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LIMITED SUBSURFACE INVESTIGATION
Residential Property
130 Fourth Avenue
Edmonds, Washington
HAMMERWORKS
ENVIRONMENTAL
ASSOCIATES, INC.
1380 - 1121 Avenue Nortbeast, Suite 300
Bellevue, Wasbington 98004
J
(425) 455-9025 Office
(888) 453-5394 Toll Free
(425) 455-2316 Fax
_J
February 19, 2002
-I ;
Mr. Colin Winters
_J
Harnmerworks
400 Dayton Street, Suite C
Edmonds, Washington 98020
JN 22045
Subject: LIMITED SUBSURFACE INVESTIGATION
Residential Property
130 Fourth Avenue
Edmonds, Washington
Ladies and Gentlemen:
Environmental Associates, Inc, has completed limited subsurface investigation of soil and
groundwater at the subject property located in Edmonds, Washington. This report, prepared in
accordance with the terms ofour proposal dated February 4, 2002, summarizes our approach to the
project along with results and conclusions.
The contents of this report are confidential and are intended solely for your use and those of your
representatives. Four (4) copies of this report are being distributed to you. No other distribution or
discussion ofthis report will take place without your prior approval in writing. Additional copies are
available for a small fee.
J Relying solely upon the information developed in the course ofour study, and within the context of
the limitations of the attached report of which this letter is a part, it would appear that areas of
petroleum -impacted subsurface soil in exceedance ofWDOE Method A cleanup levels exist on the
subject property. These include the floor of the former tank excavation as well as previously
excavated soil stockpiles. Additional discussions and recommendations are offered for your
consideration in the attached report.
Associate Offiecs: Oregon Son Francisco Bay Area
XV22045
Flammerworks Page - 2
February 19, 2002
We appreciate the opportunity to be of service on this assignment. If you have any questions or if
we may be of additional service, please do not hesitate to contact us.
Respectfiilly submitted,
ENVIRONMENTAL ASSO
Don W. Spencer, M. ., P.G., R.E.A.
Principal
EPA -Certified Asbestos inspector/Management Planner
I.D. # AM 48151
Registered Site Assessor/Licensed UST Supervisor
State Certification #947458636
License: W000010 (Washington)
License: 11464 (Oregon)
License: 876 (California)
License: 5195 (Illinois)
License: 0327 (Mississippi)
EwiRoNMENTAL ASSOCIATES, INC.
WWI
Residential Property
130 Fourth Avenue
Edmonds, Washington
7�
Prepared for,
Mr. Colin Winters
Hammerworks
400 Dayton Street, Suite C
Edmonds, Washington 98020
s
�stigation, the conclusions reached and the recommendation
Questions regarding this inw
to one of the following undersigned.
given should be addressed
Ryan K. Bixby
Hydrogeologist
VTDOE Registered Site Assessor
Don W. Spencer, -SC.,
P.G., R.E.A.
Principal
EPA -Certified Asbestos Inspector/Management planner
I.D. # AM 48151
Registered Site Assessor/Licensed UST Supervisor
State Certification #947458636
License: W000010 (Washington)
License: 11464 (Oregon)
(California)
License: 876
License: 5195 (Illinois)
License: 0327 (Mississippi)
Reference Job Number: JN 22045
ENVIRONMENTAL ASSOCIATES, INC.
February 19,2002
j
INTRODUCTIONISCOPE OF WORK .....................................
t-T
Site Description ................................. 5
Methodology/Scope of Work ..........................................
Geologic Setting ............................... .............. 5
6
SUBSURFACE EXPLORATION ...........................................
6
soil Sampling .....................................................
Analysis Results I Discussion .... .......................... 7
Laboratory
CONCLUS IONSIRECOMMENDATIONS ................................... 8
LIMITATIONS .......................... 9
REFERENCES ............................ 9
TABLES
Table I - Results of Laboratory Analyses - Soil
PLATES
Plate I - Vicinity Map
Plate 2 - Site/Exploration Plan
APPENDIX
Appendix A - Laboratory Report
ENVIRONMENTAL ASSOCIATES, INC-
JIV 22045
Hammerworks Page - 5
February 19,2002
i
7,, 77, 777777_,.*
PE, WORK;,
lbu lowt Op
SITE DESCRIPTION
The subjectproperty consists ofa vacant parcel located alongFourth Avenue South near downtown
The location ofthe site is shown on the Vicinity Map, Plate 1,
Edmonds, Washington. approximate
appended herewith.
According to the information you have provided to us, two (2) single-family residences were
from the subject property in the r of 2001. In the course of demolition, an
summe
removed
underground storage tank (UST) containing heating oil w as encountered. The UST, which measured
3.5 feet in diameter, was reportedly excavated and set to the side
approximately 7 feet in length and
of the excavation. The project supervisor advised us that approximately ten (10) gallons of oil was
released onto the underlying so il when the UST was removed from the ground. It is our
understanding that no soil sampling or testing was conducted at the time ofthe UST removal.
METHODoLOGY/SCOPE OF WORK
IND.
Your expressed interests, which included the desire to conduct a preliminary quantitative evaluation
of subsurface environmental soil conditions on the subject property proximal to the former tank
ca
locality, formed the basis for the following scope of work:
Observe the re -excavation of soil from the former location of a residential underground
0;
heating oil tank.
Collect and perform laboratory analyses on six (6) soil samples collected from the floor and
from the stockpile. The number of samples
sidewalls of the excavation and excavated
collected was determined based on conditions encountered during our reconnaissance.
Analyze the collected soil and groundwater samples for diesel and motor oil range petroleum
Z,
hydrocarbons using gas chromatography by method NWTPH-D Extended.
M
Prepare a summary report documenting our methodology, fin dings, conclusions, and
recommendations.
GEOLOGIC SETTING
Physiographically, the subject site is situated on a gently rolling elevated plain. This plain, known
last ofcontinental glaciation which ended
as the Vashon Drift Plain, was formed during the period
approximately 13,500 years ago.
ENvIRONMENTAL ASSOCIATES, INC-
Hammerworks JN 22045
February 19, 2002 Page - 6
aterial underlying
Published triaps for the site vicinity (Newcomb, 1952) suggest that much ofthe Im
the northern portion of the subject site is non -glacial floodplain deposits overlying glacial till. The
non -glacial floodplain deposits consist of interbedded sand, silt, clay and peat of the Whidbey
A Formation. Glacial till is a dense heterogenous mixture of silt, sand, and gravel. Typically, the till
exhibits relatively low vertical hydraulic conductivity which frequently results in formation of a
"perched" water table along its upper contact. The "perched" water table is frequently seasonal and
derives recharge primarily from infiltration ofprecipitation through more permeable overlying soils.
Topographically, the site is situated on a gentle westerly facing slope, approximately 50 feet above
mean sea level. Based upon inference from topography and local drainage patterns, it appears that
shallow -seated groundwater (ifpresent) in the vicinity ofthe subjectproperty may flow in awesterly
direction.
With respect to surface water resources, the northwest -trending incised drainage is situated
approximately one-half mile to the northeast. Shelkberger Creek, which originates approximately
three-quarters ofa mile to the southeast discharges to a marsh approximately one -quarter mile to the
south ofthe subject site.
_J
SOIL SAMPLING
OnFebruary 5,2002, Mr. RyanBixbyofEAI observed the excavation ofsoil fromthe sidewalls and
floor ofthe former UST hold and from the area to the south ofthe UST hold where soil appeared to
have been impacted by the leaking tank after it was removed from the excavation. Approximately
hold.
i twenty (20) square feet of oil -stained soil was noted to the south of the former tank
_J Approximately nine (9) yards of soil was excavated and placed on a layer ofplastic sheeting.
Using a backhoe, soil was excavated from the former LIST hold to a depth ofapproximately six (6)
to eight (8) feet below ground surface (bgs). The uppermost three (3) feet ofsoil was removed from
the area to the south of the UST hold where the tank appeared to have leaked onto the underlying
soil. Soil encountered during the excavation consisted primarily of brown to gray sand, silt and
gravel. Odors associated with petroleum products were detected in soil at each location.
Using stainless steel hand sampling equipment, soil samples were collected from the floor and each
ofthe four (4) sidewalls of the former UST hold and three (3) soil samples were collected from the
irectly to sterilized glassware with teflon-sealed lids
excavated stockpile. Samples were transferred d stored in an iced chest at the site and taken to the
furnished by the project laboratory. Samples were
laboratory in this condition in an effort to preserve sample integrity. Each jar was c early abe ed as
ENVIRONMENTAL ASSOCIATES, INC-
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JN 22045
Hammerworks Page - 7
February 19,2002
oject, etc. EPA -recommended sample -management
to the location and sample number, date, time, pr cumentation was observed at each stage of
ding maintenance of chain of custody do
protocol,inclu
the proi ect.
LABORATORY ANALYSIS I RESULTS i DiscUSSION
Laboratory Analysis les selected for laboratory
Since petroleum products were the contaminants ofconcern, all soil samP
analysis were analyzed for diesel and motor oil range petroleum hydrocarbons by test method
tended. The three (3) soil samples collected from the excavated stockpile were
NWTPH-D/Ex
composited into a single sample by the project laboratory. Labor
Soil samples submitted for laboratory analysis from each boring were chosen on the basis of field
ended at the end ofthis report. The following
screening measurements. The laboratory reports are aPP
tables summarize the results of laboratory testing.
SF
69
NOTE.
ta
ENVIRONMENTAL ASSOCIATES, INC'
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JN 22045
Hammerworks Page - 8
February 19, 2002
As summarized in Table I above and on the attached laboratory report (Appendix A), the soil
samples submitted for analysis from the floor of the excavation and from the stockpile contained
diesel -range petroleum hydrocarbon concentrations above Method A Cleanup Levels. None ofthe
sidewall soil samples contained detectable concentrations of diesel -range contaminants.
Relying upon the results of soil sampling and testing conducted in the course of this study by
Environmental Associates, Inc. (EAI), it would appear that past use of an underground residential
heating oil UST at the subject property has resulted in adverse impacts to subsurface soil conditions
proximal to the UST's original location and possibly at other unexplored locations and/or depths.
The full extent of the soil affected by the release of diesel -range petroleum products was not
determined, nor was such a fifll determination envisioned in the proposed scope of work for this
phase of activity.
The following recommendations are offered for your consideration regarding the previously
discussed detections of diesel fuel in site soil:
Several options exist for addressing the presence of petroleum products in subsurface soil,
depending upon the risk tolerances and overall goals ofthe various Parties involved. First of
all, a limited cleanup through excavation and off -site disposal of the impacted subsurface
soils in the vicinity of the former UST hold and the surficial soils impacted by the release
from the removed UST could be accomplished in an attempt to bring these areas into
compliance with Ecology's Method -A cleanup levels. Following removal of the
contaminated soil, remaining soil should be sampled and submitted for laboratory analysis
to confirm and document that all contaminated soil has been removed. Alternatively,
impacted soil excavated during cleanup activities could be placed on an impermeable bermed
barrier and "landfarmed" on the subject site until such time the levels of contamination
detected in the soil drop to below cleanup levels, at which point the soil may be redistributed
on the subject property.
With regard to compliance with state environmental regulations, there is a 90-day reporting
requirement under the Model Toxics Control Act (MTCA; WAC 173-340). This MTCA
requirement advises that any owner or operator who has information that a hazardous
substance has been released to the environment at the owner or operators facility shall report
such information to the department within 90 days of discovery (WAC 173-340-300). As
summarized, the decision to report the site clearly lies with the owner / operator of the
subj ect site and not the consultant. Submission ofa copy ofthis report by the owner/operator
to the department of Ecology would satisfy this requirement.
ENVIRONMENTAL ASSOCIATES, INC-
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Hammerworks XV 22045
February 19,2002 Page - 9
e at s
Decision making authority regarding implementation ofthe above referenced r commend ion or
other approaches clearly lies with the property owner and/or the lender, depending upon their
individual risk tolerances.
rworks, along with their several
This report has been prepared for the exclusive use of Harnme
representatives for specific application to this site. Our work for this project was conducted in a
manner consistent with that level of care and skill normally exercised by members of the
er similar conditions in the area, and in
environmental science profession currently practicing und
onditions set forth in our proposal dated February 4, 2002. The
accordance with the terms and c conditions may vary between those locations or at other locations
separated sampling localities and
imation is developed in
and depths. No other warranty, expressed or implied, is made. If new info
future site work which may include excavations, borings, studies, etc., Environmental Associates,
Inc., must be retained to reevaluate the conclusions of this report and to provide amendments as
required.
Newcomb, R.C., 1952, Groundwater Resources of Snohomish County, Washington, Water
igures.
Supply PaperNo. 1135, 133 pps., 2 plates, 6 tables, 19 f
U.S. Geological Survey, 1953, Edmonds East, Washington 1:24,000 Quadrangle, Photorevised
1981, 1 sheet.
ENVIRONMENTAL ASSOCIA TES, INC-
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Probable direction ofshallow-seated groundwater flow
Approximate limits ofsubject property
VICINITY M"
ENVIRONMENTAL Residential Property
ASSOCIArMS, INC. 130 Fourth Avenue South
1380 - 112th Avenue ME, Ste. 300 Edmonds, Washington
Bellmue, Wasbington 98004 Jb ftbm D-W Plate.
JN 22045 February 2002
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..................................................
........................................................................... ..
Approximate location
offormcrus Approximateftits
of UST excavation
NW-- --------------_
SPIFormer location
or on -site residence
tEW ibasement excavated)
W*I\
SW...... --------_------
SP2
ApproxiMatell0=601 d
oil gpin from excavated UST Spil sloc4ne
Approximate lifillix
oton DPW excavation
..............................
........................................................................................
Approximate location ofsoil samples collected on February 5, 2002 N
WW
Probable direction of shallow -seated groundwater flow
Approximate limits ofsubject property
ENVIRONMENTAL SITE/EXPLORATION PLAN
Residential Property
ASSOCIATES, INC. 130 Fourth Avenue South
Edmonds, Washington
1380 - 112tb Avenue N.E., Ste. 300
Bellevue, Washington 980014
Plate,
rob Numba., Dre.**
JN 22045 February 2002 2
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APPENDiX A
LaboratorY RePOrt
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Feb. 21 2W3 11:5W P1
FFabM EMIRMIENTMI F680eIATa INC PHM NO. 1 425 455 2316
ENVIRONMENTAL ASSOCIATES, INC.
1380 - lift Avenue Northeast, Sults 300
Bellevue. Wahinglon 98004
(426)455-00n
(42OWS2310 Fox
FAX MEMORANDUM
DATE: Febmwy2l,2003
FROM: Diane Spahr
TO: Mr. Colin Wintsm
FAX NO: 425-77"748
TOTAL PAGES mmumaw-vtomrs xq
ff you haw dMIMW f9cWvft this lnf--d-g- please conumt us at (425) 45"05.
SUBJECT- Hm 1* & copy of the second report mg*rding the www"on of the
coahad"aled W, VW Subs"USM teallng. " you have any qu@Sdo". ~ feel frae to Call.
CIO=. I
FM-21-2M M IL:49W 101
FRCjj eqUIFAX41ENTAL. AgMIATES INC PHDE NEI. 1 425 455 2316
ENVIRONMENTAL
ASSOCIATES, INC.
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Feb. 21 2M 11:56M P2
JN22045-1
Sukjf= UrMERGROUM STORAM TANK SITE ASMSSBWfr
Ruldleadal ProjwM
130 Fourth Avenve South
FAMOAft Waskingtm
Dw Dfir. Owma:
Enyhonmental, Associstea, 1w. (BAI� has completed an swonmentofsoil cooditiow w dw ViCanty
of an UUkqMwW baftj on tank which was removed fi-m tbb afte by others in the wrtmer of
2001.108"Sonweecoductedownp g and teatiagofsoil ftm aft armtothasOuds Ofttcbm"
UST where apVMtUwftbrtM (10) MR00 ofheating oil wasTeportedly spilled inths— ofthe
USTrwnQvaL jUsnport, prcp=Wtn woudanoc with the terms ofourproposal dated October 1.
2002, SUMMAXim our appmsch to the proact &long with results arld conclusions.
lucon offts report are eonMential and am WIN -AM 60181Y forYOuc 11" MA the use ofyovs
'buti
,cp mtdivw. Four (4) copies ofthis report me being distributedic, you. No otha diffm onor
discmion ofthis report will take place without yourprior writtcn &PPrOV21.
EKWUTP4E 5U.MMARY11
OnFdmury 5,2002,Mr. RymBixbyofEAI ob&cryed thcoxcavationofs0il fimtbe aidowalls and
ftwofdw fomerUST hold and from the am to the South oftbc USThD1d Where $Oil `PPm-Mto
hue bew imparted by the leaking umk Ow it w" mnoved by others. P-ulta ofsampling -d
wsftg ofsa coaducted at that time Mcaftd that petrolculn-0011W11WRINI wd rMabled bcocath
the fbor oftha ibmer UST bold md to the south offt fo=;;r UST in the vicinity of the Onficial
rel"M
FEB-21-c-M FRI 11:50M Me
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FROM eQlMR1EHTFL AS= I IAIM lW- PHDe NO. I 4Z 4W 2316 Fb. 21 2M U:56W P3
JN 2XV54
Ho"WrWor" page. 2
Odeber P. 200
on october2l' jmd 3'� 204 BAI returned to the sitegud observed the excavation Of*PPr0XiWAt81Y
owhmdlcd ma tw=ty_fivc (12$) too ofpctrojeum-cotttaminated wH (PCS) ftm ft subject site.
Ilia pcs was cxcavatod fim the floor Ofthe former hosting Oil twk hold and from an Area to the
South ofthe format UST where tEw surficiAl xdcm rq=tWly m=rc&
TU ttak hold vwgvakn extended to adeP&OfspM . me* tan (10) fed beneath ground surikes
ad was approximately firteen, (15) fed by hyahv (12) feet wide at the VmuM SUC&NL PC&O16um-
contaminated soil vw removed to a dcptb of qppwxWWdy swam (7) lim bencath smund surt"
in the southern otcavation. The ocalsminAW soil Was dociTiled an v1squeen and Wer looded into
fturk,p and trinsported In a thcrmal dOMOVfi= Umment faeffity in Everett, WvshhOm
Results of3amplins and testing of 96100W soil samplaa collected ftOm the 1104- and side%vlk Of
the former tok hold and *0 southern excavation 0011911110d thst soil in then areas is now
oon*ahbiowithcmlutVMoEMegodAcleanuplevalitfLv&wd-tWPPCUO'mm*=WA'=ts'
Ralying upon ft reguits of ampftg and testing completed thus far, it would MpW tA UO
oaftonal sation With M9Wd to Ocil woWd be yoq*a by 1orA sm-or federal agenda$.
We Mpredsin the oWrtuxtily to be of Wvift 00 Us AMPM-L If YOU have any questions of if
we mq be of additionst service, pUs" do not hesitate to Writ"t Us-
Ragpoot" submitted,
14 G. RX-A
Da W. spencer, K P.G., RZA. 604
prirx�
U]
Re&Wmd Site Aft"W/Utenseti UST SUPWASOT ICE
Stm Caff"fion #947458636
LIOMM 604 (wadtington)
License: 11464 (OM-)
Licam: 876 (Caftmia)
1 5195 (Tiliroois)
14oaae: 0327 (Mi"Usippi)
ZNWjR0JVMNTAL ASSOCIAIM, J2VC-
FEB-21-20M FRI titSOM 10%
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FI& e4UIFDffWAL ASSOCIATES IW- MME NO, 1 425 4SS 2316
WDCM-R,&b=vd Site Amc&W
Dm W. speam P.O., ILEA
Ra&ered Site Anmw/Lkmed Ugr SW—i—
Sta Cgrdfladw #94745W6
604 (W=bWpn)
11464 (ores-)
Limw. 976 (witomil)
licema: 519S wilgois)
Liamm 0327 (mimwppl)
Rdwwce Job Nondiar. JN 22045-1
FEB-M-aM FRI II-SIAM Mt
Feb. 21 2W3 11:57AM F4
Oet*w 9,2002
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FINAL PROJECT -APPROVAL FORM
TO: —
DATE:
WMO TO: pERNff COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTIYMNT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE-
----- aa�_
U'S 7
PROJECT
srrE.ADDREss CIL !I
PERmrr #--2j2C—L--lYa—'i2,—ADB#-------PATE INSPECTED__q_—_2_L_
DESCRIPTION OF WORK TO BE INSPECTED_C_L�_�����
A field inspection was conducted to determine final compliance with approved Plans- Final approval
denotes that there are no objections from the above signed Department to the release of
PER RMANCE BONDS and the granting of:
-GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
/),—Copy of CONDITIONS given to owner/contractor by inspector
r
S S61(— (0
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contrartor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAf'---'-'--
Date— Sign�
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1 11 FINAL P JECT APPROVAL FORM
TO: -
DATE:
MEMO TO: PERMIT COORDINATOR, 13ULD'NG DIVISION
FROM: 1_1�� 6 --' FIRE DEPARTMENT DATE__�:�— �"
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT
S]TE ADDRESS-
PERmrr#-------------ADB#________--PATEINSPECTEE'-
DESCRIPTION OF WORK TO BE INSPECTED_L),S
ai compliance with approved plans. FWalaPPrOval
A field inspection was conducted to determine fin
ove signed Department to the release of
denotes that there are no objections from the ab
pERFORMAN IE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDMONs given to o—er/contractor by inspector
I
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date_. Sign,
ocaprvi.doc.l:tuV:bldg:forrnslOIOI
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
q
Fooling......................
wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping ..........
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........... ............
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation ..........
Wall Insulation ...........
Calling insutaion
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
..................
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DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
M.ER
CONSTRUCTION PERMIT APPLICATION
JOB S ITEJAPTO
ADDRESS
OWNER NAMEMAME 01 BUSH
r:�PnO_ ;;��-,D-
PLAT NAME;SUBOIVISION NO,
LOT NO,
LIDNO,
LID FEE S
MAILINGADD ESS
Ow ZAYlb)d -w nc- c-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
00
CITY ZIP
ONE
EXISTING — PROPOSED—
0
R�PkW 0
A—— 0
IT11EP
REQUIRED DEDICATION— FT
PRv REQUIRED
NAME
YES E3 NO 0 IF
ADDRESS
REMARKS
RESPONSIBLE FOR EROSION CONTROLIDRA1NAGE
A Alto blN�
2WNEWCONTgACTOR
CITY ZIP
cv mo'J63; lkno
ITILIPHON1
qL-f- _n r- 0&7.q
alor- IAAPqHAI
ADDRESS
400
CITY ZIP
TELlPIIOI,IE
STATE LICENSE NUMBER EXPIRATION D
cm
,�.TE'd
P -cl
PROPER�TAXACC UNT FIC ELNO.
0 NEW RESIDENTIAL C] PLUMBINGIMECH
C] �DDITION COMMERCIAL 0 MPLIANCE R
CHANGE OF USE
REMODEL APARTMENT n SIGN
F NCE
C] REPAIR C X FT)
0 DEMOLISH OTHER
TA
Fi GARAGE AEN:ININ.
-1_ CARPORT F.�XFRY WALL RENEWAL
ITYP E OF USE. BUSINESS OR ACTIVITYJ.E�JPILAM:
WORK TO BE DONE
ENG"EM'NK FILL, REMOVAL, UI`T%mr-
FIRE REVIEWED BY DATE
VARIANCE OR CU S ELINE OR ADBN INSPEC71 N I PIOND
REO'D OSTEC
0 YES MNO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWE PROPOSED
EXP I — I I
LOT COVERAGE REOUIRED SETBACKS (F't) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAP. FRONT L/RSIDE FEAR
PARKING LOTAREA jFlN.IN.FGV7�EOBY DATE
RED D I PROVIDED I
CIECKID5Y ITYP
TPECIAL INSPECTOi
REQUIRED E] YES
REMARKS
PROGRESS INS
FEE
PLAN CHECK FEE
P LA H E
WYZING %
'4
T
LOT E %
L 0 0 E
I WWI
4
G
BUILDING
B U I L N
t
_P�N CRtCK NO:
0 A
D
IVEITED DATE
E E
N
PLUMBING
'L U B I G
CA
MECHANICAL
M E A
C NICK '
I IT Co VE W To
THIS PERMIT AU"ORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ON T FU
HE
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU LIC
GRADINGIFILL
RAD NG'F
I "L
C., WILL RE.
2� DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQ?jiRE
SEFARATE PERMISSION.
CHARGE
B.1pt 9URCHARGE
jEE
PERMIT APPLICATI N: 100 DAYS
, B
ENG. REVIEW FEES
E G F
N EV' W E
AY
I. I.. . S
- PEIRMITUMIT. I YEAR- PROVIDEDWORK ISSTARTEDWITHIN I&ODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'GNS AN. SU.-ESO-S
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
N. IN SPECTH`N FEE
'R.LEES '-E CITY OF
12� IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
LANDSCAPING
G ENTS FROM ANY AN.
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
INSPECTION FEE
INSPECTION FEE
RECTLY OR 'N.I..CTLY
ALLCLAIMS FOR DAMAGESOFWHATEVER "TURE,ARISINGDIRECTLYORINDIRECTLV
PE RMIT BHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Y CITY GR.'NA
IF T FY NYCITY
DEEMED OMODIW�Y�TAHIVECO O.U'CE ANY REQUIREMENT OF ORDINANCE
0 E E 7 0 MODIFY
E
PLAN CHECK DEPOSIT
PLAN CHECK DEPOSIT
NORLIMITINANY E FSEA LITYTO ENFORCE ANYORDINANCE PROVISION.*
N ORL I 0 IT IN ANY W A
TOTAL AMOUNT DUE
IHERESYACKN G ET T�A EHR�OA G T .1... Al PTL 1�.EATIUL�y. THAT I E I N FO A MATI 0 N
GO
D
GIVEN IS NO T" A AUTHORIZED AGENT OF
COP H�. NE OR
S Co R
I Y I I
THE OWNER. I E TOC P I ITY AND STATE LAWS REGULATING CONSTRUC
TION. AND IN 0 HEW H ALI &HI ED THEREBY. NO PERSON WILL BE DYED
0 G U
CALL
LEMA
IN V'OLATIO 0 T B 0 THE STATE OF WASHINGTON RE ATING TO
IN VIC . T
FOR INSPECTI(
WORKMEN S 0..
[T
SIGNKrt%E
4NLA
(425)
771-0220
A TENT
EXT 1333
W 0
TIS U USE OR OCCUPY A BUILDING OR 6TRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
TION CCUFANT,
OROU
PANT
LOAD
OCC
ER UBC I OaFFINAL INSPECTION REO'D 'S
Ll
VALUATION FEE
:EIP
APPLICATION APPROVAL
.�"_g Off'_1 D.pu,y:
OFFICIALS SIONATUPIE OATq
PINK. OWNER GO—AISE"OR
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