20010918.pdfDATE RECEIVEJ
PERMIT EXPIRES
CITY OF EDMONDS
YS E PERMIT
ZONE NUMSER200/-109/8
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINEGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: IBD DAVIS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSI GNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
I CBMONDS. WASHINGTON� ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANY AND
INSPECTION FEE
ALLCLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING CIA _ -..' ..
TE�CEJPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 Y ORDINANCE
TO MODIFY. WAIVE OR REDUCE AMY REQUIREMENT FANYCIT
PROVISION�
�lDEEMED
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
�L 2—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T I"
THEO NER IAGREETOCOMPLYWITHCI Y AND STATE LAWS REGULATING CONSTAUC-
PERSON WILL BE
CALL
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IoN.AwNDIIND ING THE WORK AUTHORIZED THEREBY. NO LEMPLOYED
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STATE OF WASHINGTON RE ATING 0
FOR INSPECTION
IN VI OLAT ON OF THE LABOR CODE OF THE
WORKMEN 5 C��SATION INSURANCE AND RCW ill,27,
OFF S S GNATURE DA
A A I
SIGNATUAE(!�
(425)
4,51
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TAT
'AELEASLDty DATE
ATTENTION
EXT 1333
IT IS UNLAWFU.TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPE16TION MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YELLOW - INSPECTOR
HAS BEEN
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD -ASSESSOR
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PARTNER'S CONST INC Fax:206-852-7936 Sep 25 '01 6:59 P.01
Micy Case No. CLEAN AIR AG Date
110 Union Sam suite 500
Scalia. WA " 101-2035
4UO103031 ='www.p6dVMff-or9 2001
A,y U. 0.1y NOTICE OF INTE
ion 3. M Dessolfflor
A. PIroi �I-As�bgl-
D. site I I;_- FAmmids I zi, 980
M.r—er, noon Anders"
L Asbe" Set or No of Dam Asbestos
Asbestos idendfied7 Inyes L-J r4o
Wait Friable 0 Asbestos Identified? CKyes []No
was Nonffmbl
Mat'l prouto StruciVrea: Was Condqaw, 7-30-1
&W besmis
Leh a ropy ofthe SUINW, ifnGnfii eas
dettitified or ifw asbestos is ulentified on YAMY.
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AHERA Budding Insipector: VakeBastanemrY
Cwff"fion No.: 546401589.03
F= Djt-- 12-&l
1 State: WA
—T)—R
F`
Training Fire WIM Tim DeP,t.)
E��;Y
F. SV
of0fd
co aler
Ordered Demolition Ch copy rider
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motion: 10-12 1 No
DemooUtle"s D 0 nonfhable asbestos be left, in plact: during 4CM0( LJ Yes 2g No
lmon Wf
If rM
wyr
Conaactor. NorWcs Construction M I- type and qty
rk Days: w F Sa Su
G. Asbegion PrOJwt jrs� 9-4
Information: Start Dat 10-9-1 C letion Date: 10-11-1
Will an ftiable asbestos Yes
TOW . to be Removed: Linw Ft. e, Ft. maiefiah be removed? No
S Inadation: BodeFumue his, Dwt Ins. Pi IM
,
OLber.
Sufacing Mat'l! F, pw" Matter, T=UWW
Otbw.
MISC. Mat'l COMCM ed cclagut Frisbk Flooring M matl
Otb-.
Nofflo a ?Mj Fee Schedgle
H .
ori-Refimdable
I e-Faindy Residence: (Chock box A & B for asbestos d
<�D4- Nodee overs Asbeslos
Asbestos Removal Project
CB.AODays Removal & Demofitio
Dewlition 'ect
All Otha Dernofitioris With No Asbestos Removal PMCCI
IV USYS 3IL50
-159 fect ofasbestos see buk
10D _S150
S300
260 999 tiow fort or 160 - 4 909 fect ofasbestos
inn. ,
rin. . $750
I OOD -9qqqlinw&dor5Ann-fQQw —fadcUsbeat"s
S2,000
in Tl� . S
nria feet of&sbertris
> lo,ODO linear few of > 50 nw
Prior Nod T�i= Project Pee
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Partners Constn&L
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PPRTNER'S CGNST INC Fax:206-852-7936 Sep 25 '01 7:00 P.02
The Puget Sound Clem Air Agency requires advance notification before any person commences 1176ii1blo-asbcst0s Project
involving materials equal to or greater in size than 10 linew feet or 48 square fed and for all demolition projects
(regardless ofasbestos content) involving structures with a projected roof area greater that 120 square few (Regulation ILL
Article 4). All asbestos removal and demolition notifications nut3t be sebmitted to the Agency on current Agency forms.
The Agency notification form must be used to submit a notification for an asbestos project, a combined asbestos and
demolition project and a demolition project where no asbestos removal is required prior to demolition After receiving a
complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and
demolition contractor by mail. The returned copywilli be your validated notification
47�
Contractor f� 0 lK S C120 S:t4.j r 7 ,)a 0--/CEI):
Contracuir's
Mailing Address; 17-3 �-b ALle I\J. Phons; Job$:
City: "ityl one( � S.: ujt-j- I ZiEl 7 3,o Z L-> Fax: L4 z 7 !;S- & C.W3 oo
GUIDELINES FOR SUSMIMNG AN ASSESTOSOEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A.
Step 2. Enter property owner information in Box B.
Step 3, Enter the asbestos contractor or prop" owner information, if the property owner is conducting a singla-flunily residential
project, in Box C. Print clearly this is your return maiiing label.
Step 4. Enter the site address for all notifications in Buz D. For multi -structure projects, attach supplemental L40M With A Site MP
(include an address for each site) and a list ofthe ripe and amount offiriable asbestos to be removed from each structure
Step S. Check either asbestos survey or material presumed in Box E. Ali demolition$ require thin an Asbestos Haziud Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy ofilic suNcy results t
We asbestos is no 'Ibegio, was idClitified giijtbc
survey.
Step 6. Enter the project information in Box F. and check the trainnig fire or ordered demolition (a copy of the official order must be
attached) if appropriate. All asbestos must be removed prior to conducting a training fire. Additional tinsining fire requirements are
contained in Regulation 1. Section 9.08 If arty tionfriable asbestos materials will be left in place during demolition. check yes and list
the type and quantity ofmaterial.
Step 7. Enter asbestos project information in Box G.
Step 8. For Single -Family Residential projjecta� check BOX HIA for renovation projects, BOX HIB for demolition projects ith no
asbestos removal and BOX HIA and HIS for asbestos removal and demolition projects. The total project fee for single-fiarnily
residential projects is $25 regardless of category or categories chosen. Asbestos removal may be conducted afler I complete
notification is racv.ved, but demolition activities can only begin an the I& day after the notification is received
For Commercial asbestos pmjects, check the project Category H2 - 6 that catches the amount of firiable asbestos that will be
removed. The project category roe includes both asbestos removal and demolition, To file for an emergency asbestos or deirwUtion
project. check the appropriate box I - 6 and the applicable emergency box in H7. All emergency reguests must be acrompan4cd by a
letter from the prop= owner demitinstradna the need to wriduck the 2ro*ect immedirtely in z"ordarice with the MULDC1111100
Regulation HL Section 4 03 (c)
Step 9. Pluse, cmify the accuracy and completeness ofthe information provided by signing the notification in Box 1.
.Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is paxticiPating in
the Agency work schedule fax program. A fifty -dollar processing fee is required for all other amendments.
Puget Sound Clean Air Agency a3bettos regulations and firms can downloaded from the Agency web page at www.pscleaniur.org,
For technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689-4090.
PSAKA(.�No 6f.160(R—d9nM)A)A
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing......................
wait .................. .
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... . . .
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
6�s piping .................
Equipment ................
Commercial Final
EXTERIOR SHEATHING
NAILING .................
FOAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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PERMIT EXPIRES
F__
CITY OF EDIVIONOS
USE PERMIT
ZONE NUMBER 200/-017j,8
JOB TVAPT,
CONSTRUCTION PERMIT APPLICATION
ADDRESS SIX
IOWN I ERIA�,ENAMEOF;BU71NE S 16 jW
P�T NAMEISUSDIVISION No. I LOT NO,
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
It
GRAoiNG,rILL
PERMIT APPLICATION: 180DAYS
lo,
PERMIT UMIT-. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END. REVIEW FEES
'APPLICANT, ON BEHALF F HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
�LII�SPECTION I
;� _
IN INTEREST, AGREES TO:NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAM�
1 ALLCILARVISFOR AMAGESOFWHATEVER NATURE. ARISING DIRECTLYOR INDIRECTL
ANOE SSUANCE OF THIS PERMIT SHALL NOT 8
FROM THE ISSUO OF THIS PERMIT I �E
9 DEEMEOTO MODIFY. WAIVE OR REDUCE AN, REQUIREMENT OF ANYCITY OAOINANC
0 NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANYORDINANCE PROVISION
LAN SCA1iNG
INSPECTION FEE
RECEIPT
PIN CHE D O!ST
RECEIPT
TOTAL AMOUNT DUE
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. JAG REETOC WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORKPLAYUTH RIZEO THEREBY. NO PERSON OLLSE EMPLOYED
IN VIOLATION OF THE LABOR CODEOOF THE STATE OF WASHINGTON RELATING TO
WOSKMEWS CgMWNSA ION INSURANCE AND RCW 18.27.
P A72,f�C DATESIGNEDt/ 0/1
CALL
FOR INSPECTION
1
(425)
771-0220
APPLICATION APPROVAL'
Th,, pp o �oj . p.-it uMd.ign.d t,y 11.
BuIdo,, ON,.., ., hioJN., C.p.ty: ..d F.o. .. P.,d. . �d
Pl 1, ,k ... lodged I, p Il-ded.
OFIIC;IALS SIGNATURE � OAT
1,?.i 7ge�ql
RELEX*AY DATE
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS 13EEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
EXT 1333
771-0221
FAX
----------------
ORIGINAL - FILE - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
5198