregoing instrument, and acknowledged that they signed the
same an their free and voluntary act and deed, for the uses and
purposes therein mentioned.
WITNESS my hand and official seal hereto affixed tho day
and year first above written.
:4 AoTA-9 Y M
:10
PUB,_10
eb
9
OFWPS�'
STATE OF WASHINGTON
an
COUNTY OF SNOHOMISH)
NOTARY PUBLIC in ai:!nd�for the State of
Washington, reeidingi
LIAIA Won b
Ry Appointment Expires's (.0 �-:) - C)-2-,
On this L3t--day of March, 2001, before me the under -
Bull
0 0
signed, a Notary Public in and for the State of Washington,
duly commissioned and sworn, personally appeared EVAN PiERcE
and SUSAN L. BLAND, husband and wife, to me known to be the
individuals described in and who executed the within and
foregoing instrument, and acknowledged that they signed the
same as their free and voluntary act and deed, for the uses and
purposes therein mentioned.
WITNESS my hand and official seal hereto affixed the day
and year first above written.
A
NOTARY PUBLIC in and,for the State of
T Y
LA
(n: Washington, residing fj k)
\r
My Appointment Expires:
11 6
O.0 W
-9-
0 0
m1gn"r & NOtaVY Public In and for the state oz washington,
duly acnaisgLo"d and sworn, personally Appeared 8VAv pjxRCj
And sag= L. RIAM, husband and wife, to Me kwwn to be the
LrALviduals described in and *4 ex"Uted the within and
'rof*Wing '"trumOnt, A" &CknOW10fted that they signed the
BANG &9 their free and v-OjMt&ry &at and dead, for the uses MW
PuZVO8*0 tb§r*iu Mentioned.
M?MXSS WW hand and offieW s&&j h&rsto affixed the day
and YOM first above written.
C1
.12-A anrs�
N;% * w� j
t4OTARYj'--. MOMY PL%UC in And for the state of
"Am ton, residing
PLfBLIC .. $ YVP
PW Appointaient, evirest
, %tt
Addendum: Page 3 is amended to include the following language after
the easement."
It. ee
C�Wte -lJnefr a
which is intended to b,-- L n sewer .1ne in the
approximate location of the existing sewer line serving -
the Mize property and lying east of the house and along
the east property line."
F1
.9.
M
0 0
signed, a Notary publjc in ar
.d for the State of W&Shinaten,
dulY COMMISSioned and sworn, personally &PPG&red XVAN pl=Cr..
a" SUB" "' 3L"M, husband and wifg, to Me )=wn to be tha
'rA'viCbMI$ described in and wW "gcUted the
fors,goift irvotrument, and acknowledged that th within am
S&M &S thoir free aW vojuntary acrt GY signed the
P"q'og*s thsr*iu MOntionad. " dead, for tha �jgea &ad
W'"M9 MY hand &nd offLejal Meal hereto affixed th@ day
Y"r first above Written.
Y RMARY PUBLZC in &.Ad for the at
W�— L�� at.* of
't"hiNtOn, residing
Appointment Ibevires
Addandumi Paqe 3 is amended to include the following language dfter
the easement."
ri
which is intended to be vscePwte line 'pr a In
n sewer .1ne the
aPP-rOximate 1OCation of the ex-istlnV sewer line serving -
the Mize property and lying east of the house and along
the east Property line.-P
-9-
n-MO
0 0
U90AL DE$CRIrUON ZXMIT
LOT 1, CITY OF ZDW=S SHORT PIATS-99-132, RICOWIM UM21 RECORDIM MMM
20001229300, BEING 4% POITZOM OF LOT 1, $LQCX 1, x.x. $CigjtoZDZRS MLAT op
FOREST OLIN, AS PIR PLAT RICORDID IN VOLUME IS OF PLAM W42 25, WORM of
EN090"Ism coum WASKINOT00
SITUATS IN THE COUM OF SHONOMISK, STATE OF WASHINGTON.
EXHIBIT A
LZOA4 DzsCRlrnoN wc=rr
LOT 2.- CZTY OF XVHMMS SHORT PLATS-19-132, RECORDED UWb2j RzCoap%M NUMRZR
20001220900. SEIM A PORTION OF LOT 3, BroOCJ( I, K.K. SMMO*DZ]tS R"LJLT OF
VOltZST GLM. " FZR KAT RZCOJW9D M VOLUM IS Or PLATS, VJ4Z 25, ASCORMS or
BNOMONUR COXW7Y KABRINGr4�W
SXTUaTt IN THE 007M OF SHOROMISH. STAT2 OF WASXjffMN.
EXHXDXT B
r.
CtTY 00 EDMONDS[ SNO140MISH !�40. WASHINgM
c mvism 2-91-01 1"
Lar
flp
oN
240 V ft. a W.
omm;=&) I I FLAT
W ago=
10 4V
now
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CLIP31 AM LAV.
3-23-99
L.B.* 17093 0
CxTg or
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sit
EXHZBIT c
0
OLYMPIC V115W WATER & SEWER DISTRICT
23725 EDMONDS WAY
EDMONDS WA M26-111191
(425) 774-7709
AGREEMENT AND SEWER EASEMENT FOR
COMMON LINE SEWEA OWNERS
THIS AGREEMERT is entered Into to be effedve this.�day of Marcht 2001 by and
between the Olympic View Water arW Sower District, a municipal corporation, located In
Snohomish County, Washington, hereinafler referred to as 0DIstrict", and
WHEREAS, A) owners of the following desoribed property in Edmonds,
Snohomish County, WashlVon, to wit
Lot 2 ' City of Edmonds Short Plats 99-132, recorded Under recording number
20062229500, being a portlon'of lot 3, block 1, R.K. schroeders Replat Of
Forest Glen, as per plat recorded in Volume 15 of Plats, page 25, records
of Snohomish County, Washington. Situate in the County of Snohomish, State of Wash.
and,2) pzrRc-r.mr-AAm are owners of the following described property in
Edmonds, Snohonfth Courdy, WaPirgton, to wit
Wt 1, City of Edmonds short plats 99-132, recorded under recording number
2000122950, bel;iy a portion of lot 3, block 1, H.K. schroaders R&Pl&t Of
Forest Glen, as pex� plat recorded in Volume 15 of Plats, page 25, records
of Snohomish Cou W higton. Situate in the County of Snohomish, State of Wash.
ai� "e %:;rre Ofte.401ov40b deofted
pmpe"Xd� 0ount*-WaSh:FntW;;'0100i
*0004)'o L areja*n9gpW th@.4Wov*f de&rribaW
jropVfin Wlori,�dso�horni � �.Was �-to�n. Writ
and WHEREAS, %a Manager of the District is authorized to approve a side sewer that serves
more than on* property upw jokit agreement by the owners of all properties Involved, and upon
the condWon that the #Ids sewer be constructed in accordance with District standards and
specifications.
0 - 0
NOW THEREFORE, for and in consideration of the mutual covenants and benefits to be derived
therefrom, the parties do agree as follows:
That a side tiewer shall be constructed in accordance with the District's standards and
specifications.
2. There shall be an easement four (4) feet wide and each party hereto does grant and
convey to the other an easement over his prop" for the period and purposes
hereinaiter expressed.
3. The cost of maintenance, repair or reconstruction of that portion of the sewer used in
common shall be borne in equal shares by the owners except that the owners of any
lowgr parcel shall not be responsible for the part of the sewer above their Connection;
and when necessary to repair, clean or reconstruct the sewer, the parties to this
agreement shall have a right of entry for that purpose. Whenever entry is made to repair,
clean or reconstruct such work shall be done in a workmanlike manner, and the premises
shall be promptly restored to their previous condition as soon as is reasonably possible.
4. The property owners who are parties hereto, their successors, assigns, (or tenants) do
hereby agree to indemnity and save harmless the Olympic View Water and Sewer
District and its commissioners, officers, and employees from all future damages resulting
from the connection of the side sewer to the above described premises.
5. This agreement shall be filed with the County and shall be a covenant with the land and
binding upon all parties and their heirs and assigns forever.
OLYMPIC VIEW WATER AND SEWER
1\
DISTRICT, XGe ral Manager
A C
Qe
V-\ 'I S ck,-4 0 f vy- y\
2
0
0
OLYMPIC. VIEW WATER & SEWER DISTRICT
23725 EDMONDS WAY
EDMONDS WA 98026-8191
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
Onthis G+d-ayof 20.L�J, personally appetred before me, the undersigned,
a Notary Public in and for the+State of Washington, J�Q
IQ me known to be the individual(s) above described, who executed the foregoing instrument,
and acknowledged to me that the said instrument was signed as the free and voluntary act and
deed of said individual(s) for the uses and purposes therein mentioned.
WITNESS my hand and officialseal hereto affixed the day and year in this certificate above
written.
A ri y
NOTARY PUBLIC ir!--ai State of Washington,
residing at WLAL10-00
0
9 My Commissioh Expires 1p
OFWPS�e_:--:'
STATE OF WASH AIVIONT
COUNTY OF SNOHOMISH)
On this L-Ibay of k&/rC4---, 20 0), personaliy appeaie�d O_efore me the undersigned,
a Notary Public in and for the State of Wa;—hir�qton,.,�;' L2-4"I�J '6LA-ob
to me known to be the individLal(S) above described, who executed the foregoing instrument,
and acknowledged to me that the said instrument was signed as the free and voluntary act and
cleed of said individual(s) for the uses and purposes therein mentioned.
WITNESS my hand and official seal hereto affixed.1he day and year in this certificate above
written.
.0 it�(DTARY
PUELIC,
OF
-iq0YAFkY PUBLIC in and for the State of Washington,
residing at P 0ODD
My Commisslori Expires 44 -'> - 0
4
0 0
OLYMPIC VIEW WATER & SEWER DISTRICT
23725 EDMONDS WAY
EDMONDS WA 98026-8191
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
. t*
On this 4�'day of 20C4, personally appeared before me, the undersigned,
a Notary Public in and for the State of Washingt, E:L" C-
to me known to be the individual(5) above described, who executed the foregoing instrument,
and acknowledged to me that the said instrument was signed as the free and voluntary act and
dead of said individual(s) for the uses and purposes therein mentioned.
WITNESS my hand and official seal hereto affixed the day and year in this certificate above
wdtten.
\14A q
Cc \ON
ARY
0
NOTARY PUBLIC in and lor th ashington,
It PUBV
residing at b�&)U (AX-70
6. 9 - 0..
MyCQmmission Expires
OF WP5
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
On this _day of , 20 _ , personally appeared before me, the undersigned,
a Notary Public in and for the State of Washington, I
to me known to be the individual(s) above described, who executed the foregoing instrument,
and acknowledged to me that the said instrument was signed as the free and voluntary -act and
cleed of said individual(s) for the uses and purposes therein mentioned.
WITNESS my hand and official seal hereto affixed the day and year in this certificate above
written.
NOTARY PUBLIC in and for the State of Washington,
rssiding at
My Commission Expires
0
STATE OF WASHINGTON
ss.
County of Snohomish
day of 2-949, before me personally appeared Rebecca
On this dt H 0j(
C. Mize, to me known to be the individual who executed the foregoing instrument as
Attorney -in -Fact for Bryan D. Mize, and acknowledged that she signed the same as her
free and voluntary act and deed as Attorney -in -Fact for said principal for the uses and
purposes therein mentioned, and on oath stated that the Power of Attorney authorizing the
execution of this instrument has not been revoked and that said principal is living and is
notinsane.
GIVEN under my hand and official seal the day and year last above written.
C)
:4 xAoTARY
0 Cn
PUBUG
C)
OF WAsk,
Notary Public in and for the State of
Washington, residing at Lynnwood.
My commission expires 06/09/03.
PLANNING DATA
NAME: PVCt^ f`,eg DATE: J'avoq
SITE A DRESS: XqQ17 1611& Ave- wo-'r % PLAN CHK#: 04-133
PROJECT DESCRIPTION: CasvvcT q,--- SFR A-d da-cd - -rk-v -Cc(/' 441-Ahe
REDUCED SITE PLAN PROVIDED?
MAP PAGE: 0 CORNER LOT: (Yes FLAG LOT:
ZONING: CRITICAL AREAS DETERMINATION #
El Study Reciulred:'
XW7_alver
Conditional Waiver
SEPA DETERMINATION:
Fee
Checklist
UAPO list wl notarized form
(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
Exempt ff
qk 7e qq
SETBACKS: S�Iff . —IFf - /'11.1 f -e 0%r
Required Setbacks: -7 it 11 /11
Streete Left Side: Right Side:_7 2( Rear.__L�L
Actual Setbacks: It q�?
C-ok fp,� e---36treet- ak 6 Left, Side: 6 ""WiRight Side.- 7 ear
ire
k
Street map chocked for additiona4bac uIred? es No A.
aDETACHED STRUCTURES:
ROCKERIES:
FENCES/TRELLISES:
BAY WINDOWS I PROJECTING MODULATION:
STAIRS/ DECKS:
PARKING: Required: ;� Actual:l+_
, f%*r ADcAs q i1q—
i
,q, �q� = 33, ), Ya
a, !0�
BUILDING HEIGHT:
Datum Point: ^0 VA -1 /1
Maximum
A.D.U. CREATED?:
, ce, �
Elevation: 300-00
. i, All/
Height: e
SUBDIVISION: 130
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes
14-f- 5' - 7'-W_ (e�4?j Ifef dea(12* _&k' I
OTHER: 7 . it�'
CAAD. (dr(&,-�rif;, 5',eCr -m Q&, de\. LL/117ALI�
NewBPPIanningDataForm.D0C
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Pla-hnib g Perm- it's
FT-F-1
Permit'll): J�378
Old Tax Acct #: J5649'-OV003-00
New,Tax, Acct #:
New.. Undo GoTo..
Prin t..
Exit..
I Year: App #: Type:
Applicant's Name:
Building #:
i
Street: 240th
Suffix Dir: Apt#.
-
El s
Intersection? treets:
��how Proces's + Subdivisiori�Det6ils-
Permit Informaiion..
Description: 12 Lot
Date Rec'd:
7
Hearing -Date: Final Hearing: r
Decision: Date Decision Final: 1!1!5129
Total Process TI me: Expiration Date:,
Staff Member: Kawarnoto
Extension?
ProjectcName:
� 11 --- - -- --- -- ---
---- -- -- ... 1 ojects
Subdivision Data?
—
FILE NO.
Critical Areas Checklif
---------------------------------- - ---------
-7
Site information (soils/topography/hyclrology/vegetation)
I 9he Addres's/Location:
2. Property Tax Account Number: 0o C-> f
3. Approximate Site Size (acres or square feet): /7 R-r
4. Is this site currently developed?. )( yes; _no.
If yes; how is site developed? (�'jtn!�Ie7 Pee, <-;,jo, ,, ee
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
I 0-feet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet). -
Other (please describe):
Site contains areas of year-round standing water: 100 ; Approx. Depth:
Site contains areas of seasonal standing water: PJ 0 —; Approx. Depth:
What season(s) of the year?
Site is in the floodway floodplain of a water course.
,,9-" Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
Obvious wetland is present on site:
----------- City Staff Use Only--7—---------
---- ------
1. 81 te is Z on e d
...... .... -
2. SCS mapped soil type(sr JZL4 .4 Alre M
.3. W ed and inve . ntory or C.A. map* indic 3teXetlan sQ AM
4. Critical Areas inventoiy* or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
ite designated on the Environmentally Sensitive Areas Map? CZ
:bETERMINATION
.:STY I D . Y . REQ U I ME . D
IV
�
Reviewed tov-16i,
CONDITIONAL WAIVM
Oaie I
^rA_chk.doc; Rev 10/03J97
City of Edmonds.
RECEIVED
FEB 2 3 1999
PERMIT COUNTER
`R�W CRITICAL- AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any p erson preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, 'or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and. submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent informati on (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
11---; r
15 —b I
Name
10 W -� a? �f 0
Street Address
I; 99762C)
d 13no OA
city State Zip
0 6) ,5-q g-rl 3
'Telepho/ne
Sig4a-tur
Applicant Representative:
Name .
Street Address
city State Zip
Telephone
Signature
0
Date
crecepflon\janakcaddoc
Date
(over)
0
City of Edmonds
0
Plan Review Corrections
Plan Check#: 04-133 Date: A
pjil 23, 2004
Project Name/Address: Pierce 24017 104'h Ave. W.
Contact Person/Address: Evan Pierce PO Box 22198, Seattle, WA 98122
Reviewer: Ross Becklev Department: Planning
Mr. Pierce,
I have reviewed the above noted building permit application on behalf of the Planning Division. I am unable to
complete my review until the issues listed below are addressed:
Tree Clearing Plan: The Findings, Conclusions and Recommendations for the short subdivision (S-99-132)
which created your building parcel require that a tree clearing plan be submitted with the building permit
application. This plan is to "...ensure retention of as many trees as possible." A tree clearing plan was not
submitted with your building permit application, and the site plan simply states that all existing trees on the site
are to be removed. I have reviewed the preliminary plat documents including a map which shows the location
of existing trees on the site, and it appears that trees on the site could be retained. I have enclosed a copy of the
recorded plat and Findings document that require the plan and show the location of existing trees.
Please submit two copies of a tree clearing plan that address this requirement.
Please submit revised plans to a Development Services Coordinator Monday through Friday, 9am to noon or
Ipm to 4pm. Feel free to contact me if you have questions. I can be reached Monday, Wednesday and Friday at
425.771.0220 ext 1224.
Thank you,
Ross Beckley
6�(Attach fax transmiftal)
DATE i -��
10/0
PAGE I OF Iq
CffY OF EDMONDS
121 STH AVENU NORTH, FDMONDS, WA 98020
PLANNING DIVISION
ADVISORY REPORT
CONCLUSIONS9 AND RECOMMENDATIONS
FINDINGS
To: BRY
From:
�jawamo
4W�ssua OtO
project Planner.
Date: MAY ll,.2000
File: S-99-.132
Table of Cont &nts je e
Section
.............. 2
]L INTRODUCTION ...................................................................................................
......................................... 2
A. AnUcATION ........................................................................................ .................. 2
B. DECISION ............................................................................................................................
][L FINDINGS OF FACT AND CONCL . USIONS ..................................................................... 3 .
A. Sn-E DEscRjvnoN
poucy AcT (SEPA) ......................................................................................
B. STATEENvIRONmEWAL A
C. EDMON])s ComwiNny DEvELOPMENT CODE (ECDC) COMPUANCE .................................................. . 5
. ........ I ...................................................
D. TEcwacAL commrnEE ....................................... ............... .. .......... 5
E. COMPREHENsm PLAN (F-CDC) .....................................................................
.................................................................................................... 5
F. CONIN(PrM ......................................
................ 5
H]L RECONSIDERATION AND APPEALS 5
A. REQUEST FOR RECONSIDERATION ....... ...................................
................... 6
B. APPE.41S ....... ...............................................................
........................................... 6
C. TIMEFRAMES ..........................................................................
IV. LAPSE OF APPROVAL
6
V. NOTICE TO THE COUNTY ASSESSOR
6
VIL ATTACHMIENTSo.o.o.-o-o-0000.-oo-000 ........ o ... o—o"o-o'"
CORD 000 ... o—o.— ....... ...... o ... oo .......... o.o.o.00..00
vEL PAR17IES OF BE
S-99-132 MAW / MBY 11, 2000 / Saff RePwt
Min 2-W Nat &ib�on
Re No. S-99-132
Par 2 ofd
INMODUCTION
A. Application
1. AMI Bryan Mize (see Attachment 2).
2. Site Locatio : 10413 24& Place SW (see Attachment 1).
3. 2 lot subdivision (see Attachments 2 and 3).
4. Review Administrative Review and Approval.
5. hftor Issues:
(1) Compliance with Edmonds Community Development Code (ECDC) Section.
16.20.030 (SINGLE-FAMILY RESIDENIIAL - Site Development Standards)'
(2) Comphancewith Edmonds Community Development Code (ECDC) Section 20.75
(SUBDMSIONS).
B. Decision
Based on statements of Fact, Conclusions, and Attachments in this report staff grants
APPROVAL of the 2-lot short subdivision as shown on Attachment 3, subjec.t.to the following
conditions:
Prior to recording*
(1) Complete Engineering requirements contained in the subdivision checklist
(Attachment 4).
(2) Demolish or relocate the shed from Lot 1.
(3 1�emovc the encroaching concrete from Lot 2, to leave an 11-foot minimum setback
Lot 1.
(4) Stake all new property comers.
(5) Prepare City approved storm drainage hold harmless and PUD easement for
recording with the plat documents or on the face of the plat (Attachment 5 & 6).
(6) Replace t . he word "Alley" to describe the 2o-foot wide area adjacent to the north
property line of Lot I with "City owned property".
'Add to fam of plat "setbacks shown are for reference only.and vest no right".
(8) Add to face of plat "Tree clearing plan.requircd with new single family residence
building permit for Lot 1-.
(9) Submit the draft recording document and associated few.
Prior to building permit issuance:
(10)Complete the Enginee . ring checklist of requirements for building Permits (see,
Attachment 4).
(11) A tree clearing plan is required at the time of building permit submittal to ensure.
retention of as many trees as possible.
a-oa-r%,7 Rim &w.. / Umv 11. 20M / StaffReoort
Mize 2-LotShort Subdivision
File No. S-99-132
Pap 3 of6
FINDINGS OF FACT AND CONCLUSIONS
A. Site Description
1. Site Development And Zoning:
a) Facts:
(1) JAt S 17,041 square feet (.39 acres).
(2) Land A single-fimily residence and outbuilding occupy the subject property.
(3) Zonin The subject property is located in an RS-8 zone.
(4) Terrain and Vegetation: The property is relatively flat The area designated as
Lot I is heavily treed. Approximately 12 significant evergreen trees will potentially
be removed for construction of the home and improvements.
2. Neighboring Development And Zoning:
a) Fact: The prinvuy land use is single hmily residential.
B. State Environmental Policy Act (SEPA)
1. Fact: Short subdivisions are typically exempt from SEPA review (WAC 197-11-800(6)(b)
and ECDC 20.15A.080).
C. Edmonds Community Development Code (ECDC) Compliance
1. Critical Areas Compliance
a) Facts:
(1) This proposal is subject to review' under ECDC Chapter 20.153 (Critical Areas
Ordinance).
(2) The applicant has submitted a Critical Areas Checklist (CA-99-39). A waiver was
issued.
2. Compliance with RS-8 Zoning Standards.
a). Facts:
(1) Proposed number of lots: 2
(2) Approximate size of proposed Lots:
Net so. Gross so,
Lot 1 9,644 8,644
Lot 2 8,397 8,397
(3) Areas, Setbacks and Lot Width: Lot areas and lot, width (minimum 70 feet wide)
for both lots are adequate for the RS-8 zone. Setbacks should be as follows:
Front: 25'
Side: 7.57
Rear. 15'
At the time of this report, the 20 foot wide strip of City owned property was utilized
for emergency vehicle access to the Woodway I-lighland development only. It was
not designated right-of-way and therefore, a 7'6" side setback can be enforced'.
e-aa-IT)ROV A�. / UOV I I 7(M / %affRam"
. . 0.1 . I . I I . . . . . 1 0 . 1. 6
hfin 2-1A Short Sub&visim
File No. S-99-132
. Pap 4 of6
(4) Comer : As it currently stands, neither lot is a corner lot If in the future the
City owned property becomes active, vehicular access, W I would then be
considered a comer lot.
'(5) Flag lot determi Neither of the lots is to be considered a flag IoL
(6) Lot arrangpment to topg The proposed lot locations are satisfactory.
(7) Lot Coverage of Existing Buildingi on RMRgKd Lot 2 contains the existing
house, totaling approximately 1,220 square feet Reducing the lot size to 9,397 will
result in lot coverage of 14.50/,L Maximum lot coverage allowed is 35%.
b) Conclusion: The applicant has proposed a subdivision that will comply or has been
conditioned to -comply with all RS-8 development standards. -All new development
proposals will comply with the setback& in effect at the time. Of building permit
submittal.
Compliance with Subdivision Review Criteria
a) Facts:
ENVIRONMENTAL
(1) The ECDC places an emphasis on protection of environmental resources and design
proposals which minimize the significant adverse unpacts. Special restrictions may
be imposed.
(2) Proposals should be designed to minimize grading by using shared driveways and
by relating street� house site and lot placement to the existing topography.
(3) Hazardous conditions to future residents of the site or adjacent property own ers is
cause for denial.
LOTLAYOUT
(4) Lots are to contain a usable building area.
(5) Lots are not to front on highways, arterials or Collector Street. Shared driveways,
turnarounds or frontage streets may be required to minimize traffic hazards.
(6) Each lot is to meet the applicable dimensional requirements of the zone in which it
is located.
(7) Pedestrian waUbike paths are to be provided to serve schools, parks, public
facilities, shorelines and streams.
DEDICATION
(8) Any approval of a subdivision sh . all be conditioned on appropriate dedication of
land for streets, including those onthe official street map
EUPROVEMENTS
(9) Improvements which may be required, but are not limited to: streets, curbs,
pedestrian vaft bicycle paths, sidewalks, street landscapmg, water lines, sewage
systems, drainage systems and underground utilities.
b). Conclusions:
(1) The am covering proposed Lot I are the most visible environmental element on
the property. Several of the trees exceed 20". in diameter and a few are over 40".
Unfortunately, many are located within the buildable envelope of the lot A tree
clearing plan will be required with the building permit to encourage tree retention if
possible. Very little grading will result from the construction of a home because the
property is fairly flat.
S-99-132 SRP.doc / May 11, 2000 / StsffRqxprt
hfiw 2-LAt Shod Subdivision
File No. S-99-132
Par 3 of 6
(2) Both lots meet or exceed the minimum lot area. There will be sufficient builchble
area on the new W I to construct a single bmily residence that is similsk to others
in the immediate area
(i) The subdivision will create 2, somewhat' odd shaped lots. Both appear to provide
satisfikctory spa cc to construct a single bmily residence.
(4) All dimensional standards of the RS-8 zone will be accommodated by the Not plat.
.(5) Engineering division has required an on -site turnaround for each lot, saw
improvements, water, sewer and storm installation (see Attachment 4).
D. Technical Committee
1. Fact: The short plat application has been reviewed and evaluated by the Fire
5;�artment, Public Works Division, Engineering Division, and the Parks and Recreation
Division. Engineering has provided their requirements in a checklist (see Attachment 4).
E. Comprehensive Plan (ECDC)
1. Comprehensive Plan Designation
a) Fact: The subject property is designated as "Single Family" residential on the
comprehensive plan.
b) Conclusion: The proposed development is consistent with the existing Comprehensive
Plan Land Use designation for the site.
2. Comprehensive Plan. Goals and Policies
a) Facts: The Comprehensive Plan identifies goals and policies which relate to
"Residential Development" in the City. Specific goals and policies are discussed in
detail below.
(1) Goal B. "11igh quality residential development which is appropriate to the diverse
Iffestyle of Edmonds residents should be maintained and promotW.
(2) Goal B.2. "Support retention and rehabilitation of older housing within Edmonds
whenever it is economically feasible-.
(2) Goal B.6. "Require that new residential developmentbe compatible with the natural
constraints of slopes, soils, geology, vegetation and drainage".
b) Conclusion: The two lot Subdivision does not violate any of the Comprehensive Plan
goals and policies and appears to be consistent with the development vision.
F. Comments.
The City received no letters from the public during the comnient period.
III. RECONSIDERATION'S AND APPEALS
The following is a Summary of the deadlines and procedures for filing reconsideration!s and appeals. Any
person wishing to file or respond to a recommendation or appeal should contact the Planning Department
for further procedural information,
A. Request forReconsideration
Section 20.95.050.B.2. provides for Staff to reconsider his decision or recommendation if a
written request for reconsideration is Med by the applicant within fourteen (14) working days of
the date of the initial decision. The reconsideration request must ate specific references to the
S-99-132 SRP.doc / May 11, 2000 / Staff Repod
Mize 2-Lat Mwrt Sub&vW=
File No. S-99-132
. Par 6 of 6
findinas and/or the criteria contained in the o governing t he type of application being
reviewedL
B. Appeals
Section 20.105.010.A describe how appeals of a Staff decision shall be made. The appeal shall
be made in writing, and shall include the decision being appealed along with the name of the
Project applicant and the date of the decision, the name and add of the individual or group
appealing the decision, their interest in the matter, and reasons why the appellant believes the
decision to be wrong. The appeal must be filed with the Community Development Director
within fourteen (14).calendar days after the date of the decision being appealed. Appeals are
presented to the Hearing Exammer Appeals of the Hearing Examiner are to be heard by
Superior Court of Snohomish County.
C. Timeframes
The time limits for Reconsiderations and Appeals run concurrently. If a request for a
reconsideration is filed before the dine limit for filing an appeal has expired, the time "clock" for
filing an appeal is stopped until a decision -on -the reconsideration request is completed. Once the
Hearing Examiner has issued his decision on the reconsideration request, the time clock for filing
an appeal continues from the point it was stopped. For example, if a reconsideration request is
filed on day 5 of the appeal period, an individual would have 9 more days in which to file an
appeal after the Hearing Examiner issues his decision on the reconsideration requesL
IV. LAPSE OF APPROVAL
Section 20.75. 100 (as amended by Ordinance No. 3190) states "A preliminary approval of a subdivision or
lot fine adjustment will expire and have no further validity at the end of five years, unless the applicant
has acquired approval of the final plat or final short plat approval within the five year period.-
V. NOTICE TO THE COUNTY ASSESSOR
The property owner may as a result of the decision rendered by Planning Divisionrequest a change in the
valuation of the property by the Snohomish County Assessors Office.
VI. ATTACHMENTS
1. Vicinity / Zoning Map
2. Application
3. Site Plan
4. Engineering Requirements
5. Hold Harmless Language
6. PUD Easement Language,
VIL PARTIES OF RECORD
1. Applicant
2. Staff
S-"-132 SRP.doc / May 11. 2000 / Staff Report -
city 4f edmonds OECEIVED.
land use* a plicafi o*n JUN .2 411999
P
.0 ARCHITECTURAL DESIGN BOARD
0 COMP PLAN AMENDMENT
U CONDITIONAL USE PERMIT
0 HOME OCCUPATION
C) FORMAL SUBDIVISION
SHORT SUBDIVISION
LOT LINE ADJUSTMENT
0 PLANNED RESIDENTIAL DEVELOPMENT
CI OFFICIAL STREET MAP AMENDMENT/
STREET VACATION
E3 REZONE
13 SHORELINE PERMIT
(3 VARIANCE / REASONABLE USE
EXCEPTION
13'OTHER
% tRe
Address
Property Address or Location
Property Owner
FILE ZONE
I)AaE� REC-D BY,,���
FE RECEIPT#J55 5
HEARING DATE-------_____�
13 HE STAFF 0 PB 13 ADB C3 CC
ACTION TAKEN:
APPROVED .(3 DENIED 13 APPEALED
APPEAL#
Phone G
if
Lmff. =
00 S"t C, - rr/'-3
Address 5;:�— ry-L-t--
Agent Phone (ILI Z i5) 7 7
Address 1,2?1 021:jm6c
Tax Acc #_!5b'V9 - 00 1 - COS - 0 00 1
Legal Description
AocesT'
Twp. 2 7 Rng., 3
A . fi
Details of Projector Proposed Use 17,00
as-r
J�L- 62) n--)o -Z-Ors >- coo CPr
The undersigned applicant, and his/ herl Its heirs, and assigns, In consideration of the processing of the
application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all
- - iding reasonable attorneys fees, arising from any action or infraction based In whole or in part upon
false, misleading, inaccurate or incomplete information fumished by *the applicant his/ her/ Its agents or
employees.
The undersigned applicant grants his/ her/ its permission for public officials and the staff of the C . ity of Edmonds to
enter the subject property for the purpose of inspection and posting, attendant to this application.
SIGNATURE OF APPUCANT/ OWNER/ AGENT
T7AC-A ENT2
AN MIZE
BRY
OF SWI 0F.SWl OF sM. 3.6-M3 PRELIMINARY PLAT, HDR
SHOWMISH C(L' ON
(in WAL
val. of . mat
4 IN.\
wn 0100.
W60 Soo" fL.
was.
farm
or L
oar.
low&
'*Wz
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wr ma" 1. a& amwnw* wour m sommor summ.
Rw Tommump womm IN Ift" a
OP ^XVN, MW W AM U.11111101 CP --WQ—W.
as woolmorml . somm Soso" we
mosaw-w ft-mon%ammorromms'Noww'nowm"m
SASA.- VAUM 00lown UW-
jAp, wM^WW QW"AOW PFJW nAr AW QW110010
.0 offfoxwOrm mmom ammon. momm"m ow-ows
MAO, Appopporwroftl 11111 VON SLOW KAOAT 'A"
INSINICIR
Somwao Um. NPWW UM NO
-M 9011101010M 4F VW SAW
scms nommum swommommor NP
SUMOR CWIFKATE:
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Amw am poompm "so m mosomm a
av=."".Arvw 141, dpoommomm.
somm. raw Atom
Also anium sm S.
% AIR JUNNOILA,10031N.Ift"
DO"
av Of
Col.) "s,
I
I
I
I
I
A's = WA
A
It INN.
�9
X - w,,� 54 6§1
Req'd prior to
recorft
Req'd w/bldg-
Permit
Bond posted Complete
a) Drainage Mtern desip review at $50 per lot
x
b) Sewer cormecdon chargeALID'few to be paid in.full.
x
(O.V.W.Sm.)
c) Drainage Mtem ins�tion fee.
x
d) Plan review/fimpection fee of 2.2% of improvement costs
x
lus $250.00.
e- Y/10
INEER. CrIY OF EDMONDS DAIT
The Engineering requirements have been con4pleted and the subdhWon can be recorded.
Auffiorized for recording by: Date:
9132ADC
0
HOLD HARMLESS
OWNER, AND ALL PERSONS HAVING ANY PRESENT, OR SUBSEQUENT,
OWNERSHIP INTEREST IN THESE LANDS, AND ANY SUCCESSORS AND
ASSIGNS OF OWNERS OF OTHER PARTIES HAVING ANY SAID INTEREST,
HEREBY AGREE THAT THE CITY OF EDMONDS SHALL BE HELD HARMLESS IN
ALL RESPECTS FROM ANY AND ALL CLAIMS FOR DAMAGES FORINJUNCTIVE
RELIEF WHICH MAY BE OCCASIONED, NOW OR IN THE FUTURE, TO ADJACENT
LAND OR IMPROVEMENTS BY REASON OF THE CONSTRUCTION, OPERATION
AND MAINTENANCE OF THE DRAINAGE SYSTEM AND HEREBY WAIVE AND
RELEASE THE CITY OF EDMONDS FROM ANY AND ALL CLAIMS FOR DAMAGES.,.,
EXCLUDING DAMAGE SOLELY CAUSED BY AN ACT OR OMISSION OF SAID CITY
AND INJUNCTIVE RELIEF WHICH THE OWNERS, OR THEIR SUCCESSORS OR
ASSIGNS, MAY THEMSELVES HAVE NOW ORIN THE FUTURE BY REASON OF
THE CONSTRUCTION, MAINTENANCE AND OPERATION OF SAID DRAINAGE
SYSTEM.
A TT
ACHMENT 5
PUD EASEMENT
AN EASEMENT SHALL BE RESERVED FOR AND GRANTED TO ALL UTILITIES
SERVING THE SUBJECT PLAT AND THEIR RESPECTIVE SUCCESSORS AND
ASSIGNS, OVER, UNDER AND UPON THE EXTERIOR TEN (10) FEET PARALLEL
WITH AND ADJOINING THE STREET FRONTAGE OF ALL LOTS AND COMMON
AREAS IN WHICH TO INSTALL, LAY, CONSTRUCT, RENEW, OPERATE AND
MAINTAIN UNDERGROUND CONDUITES, CABLES PIPES, AND WIRES;
TOGETHER WITH OTHER NECESSARY FACILITIE� AND EQUIPMENT, FOR THE
PURPOSE OF SERVING THIS SUBDIVISION AND OTHER PROPERTY WITH.
UTILITY SERVICE, TOGETHER WITH THE RIGHT TO ENTER UPON THE LOTS AT
ALL TIMES FOR PURPOSES HEREIN STATED.
A17ACIH MENT 6
V .
STANDARDPRAINAGE DETENTION SYSTEM
WORKSHEET
"DRM 2, `7 A mom..
e�
DAT.&
*DESIGN DA TA
IMPERVIOUS AREA PIPEDIA PIP9'LG ..ORIRCE'
DETENTIOk PIK LM1W Lo
rims u
HIM
T w
CDC BOX at RM
Two Ix
CONTIVIL
ut
UPPER CATCH BASIN
CONTROL CATCH BASIN 'EC'EIVED
SYSTEM.CROSS SECTION AP.R.,:1 6 2004.
P'ERMI * COU
T NTER..
eAL*XG* KEP, 4-6' VALLS OR EGLIAL
CITY. Ch'"%p
FROM CONTROL CS rX VX r DW. 3/ ROCK ISTING GRAK up
L"X 3' .0�,* 3,14' C07MED
F FM
ROM CONTROL
Ot= VA
P An
PERF PWK W DID CAPS
NPJUP,OUTLrr
RUNOFF SPREADER. TRENC,H
FOOMG DR"NS..Szuu NOT -BE COMOCMD. W DETEMON SZWM.
JVUTM:
1. Call Engineering Division (771-0220) for a tightline and detention system inspection.,
below badfiffing and ibr final kspections.
APPROVED BY
2, Responsibility fbr operation and maintenance of drainage systems on privaW pwpwty is &e
ibility of ffio property ownw ' Material ac=nwIated in the -storage pipe must be
wsponsi
flud�l. DAZE
out and remved from the vdch basins to allow proper opemdoiL IU outletcontr6l orifioe
30 1.? i
N -12 A VS
pt PC
3;�fio-
2-q"
I i
-T
e- 15 - lell
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.I-
WASHINGTON, SURFACE WATER DESIGN MANUAL
4.5.1A ROOF DOWNSPOUT INFILTRATION SYSTEMS
iA
6 L 5
R-A fA v it-
1" 1141
Vk i---W
ut
. Itmin
;.At 0 J4
lop
a4pevvdiva Weil
te j do LV-
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0
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for 5 / d-4 /At F.
= ys. 6 f+
SCAJ
42
4r
Ll F P-4
Or /0 J'J e c c4 Cv r-S I lt-�
)O)C
I 12-310y
K 00 DEt.: 53' 11" E
M.I.C. ASS MED 300.00'
DATUM TOP MON IN MON CASE
DRAINAGE SYSTEM STANDARD
DESIGN
24- ROOF O.H.—
INCLUDES GUTTE
DRIVEWAY:
835 s.f.
ACCEPT
k8bMIGW4B
OPEN PATH:
241 sf.
MATERIAL
GARAGE ROOF:
1,412 0.
SDR 35
ConcAam—
HOUSE ROOF:
OPEN DECK:
2J31 s.f.
218 S.f.
SCH 40
01r
TOTAL:
4,923 s.r. ov
N, 12
ot"
F81 0 HANCOR
IMPERMEABLE AREA: 4,923 a.f.
REQUIRED VOL CU.FT.: 125 c.f.
PIPE DIAMETER: 30"; 25' LONG
OUTLET ORIFICE DIA: 1/8" YVATER
CATCH BASIN: TYPE IL.
RESIDENCE GARAGE
HEIGHT CALCS
GARAGE GRADE
A=304.0
AT CORNERS
B=304.0
305.0
C=304.0
D=303.0
AVE GRADE=303.15'
AVE GR=305.0'
ACTUAL=328.08'
ACTUAL=319.3'
MAXIMUM=328.15'
MAXIMUM=320.0'
REQ'D.
0 EXT. 1
e
+304
N 00 DEG. 53' 11" E 43-94
A
+3040
-9+304
1+303.0
D
32-(r
IC
'RESIDENCE
aEV.- 328 , 08'
--------------
BSMT. §3�&f. Cld
IST M: t,570s.f.
'9359.f.
UPPER FLR:
FIRST FLR. ELE�'-304.jl'
BSMT gR 2,
FIG D 295.
FIR
CRAW1,4ACE
FTG D�,PTH: 302.25
ELEV- 304.41'
RJ� w w
A4304
yi
B +304.0
NO TE.- FOOTIN I, �pdlms�
CONTRACTOR TO VERIFY TO BE, TIED INTO
rEMI
GRADE POINTS USING TRANsWENTION SYST7EM"
PER CITY OF EDMONDS PRIOR STOW -
TO START OF CONSTRUCTION WAT8
SYSTEM
LOT COVERAGE CALCULATION
SITE AREA: 8.444 S.F.
WATER
35% OF SITE = 3,025 S.F. rox-�,
RESIDENCE AND PORCHES: 1150 S.F.
SPREADER
TRENCH
10'LONG
31-01 WIC
ASPHAL
WALKWA
8 — 8
---------------
SHOP:
C�
----------- ---- --
OLYMPIC VIEW co
10- 25'-T
WER DISTRIffi6
04- losprrucidt-1 2-CAR
GARAGE AVERAGE GARAGE:
GARAGE SHOP: 1.123 S.F. FIR ELEV304.16'
TOTAL ROOF AREA: 2,813 'S.F. FTG DEPTH-,302.5
n rv- 1410 141,
LEGEND OF SYMBOLS TEMPORARY CONSTRUCTIO 4
UIRED
�R
STORM WATER TIGHTLIKE T-9tMARES E
w — W WATER PIPE NOTE:
89— 98 SANITARY SEWER PIPE ALL EXISTING TREES
—6-6— GAS PIPE ON SITE TO BE REMOVED
APPROVED AS NOTED RIGHT-oF.WAy N 01 DEG 11' 21" E
CONSTRU991ON PERMIT-305.1
BY ENGINEERING AND INSPECTION REQUIRED
A ee.,j
SITE PLAN
9LL@ 1204
r —MALE: 10 = 20'
0
0
co
Tla
0
-0
0:
lu
z
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LL
W.
CITY1
PROTERTY
1+306.0,
rdiSr. F&MAIIAlt-
HENE JOHNS PLAN NORTH III I-f-, w u 40.
A R C H I T E C T PROJECT ADDRESS:- 24017 104TH AVE. NW APPROV D Y PLAN IN�
EDMONDS, WA 144 q
7310 R Skyvlew PL *W&E C E JMcr&Q). ()o5649oojoo3oj
Tacoma, Washington 98406 On
0 WS: EVAN PIERCE AND SUSAN BLAND
N 01 DEG 11' 21" E q-[J04T_� AV WEST
Phone/Fax (253) 565-627APR 0 2708 E. Pn ST., IN
SEATTLE. WA 98122
PERMIT COUNTER cff I v COP
�-Ce,-Jo
1� 0��S.N
R, ��;, o
C3
SPt
lo-
, - i P,' i " '%. I ! - I
+304.0 D,4ok7 t 01,1A Av-('
N 00 DEG. 53' 11" E 98AIl-
D +303.0
-r --------------------
C1+304
0)
IMPERMEABLE AREA: 4.293 S.F.
44)' ------------
CO
REQUIRED VOL CU.FT.: 112 RESIQENr-E
PIPE DIAMETER: 24'. 34'LONG 1.160,''S'F' ' -"-;O'l 2'-0' ROOF OVERHANG
OUTLET ORIFICE DIA: 1/8" FOOftPRl*N't, SHOWN DASIHED, TYPICAL
CATCH BASIN; TYPE 11. CB 19 (48" BASIN)
HEIGHT CALCS
A=301.0
B=301.0
C=304.0
0=303.0
AVE -GRADE=303.15
ACTUAL=--
MAXIMUM=328.15
LOT COVERAGE CALCULATION
SITE AREA: 8,414 S,F.
35% OF SITE = 3.025 S.F.
RESIDENCE AND PORCHES:
GARAGE SHOP:
TOTAL ROOF AREA:
44/
EXISTIN(
TO BE F
SHOWN C
411 +
LLI
0
7. -
00
Co
B
Z
304.
1.150 S.F. 0..
943 S.F.
2,113 S. F.
PRELIMINARY SITE PLAN
SCALE: 1" 20'
PLAN
NORTH
. f 0
0)u I
RHENE JOHNS
A R C H I T E C T
7310 N. Skyview Pl. 18302
Tacoma, Washington 98406
Phone/Fax: (2531565-6277
ASP ALT
--WAL WAY
0.
C)
SH6P CIA
- ------- ---
"N
in
--------- -
FIR TREES
�MOVEID
kSHED
ASPHALT
0
tDRIVEWAY 0\0
G 11' 2
N 01 DEG 11' 21" E ATH AVE. WEST
[7 _0
__4
MAY-25-2004 11:15 P.02/04
CITY OF EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
The project at V/ �0 r,', w_ f
issued under buildin
pennit number equires special insn9 tion amid/or testing per UBC Chapter 11
ind WAC Amendments 1702. The complete list of spei4ail inspections is attacheid to this document
BEFORE A PERMIT CAN BE ISSUED: The owner and contracto� and special inspector shall
complete this agreement and the attached'structural test(s) and inspections schedule including the
required acknowledgments.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the
Buil cial -prior to performing any duties or inspections, Each special inspector shall submit
Stat=gtooffif Qualifications to the Building Official for review. Special inspectors shall display
identification when performing special inspections on site. Special inspection and testing shall meet
the minimum requirements of LJffC Chapter 17 and the followifig:
1. Observe Work
Ile special inspector shall observe the site work for conformance with the approved
(stamped) plans and sp�cifications and.applicable workmanship provisions of the UBC.
Architect or Engineer reviewed gs may be used only as an aid to inspection.
§pecial inspections are to be p d on a continuous basis —meaning that the special
Inspector is on site at all timei observing the work requiring special inspection. Periodic
inspections, if any, must have prior ap A by the CAy.based on a separate written plan
grov
reviewed and approved by thi g fficial and the engineer or architect of record.
2. Report Non -conforming Items
The special inspector shall bring nonconforming items to the immediate attention of the
contractor and note all such items in the daily field reporL Any item not resolved in a timely
manner shall be immediate cause of the special inspector to notify the Building Official of the
plan deviation error, change or omission. It shall also be the duty of the special inspector to
promptly noii?y the engineer or architect.
3. Complete Dafly Reports;
Each special inspector shall complete and
report form for each day's inspection.
contractor for review by the City Building
4. Furnish Weekly Reports
sip both the special inspection record and the daily
These records shall remain at the jobsite -with the
Inspector.
The special inspector or inspection agency shall finnish the City with weekly reports of tests
and ifispections. The . t engineer or architect, and others as designated ihall also be
copied on reports. WeeT�I=rts must include the following:
DescnTtion of daily inspections and tests made with applicable locations
List o all nonconformifig items
Report on status of nonc�xffbrming items (resolved or unresolved)
Iteinized changes authorized by !he Architect, Engineer and City if not included in
nonconformance item
S.'Furnish Final Construction Report
The sg�ia inspec.tor or inspection agency shall submit a final signed re
port to the City stating
that a) items requiring special inspection and testing were fliffilled and reported. And, to the
best of his/her knowledge the project is in conformance with the approved plans and
Wfications, approved change orders and the applicable workmanship provisions of the
Ci ' Items not in conformance or unresolved items or any discrepancies in inspection
coverage, (i.e., missed inspections, periodic inspection when continuous inspections were
required, etc.) shall be specifically iterhized in this report. RECSIVED
MAY 2 6 2004
PERMIT COUNTER
Ma,,j 25 04 11:43a CASCADE TESTING
I KAY-2S-2004 lli:15
425-823-2203 p.3
P. 03/04
IL Contrulox RespoAgUffia
1. Notify. the Special! Inspector
It is the duty of the contractor'to notify the special inspector when work is ready for special
iuspectiom Note. the items listed on the attwhed schedule and as noted on the approved
plans and specifications are required to have special inspections. Adequate notice shall be,
provided by the contractor so that the special in.Vactor has time to bewme familiar with the
proj ect.
2. Provide Access to Approved Plaus
The contractor is responsible for providing the special inspwor accm to appruved plans at
the jobsite.
3. Retain Special Insliection Records
The contractor is responsible to retain at the ' b1site all special inspection records submitted
by the special inspector. These records are Ne Provided to the City building inspector upon
request
C. CIIyofEdmoladsBuildinpT)Cpartmentigesponiqihil*ties
1. Approve special inspectors or inspection agencies
Ime building department shall approve all special inspectors and special inspection
requirements,
2. Monitor special inspection and approve wee)J-y reports
Work zubmt special i ff ti and the performance 'of special inspectors shall be
monito by a City H c9gonlaspector. His/her approval must be obtained prior to
placement of concrete or other similar kfivities, in addition to dud of1he special imp.,tor.
3. Issue Cerfifleate of Occupancy
The Building Official -may issue a Certificate of Occupancy after all weekly special inspection
ireporU including the final report have been snbmitted-�nd accepted. .
R, Qwner RgSonsibiliti
The p�oject owner or the engineer or architect of record acting as the owner's agent shall fimd
special inspection services.
E. Engineer orArchiteetof RecodResilonsibiNties
The engineer or architect of record shall include special inspection requirements on the plans and
specifications.
ACKNOWLEDGEMENTS
I have read and afl7ee to comply with the tam and conditions ofthis agreement.
Special Inspector
-�-/ 2-� C) q
General Contractor
City Building Official 14��
48Rf ae:--
MAY-25-2004 11:16 P.04/04
SPECL&L INSPECTION AND TESTING SCHEDULE
MtOJ=NAb&
7 /,P 11-11,4ow- /I(/, ��� - A. -It
ROMa AM*= w=wa*;sncn0N AC29CY a SMtCL4 nipeCM
REINFORCED CONCREXE, GUNnM GROUT AND MORTAR:
r—r-mo r—ito r--v U-.A—
A Tests
9!��s Tests
Mix Desi
Rcinforcing Placenicat
B" Etw Inspection
Inspect Pwcing
cut Sn!!2
Pick-up Samples
Compts3ior, T=
PRECASTIPRESTRESSM CONCRETE:
POes Pan-Tais Ptr-Tem Mddl"
Em— TaRt
Rginforcing Tests
Tendon Tests
Mix Dc:dps
Reinforcing PlKamcnt
Insen PlKarocut
C=Mte axiching
conctete Placcracat
1=4 lation Insexuall
Cut Samples
Pick-upsamples
Campienion Ticus
MASONRY;
— SPCCiAl Inspection SMSCS Used
— Pmliminvy Accepwca Tcas (Maonry Units. Wall Prism$)
— Subsequent Tam (Mww. Grow. Field Wall Prism)
— placement Inspection of Units
ADDITIONAL INSTRUCTIONS OR OTHEXTESTS
AND INSPECTIONS.
141S4(14-Zf-d&�V"44 6"
F�brm completed by.
STRUCTURAL STREILIWELDING:
— S=plc and Tem (lip spccific klow)
— Shw Mataiii! Idmdri ion
— WcJdin& Inspection 0 Shop OFeld
— U1823011ic Inspection '0 Shop 0 Field
High-struno Boldng
Ins '00 El Shop 0 Field
13 A325 1314 0 0
0 A490
McW Dcck Wiciding Inspec4on
RcidgMul; Stccl Welding lmpcc6on
— MeW Siud Welding Inspection
— Concrete Iftseff wcldins Inspection
FIREPROOFING:
— placcincm Inspwion
— Density Tests
— Thielcor Teas
— Inspm awcwn;
INSULATING CONCRETE:
— Sample and Test
— Plac-- Inspection
— Unit Weights
FILL MATERIAL:
— Acccpb= Tests
— Placement Inspection
— Field Density
STRUCTURAL WOOD!
— Shm %Wl Nailing lnspwX=
— Inspection of Glu-1am Fib,
— Inspecdw of Truss Joist Fab.
— Swupic and Test Components
I-1b,911
Title:
Telephone No.: Dow
TOTAL P.04
CASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
PREVIOUS
115941
12919 N.E. 126TH PLACE
REPORT No. No,
KIRKLAND, WASHINGTON 98034 (425) 823-9800
EVERETT (425)259-0817
DATE VVMNE�� CERT. NO.
AU&. I I ZDO"t 10+08 -7-7E
FiaD REPORT
A
PROJECT
pE9c_.Z;_l
LOCATION ' -
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TO:EVAN
BLDG. PERMIT NO. OWNER
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-ZDOt-0511
WEATHER TEMP. AT AM
IS TTLE c7g= AUG 3 1 2004
_AA
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DEVELOPMENT SERVICES CTF
ENGINEER
CITY OF EDMONDS
8:*ADMD &QN6M
ARCHITECT
K"ENE -JOhElt
ATTN:
CONTRACTOR
(2)
(3)
INSPECTION PERFORMED
ITEMS INSPECTED FOUNDATIONS
RESTEELICONCRETE RESTEEL ONLY
FOOTINGS SLAB
RESTEEUMASONRY STR.STIWELDING
AUGER CAST PILES COLUMNS
OTHER Vt 20- STR.STIBOLTI NG
DRILLED PIERS WALLS
Ab.
BEAMS
(4) U_t% EINCEFT 5?q Z&IUJ—
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LOCATION (AREAS) _2�L_
(5)
CONCRETE/MASONRY MIX NO. (00-NOOOK
DESIGN STRENGTH (f'c) V7"5, 1.
SUPPLIER Q4AQtMN
TOTAL CU.'YD. PLACED
(0
3— -
SLUMP (INCHES)
SPECIMENS'CAST
-7
7-700
AIR CONTENT (%)
SEE CYLINDER REPORT NO.
-:61YES — NO — ITEMS INSPECTED WERE IN CONFORMANCE WITH BLDG. DEPT. APPROVED PLANS
REMARK&RE-51 EZ-1 AU- -MF- AW\/E hbM= LUATION'5 CA E:CXED OKAY
A15 TZK FLAM5. N UTE 102 - 103. t 09/5 L (D'STWO-DE, I NSTALLED 0)
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT
BE REPRODUCED EXCEPT IN FULL, WITH-
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY, INC.
injorm, I urik
INSPECTOR
REVISED 8/00 1 SIGNED BY
ASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
12919 N.E . 126TH PLACE
KIRK1AND, WASHINGTON ga03A (425) 823-980C
OL-JI EVERETT (425) 259-08 17
COMPRESSION REPORT
R 5c
'SIVEJ
7-70 8 E. Fl KZ' A06 3 1 'u"
3wes -T SFFtVICES
WA. '11312 L pEVE4L Ml,, pnMo DS
05\-TTL-E P
IF
ATTN:
THE FOLLOWING WAS NOTED:
CDRCRE'TE
FIELD TEST DATA
FIELD
REPORT NoA 67"t I —No. 52700
DATE
0
AM%
0�' 0 0-Z7F-
PROJECT F
PEF-CE KE15.
LOCATION
)r7A-
t_..zx 01-7 - 10t-mA\E-W- EQIVDND-�
BLDG. PERMIT NO.
OWNER
zjoOt - C6-� 1
W HER
TEMP. AT AM
AT PM
ENGINEER
EDAAWD E590ANN
ARCHITECT
CONTRACTOR
InGxz I
TRUCK SAMPLED ZB6 TRUCK TICKET NO.Ot-,frf 5137-7 MIX NOA60304X
TIME
SLUMP
ASTM C-143
% AIR
UNIT
WEIGHT
ASTM C-138
YIELD
CEMENT
FACTOR
TEMP.
ASTM C-1064
CONC-T
-AIR
7—&
fze
AIR TEST METHOD: M PRESSURE ASTM C-231 OR n VOLUME ASTM C-1 73
EQUIPMENT USED I.D.
SLUMP CONE CSLCOO THERMOMETER CCOTHO
AIRMETER CCOAIO OTHER
TYPE OF BREAK: (A) Cone (C) Cone and Shear
(b) Cone and Split (d) Shear (a) Columnar COMPRESSIVE STRENGTH
aATCH DATA FOR
I CU. YD.
DESIGN
WEIGHTS
%
MOIST.
ADJUSTED
WEIgHTS
CEMENT
NZM ofa
MUKE7
FLYASH
C.A--
G.A.
C.A.
FINEAGG.
WATER
TOTAL
CYLINDER
NUMBER
MM
0 ME
CONCRETE COMPRESSION MACHINE I.D. #L;L;UL;UUU
SAMPLE P/U DATE TEST METHOD
SUPPLIER CMIMN CEMENTTYPE
AEA
PLACEMENT AREA& NOTES
ADMIX
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT
BE REPRODUCED EXCEPT IN FULL, WITH-
OUTTHE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY, INC.
REVISED 1/02
0 ASTM C-1231 SAMPLING IN ACCORDANCE WITH
0 ASTM C-617 APPLICABLE CODES & SPECS. —
CAC12— %
— CU. YARDS PLACED 30
DESIGN STRENGTH Zr6w F.1511,
I
INSPECTOR(S), NAME(S) PRINTEDDUAN1t,,JAC0B':j0h
INSPECTOR
SIGNED BY
COPIESTO:
SCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
1 2919 N.E. 126TH PLACE
1IRKLAND, WASHINGTON 98034 (425) 823-9800
aLil EVERETT (A25) 259-0817
COMPRESSION REPORT
TO:E)I,/M%,1 PlEaF
7-70 8 E. ?I Y,.F-
eff-TTLE.M. c[8122
IF
ATTN:
THE FOLLOWING WAS NOTED:
CADRCRETE
FIELD TEST DATA
FIELD
REPORT No.1 t5r-Kl —No. 52700
DATE \&4E[XNF1j[)h--
f
CERT NO.
AW. I k 700t
Qt00-Z7F_
PROJEC, 0
PI&ICE KE-5.
LOCATION
7--t 01-7 - I Otm AVE.W. EQNIONM
BLDG. PERMIT NO.
OWNER
zJ00t —
WEATHER
TEMP. AT AM
CLEAR
AT PM
ENGINEER
EDAAWD E54RDAN
ARCHITECT
CONTRACTOR
InEK(Z
TRUCK SAMPLED TRUCK TICKET NO.Qwt-tI5137�7 MIX NOA903111=
TIME
SLUMP
ASTM C-1 43
% AIR
UNIT
WEIGHT
ASTM C-138
YIELD
CEMENT
FACTOR
TEMP.
ASTM C-1064
GONG
AIR
7 _ #-IT
- 71
AIR TEST METHOD: F-1 PRESSURE ASTM C-231 OR n VOLUME ASTM C-173
EQUIPMENT USED I.D.
S6UMP CONE CSLCOO THERMOMETER CCOTHO
AIRMETER CCOAIO OTHER
TYPE OF BREAK: (A) Cone (C) Cone and Shear
(b) Cone and Split (d) Shear (a) Columnar ' COMPRESSIVE STRENGTH
&4TCH DArA FOR
CU. YD.
DESIGN
WEIGHTS
%
MOIST.
ADJUSTED
WEIGHTS
CEMENT
FLYASH
C.A.
C.A.
G.A.
FINE AGG.
WATER
TOTAL
_j
CYLINDER
NUMBER
DATE
MADE
DATE
TESTED
AGE
DAYS
SIZE
AREA
(SQ. IN)
TOTAL
LOAD
STRENGTH
PSI
TYPE
BREAK
e)9_16
7
"'T� -1 to
Z--750
0 1;
ZE
/Omo
38zo
CONCRETE COMPRESSION MACHINE I.D. #CCOCOOO
SAMPLE P/U DATE TEST METHOD
S U P P LI E R.CJAM/96N __ CEMENTTYPE
El ASTM C-1231 SAMPLING IN ACCORDANCE WITH
El ASTM C-617 APPLICABLE CODES & SPECS. —
CU. YARDS PLACED —W
AEA ADMIX. CAC12- %_ DESIGN STRENGTH Zr5w F"5111
RECEIVE:D
PLACEMENT AREA& NOTES. t). F. Z. WAU_d)f__
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT
BE REPRODUCED EXCEPT IN FULL, WITH-
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY, INC.
REVISED 1/02
SEP 17 _=4
DEVELOPMENT SEJRVICf:,�.
�;, I Y Ul- LDMONDS
INSPECTOR(S), NAME(S) PRINTED0RNN1!!nl,,JAC0MM
INSPECTOR
SIGNED BY
COPIES TO: iL- P, k (3 V ct —
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�01)m- AV-( W
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C
LEGACY REPORT
WCROF-ILM
ER-6133
Issued May 1, 2003
ICC Evaluation Service, Inc.
Business/Reglonal Office # 5360 Workman Mill Road, Whiffler, Califomia 90601 # (562) 699-0543
Regional Office # 900 Montclair Road, Suite A, Birmingham, Alabama 35213 # (205) 599-9800
www.icc-es.org
Regional Office # 4051 West FlossmoorRoad, Country Club Hills, Illinois 60478 # (708) 799-2305
Legacy report on the 1997 Uniform Building CodeTm, the 2000 International Building Codee, and the 2000
International Residential Code
DIVISION: 03—CONCRETE
Section: 03130—Permanent Forms
LOGD(INSULATED CONCRETE FORMS
LOGIX INSULATED CONCRETE FORMS LTD.
12150-160TIl STREET
EDMONTON, ALBERTA T5V I H5
CANADA
AMC INSULATION CORPORATION
151 PARAMOUNT ROAD
WINNIPEG, MANITOBA R2X 2W6
CANADA
BEAVER PLASTICS LTD.
12150-16OT" STREET
EDMONTON, ALBERTA T5V I H5
CANADA
FORM SYSTEMS INC.
POST OFFICE BOX 16923
WICHITA, KANSAS 67216
PERMA R PRODUCTS INC.
106 PERMA R ROAD
JOHNSON CITY, TENNESSEE 37063
PSC MOULDING CORPORATION
840 DIVISION STREET
COBOURG, ONTARIO K9A4J9
CANADA
1.0 SUBJECT
Logix Insulated Concrete Forms.
2.0 DESCRIPTION
2.1 General:
The Logix Insulated Concrete Forms consist of expanded
polystyrene (EPS) interlocking rigid polystyrene foam plastic
boards that serve as permanent formwork for reinforced
concrete, exterior and interior walls and lintel beams, and
foundation and retaining walls. The interior of a building
constructed with Logix Insulated Concrete Forms must be
protected with a thermal barrier complying with Section
2602.4 of the 1997 Uniform Building CodeTM (LIBC), Section
2603.4 of the 2000 international Building CodeP (IBC) or
Section R318.1.2 of the 2000 International Residential Codep
(IRC), such as*a '/,-inch-thick (12.7 mm) regular gypsum
wallboard installed in accordance with Section 2.5; and the
exterior surface must be covered with an approved exterior
wall covering. Recognition is in accordance with Section
104.2.8 of the UBC, Section 104.11 of the IBC, and Sections
R404.4 and R611 of the IRC.
2.2 Materials:
2.2.1 Logix Insulated Concrete Forms: The Logix
Insulated Concrete Forms consist of two EPS foam plastic
boards separated by injection molded polypropylene webs,
which are preinserted into the EPS mold before molding so
that they are partially embedded into the EPS boards. The
polypropylene webs, which are spaced 8 inches (203 mm) on
center horizontally, maintain the EPS board facings at a fixed
clear distance of 4 inches (102 mm), 6.25 inches (158 mm),
8 inches (203 mm) or 10 inches (254 mm). For the standard
forms, the EPS boards are 16 inches (406 mm) high by 48
inches (1219 mm) long. The EPS boards are 2'/2 inches (63.5
mm) thick measured at the center of the board, and have a
maximum thickness of 23/4 inches (69.9 mm). When stacked
in a running bond pattern, the Logix Insulated Concrete
Forms create a cavity where steel reinforcement bars and
concrete are placed. In addition to the standard forms, 45-
degree angle forms, 90-degree angle corner forms, taper top
blocks and brick ledge blocks are also available. Typical
Logix Insulated Concrete Forms are illustrated in Figure 1.
The 45-degree angle forms and 90-degree angle corner
forms are used to construct wall intersections. The taper top
block is used to construct corbels in the wall at the desired
locations. The brick ledge blocks are used to construct
corbels that serve as ledges, for supporting exterior brick
veneers.
The EPS foam boards are molded from beads specified in
the approved quality control manuals. The foam plastic has a
nominal density of 1.45 pcf (23.2 kg /M3) , and has a maximum
flame -spread rating of 25 and a ma)dmum smoke -density
rating of 450 when tested in accordance with UBC Standard
8-1 or ASTM E 84. The foam plastic insulation complies as a
Type 11 rigid cellular polystyrene*(RCPS) in accordance With
ASTM C 578-01.
The polypropylene webs are 8.5 inches (216 mm), 10.75
inches (273 mm), 12.5 inches (318 mm) or 14.5 inches (368
mm) in length and have a 1.25-inch-wide-by-14.25 inch -high
(32 mm by 362 mm), 0. 1875-inch-thick (4.8 mm) flange. The
ICC-ES legacy reports are not to be construed as representing aesthetics or any other attributes not specifically addressed. nor are they to be construed as
an endorsement of the subject ofthe report or a recom mendationfor its use. There is no warranty by ICC Evaluation Service, Inc., express or implied, as to
any finding or other mailer in this report, or as to any product covered by the report.
�V
Copyright 0 2003
Page I of 5
J
Page 2 of ER-6133
plastic flanges, embedded 1/2 inch (12.7 mm) below the
outside surface of the EPS foam boards, provide supports for
attaching interior and exterior wall coverings. Refer to Figure
I for details.
2.2.2 Concrete: Normal -weight concrete with a maximum
size aggregate of 3/, inch (19 mm) and a maximum slump of
6 inches (152 mm). The maximum water—cementitious
materials ratio must be 0.5, unless otherwise approved by the
building official. Concrete must have a 28-day minimum
compressive strength of 2,500 psi (17.2 MPa). If construction
of the Logix Insulated Concrete Forms is based on the IRC,
concrete must comply with Section R404.4 or R611.6.1 of the
IRC.
2.2.3 Reinforcement: Deformed steel reinforcement bars
must have a minimum yield stress of 40 ksi (276 MPa), and
must comply with Section 1903 of the UBC or the IBC. If
construction of the Logix Insulated Concrete Forms is based
on the IRC, reinforcing steel must comply with Section
R404.4.6 or R611.6.2 of the IRC.
2.2.4 Other Components: Wood members, if not protected
from the concrete, must be preservative -treated by pressure
process with an approved mod preservative, and attached to
the wall with anchor bolts complying with Section 2304.3 of
the UBC, Section 2304.9.5 of the IBC or Section R323.3 of
the IRC. Materials other than wood, such as vinyl, are
permitted for window and door framing if approved by the
building official.
2.3 Design:
2.3.1 General: Design of concrete in the Logix Insulated
Concrete Forms must comply with Chapter 19 of the UBC or
the IBC. Walls must be anchored to the floors and roofs in
accordance with Section 1633.2.8 of the UBC or Section
1604.8.2 of the IBC.
2.3.2 Alternate Design: In lieu of calculations required by
Section 2.3.1 of this report the structural design of residential
buildings, constructed with the Logix Insulated Concrete
Forms and regulated by the UBC, is permitted to comply with
the Prescriptive Method for Insulating Concrete Forms in
Residential Construction (publication No. EB1 18), dated May
1998, published by the Portland Cement Association (PCA),
subject to all limits applicable for a flat insulating concrete
form (ICF) wall system specified in that document. The PCA
document must be made available to the building official upon
request. Buildings constructed with the Logix Insulated
Concrete Forms and designed in accordance with this section
must not exceed a height of two stories plus a basement,
where the maximum unsupported wall height is 10 feet (3048
mm).
2.3.3 Design in Accordance with the IRC: Walls
constructed with the Logix Insulated Concrete Forms must be
designed in accordance with Section R611 of the IRC. The
Logix Insulated Concrete Forms are defined as a flat ICF
system in accordance with IRC Section R404.4.2 or R611.3,
and corresponding requirements shall apply.
2.4 Installation:
The Logix Insulated Concrete Forms must be supported on
concrete footings complying with Chapter 18 of the UBC or
IBC, or Chapter 4 of the IRC.
Vertical reinforcement bars, embedded in the footing, must
extend a minimum of 24 inches (610 mm) into the block wall
system. The Logix Insulated Concrete Form blocks must be
stacked in a running bond pattern such thatthe polypropylene
webs align vertically. Vertical and horizontal reinforcement
bars must be placed as required by the design and the
applicable code. All horizontal and vertical reinforcement bars
must have minimum concrete protection in accordance with
the UBC or IBC. Concrete quality, mixing, and placing must
comply with Chapter 19 of the UBC or IBC. Refer to Figure 2
for typical installation details.
When regulated by the IRC, reinforcing steel for the Logix
Insulated Concrete Forms used above grade must comply
with Section R611 of the IRC.
Pressure -preservative -treated wood ledgers must be
attached to the concrete wall by removing the face shell of the
EPS units, with the height of the removed portion equal to the
depth of the wood ledger. When concrete is poured into the
wall system, the concrete -filled volume, provided for the
anchor bolts, forms a solid concrete connection from the
ledger board to the horizontal bond beam. The spacing and
embedment depth of the anchor bolts must comply with the
structural design or code requirements, whichever governs.
Anchor bolts used to connect the wood ledgers or plates to
the concrete must be cast -in -place, with the bolts sized and
spaced as required by the design.
2.5 Interior Finish:
Logix Insulated Concrete Forms exposed to the interior of the
building must be finished with minimum '/,-inch-thick (12.7
mm) regular gypsum wallboard complying with ASTM C 36,
attached to the flanges of the polypropylene webs. The
minimum '/2-i nch-thick (12.7 mm) wallboard must be installed
vertically and attached to the flanges of the plastic webs with
1.625-inch-long (41.3 mm), No. 6, Type W, coarse thread
gypsum wallboard screws spaced 16 inches (406 mm) on
center horizontally, and 12 inches (305 mm) vertically.
2.6 Exterior Finish:
2.6.1 Above Grade: An approved exterior wall covering
must be designed and installed in accordance with the
applicable code or an ICC-ES evaluation report. When the
wall covering is required to be attached to structural
members, the wall covering must be attached to the flanges
of the polypropylene webs with either No. 6, Type W, coarse
thread drywall screws or No. 6, Type S drywall screws. The
screws must be corrosion -resistant and have sufficient length
to protrude through the flanges of the polypropylene webs a
minimum of'/,, inch (6.4 mm). The screws have the allowable
pullout and lateral load capabilities shown in Table 1. The
maximu m spacing of the screws shall be designed to support
the gravity loads of the wall covering and resist the negative
wind pressures. The maximum negative wind pressure is 99
psf (4.74 kPa).
Negative wind pressure capacity of the exterior finish
material must be the same as that recognized in the code for
generic materials, or in a current ICC-ES evaluation report for
proprietary materials.
2.6.2 Below Grade: Wall surfaces must be dampproofed
and, when required by the building official, waterproofed in
accordance with Appendix Chapter 18 of the UBC, Section
1806 of the IBC, or Section R404.4.11 of the IRC.
Dampproofing and waterproofing materials must be approved
by Logix Insulated Concrete Forms Ltd. and the building
official, and must be free of solvents that will adversely affect
the EPS foam boards.
2.7 Foundation Walls:
The wall system is permitted to be used as a foundation stem
wall when supporting wood -framed construction and when the
structure is supported on concrete footings complying with the
applicable code. Compliance with Table 18-1-C is mandatory
when regulation is by the UBC. Installation of the Logix
Insulated Concrete Forms as foundation walls must comply
with Section R404.4 of the IRC.
J
Page 3 of 9
ER-6133
2.8 Underfloor Crawl Spaces: 3.0 EVIDENCE SUBMITTED
Logix Insulated Concrete Forms located in underfloor crawl Data in accordance with the ICC-ES Interim Criteria for
spaces are permitted to be exposed to the crawl space, Concrete and Concrete MasonryWall Systems (AC15), dated
subject to all the following conditions: January 2001, and the ICC-ES Interim Criteria for Foam
1. Entry to the crawl space is only to service utilities, and no Plastic Insulation (AC12), dated July 2001; and quality control
heat -producing appliances are permitted. manuals.
2. There are no interconnected basement areas.
3. Air in the crawl space is not circulated to other parts of the
building.
4. Underfloor ventilation complies with the applicable code.
2.9 Fire-resistant Construction for Recognition under
the UBC:
Concrete walls meeting the construction specifications listed
in Item 7-1.1 of Table 7-B of the LIBC are formed by the Logix
Insulated Concrete Forms and have the fire -resistive ratings
specified in Table 7-B of the LIBC, for a maximum fire -
resistive period of 3 hours.
2.10 Special Inspection:
Special inspection is required as noted in Section 1701 of the
LIBC, or Section 1704 of the IBC, for placement of reinforcing
steel and concrete, and for concrete cylinder testing, except
that special inspection is not required for foundation stem
walls conforming to Table 18-1-C of the LIBC, or Table
1805.4.2 of the IBC. Additionally, when the building official
approves and recognition is under the LIBC, special
inspection is not required when all of the following conditions
are met:
I . Wall systems are a maximum of 8 feet high (2.4 m) and
are limited to use in single -story construction of Group R,
Division 3, or Group U Occupancies.
2. Maximum height of a concrete lift is 48 inches (1219 mm).
Succeeding lifts must be placed in accordance with
Section 1905.10.5 of the LIBC.
�3. Installation is by properly trained installers approved by
Logix Insulated Concrete Forms Ltd.
4. The installation instructions indicate methods used to
verify proper placement of concrete.
5. Specified compressive strength of concrete used in
design is one-half of that specified.
2.11 Identification:
Each package of Logix Insulated Concrete Forms bears a
label specifying the product name (Logix Insulated Concrete
Forms), the evaluation report number (ER-6133), the phone
number and web page for the product, a checkbox for which
manufacturing location the product comes from, the date of
production, and the name and logo of the quality control
agency (Intertek Testing Services NA, Ltd. —Warnock
Hersey).
4.0 FINDINGS
That the Logix Insulated Concrete Forms described in
this report comply with the 1997 Uniform Building GodeTm
(UBC), the 2000 International Building Codd* (IBC), and
the 2000 International Residential Codd9 (IRC), subject to
the following conditions:
4.1 The forms are manufactured, Identified and Installed
in accordance with this report and the
manufactureesinstallation instructions.
4.2 When regulated by the UBC or IBC, walls
constructed with the Logix Insulated Concrete
Forms are considered Type V construction.
4.3 When required by the building official, plans and
calculations showing compliance with this report
are submitted to the building official for approval.
4.4 The EPS foam forms are separated from the building
Interior with an approved thermal barrier, such as
minimum '/,-Inch-thick (12.7 mm) regular gypsum
wallboard installed as specified In this report. Other
thermal barriers, having an index of 15 and
attachment complying with a current ICC-ES
evaluation report, are acceptable.
4.5 When regulation Is by the UBC or IBC, special
inspection Is provided in accordance with Section
2.10 of this report.
4.6 When regulation is by the IRC, compliance with
Section R324A must be demonstrated.
4.7 Logix Insulated Concrete Forms are manufactured
by Beaver Plastics Ltd. located in Edmonton,
Alberta, Canada, and Chilliwack, British Columbia,
Canada; AMC Insulation Corporation In Winnipeg,
Manitoba, Canada; Form Systems Inc. in Haysville,
Kansas; Perma R Products Inc. in Johnson City,
Tennessee; PSC Moulding Corporation in Cobourg,
Ontario, Canada. Logix Insulated Concrete Forms
are produced under a quality control program with
inspections conducted by Intertek Testing Services
NA, Ltd. —Warnock Hersey (AA-647-2).
This report is subject to re-examination in one year.
TABLE I —ALLOWABLE PULLOUT AND LATERAL CAPACITIES OF SCREWS
SCREW TYPE
ALLOWABLE CAPACITY (pounds)
Pullout Capacity
Lateral Load Capacity
No. 6, Type S, fine -thread, corrosiorresistant screw
35
49
No. 6, Type W, coarse -thread, corrosion -resistant screw
33
49
For Sl: 1 pound = 4.45 N.
Page 4 of 5' ER-6133
32A'
4'
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PLAN XjFW 6- LFFT HAND 90 STANDAP L HAI F HFIGHT
/---, 16, 16,
4,�.21%'
FIGURE I—LOGIX INSULATED CONCRETE FORMS
Page 5 of 5 ER-6133
TOP & BaTTTaM
45*
TYP CUT OUTS IN FORM
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L
+
RACKFILL
+
+
+ +
(FREE DRAINING)
R '
+ +
+
FILTERCLOTH
+
+ +
+ +
+
OVER STONE)
+
+ +
3/4 CRUSHED STONE
(6" MIN OVER PIPE)
4' BIG-O(PERFERATED)
(PER SPECIFICATION)
%S SPECIFIED
LATE
7 DRYWALL
.IN. THICKNESS 1/2')
—ANCHOR BOLTS AS SPECIFIED
(INSTALLED BEFORE POUR)
/—SURFLOOR
—IST FLOOR JOIST
—LEDGER PLATE (PER CODE)
\—CUT OPENINGS IN FORM
(AT ALL ANCHOR LOCATIONS)
SIZE 4 1/2 X 7 MINIMUM
—1/2' DRYWALL (MIN. THICK)
FOOTING (CONTINUOUS)
'uu "'
\a 4(PCR SPECIFICATION)
CONC FLOOR
PER SPECIFICATION)
STONE AS SPEC.
0 (COMPACTCD)
0
NDISTURBED
SOIL DR BEDROCK
FIGURE 2—TYPICAL INSTALLATION DETAILS
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PRODUCr MANUAL 8A - INTERTEK TESTING SERVICES
Intertek Testing Services
ETL SEMKO
Aug.22,2002
To whom it may concern,
This letter certifies that Logix Insulated Concrete Forms have been subject to and
complied with all of the following testing:
• Meets 3 hour fire rating in accordance with ASTM El 19 and CAN/ULC S101
• Room fire Test Standard for Interior of Foam Plastics Systems in accordance with
ASTM D1929, D635 and D2843
• Craw!Space evaluation conducted in accordance with ICBOES requirements
• Conforms to ASTM C578, with equivalency CAN/ULC S701 (standard Specification
for Rigid, Cellular Polystyrene Thermal Insulation)
• Fastener Withdrawal Evaluation in accordance with ASTM D1761
• Fastener Lateral Resistance tested in accordance with ASTM DI 761
• Polypropylene web material conforms to CC[ Plastic material when tested in
accordance with ASTM D1929, D635 and D2843
Applications have been submitted for the following evaluation reports:
- CCMC ER # pending
- ICBOES ER # pending
- SBCCI PST and ESI RR # pending
- BOCAES RR # pending
Testing and ongoing evaluation of Logix Insulated Concrete Forms is carried out by
Intertek Testing Services (ITS). Logix Insulated concrete forms are a listed product with
ITS (#6245) and are eligible to display the Warnock Hersey Certification Mark.
If you have any question or concerns regarding the above information, contact the
undersigned at 1-800-668-TEST.
INTERTEK TESTING SERVICES NA LTD.
Wanock Hersey
Sheldon Warman, P. Eng.
Manager, Construction Products RECEIVED
MAY 2 6 2004
PERMIT COUNTER
PRODUCT MANUAL 8.1 - INTERTEK TESTING SERVICES
TEST PROGRAM
1. Physical Proper" of Pqtypropylene Reinfoming Webs
Physical properties testing of polypropylene reinforcing web material was performed in general accordance
with the following test methods:
A. Screw Witurawal:
ICBOES ACI 16 (July 2001) -Accepeance CWAviaforNalk andSpikm In conjunction with AS7M
D 1761 -88 (Rcapproved 2000) -&Wu1hrd rat Maho&for Modkinkat Falleners in Wood - sections
I througit 12 (two tocs of &steners were team&- a " 'W couse tilread drywall screw, and a type
IS' fine tbread drywall screw)
a lateral Screw Resistance:
ICBOES ACI 16 (July 2001) 'Acceptance Criteriafor Nails andSpAm'in conjunction with ASW
DI 76148 (Reapproved 2000) Vwtdard rest A"to,*)br MWA=kaf Fasteam in W004 - Sections
13 ftmgh 20
C Tensile Sbvngth:
ASTM D639-01 -S1Wxkwd rest Merhodfor 7kwile Properfia ofPtalffiCs-
TEST RESULTS
1. Physical Pronertics of PolypEWlene Blintemine W_ejm
A. Screw Withdrawal Lateral Screw Resistance LAM D1761-M:
Fastener Type
I
Withdrawal Lateral
Max Load (lbs)
Max Land Qbs)
Amerage
Type IVP Coarse Thread Drywall Screw
166
367
COV
Type IVP Coarse IMread D=H Screw
10.6%
8.4%
Avera Type AS' enrced Drywall Screw
1 169
328
Type IS' Fine Thread Drywall Screw
t 8.4%
4.1% 3
Note: Test results above were based on twelve witnarawal samples and ten izacrai samples.
Complete results are included in the Appendix D.
0. Tensile StmnrM (ASTM D638-01):
Ultimate Tensile Strength (lbs)
Average 942
COV 1.7%
lote: Akcomplete web was used with each side ofthe web gripped and loaded perpcWicular to
the exterior surf= of the web. Test results above were based on ten smples. Complete results
are included in Appendix E.
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PRODUCrMANUAL 8A - INTERTEK TESTING SERVICES CONTINUED
DISCUSSION
ICBOES AC 116 references ASTM D1761 for lateral and withdrawal testing, The ASTM D6117 and ASIM
D 1761 are very similar in methodology, however ASTM D6117 is used for solid sections of plastic members
and not for sheets of plastic material. In addition to this. the ICBOES ACI 16 document gives guidance on
establishing allowable loads, which ASTM D6117 does not provide. in the absence of a standard that more
specifically addresses this issue, ITS recommends that ACI 16 is more. appropriate.
It is our opinion that it is aWopsiate to state specific loads for this material. ASIM D345&99 clause A2.6.1
states, -Me equivalent specific gravity is determined ftm Tbbte 1221 or ftf. (3) such (hat the table value for
the tested nail does not exceed the average ultimate withdrawal resistance in pounds per inch (Nhm) from
A2.4 divided by S.O..." The safety factor for withdrawal in ASIM D5456 matches that of AC 116, again
justifying its applicability to this ism. ASTM D5456 does not haw a comparable s&ft factor fbr lateral load
resistance. In the absence of a standard that more specifically addresses this issue� we suggest that AC 116 is
mom appropriate.
Given the low CAV. of the web tensile test results6 it is the opinion of M that a safety factor of
approximately three is appropriate. We chose to use the lateral resistance factors of AC 116 for consistency.
CALCULA71ONS
1. Web Tensile:
942 lbs. x 0.75 = 631 lbs (Proportional limit assumed to be the same as ultimate load — brittle failure)
942 lbs. / 3.2 - 263 lbs (Based on average ultimate load)
2. Fastener Testing:
(A) Withdrawal Resistance
Type -5- Screw
Type -w- Screw
(a) Lateral Resistance
Type "S" Screw
Type -W-- screw
F.w. - 178 ft. -!- 5 - 35 ft
F,_ — 166 lbs. + 5 = 33 lbs
FA_ - F ; 3.2 - 328 lbs. + 3 2 = 102.3 lbs
F.g,. - F + 3.2 = 367 tbs. + 3.2 = 114 lbs
I
PRODUCr MANUAL 8.1 - INTERTEk TESTING SERVICESCONTINUED
CONCLUSIONS
1. Physical Pinoperttes of Polyprogylene Itellofordag Webs
'Me polypropylene reinforcing webs were found to have ft (bllowing allowable loads, as recommended by
ITS when analyzed in accordance with ICBOES ACI 16 (July 2001) 'Aceviance Criteria for Nails and
Spikes. "(The withdrawal resistance utilized a safety factor of five as per ICBO ES AC 116, Section 4.2. The
lateral resistance of both the Type "W" strews and the Type *S" screws utilize a safety factor of 3.2 when
analyzed in accordance with JCB0 ES AC 116, Section 4. 1.).
• Withdrawal resistance of a Type "S" fine ducat! drywall screw is 35.
• Withdrawal resistance of a Type *W" course thread drywall screw is 33.
• Lateral resistance of a Type "S* fine thread drywall sm-ew is 102.
• Lateral mistance of a Type 'W" course thread drywall screw is 114.
The Polypropylene Reir&rcing Web tensile strength is recommended by ITS to be 263 ft. based on a Safety Factor
of 3.2 analyzed in accordance with ICBO ES ACI 16, Section 4. 1. no maximum negative wind pressure for a cladding
system anached to thi EPS foam plastic panels is based on the maximum fastener values connected into the
Polypropylene Reinfoming Webs. For a screwed system into the webs, r on center vertically, and 6" an center
horizontally, the allowable negative widutmwal is "lbsW. This withdrawal capacity can be converted to a wind speed
based an the following formula extrapolated from the 1997 Uniform Building Code Table 16-F at standard height of
33 feet
q. - Kv2
when; (L = wind pressure (psf)
and: v = basic wind speed (mph)
and: K — 0.00256
thus: v (q, + 0.00256)"
given: % 99 lbslfe (allowable negative withdrawal)
then: v — 197 mph
INTERTEK TESTING SERVICES NA LTD.
Warnock Hersey
Testedt
Reported by:
Craig RL Lawson, NZCE (Mech),
Technician, Consftction Products
Reviewed by:
Cam Robinson, P.Eng.
Manager, Construction Pioducts
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M.I.C. ASSUMED 300.00-
DATUM TOP MON IN MON CASE
DRAINAGE SYSTEM STANDARD
DESIGN
DRIVEWAY: 835 0.
ACCEPT
OPEN PATH: 261 Lt.
GARAGE ROOF: 1,412 0.
SDR 35
HOUSE ROOF: 2,131 &.1.
SCH 40
OPEN DECK: 218 Lt.
N - 12
TOTAL: 4,923 Lt. 0#/
F81 0 HA
IMPERMEABLE AREA: 4,923 Lt.
REQUIRED VOL CU.FT.: 125 c.f.
PIPE DIAMETER: 30*; 25' LONG
OUTLET ORIFICE DIA: 1/8'
CATCH BASIN: TYPE IL. CB IANATER
RESIDENCE
HF-ICjHT CALC5
GARAGE GRADE
A=304.0
AT CORNERS
B=304.0
305.0
C=304.0
D=303.0
AVE GRADE=303.15'
AVE GR=305.0'
ACTUAL=328.08'
ACTUAL=319.3'
MAXIMUM=328.15'
MAXIMUM=320.0'
NOTE:
CONTRACTOR TO VERIFY
GRADE POINTS USING TRANSIT
PER CITY OF EDMONDS PRIOR
TO START OF CONSTRUCTION
'SwT
24' ROOF O.H.
WHAW. T6yP.
JERIAL
lit.
"%OR
REQ'D
-
EXT. 1
+304
C8 16
N 00 DEG. sw Ill, Eg.91,
010
D
BSMT. '43�sf.
1ST FVL- t47OLL
UPPER FLR: -R35s.E
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STORM -
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LOT COVERAGE CALCULATION e4P1eA6NACT OLYMPIC
SITE AREA: 8444 S.F. WA R/SEWER DIS
1
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GARAGE AVEI
RESIDENCE AND PORCHES: 1,150 S.F. GRADE 305 0'
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304.41' w w I
--4 B
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ASPHALT
WALKWAY
---------------
GARAGE SHOP: 1,123 S.F.
TOTAL ROOF AREA: 2,813 S.F.
7!rwp�RARY CONSTRUCTIOW
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LEGEND OF SYMBOLS ENTRANCE REQUIRED
10
— 0 — 8 — STORM WATER TIGHTLINE TO DRAINAGE SYSTEM
— w — w — WATER PIPE NOTE:
SANITARY SEWER PIPE ALL EXISTING TREES
GAS PIP ON SITE TO BE REMOVED 0
APPROVED AS 'NOTED RIGHT-OF-WAy CON N 01 DEG 11' 21" E -
BY - ENGINEERING
AND INSpECTI STRUMN PERMIT -3
I kotjoa& -- ON REOUIRED
i Ilgi -SJ—TE . PLAN
cot
f SCALE: 1* = 20'
RHENE JOHNS PLAN NORTHAOnR(
A R C H I T E C T PROJECT ADDFESS, 24017 104TH AVE NW
RECF
.PIVFrp EDMONDS, WA
7310 R Skyview PL #B 0
Rbr , 00564900100301
SHOP:
21
2
2-CAR
GARAGE:
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FLR E!". 304.16'
FTG DEPTH: 3OZ5'
.,'::--C- ONCR9T--'P-..
DRIVEWAY
Tacoma. Washington 9MOe APR 1W EVAN PIERCE AND SUSAN BLAND N-01 DOE
Phone/Fax (253) 565-62T7 2708 E. PIKE ST. EG
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PROTERTY
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PLA NINII
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SEATTLE. WA 98122 w
PERMIT COUNTER
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104TH AVE W.
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS
24017 - 104 AVE W
HOMEOWNER CONTRACTOR SCALE
PIERCE NTS
DATE �IRIWN PERMIT
12-07-2004 BY SIBREL NO. 2004 - 0511
Permit No: rogo
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: Imn /too 4W
B. Type of Work (be specific): (A.-TI 1, 1:119 d))?A Alk),N eo�fv
Contact:
C. Contractor: �rtv�vy zll"!!�e Ice
MailingAddress: Yqb '�1416 Hu5YPhone: 3 e�V
State License #:- TIN-rA10C, Iq 7rZ )a "C-' Liability Insurance: )!Le- -5 Bond: $
City Business License #: ir
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F� Commercial Subdivision City Project EUC (PUD, PSE, COMCAST, OVWSD)
? E] Multi -Family Single Family Other
1 1 /il-&, A"LlS. �
INSPECTOR: _-.1 - F I 1 7
F. PAVEMENT CUT: [:1 YES....�,/E3 NO G. SIZE OF CUT X
El YES E] NO
rONCRETE CUT
G. El Mail Approved Permit F� Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands �y his/her 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 de�artments or employees, including but not limit'M to the defense of any legal proceedings including defense
costs and a'ttorneyfees b)i reason ofgranting this permit.
101'
-M
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERI LS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBITORC PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public safety shall be in accordance with ity regulations as required by the City Engineer.,. Every
.1 o
flagger must be trained._as required �by.(WAC) 296-155-305 -and must have certification verifying completion'of the
required training in their possession.
+ Restoration is to be in' accordance with City codes. All street -cut 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.
CALL DIA-A-DIG (1-800-424-555'5) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUS T MA KE THE PIN��KCO� AILABLE ON SITE A TALL TIMES FOR INSPECTIONS
THE PERMIT A V
,,7
Signature: Date:
-- -- -------------- 1 ------
REQUIRED INSPECTIONS:
Call 425-771-0220, Ext. 1326for a 24-hour voice-rec" inspection request line.
2-
014 DATE:
FINAL APPROVAL OF PERMITTED WORK: J
InS4Cto'rsSidhature
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE i
CADocurnents and Settings\Curiis\My Documents\Fomis\Engnrng\ROWpermit_.doc Revised 10/01/03
RECEIVED,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
,/-'/> 4?V.X 22 /? �r
CITY ZIP TELEPHONE
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NAME
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CITY TELEPHONE
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zip T
NAME CBL ef-�
ADDRESS
ZIP
11
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED
PROPERTY TAX ACCOUNT PARCEL -NO.
0015�4f,10010030/
NEW
of RESIDENTIAL
PLUMBING I MECH
ADDITION
E] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
CYDS
FENCE x
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
F RE SPRINKLER
ME
CARPORT_-
ROCKERY
ALARM
(TYPE OF USE. BUSINES4 OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER.
DESCRIBE WORK TO BE DONEL
e.,
Xl&" Ile,
REAT SOURCE GLAZING 99 LOT SLOPE %
PLAN CHEC70KNO6-- VESTED DATE
/ 7j
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPILICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED wrrmt4180 DAYS
SEE BACK OF �,Ikk PEAMIT FOR MORE INFORMATION'
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO INDEMNIFX 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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C11YS 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 OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. t, I
SIGNATURE (OWNER OR
E" DATE SIGNED
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"'I'VI
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USE PERMIT
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NUMBER�
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ADDRES
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW d
Par"' ":t,"ll
EXISTING -' PROPOSED
stree, Us. I I'd
inspection Required 13'
REQUIRED DEDICATION FT
Sidewalk Required 13
underground
Wiring required
METER SIZE
LINE SIZE _T
NO. OF FIXTURES
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VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
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COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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REMARKS 40 110,�W4
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D !j
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VALUATION
Description
FEE
Descriptlon
FEE
Plan Check ,
1477—
State Surcharge
5TO
Building Permit
City Surcharge
Plumbing
4D::; 'D"
Mechanical
—h�
Grading
Engr. Review
Engr., Inspection':
�.i
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Fire Review
Plan Chk. Deposit
AF77
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknoWledged in space provided.
OFECIALS SIGNATURE DATE
®RELEfA§EUB'
S01 DATE
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02' PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTO
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
RECEIVED
C ITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
EA NAME/NAME OF 13USINESS
MAILIhLG ADDRESS
A� SPX
CITY 7ZC-- zip TELEPHONE
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NAME
ADDRESS
CITY
TELEPHONE
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NAME I CBL # VA,
ZIP
STATE LICENSE NUMBER
IROPERTY TAX ACCOUNT PARCEL NO.
. T1__
eZ5 5,4
NEW
DENTIAL
ADDITION
COMMERCIAL
REMODEL
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REPAIR
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ARPORT
ROCKERY
(rYPE OF USE. BUSINESS OR-Ar.T[VITY) EXPLAIN
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OTHER
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
.STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
,��-4 C, I I
PLAN CHECK NO: - I VESTED DATE
PERMIT EXPIRES
Usif PERMIT
ZONE
NUMBER
JOB
SUITE/APT#
ADDRESS 2
PLAT NAME/SUBDIVISION NO.
LOT
L D NO,
jq? q
NO.
L�D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TES P Approved
RW rmil Required
Street Use Permit Req'd
EXISTING PROPOSED
inspection Required
Sidmalk Required
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
I I
NO. OF FIXTURES
PRV REQUIRED
__
YES 1:1 NO C3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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SIGN AREA
HEIG
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PRO90SEP
I X
EXP
LOT COVERAGE
RE UIRED SETBACKS (FT.)
FRONT
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSR*D
35 Vio � 33
SIDE REAR
FRONT LIR,,SIDE A
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PARKING
REO'D I PRTIED I
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Fr) I REMARKS
THIS PERMIT �UTHO�IRIZES ONL'Y THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT UMIT11 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 PERMrr. 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT TH E 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 VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN! S COMPENSATION INKINANCE AND RCW 18.27.
5 ONATURE (OWNER Oft AGENIIoe DATE SIGNED
ATTENTION
? includo dli-oA
,7'
CHECKED 8 TYPE OF CONSTRUCTION CQQE - OCCUPANT
_<4m I V_- 1 GROUP ��_3A
SPECIAL INsPCTION JARI�QI CUPANT
403�e C
10
REQUIRED YE S LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D
-) A/ /) /I 44.,o) , i -X �fi //..,-2 ) 1
VALUATION
$ J il —
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFFJCIALS SIGNATURE DATE
6 0 0
(425)
771-0220
EXT 13:33
RELE a DATE
/A -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 'A , ' 11 4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL-FLE YELLOW -IN PECT6
CATE OF OCCUPANCY HAS BEEN GRANTED.UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
09/03 PRF.Q-q WARn.vniiARF_ MAKING 4 CC)PIES