20020600.pdfAft DATE RECEIVED 1
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PERMIT EXPIRES Ef
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CITY OF EDMONDS ZONE PERMIT Ij 1�)z
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CONSTRUCTION PERMIT APPLICATION JA00CRESS 7�v568 - e5'fk ft_ iA) SUITEIAPIT#
PLAT NAME/SUBDIVISION LOT NO. LID 1111,
ING ADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 3W1.1—sou
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EXISTINGO PR wmro 1.11.11=1 8
77y- REOUIREUVEDSVMET--Ta-REFCLEANr&D-ol,
MEIER W I DIAN t ffik ER V9LO&F ED 9& REQUIRED
F OPERTY Vff I YES 0 NO C3
FESS REMARKS
Enicallim AM&%W.**WM1 0001101CRENIRMOMM
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NWM—E- SEE I)I3,M0L1T!0.11 INIPE17ION
ENGINEER! C I., CA.,
Rr %ffMjTE
FOR INSPECTION QUffi
ADDRESS
0, 60x 3 q_V Ca
FIRE REVIEWE By DATE
CITY ZIP TELEPHON
C-61410A(b %02,0 02-51'77�-'3161'
'P' T`7
STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADN# :1N ONO BOND
a.. D POSTED
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LOAR=/sun2�z I Let
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SEPA REVIEW SIGN AREA HEIGHT
PARCEL — COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
7WACCOUNT
&.- 02,7- 0 00 m�_ I I
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NEW RESIDENTIAL PLUMBING I LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
MECH ALLOWED PROPOSED FRONT SIDE BEAR FRONT 1JR BIDE -'REAR
0 ADDITION COMMERCIAL COMPUA CE OR
[:1 CHANGE OF USE PARKING LOT AREA LANNING REVIEWED ST DATE
EMODEL 0 APARTMENT [I SIGN PROVIDED
REPAIR GRADING CYOS o F NCE
X Fri REMARKS
0 DEMOLISH [3 TANK o OTHER
GARAGE o RETAINING WALL
CA PORT ROOKERY RENEWAL
fTYPyj;; BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF
OF DWELLING NSPECTOR OCCUPANT
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STORIES 7Z- )r JARFA
YES LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
L, I S 4 19�)C I ST/ A_�11—
I VALUATION
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PLANCHECKNO:
TID DATE
Plumbing
Mechanical
t:
THIS PERMIT AUT140RUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
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8 DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
DOMAIN (CURBS, WAYS, MARQUEES, ETC.� WILLREQUIRE
SIDEWALKS, DRIVE To I WILL m.
SEPARATEPERMISSION.
Engr. Review
City Surcharge
PERMITAPPLICATI N: 180DAYS
... .. ...
PERMIT LMAIR I YEAR PROVIDED WORK 18 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
ON BEHALF OF HIS 01 HER SPOUSE. H1111. ASSIGNS AND IUCC11011
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMUE S THE CITY OF
111101111, WASHINGTON, III OFFICIALS, EMPLOYEES, MID AGENTS FROM ANY Alto
Fire Review
Receipt #
ALL CLAIMS FOR OMAAGES OF WHATEVER NATURE, ARISING DIRECnY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFV: WAIVE OR R50UCE ANY REQUIREMENT OF ANY CITY
Fire inspection
Total Amount Due
ORDINANCE
NOR LIMIT IN ANY WAY THE CRTYS ABILITYTO ENFORCE ANY ORDINANCE P OWSION.'
Landscapainsp.
Receipt
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
THE OWNER. I AGREE TO Co PLY WITH CITY AND STATE LAWS REGULATING CONMUC,
CALL
Knori Is no' 11
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE USDA CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS CPPS�SATION INSURANCE AND now 18.27.
FOR INSPECTION
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ding Offic'.1 nh "' D`P`XY: .0
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SIGZI,,E NEI I IIEY� 4
'DATE 11,NED
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OFFICIALS SIGNAT
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1,13 u L�z,
10
771-0220
-RELEASED BY
ATTENTION I I
E)(T 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNIIL
771-02-21
1
A FINAL INSPEM ION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW-INSPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK � OWNER GOLD - ASSESSOR
10/01
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PRRTNER'S CQN$T INC Faxi206-852-?936 Jut '3 'U" Utz ' �U r'. Ul
5f6FUE—AN Date -Rocowed
—PU—G�T 961, kM AGENCY
Mency case 1110.
I 10 Vow. swat, sui- 500
........ Swd,, Wk 99 i0l .2039 P S. I p 0 0 2]
200202337 wwwrawrWy-ors
NOT[CF OF 114TWT
jg""y Ilse 0.1y
A 3. Demolition, No Asbestos Removal
C� Develop.Lent Phone 425 7-14-3181
AsbesW Owner/CEO- DAniel R MurrAY
Contractor:, _!�*-rt�ers Construction, Inc. 4,OrRrMCZOT
1313 Ceiltral Ave South I Suite A Phone: 2D6-575-7429 Job No.,
enA tate: WA Zio; 0802.140 �fax. 2S&992-7936 21,15
Site Ci Edmonds I'L21— 980,
Site
I I LOW Phone, 425 774-319)
Rick Klemm
E.. Ash" os Survey or
No. of Ditte Asbestos Survey
Was Friable AJ)eV CIS Ideirtified? WY" I I No
M10 Pr-Uumed
Structures: 2 was Conducted: 6rt?A)�
ws Noniiiable Asbestos Identified? LJYes 0 No
Attach I copy of the stavey, if nonfiriAble asbems is
� /—pca
A1,00,AAWIdingl F� ArL H. Schadder
Wcatificd or if no Hubcatos is identified On wrvey.
Ceyttlicstion NO: CLAY5327
h Date: WWII?
I Rr.w WA
No. of I ral' ru Fire (List Fire DqA.)
Stru 5 1 2 Ordered Demolition (attach coiry ofOrd
VAte:7/Z3/02
Umb-t Wilt Mliableasb osbelaft" dun'1tgd=O?Lj Yes Z
Contractor: cajun Fixcavating Ifyca, list We -d qty.
ork I S. Su
los Project
lefortaxtian; Stut Date: 7127JO: Cortoledon Date: 7131102 Hours: 8-4
Will all ftiAble asbestos X Yes
7c.tal .10 Ov Ft.
S so -, TV '1cffurnace; 1%. jyk& Pipe ties,
S cing MAtT I Virop M Met$ Plastar Textured Coatings CAINO�
cut ce,"tPip.
00.:
ResideAcc- (Check box A & B for asbonos removal demolition)
$,.25 =NQn4(vfund&blv
Removal Project
go"
A. Asbestos
vs
�.15,
s Asbestos
Fee Covers
RQMOVAJ & Ditmoli
R movet
I Demolition Prow
B 1, § ___.OL_
.
Oli'l Ail Proiect
Ali 0 Les o Arth No Asbestos Rtmov
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5'! z 10 �L91 �-f-- or ?. 48 - 159 squarefibet of be to3 si�gback)
5 car g� _
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—47 26o - Q- tin"r hent or 160 -
0 Da](s
5. Tl 1-06C
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1013
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Tvica roim Fee I
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F,PRTNER'S CONS, I INC Fax:205-852-79,, jul 9 'U2
tic Puget Sound Clean Air Aguncy requires 4dvarice notafication birfiore any person commences a ffiable asbestos project
in,cl�tnjt materials equal to or greater in size than 10 linear feet or 48 squart feet and for all clemotitlop prc�le�ns
rrwdjtss or asbestos �;cinteru involyme suiscnires�th a projected roof area grcater tha,i Wscluaief=(Kc�ulaucrr 111.
-�rijcic 4) All asbcsios removal and demolition nonificalsons must be Zubmitic4 to the Agency on current Agcnc� terms
A',besl ,; r ov-1 _h rW
cation ths�eh - 1
�9�
'6=41
is a cQmlaxned asbestos —0
n�y nottri"tion form m%xv be wed to submit a notification for an "b stos Project.
dcrno:ition project and a i1cinolmon project where no asbestos removal is recuired prior to demolition Attar itcciNiris a
i:wnp;ete notifcation �ah the appropriate project fee, the Agency will review the farm and return a copy to the asbestos and
Qor.v:it),jn *.��rrzraclor by mail, I -he returned col7y will be youe validated nolijication.
dccs'; Phort
Stott Fox!
GUIDELINES FOR SUBMI71ING AN ASSESTOSMEMOLMON NOTIFICATION
Siep 1, cjcci, tre, appropriate project type in box A,
�tojs 2. Ero�r liropert�,�wncr information in Box 8�
Step 3. Enivr the asbestos contracior or ptoperry owner infortmation, if ilse property uwisQr conducting a sirL;de-farmly
Print clearly this is your rat urn mailing labe!
.,tev 4 F.riar the s;te adorcss for all noinicItions in 8�01 1) For mulo-st,ticrure prcilgigs, tittech supplements; shm w,11i a site nsp
,n�wdt an address for each sit*) and & list ofthetyp4 and amount offiriableasbestos to be removed*om each structure
Step 5. Check either asbestos survey or material presumed in DOI X. All.dericiltions require that an Asbestos MuAfd EmciscncY
e�e� en-,�.e kCt (AFXRA) asbestos survey be conducted by & cemilied AHEPLA building Inspecror-694i;hl—c-011
h n the
wtrj_Zftid1, asbestos
�('p 6 vm,tr 'he Project itift'retation in Box F. and check the trisiping fire or ordered demolition (a COPY Of the Official order mu;i 0�
is 4 a
attached) if appropriate All asbestos must be removed prior to conducting a training fire Additional triuning 6ra rcqui, 0 r
ack yes and 1,3t
Rewulcion 1. $=ion 8 08 ll'iury noriftiable asbestos materials will bit lefl in place during demolition, an
let !vpe an� �-J&nwy of mirenal
Step -.. Enter 4sriows t)ro)ei;l ;nJormitoon it) Box G
Slat, ii. p,), Sjnilla�Frsmily Residenlisil projects: check BOX HIA ror renovation projects, BOX HIB for ciftnOtitiOn Project, "I'll no
I project fee for
ZibesTo, emo�al and BOX HIA and FOR for asbestos romQ4 and dessioJition projects. The (oil it I
�,,icerriaj pro)ecis is S25 rqardless of Category or categories choscrr. Asbestos removal may be conducted a at a a
,iitaiton $5 race,,1. but demviitioll act,yitres mar% only begin on the ii)" day After ilia notifi-tion is received
1'�)r Comeler,ml Asbestos projtcw check the projecl category M - 6 riat matches the ainuunt of triable asbestos Inat I'll bt
ec� The project category fee includes both asbestos removal and demolition. To file for an emergency asbestos or demobtion
he applicable emergency box in H7
11, ('Tct check the appropriate box I - 6 and t
e immediate
;'eug-' =—Tht 0
meness of the inforynadron provided by sigking the notsficanon in Box I
�,q 9, please certif, tne accuracy and comple
v all1comclits jo the notirlealion art required lot changes that increase the project category, change the types of a5vevus
ni�tensjs to ite rerri.,edl and work schedule changes, No fee is required for work schedule changes if the contractor is In
.�atn,:� vork icnedvlt hx program. A I'lliy-d011tir Processing tat is required for all otrict amendments
�Ije,t c—nd (*".,, Av Agency asbestos regulations and forms cAn downloaded (rom the Agency wett Page at u� P $c 1 t4 dIr rg
d'Mslahce cInt'01 OW 689-4oss and for admiristranve inqutric:i corta4i (200) 639,409,�
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waste Gane'Oted �ite NoMeOncl Acid -77
s Name: �5—�ner
3 TF6no No,
LOwner
2 Operotofs NOMe Ono Address opislotors Phone No.:
'7
waste 61soosorme MO$) Nome, Address. Ono vnysiCqI Site LOCOtIon: WoPnbre No�;
RABANCO REGIONAL LANDFILL I-eM-927-5641
500 Roosevelt Grade Rd.
Roosevelt, WA 99366
PSAPCA
I 10 tjnIon Street
Ssiot!W WA 98101
—7, of waste Matenols: 6, Containers oral WuO MY
N. [Yorr (Yd)
I
AsOestos Containing Moterials
DOUBLE BAGGED & LABELED
9 OPERATOR'S awrIFICATION: I riereby declare that the contents of this consignment are fully and accurately described
above by proper shipping name and Ore Classified. pocked, marked and labeled, and ore. In all respects In proper
con4jition for transport by highway according to applicable international and government regulations.
RintidiTypeel Nome
Signotuf67
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Y
V;�
10, To,�sport6i)��cvnowledgrn�n!_Of ocelot of Materials
Rl'itecl/Tv N.m e
Signature Month Day
170or
11, Transporter 2 of, Receipt 017�a
torials
intoO/TypoOl Nome
R RQbanco Train for Signature --Fm`-T-5zT""'
2733 3rd Ave� r
Seattle, WA 20 - 16-2565
12, Chscirrooncy
111asto D:nPC`oC%0at)10RRL`C0C"
Zirmozed Waste Disoosai site owner at Operatoi: Ceffificotion of tocetol of asbestos materials Covered by this manifest
!
except as noted ir, item 1-2
Pr,rij.djTyped Nome month 06TT—Y
MITE 10 0-1.101
YELLOW: Waste Sit. PINK: T—so.09,
WHITE� Oowoto,
4
PRUNER'S c6NST RIC Fax': 2106-852-7936 rl't7i 2 '," 5:10 1 P. 01
AVE, SUIIE A
131 � SourH CCN7RAL
X��-r WASHING rON 61
5. 9 PAX (20) 662-7936
57 742
(2,06)
Bill
LICEN SE pARTNC1065NU AS86' 1 05 LICENSE # 1172 EMAIL: POHnOTSCIII
ASBESTOSASATEMENr ASBESTOS mANAGEM9NT GENERAL coNTRAC70R
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'rest Development
North C
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P.O. box 340
Edmonds, WA 98020
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Rick:
-11
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()Ur (,ompany has reMOVI ad all Asbestos referred to by Asbesto-Test, in the su rvey done
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on June 17, 2002 from the site of 20508 Ile Place West in Edmom WA, This has been
do, ie in accordance with all current Labor & Indust ry and PSCAA Rules, Should you find any
material during the dem olition phase of your project, please call us 8 nd we will come
,Llspect
ASAP to remove it.
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Cali me with any questions you may have and thank you for allowing us to be 0 f service
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Carl Dykstra, manager
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DAT
T4. L46 EW-1— DIVISION DATE...-
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P G DIVISION DATE —
PROJECT
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PERMIT #-AQ-022L �O& 00�ADB#_____---PATF INSPEC
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DESCRIPTION OF WORK TO BE INSPEC
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from, the above signed Depa ment to the release of
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P_ERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
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u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTS TANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3-
RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date_ Sign_
ocaprvl.doc.l:tenip:bldg:fonmIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ................
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 ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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