20030216.pdfPERMIT EXPIRES
CITY OF EDMONDS
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PERMIT e-7
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CONSTRUCTION PERMIT APPpCATION
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Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit R �d
CITY PHONE
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EXISTING — PROPOSED Inspectio" Required
Sidewalk Required
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REQUIRED DEDICATION—
FT Urlderground
w gr
w 13
NAME
METER SIZE LINE SIZE
NO. OF FIXTURES PRV REQUIRED
YES E3 NO 13 3
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ADDRESS
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ONE
NAME CBL
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ENGINEERING REVIEWED BY
DATE
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FIRE REVIEWED BY
DATE W
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CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE
REO'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED �ALLOWED PROPOSED
+
EXP ,
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NEW RESIDENTIAL __—MBING40
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION Iff—COMMERCIAL 0 CHANGE OF USE
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PARKING LOT AREA I FIANNING REVIEWED. BY
REOD I PROVIDED
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GRADING X
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REMARKS
DEMDLISH TANK 0 OTHER
GARAGE [3 FIETAJNINGWALL FIRE SPRINKLER
CARPORT ROCKERY 0 FIRE ALARM
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(TYPE OF USE. BUSINESS EXPLAIN'
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CHECKED BY ITYP:j=
OCCUPANT
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTIOR AREA OCCUPANT
STORIES UNITS NUMBER
REQUIRED [3
LOAD
DESCRIBE WORK TO BE DOME
REMARKS
PROGRESS INSPECTIONS PER USIC IGO/FINAL INSPECTION REG'D
VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
T
Building Permit
City Surcharge
PLAN CHECAPJ% VESTED DATE
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Plumbing
Mechanical x
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLX AM CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS. UARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t:
Engr. Review
I PERMIT APPUCATION: 180 DAYS
106 PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WIT141H 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
12 -APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
Landscape Insp.
Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Receipt #
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Buildino Oftial or histher Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
IN VIOLATION OF THE LA V t&0D*1E
WORKMENS COMPENSAgN I E AND RCW 18.27.
OFFICIALS SIGNATURE ATE
SIGNA� DATE SIGNE __
(425)
771-0220
DAtE
RELEASED BY
A'17TENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINA— FIL - YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK-U GOLD -ASSESSOR
GREEN - ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
Ai,
Letter orTransmittal
February 7, 2003 Washington State Department 4
kjHealth
Construction Review Services
2725 Harrison Ave. NW Suite 500
PO Box 47852
Olympia, Washington 98504-7852
JEANNINE GRAF r-zr=.cEivFr5 ww.doh.wa.gov/crs
CITY OF EDMONDS
121 - 5TH AVENUE N FEB 14 2003
EDMONDS WA 98020-3146
BUILDING DEPT.
Letter orTransmittal
February 7, 2003 Washington State Department 4
kjHealth
Construction Review Services
2725 Harrison Ave. NW Suite 500
PO Box 47852
Olympia, Washington 98504-7852
JEANNINE GRAF r-zr=.cEivFr5 ww.doh.wa.gov/crs
CITY OF EDMONDS
121 - 5TH AVENUE N FEB 14 2003
EDMONDS WA 98020-3146
BUILDING DEPT.
7"' .7
Project Info:
CRS# 6914 Project
Edmonds Rehab & Healthcare Center location:
Chapter 388-97 WAC Nursing Homes
Kitche/Storage Water Damage Ren rs
Key People:
Facility
Sherry Johnston
Administrator:
21008 76th Avenue W
Edmonds, WA 98026
(425) 778-0107
N/A
Architect
RBI Construction, Inc.
Engineer:
Jim Bray
1807 132nd Ave. NE #2
Bellevue, WA 98005
(425) 881-1985
N/A
Review Staff:
Fire & Life Chad E. Beebe, CSI
Safety and chad.beebe@doh.wa.LYov
Program (360) 705-6648
Manager:
Sanitarian: John R. Templar, R.S.
iohn.templar@doh.wa.gov
(360) 705-6786
Small Projects Douglas Taylor
Reviewer: douglas.tavlor@doh.wa.gov
(360) 705-6628
Copies To:
0 Local Building Official: City of Edmonds
0 DOH Office of Accommodations & Res. Care Survey
0 DOH Office of Health Care Survey
0 Architect / Engineer: RBI Construction, Inc.
0 Sub -Contractor:
0 Sub -Contractor:
Page I of 4
Facility
Contact:
Building
Official:
21008 76th Avenue W
Edmonds, WA 98026
Greg Schroeder
21008 76th Avenue W
Edmonds, WA 98026
(206) 953-0087
gregory—schroeder@kindredhealthcare.com
City of Edmonds
Jeannine Graf
121 5h Ave. N
Edmonds, WA 98020-3146
Architect: Richard M. Swanson
richard.swansonC&doh.wa.gov
(360) 705-6782
Mech. /
William M. Kingrey, PE
Electrical:
william.kinUe doh.wa. ov
Y@ oh.wa.
(360) 705-6783
Small Projects
Rob Bradley
Reviewer:
robert.bradley@doh.wa.gov
(705) 705-6685
El DOH Child Birth Center Licensing
0 Washington State Patrol, Fire Protection Bureau
El DSHS, Aging & Adult Services Adtriinistration
0 Other:
0 Other:
0 CRS File
Plan Review Comments for Project #6914
0
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1:4
Edmonds Rehab & Healthcare Center
Chapter 388-97 WAC Nursing Homes
KitchelStorage Water Damage Repairs
Memo:
-APPROVED-
The construction documents for your project have been reviewed per Chapter 388-97 WAC Nursing Homes (NH) and
li
found acceptable. The stamped approved copy of the documents shall be kept and available for the censing staff on
site. Please note the following:
E3 Nursing Home regulations do not allow occupancy of the completed project area until authorized by DSHS
Residential Care Services.
t3 IMe local building official is responsible for building construction permitting a nd occupancy.
E3 FInal licensing approval is subject to a site inspection by DSHS Residential Care Services to verify
compliance with Nursing Home regulations.
7be enclosed "PUM' construction completion card must be returned to this office before occupancy once you have
completed construction. When we receive this card, we will close your project file and notify DSHS Residential Care
Services that you have completed the review process.
If you have any questions please feel free to contact Construction Review Services.
A f.11 t ^"r r%nims. Q"ru nt W UV doh wa crov/crs
Please a W 111VAAMill 0 GUI VU -J . .
Page 2 of 4 Plan Review Comments for Project # 6914
Review Key: A = Architect F = Fire & Life Safety S = Sanitarian M = Mechanical / Electrical SP=Small Projects C = Conference Note
A
Facility Name: Edmonds Rehab & Healthcare Center Facility ED: 007702
Site Address: 21008 76th Avenue W
Edmonds, WA 98026
Facility Data:
Occupancy Group: Construction Type: Applicable Code: M79 IM
Number of Apartment units: Private occupancy: Two person occupancy:
Automatic Fire Sprinkler System: %Q53 E]13R E]13D F1 Not Applicable
Automatic Fire Alarm System Yes Not Applicable
Compartmentation on all floors required: Elyes ot Applicable
d
Special Egress Control Devices:
Approved Smoke Control System: []Yes KNo
Maximum allowable licensable Beds:
Based on size of rooms used for sleeping Residents
Based on size of common rooms Residents
The data above is based on the information presented to the Department of HealthConstruction Review Services.
Any change in the facility or facility program that causes the above information to be inco rrect Is subject to
review by DOH Construction Review Services. Approval for cons truction Is not approv al for licensure. A copy of
this certificate will be sent to the licensing agency.
XAnn L, A ority
pprovinjAut ority
Plan Review Comments for Project # 6914
Page 3 of 4 C Conference Note
Review Key: A Architect F Fire & Life Safety S Sanitarian M Mechanical Electrical SP=Small Projects
Ja
FZ
iew Comments for ect # 6914
Plan Rev Proi
Page 4 of 4
an M = Mechanical / Electrical SP=Small Pro ects C = Conference Note
Architect F = Fire & Life Safety S = Sanitari
Review Key: A
X I
:
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