20000458.pdfDATE RECEIVED
PERMIT EXPIRES
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USE
PERMIT
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CITY OF EDMONDS
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NUMBER
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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no RTyON A C N
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3 SEPARATE PERMISSION.
TATE � LR A loaE "T
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PERM" APPLICATION* "' '
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PERMIT LIMIT. I YEAR P' 'O'R.E. WORK.. STARTED WITHIN 180 DAYS
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PERMIT FOR MORE '.
SEE BACK OF PINK IN AMATION
�APPLICAN 01 HI R SPOU BE, ".E I R S, ASSIGNS I�N�l GESORS
N 110 HARMLESS T CITY OF
EFEND A "'LD""N' F E
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IN INTIRE EMPLOYEES, AND AGENTS FROM ANY AND
ED NO. WASHINGTON. ITS OFFICIALS.
INSPECTION FEE .... ...... . .
M VER NATURE. ARISING DIRECTLY 0' ""DIRECTLY
AULCI_AIM� FOR DAMAGESOF WHATE
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OF THIS PERMIT. ISSUANCE OF THIS EFN'T SHALL NOT BE
PLAN CHECK DEPOSIT
FROM THE ISSUANCE ANY CITY ORDINANCE
DEEMED OMODI WAIVEOR OU ANYSEQUIREMENTOF
T FYAY ENFORCE ANY ORDINANCE PROVISION,
TO
MORUMI INANYW THECITYISEABICLIET
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I U UNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION�'T.AT THE INFORMATION
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RIEE.UL AUTHOR ZED AGENT OF
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GIVEN ISICGRRECT�IE`NDC`.AT WHEC.,NER
THE 0 'P 60 LAWS RIGULATING CONSTRUC
W. I A.R TO , Ly IT. 'TA STAT
BE EMPLOYED
CALL
THEREBY, NO PE N WILL
TION, AND IN DaNG THE "So
HE STATE OF WASHINGTON RELATING TO
FOR INSPECTII
L=CAOUTHOORFIZTED
IN VIOLATION OF THE DE
WORKMEN S COMPENSATION IN SURANCE AND RCW 18.27.
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DATE
GNED
(425)
771-0220
EXT 333
ATTENTION
IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT -R()VAI OR A CERTIFI-
INSPECTION HAS
A FINAL -
UBC SECTION 109
FAX
CATE OF OCCUPANCY HAS'��'&WANTED.
519.
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ORIGINAL -PILE - YECLOW -INSPECTOR
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Project Review Checklist
PlanCheck* Ub-170
Project Name'
P ect Address:
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Receipt Date:
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Underground Wiring Required
Hydraulics Permit
Plat/Subdivision Requirements
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Street Dedications
Easements - Public/Private
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Engineering Storm Drain Review Feel
Engineering 2.2 inspection Fee
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Drainage Plan (On -site)
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Setback - Storm Drain Line
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Open Ditch - Existing
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Culvert Required,
Culvert Size
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Driveway Slope & Vehicle Access
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Street Paving Required
on ction Permit Required
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FEMA Map Check/Water Table
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side sewer Availability
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Calculate Sewer Fee if No LID#
Water Meter Size
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Hydrant Required
Street Cut
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Miscellaneous
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RW Permit #
Date Issued Receipt #
Date Issued -7/ % Receipt #
SS Permit #
Fire Connection$
Date Issued Receipt #
Meter Size Paid$1-7;110� Date 5_//_7/Y0 Receipt #
Mrj Materials Te,,Aing &
C01IS-1111ting, ITIC. R E &F I V S D
OCT 3
Report #F 8314)EVELOPMENT
FIELD REPORT
F
Materials Testing & consulting, Inc. FILE NO.: 000610
777 Chrysler Drive, Suite A DATE: October 17, 2000
Burlington, WA 98233 Phone: (360) 755-1990 CLIENT: Compton Construction
Fax: (360) 755-1980 PROJECT: Steven's Health Care
ADDRESS: 21700 Hwy 99
CITY: Edmonds, WA.
CLIENT: Compton Construction ENGINEER: DCI
ADDRESS: 1370 Stewart St. ARCHITECT: Boxwood
Seattle, WA. 98109 CONTRACTOR: Compton
Attn: Pat Compton PERMIT NO.: 200468
Time:
MTC was on site for welding inspection in the emergency department fast track blood
bank. All work was done from approved drawings A5.0 details 3-4. All welding was done
by WABO certified welders and in accordance with AWS D1.1. Contractor has
photocopy of WABO card on file. Work performed includes welding of 6x8 angle iron to
tube steel columns with fillet welds and tube steel columns to structure at the tops of
columns. All work was satisfactory and complete.
Inspected By: Russ Jones, Field Inspector
Reviewed By: Niall P. Hackett, Technical Director
DISTRIBUTION:
ORIGINAL: Client
COPIES: Dcl
Boxwood
Steven's Health Care
City of Edmonds
ALL REPORTS ARE CONSIDERED CONFIDENTIAL AND ARE THE PROPERTY OF THE CLIENT AND MTC
REPRODUCTION EXCEPT IN FULL WITHOUT THE WRITTEN CONSENT OF IVITC IS STRICTLY FORBIDDEN
-1980
777 Chrysler Drive, Suite A Burlington, WA 98233 - (360) 755-1990 Fax 755
814 Lakeway Drive, #161 * Bellingham, WA 98226 - (360) 647-6061
I
NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT,
"a A
- -as
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Bond Due To ExPil
Bond Number 6068811
A
CITY 0 F EDMONDS
321 5TH AVENUE NORTH EDMONDS, WA 950 20.(425) 771-0220 -FAY, (425) 771-0221
E)FVELOPMENT SERVICES DEPARTMENT
Planning - guilding - Engineering
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Edmonds Building Permit NO.
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P,,j..t Address
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Develop
'd to as �Ibe principal", has
hereinafter referrr
astructiOn
rMEREAS, _Sc2m���� to as ,the City,% to construct the project known
er referred
City of Edmonds, hereinaft on a site located
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applied to the
as and
the City of Edmonds
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W_rpX,4S, the City approved the requested action and,
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and the provisions of the Edmonds Development
W11EMAS, the approval granted by the City of the project, and
with construction
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'ertain improvemonts to be made in DO uncodon
Code require a Site pinnd other required plans and Ore furiher
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i mprovements are shown on the aPPrOvO
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whereas the
defined. by the conditions 'dent' fied in the city file, First National insurance
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company of America a
NOW, TnEnFORE' the undersigned Principal and bonding COMPSAY to
hu"ne" " the State of Wasbingo,, hereinafter referred as
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corporation authorized to transact Surety ylistrators and assigns, unto the
bind themselves, their heirs executors' admin
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agree and lawfw
.1he Surety" S
Cityith.-,;;
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6. =cording to the following terms and conditions:
the United State ibove."forenced.
em ents requked by the
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If the Principal does not complete all In'* �th" th
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conditions, Plans- and file within L (10) days of ieccipt of said
surety shall, upon the demand ,I =th-e- ��City,rewrmt to the City within ten
be specified in the d0mimd-
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demand the amount of this bond or such lesser amount as may
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all of the above referenced improvements within
2) In the right at their sole election
tile event the Principal fails to complete have
City, its employees and agents Sball s
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In
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and specified by th
the time ped a
said property described above for the putpose of completing the improvements-
to enter onto an obligaition on the part of the City or its representatives to
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provision shall not be construe as creating
complete such improvements.
he Principal or the surety to
instituted by the City of Edmonds t
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jewsuit is
3) In the event y prevailing party in
e ights of any party h
terms of this bond or to determin the I S, including reasonable
its
enforce the the losing party Dust'
Such litigation ShaU be entitled to recover from
attorneye fees, incurred as a result of such lawsuit.
City of E(11,,,d, performance Bond Bonding Company
page Two
4) This bond shall remEan in fall force and effect until the obligations secured hereby have
of .11 impmveraints for a period o f
.
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been fully performed and a bond guaranteeing maint to be determined by the City, Of the
-Atted to the City in an amount
City
yeoX from acceptance has been suhn d in writing by the at
of the improvement, and in a form suitable to the City, and until release
the period specified in the above
cost ,roiration of
the request of the Surety or the Principal Upon
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paragraph.
2000
DATED this 5th day of
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F insurance company of Americ8 Compton Construction
irst INati Developerlowner
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V iasi�.ta
"tTit y L. Villasista
Cin -Fact
officer/Tri -in
Attorney
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Mailinf Address
Mailing Address 206 4809792
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Yirkl,,.d, TclephonelTumber
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BonriNumber
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Bond Accepted by velopment SeMOO an Date
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STATE OF WASMGTON
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so.
COM-Try OF King
on this 5th day of June 2000 before me, the
—')n duly commissioned add sworn,
in and for the State of Washingt(
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under,aipcd, a Notary Public ttorney-In-Fact of
Villasist�l to me Imown to be the A
erson ared cind L. th
fflyiwl: foregoing instrument' and se"Olowledged e
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I�irst A anc muted the
compan t ona the corporation that deed of said Wrporation, for the uses and purposes
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said instrument to be the ffee and voluntary Oct on as authorized to execute
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therein mentioned. and On Oath stated that
said instrument and that tl'c seal affixed is the c orporate seal of said comolati(W-
WXTIwss MY hand off icial real hereto �Mxed thq Bud ye ar first abo�e Wlittm
N PU13LIC in and for the
state OfAVaSW. gt residing at :0
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City of Edmunds performance Bond Bonding Company
page Three
STATE OF WASHINGTON)
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as.
COUNTY OF
71
01,
On this day of —before me, the under -signed- I
Notary Public in and for the State of Washington, duly commissioned and swom, personally appeared
to tie Imown to be the Of
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the general partnership that executed the forego ing instrument, and
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acimowledged the said hwrumeot to be the fmo and voluntary act and deed of said p amershiP, for the
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uses mid purp oses therein mentioned, and on oath stated that
authori2ed to execute said instrument.
WITMSS my hand and official seal hereto affixed the day and yen first above vnitten-
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UBuC W for the
NOTARY PUBUC iwu
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Stale of Washington, residing at
NW,
L:t=P-b1dz:fb=ilRV99
�IRSTR�TIONALI E
POWER BROOKLYN NSURANC COMPANY OF AMERICA
333 AVE NE
OF ATTORNEY SEATTLE, WASHINGTON 98105
4333 Brooklyn Avenue N.E.
Seattle, WA 98105 No. 7351
KNOW ALL BY THESE PRESENTS:
That FIRST NATIONAL INSURANCE COMPANY OF AMERICA, a Washington corporation, doe� hereby appoint
I OSBORNE MIKE AMUNDS S M. SCOn DARLENE JAKIELS1q;
.................... ................. * ..... *..STEVEN K BUSH; MA COTrON; NANCY
............................ * ..................................
MARK JENSEN; JULIE M. GLOVER; CINDY L VILLASISTA; KW-d, W-hi-Zoo* ......
the fidelity and surety bonds or undertakings and other documents ofa similar
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its true arid lawful afforney(s)-in-lact, with full authority to execute on behalf of company
to bind FIRST NATIONAL INSURANCE COMPANY OF AMERICA thereby as fully as If such
character Issued by the company In the course of As business, and
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instruments had been duly executed by its regularly elected officers at its home office.
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IN WITNESS WHEREOF, FIRST NATIONAL INSURANCE COMPANY OF AMERICA has executed and attested these presents
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this 30th day of June 11999
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W. RANDALL STODDARD, PRESIDENT
RA. PIERSON, SECRETARY
CERTIFICATE
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Extract from the By -Laws of FIRST NATIONAL INSURANCE COMPANY OF AMERICA:
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"Article V, Section 13. - FIDELITY AND SURETY BONDS the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that
Individuals as attomeys�ln -fact or under other appropriate titles with authority to
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purpose by theoffimr in Charge of surety operations, shall each have authority to appoint
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behalf of the company fidelity and surety bonds and other documents of similar character Issued by the company In the course of Its business On a y
bond or
execute on
instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any Instrument conferring such authority or on any
thereof, may be impressed or affixed or In any other manner reproduced; provided, however, that the seal shall not
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undertaking of the company, the seal, or a facsimile
be necessary to the validity of any such instrument or undertaking."
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Extract from a Resolution of the Board of Directors of
FIRST NATIONAL INSURANCE COMPANY OF AMERICA adopted July 28,1970.
"On any certificate executed by the Secretary or an assistant secretary of the Company setting out,
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(1) The provisions ofArtele V, Section 13 of the By -Laws, and
(it) A copy of the power�of-attomey appointment, executed pursuant thereto, and
(111) Certifying that Said power -of -attorney appointment Is In full force and effect,
the signature of the certifying officer may be by famIrrille, and the seal of the company may be a facsimile thereof."
1, R.A. Pierson, Secretary of FIRST NATIONAL INSURANCE COMPANY OF AMERICA, do hereby certify the I the foregoing extracts of the By -Laws and of a
thereto, are true and correct, and that both the By -Laws, the
Resolution of the Board of Directors of this corporation, and of a Power of Attorney Issued pursuant
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Resolution and the Power of Attorney are still In full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed th-facsimile met of said corporation
this 5th
lidice -
PON,
SEAL
1928
op
6-1049IFNEF?198
Frozen Fund Posted..
Fund Expires�__'
Fund Number—
"7
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
PERFORMANCLEROZENIMND
Edmonds Building PemiitNo.—.V-oo 53
Project Mdress 1`700 14,2�X '�?C? C_DMO't40.5 ` I A
owner/Developer_!LIA rip AjAl I�Aet)icAL_ �)r=tjEL-g49AAENT
With reference to the above identified project, this will certify that this institution has a savings
account (or loan) for the above -referenced developer/owner for the project so identified. In
consideration of the permitted development of the property, and in lieu of a performance bond, this
institution hereby agrees that it will freeze the sums of money for the indicated site improvements
pending written authorization for release of said funds by the City of Edmonds in the amount of
The total sum indicated will be withheld by this institution from any disbursements of any kind
until written authorization has been received by the institution from the City of Edmonds to release the
sum of money indicated by the written authorization from the City.
The design, location, materials and other specifications for the indicated site improvements are
those required by the City of Edmonds and appear in the above -referenced Edmonds building permit
file and are in compliance with the Edmonds Community Development Code of said City. ,
In the event the owner/developer fails to complete the indicated improvements within and,
ta rK o " weeks/months, (not to exceed 24 months) the City of Edmonds may dem
and the institution shall make, payment to the City of said funds so that the improvements can be
installed or completed immediately to City standards. The institution shall not be liable to the owner
for any disbursement of said funds to the City of Edmonds.
It is hereby specifically agreed by and between the parties hereto that in the event that any legal
action must be taken to enforce the provisions of this agreement or to collect said frozen fund, that the
prevailing party shall be entitled to collect its cost and reasonable attorneys' fees as a part of the
reasonable costs of securing the obligation hereunder. In the event of settlement or resolution of these
issues, prior to the filing of any suit, the actual costs incurred by the City, including reasonable
attorneys' fees, shall be considered a part of the obligation hereunder secured. Said costs and
reasouabIC6 legal fees shall be recoverable by the prevailing party, not only from the proceeds of this
frozerl'tand -account, but also over and above said body as a part of any recovery in any judicial
prodee I ding. -in addition to recovery of the funds.
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City of Edmonds Performance Frozen Fund Account
Page Two
lu,441 �,j6L. L d rr
Financial Institution Owner/Developer
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Officer/Title Title
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MailingAddress Mailing Address
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FiNANCIAL INSTITUTION ACKNOMIEDGEMENT
STATE OF WASHINGTON)
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COUNTY OF .0
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On this (I me, the
day of before
undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn,
persqnallyappeared—Z-1-L-�'�"�I ,tomeknowntobethe _CE0
OfS-1-�.3 //�c-�—the corporation that executed the foregoing instrument, and
acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the
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uses and purposes therein mentioned, and on oath stated that 'a�� Awas i 0:
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authorized to execute said instrument and that the seal affixed is the corporate seal of said corporation. m
WITNESS my hand and official seal hereto affixed the day and year first above written.
NOTARY PUBLIC in and for the
Brian David State of Washington, residing at
CFO 75/l/ —20t�_'S_r
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City of Edmonds Performance Frozen Fund Account
Page Three
DEYELOPENOW-NER ACKNOMLEDGEMEN1
STATE OF WASHINGTON
ss.
COUNTY OF
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On this day of 7-�A g:_,--22 before me, the under -signed,
a Notary Public in and for the 5�tate of Washington, duly commissioned and sworn, personally
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appeared to me known to be the 'fir- —of
AA 1, C-O-Q- the general partnership that executed the foregoing
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instrument, and acknowledged the said instrument to be the free and volunt ary act and deed of said
partnership, for the uses and purposes there in mentioned, and on oath stated that
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ioa4 authorized to execute said instrument.
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d ffi I seal hereto affixed the day and year first above written.
WITNESS y han an o icia
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ind for the
Washington, residing at
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FINALTROJECT APPROVAL FOdM
TO:
�DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE—
r) ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE —
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DESCRIPTION OF WORK TO BE INSPEC T
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A field inspection was conducted to determine compliance with approved plans. Final approval. denotes that
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there are no objections from the above signed Department to the granting of:
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Final approval of the described work
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________--)?erformance Bonds associated with the project may be released
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�—GRANT FINAL PROJECT APPROVAL
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FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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--FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
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______RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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1E1NAnMRbJEC1 APPRO-V
TO---V
-DATE: ex.�'
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MEMO TO: PERNUT COORDINATOR, BUILDING DIVISION
F ROM: :-��-��.FIRE DEPARTNIENT DATE,
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE—
PROJECT P-
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SITE ADDRESS—
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PERMIT ka—b( ADB# ----------- DATEINSPECTED—(ff-3 --Loao
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DESCRIPTION OF WORK TO BE INSPECTED—
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A field inspection was conducted to determine compliance with approved plans. Final approval. denotes that
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there are no objections from the above signed Department to the granting of:
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Final approval.fthe d .. ribd work
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er,formance Bonds associated with the project may be released
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GRANT FINAL PROJECT APPROVAL
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FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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_GRANT
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FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
_RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp*.bldg!fonns6/98
FINAL PROJECT APPE
To,
-DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: eZ2- FER DEPARTMENT DATE2f--'-L---Cd0
ENGINEERING DIVISION DATE-
-PLANNING DIVISION DATE —
PROJECT A-A-'C t
SITE ADDRESS 0 4y
INSPECTED
PERMIT
DESCRIPTION OF WORK TO BE INSPECT
A fi I eld inspection was conducted to detennine compliance with approved plans. Final approval. denotes that
there are no objections from the above signed Department to the granting of:
nal approval ofthe described work
_Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
_GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
_FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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2.
3.
__.RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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FINZ�RQJECT APPROVAL
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
—ENGINEERING DIVISION DATE
/;7. LANNING DIVISION DA OrD
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SITEADDRESS LU—IM
PERMIT #_Q(_1Q�_ADB#------DATE INSPECTED —
DESCRIPTION OF WORK TO BE INSPECTED--T—Laa—
A field inspection was conducted to determine compliance with approved plans. Final approval, denotes that
there are no objections from the above signed Department to the granting of
Finalapproval of the described work
edormance Bonds associated with the project may be released
--P
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GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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AILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
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—RE-INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
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IVESTED OAT'
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
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PERMISSION.
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PERMIT APPLICATION: 180 DAYS
S E ACTA GE
1647
P. PERMIT LIMIT.- I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
FEE
OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND S BE HE
ENV�'S54ECTION
;APPLICANT�ONBEHAL
N INTEREST, AGREES TO:NDEMNIFY. DEFEND AND HOLD HA LE THE ITY F
AND
LANDSCAPING
EDMONDS, WASHINGTON. TS OFFICIALS. EMPLOYEES, AND A ENT R IN ANY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE . ARISING DIRECT R IRE TLY
INSPECTION FEE
REIIIPT
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
EMED TO MODIFY. WAIVE OR REDUCE ANY BEMENT OF ANY CITY ORDINANCE
OE REQUI
TO ENFORCE ANY ORDINANCE PROVISION.'
PLAN CHECK DEPOSIT
CEIPT
REC—E—IPT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY
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IHEREBY ACKNOWLEDGE THAT I HAVE READ I � IIS APPLICATION; THAT THE INFORMATION
APPLICATION,
APPROVAL
GIVEN ( CORRECT. AND THAT I AM THE OWNf R, OR THE OULY AUTHORIZED AGENT OF
WITH CITY AND STATE LAWS R
S EGULATING CONSTRUC-
Tl" Ppli-- il A -il �19— 11 Ih.
CALL F.—A
THE OWNER. I AGREE TO COMPLY
TION;ANDIND ING THE WORK AUTHORIZED -DIEREBY, NO PERSON WILL BEE mPLOYED
0
RELATING TO
Buildillo 011I.W ., N.M., D�P.Iy: .�d PlId.
racopi is acknowledged —0— P.v d'd
FOR INSPECTION
IN VIOLATION 01 THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICI 0 NPJR 1.
IGNAWRE JOWN��O
(425)
771-0220 DATE
ATTENTION
33 lay
EXT 3 1 '
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL,� -4171-0221 'LOW
A FINAL INSP ECTION HAS BEEN MADE AND APPROVAL OR A,CERTIFI-
I ORIGINAL - FILE YEL 4SPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 10
FAX PINK - OWNER - GOLD � ASSESSOR
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