20020173.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUS11 EBB
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MAILING BORES$
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NUMBER -6) -1
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ADDRESS ST,
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REMARKS
WNERICONTRACTOR RESPONSIBLE FOR EROSION COI±NTROUDR�AINAGE
NAME
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ENGINEE81e, REVIEW
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FIRE REVIEWED BY DATE
FIRE REV`
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PROPERTY TAX ACCOU RCEL NO.
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NEW RESIDENTIAL 'Q4LUMBING MECH
LOT C,
LOT COVERAGE
ALLOWED 'R7
REQUIRED SET13ACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT R SIDE REAR
, , HANGE OF USE
ADDITION COMMERCIAL o COMPLIANCE OR
A. L.G JOIOTSLR51AJ�FZ�NINING
REDD I PROVIDED
�REVIEWED �Ry �IbATEtt
0 REMODEL 0 APARTMENT 0 SIGN
NICE
0 REPAIR cyos 0 IS_ X F11
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=� 6012- AA/
DEMOLISH TANK 0 OTHER
Aee_�;air r>vvEz_"^J,,�- "IVI-r-
��-A.G. 0 RETAINING WALL
ARP FIT ROCKERY E] RENEWAL
ITYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
I!:
*7R-1M,&v-y 0;6lotgri-
CHECKED BY
TYP OF 132�&ON
JC61_�_
OCCUPA
-GROUP
NUMBER
OF
STORIES
NUMBER OF
G WELLING
UNITS
I N
CA,
T' . L 412'0'
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LIM EN
8 nr.-LE�DN.P.CTOR
R'E. RIED
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JAIMEANIMMf
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
R
PROGRESS INSPECTIONS PER UBC 101)/FINAL INSPECTION III
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Description
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FEE
Description
FEE
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Plan Check
P IT
HEAT SOURCE 11 L1jg1
Bulding
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VESTED DATE
PLAN CHECK NOf-p
Plumbing
P m L I
0 j_y
.'is
Mechanical
ME
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THIS PERMIT JURIHOIUZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
.1K
t BEDONEON PRIVATE Is PERRY ONLY. ANY CONSTRUCTION ON THE
2
Grading
-r-d"'
Recording Fee
nPuBI
a
3 DOMAIN JCURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL Eau RE
SEPARATE PERMISSION.
Eng,
ngr. Review
City Surcharge
PE MITAPPUCATION: 180DAYS
PERAMI'LIMM I YEAR- PROVID D WORK IS STARTED WITHIN 180DAYS
Engr, Inspection
.ngr'
State Surcharge
f5o
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk Deposit
ON BEHALF OF HIS Oil 11111 SPOUSE, HEIRS ASSIGNS AND SUCCESQrfa
-C -
Traffic Mitigation
a
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
, AND
EDMONDS, WASHINGTON FFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IOTSF OHATEVER
R
Fire Review
' ""
Receipt #
,TLY
C
ALL CLAIMS FOR DAMAGEs W NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT $HALL NOT BE
Fire Inspection
Total Amount Due
DEEMED -to MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITYORDINA CF
I
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PR `
ov"'ON
Lwds�.p. In.p.
Receipt #
I ION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 0
THE OWNER. I ABBE TO COMPLY WITH CITY AND STATE LAWS REGULATING C TR
� I CALL
T
T application Is not, permit until signed
by Me
WILL BE
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL SE , P
Build"'11S
a, 11. hal.spell: a Ittestile
lace,tead
IN VI.LAT LAZO. CODE .1 THE STATE OF WASHINGTON FUEL—ATI.. TO
W..XaUN!;1 ATION INSURANCE AND ACW 18.27�
01�11 INSPECTION
ni�1.1�cicfl
pl I—Inal.1whdood In ap ...
plonid.d.
OFOCIALS SIGNATURE
DATE
SIGNA:MR
(425)
ZE� �
771-0220
a
BY
_ATTENTION
EXT 1333 ��
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE -'YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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Agency Case No. PUGET SOUND CLEAN AIR AGENCY Date Received
110 L'-o Street, Suite 500
Seartle.WA 98101-2038 RECEIVED
200103637 ..pscleanair.org DEC 2 8 2001
NOTICE OF INTENT
A. 3., No Asbestos Removal
Project Type: 1 1. 0 Asbestos Removal 2. Q Asbestos Removal & Demolition 'B�Demoliti.n.
Property Owner -'� 7lEr7J Phone: 7-C&
Mailing Address: �X- state U-A zi'l-ef-77
—1 Ciry
Asbestos tZilg PRW ClZi All, MS 11144 BE — Re �B' - =G " BE'
00
Owmer/CEO:
g"Uu'W
wriscm,
ddre
Phriva: t"
Job N o.:
A ss:
Cirv: State:
Ziu:
Fax:
D. Site
dress: 9
abwl0Aj r.�as- zio: qle�n'?o
Sill' S
mini.ger:
Local Phone:
E. tos Survey or
", I I
, " Preumed
0 mav, Presumed
No. of
Structures:
Date Asbestos Survey
was Conducted: 1 0
Was Friable Asbestos Identified? Jyes 4NO
Was Nonfriable Asbestos Identified? UYes )4NI�
LAsbe
a- requireaglFe. a-cawn ralsets
M t ctiu Glu", I 'P'O"A� AMA , A"_
- J
Anach a copy of the survey, if nonfriable asbestos is
identified or if no asbestos is identified on survey.
AHERA Building Inspector:
P us A�
A14J
.fic 9 -17 7 04
errificanion Nio.:
C Ce
Exv.
Date: FV��. Zw 1, 7-co
State: WA.
F. Demolition —7start
Information:
I Date: FE��- Ze;o 7-
No. of
Structive
I s:
Training Fire (List Fire Dept.)
2 Q Ordered Demolition (arta h fOrder)
a �71)!�15k
Demolition dermaluson contractor mailing adder, on back. Will nonfriable asbestos be left in place during demo? No
Contractor: el=- >,,�T
if yes, list type and qty.
I
G. Asbestos Project
Information:
Completion Date:
Th F Sa Su
Total Qtv. to be Remov d: Linear Ft.
quote t.
is U Yes.
0 No
Thermal System Insulation: I U13oiler\Fumaceftis. LJ Duct Ins. L.1 Pipe In&
Other.
Suribu; mg Fireproofing U Points Plaster Lj Textured Coatings
Other.
Misc. Matl I L.J Cement Bit. L.1 Cement Pipe LJ Friable Flooring or Roofing Mat'l
Other.
H. Asbestos/Demolition Project categories:
1. Single -Family Residence: (Check box A & B for asbestos removal & demolition)
A ' C3 Asbestos Removal Project
Project
Notification Period
A. Prior Notice
B. 10 Days
Proiect Fee Schedul
S 25 Non -Refundable
Fee Covers Asbestos
Removal & Demolition
-13-1WDerricifition
2. LJ All Other Demolitions With No Asbestos Removal Project
10 Days
$150 —
3. Ll 2:10 - 259 linear feet or z 48 - 159 square feet ofashestos (see back)
10 Days
$150 —
lineilr feet or 160 - 4,999 square feet of asbestos
10 Days
$300
�260999
0 �.qqq
I%
0
; Li 1,000 - 9.999 Imear feet or 5.000 - 49.999 square feet of asbestos
6. LJ > 10.000 linear teet or > )0,000 square feet of asbestos
10 Days
10 Days
S750
$2.00
-Entergenc m Proiect
Prior
I do hereby cemf� that the infirmation contained in this notificattim& supplement2i dam described herein is, to the best army
knowl.tig ccurate & co —pi re.
Sizm R-c"mmir
Agency Us,
1.gtt Sound C1... All Agency F.m No. 66-160 (R-sed 917100) AM
41
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Height Calculation Worksheet
Address: I 5LS
Date: (00-0—?
Inspector(s):
1. Datum Point: V�j
2. Datum Point Elevation: 13-7 -
O�
3. AverageGrade: 70
4. Maximum Elevation Allowed: (average 25'=Pt %)
ra
am
grade)+
a
m 0;
5. Reference Point Elevation Shot to House:
0,
C,
, t i
9--7-?7(datum elevation)+'?, G (grade to transit,level line shot to house)= 9'3 -'s
MT
6. Measurements from line shot onto house to roof ridge:
10-4
0 -n
mm,
09,
0
In
z
zi
Total S,(,(.,
m
7. Actual Elevation: ko(g, (reference voint elevation) (measurements
from #6)
Conclusion:
P(c`7,-4S (actual) is greater ij�,O to, -b (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
LATEMPSUILDINGNISOHeight Calculation Worksheet.doc
FINAL P
TO:
DATE:
MEMOTO: PERMIT COORDINAToiz, BUILDING DIVISION
FROM: FIRE DEPARTNIENT DATE—
(Ce. pq ERING DIVISION DATE
PLANNING DIVISION DATE
PROJE
SITE ADDRESS— axe. A).
PERMIT #-JOOA 0 (7 3 ADB#—DATEINSPECTED�—...
DESCRIPTION OF WORK TO BE INSPECTED-4E��....
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
RFORMANCE BONDS and the granting of:
tl�,GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
U Copy of CONDITIONS given to owner/contractor by inspector
1
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
I
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:temp:bldg:forzmlO/01
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .............
—0-2 U
Wall.......................... vIn S
-7 -,Di
z
Pier/Porch .................
Retainin Wall ...........
9
4
Slab Insulation ..........
PLUMBING:
M
Underground .............
ma
0
0
a
r
Rough -in ................
IT!
Commercial Final
ITI
lo
�HEATING:,
C
>
Gas Test ....................
Gas Piping ..........
V)
'03
.................
ITIEquipment
Commercial Final
00
I
EXTER OR SHEATHING vy\
C
NAILING ..........................
Q 0
FRAMING ............. ..........
FIRST FLOOR FRAMING
INSULATION
...................
Floor Insulation
z
Wall Insulation
z
0
Coiling Insulation
o3
0
M
SHEETROCK NAILING
SPECIAL INSPECTION
72 S,
MISCELLANEOUS
FINAL APPROVAL FOR
CO
OCCUPANCY ...............
'SIdeSewer#
$ 55;!1_ReCeIPt#.
A60ut Paid
Date Usued-4wax, xpires 41644,
J� 4,,,r)
+
L/
ipt
A
D aePurc% ns
ilow 0
Amount Paid Mpt if —
4:1 A0000,