20020798.pdfDATE RECEIVED
CITY OF EDMONDS Z;,EC PERMIT -6-
NUMBER 9poi—o] 19
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
71
ADDRESS —1
PR NAMEINAME OF BUSINESS
h-ocQ6, 14. el -I FLAT NAMEISUBDIVISION NO. LOT NO�
ING ADDRESS 1 LID ICC I
11 Pf),k 4 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ZIP EXISTING — PROPOSED __ 1 ft,,IIM 13
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FEES REMARKS
D- k/ IV I I "r) 19c. iij 6 0 NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLADF.tAINACIE
CITY ZIP I TELEPHO . IIE FIRE REVIEWED BY
DATE
CIAT.
STATE LICENSE NUMBER EXPIRATION
VAWANCEORCU
1HOREU11OAAD11 INSPECTION BOND
RE 'D POSTED
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REMARKS
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING
__ I I- I�FF
it �_ (:) Z
Building Permit
City Surcharge
PLAN CHECK NO: VISTID CIATI
Plumbing
M echanical
THIS PERNITTAUT"ORIMSONLYTHE ORK NOTED. THIS PERMIT COVERS WORK TO
t; BE DONE ON PRIVATE PROPERTIF ONLY. ANY CONSTRUCTION ON THE PUBLIC
a
Grading
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS MARQUEES. ETC.I WILL REQUIRE
SS
h SEPARATEPERMi 'ION.
—
PC MITAPPLICATION: INDAYS
Engr. Review
PERMIT LIMM I YEAR - PROVID D WORK IS STARTCD WITHIN NXIDAYS
Engr. Inspection
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC W. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARM EBB THE CITY OF
2 E MONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt N
ALL CLAIMS ED DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI ' ORDINANCE
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE NOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED
IN VIOLATI 0 LARO CODE OF THE STATE OF WASHINGTON RELATING TO
,n ofil"I" ""Dep'ly: a'd Foos are paid, and
B ""i 0 `hla
FOR INSPECTION lalpt 1, ack—ledg,d 1, spaeo pro,ided.
�OF AT-
WORKMEN' CPM ATION INSURANCE AND HOW 18 27�
�IGNATURE DATE
S NATURE OW R AGE
(425)
771-0220 -REAE" f
ATTENTIONI/
BY A*
Off 1333 /4yk Z,
L&
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-FILC YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASS SSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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'11/04/20e2 14: 55 2069321007 TANK 141SE PAGE 05
FRIF,6MAN & BRUYA, INC.
VIRONMEN TAL CHEMISTS
Date of Report; 10/29102
Date Received: 10/24/02
project: Khuong 7213 Balanger
Date Extracted: 10/24/02
Date Analyzed: 10124/02
RESULTS FROM THE ANALYSIS OF THF SOIL SAMPLE
FOR TOTAL PETROLEUM HYDROCARBONS AS DIESEL
F
USING METHOD NWTPH-Dx
Extended to include Motor Oil Range Compounds
Results Reported on a Dry Weight Basis
0
Results Reported as 419 (PPra)
Surrogate
'n
Sawqle 11) Diesel E (OA Reme
0 M,
M0
P
Laboratory ID (Limit 46-153)
-40
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Profile d 8,600 86
210203
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Method Blank <50 97
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d 11he sample was diluted,
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11/04/2002 14:55 .20693210@7 TANK WISE PAGE 06
Date ofRepol-t- 11101102
Date Received: 10131/02
i'l
Project: 7213 Ballanger
Date Extracted: 10181/02
Date Analmd. 11/01t02
RESULTS FROM THE ANALYSIS OF THE SOIL SAMPLES
FOR TOTAL pl:TROLEVU YJVDROCARBONS AS DIESEL
USING 7iIETHOD NWPII-Dz
Extended to Include Motor Oil Range Compounds*
Results Reported on a Dry Weight Basis
fiesults Reported as wg (ppro)
Rl"
Surrogate
'Vi V ;
$,arajok ID (% RNU=)
I M
Bottom Centtt 7No IVE <50 104
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No Wall IVE ICN 1,400 104
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so wau 2 107 150 101
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,� MATERIALS'
Northwest Division
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overett, WA
atoned
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P"kNol Unit AMOUNT
PRODUCT DESCRIPTION P'"
0—lity
Qvithilty
I
Q I � IP 291H
WEIGHT Tare Lb 5,55Vg
Net .15,960 Lb 7, V9 Kg
p -(ROLKIA CUNT. -301L CL.--3
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ORDER
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Al oehounle not paid Within 30 day. of leaven, Will bast thWeIrl
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.1liho ah, .110% par
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Not Ro3poh,joje I., R ... live Agglgalv or Color our,lity� NO
Cuirn All —ad Urii— Made a( Tnia Material I'
LOAD R CE"60 BY
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A $40.00 Service Charge and L093 Of !hr, Cash DiSCou', .1
0981875
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REPRINT
Northwest Division
WISE LLC
lYtil"Yk BAL.INSER Wily
EVEREIT, W41 9P20-3'
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Val AMOUNT
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11,700 Lb 5,307 Kg
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—40
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PMOLEUM CLINT. SOIL C.L.3
!3.14
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olo;� Allowo� Units% MO. .1 T- 1.
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0981913
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11/04/2002 14:55 2069321007
TANK WISE PAGE 02
WTINALS'
Northwest Division
F,
w ISE. LLI*.*
T" mchec
job MANGER WAY
EVERETT, 0 No Ime
?PN
Los,, p a,, A,6,* "I
02:06 PPI
lj
Z%
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pic"
VR l
AMOUNT
P,ft
5K
Load
Owtity
Taro
6 5,7
10 j�60 Lb %1Kg
-
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W TGH
met
1
1� jj.10 Lb 6, 613 Vg
4�
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TkOLFUM W GOIL CL...*,
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C a
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0
C
P 1.
C
m
m z
10
C
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F-
ORDES
TICKET
0
-n n
566-TOTAL TAX
TOTAL
I � 1
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n'11-1.1-11
mm
IncludinI) roo
0
0
roml.gsto pay ap coots,
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All A—UntS not pajodlhj� 30 day. ot d.11yerV WHI boot
N no,ponsible for n.ac.iivo4ggr=,,s lc�_101 Ity. NO
O,�Ajj_du�jso,.. Oao
Wi at TI..
LOAD nce.fio
A $40-00 S4— rhog..w Loss, 0 f th. Cash
0 9 8 1
11.1ad V A.I.—ol Ch..4,�
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COPY
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FINAL PROSLCT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: DEPARTmENT DATE—LO
Z--
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE —
PROJECT'
SITE ADDRESS--? z
PERmrr #-29,2-,�2-7 �ADB# —DATE INSPECTED-.��-�.
DESCRIPTION OF WORK TO BE INSPECTED--���V
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
PERFORMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
0-7-r)
GRANT PROJECT APPROVAL WrM CONDITIONS NOTED
o Copy of COMMONS given to owner/contmctor by inspector 0, f
64 �-d< (0*y,
FAILED FINAL INSPECTION - OUTSTANDING ISSUES CC,4"AV Eip
t3 Copy of CORRECTION NOTICE given to ownalcontractor by inspector
1. Y
2.
3.
RE-INspECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— sign—
omptvl.doc.l:t=V.bldg:formsIO/OI
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .................
FOUNDATION:
Footing ..............
Wall ............. ............
Pier/Porch .................
Retaining Wall ..........
Stab Insulation
PLUMBING:
Underground .............
ITI
C=
Rough -in ...................
IT,
Commercial Final
C
HEATING:
M
Gas Test ....................
-4
Gas Piping ................
Equipment .................
Commercial Final
M M
EXTERIOR SHEATHING
NAILING .............
0
FRAMING ....................
Q 0
FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................