20030332.pdfDATE RECEIVED Hj
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS t I
ADDRESS
ZIP ITELEPHONE
ADDRESS
CITY r P ZIP
NAME
TELEPHONE
j2S- 770 iez"
I . ICBLN
3/(/2
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1 PERMIT EXPIRES 47L IVIZ
WE— PERMIT
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J'�7�2�2L_
ik NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Rsq'd
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required [3
REQUIRED DEDICATION- Fr
Undevound
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO E3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
• PRE-INSPEMON REQUIRM
• STRIUM TO BE CLBANM CIF DRIM
• SIDE SEWEIt MUST 118 CAFM AT
ENGINEERING REWMANDDIMS I AdAnD DATE
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FIRE REVIEWEDIWM%P&A Wallis Will&" "VAP 111"W&ftGAAME
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CITY
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STATE LICENSE NUMBER EXPIRATION DD EE [115MUfM I POSTED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR FRONT L/RSIDE REAR
o COMPLIANCE OR
1:1 ADDITION 0 COMMERCIAL CHANGE OF USE
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REMODEL MULTIFAMILY SIGN
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REO'D
LOT AREA PLANNING REVIEWED.BY DATE
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REPAIR 0 GRADING FENCE
CYDS
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REMARKS
$eDEMOLISH 13 TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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GROUP
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NUMBER NUMBER OF
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NUMBER
0 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS
PER UBC 108/1FINAL INSPECTION REO'D
A L?-T A f) 61440
VALUATION
$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
PLAN CHECK NO:
0.—
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLXt ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. FTC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIUM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
t; 0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
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. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING TH THORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT ! ON OF THE LAD OF THE STATE OF WASHINGTON RELATING TO
�NS
FOR INSPECTION
WORKMEN S COMPENSA� I CE AND RCW 18.27.
R d�LAG�E
SIjN(AT
DATE21GNED
(425)
r(O
771-0220
L
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
4,411cation is not a permit until signed by the
10 9111cial or his/her Deputy: and Fees jife paid, and
I Edcalpt Is acknowledgellilln spage gfoided. .
ATTTION Off 1 33 1�
J VI
IT IS U WFUL TO USE OR OCCUPY A BUILDING OR TRucTuRE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 01 ORIGINAL - ' ILE YELLCV/INSACTO
PINK - Lz_� GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 0
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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APR 25 '03 02:44PM PUGET SOUND CLEAN RIER A.GEN(C: P.1/2
PUGET 59UNIJ CLEAN AIR Date Received
Agency Case No.
AGENCY
I 10""hion street, Suite 500
'5 037 1.,
200300469 Seattle, WA 98101-2038 APR 2 1 2003
www,pscleanair.org
y
,4sellc�v Use 0)1�v 41 NOTICE OF INTENT
2. Q Friable Asbestos Removal& Demolition 3— -Demolition -Only
Friable Asbestos lkcmOvzl
A. Pro I ect Tyne_;__J__L-J
B. Phone: 7. -7
Property owner: _ru
AT) A,�,
7;
C M�,u ZID!,
Mailina Addr"s.. H,
75DYMPT01 LING IA 8 EL -
PLEA PmmfCLZAJ
C. Asbestos
Owner/CEO:
Contractor". aea�!�
Con, ror
Job �
o
Phone:
Mailine Address, &Asp
te: Zip: ?"-I Fax:,ara a&
Cirv. m
D. Site Ci ez, Zip:
Address: a
Et
Site Local Phone: am
Manager:
C
M
-JENo
Was Friable Asbestos Identified? uYes
ros Survey Date of Asbeitps --I
E. _A��sbesi 0yes ONO
qllrvev: Was Nonfriable Asbestos Identified? 0
C3 imat'l Presumed C
Attach a copy of the survey unlessfriable asbestos
AHER.A Building Certift afi
c on is identified
Inspector: Ext). Date; m
! -Ontr%ctor.
inpldd ;t:s�- Phone:
Stat, 1; X.
Zi a
required before all olitionpruiects
An AHERA Survey is t Fire Dep 4".
0 z
No. of U Training Fire (Lis
F. Demolition Star%
oit 1! lition (attach copy of Order)
X structures: 2. Q Ordered Demo
n _LJ No
Information: IDate. 0&r+
tic s on bact ble asbestos be left in place during demo7 U
—L —4 Insert demolition coniracror's malling Will nonfria
Demolition
C Co If yes, list We and city. "n 1!�
ontmctor: dkq,0J M�
work Days: M T W Th, F Sa Su !E
G. Friable Aibiestos OR M,
Prolect Information: Start Date: Completion Date: Hours:
Will all friable asbestos 0 Yes
13 No
,ir* Sc mgved?
_warti Ft. materials be re
Total Qtv. to be Removed linear Ft. §
C
;000
List ty oved:
pe(s) of material to be rem
m0:
.0o_
MM % - - e
% Notification Period I Project Demolition
tion Project Categories:
H. Asbestos/Demoli Surcha
1. Single-F2mily Residence* lotice A. $25
A. Prior N
AL.
A. U Asbestos Removal Project Only B. 10 Days
on Project (with or without asbestos remova Z,
B. A-Demoliti
val can be in; upon notification: demolit 030MUS1 wait 10 days)
T:LJ I --'
*(Asbestos remo 1�1.
has been or Wiftle using the residence as their domicile, the above box
e uIldi
vote: if the singlefamily residence is owned by onefamily who
mu!�-Lamily units. or anv mixed -as b
JA of B may be checked.- A single family residence es not include rental propertsL,
ject 10 Days_ S200
her Demolitions With No Asbestos Re Z:
2, All Ot __'�A_sbestos Demo
My �,Pito
other than Single
Friable Asbestos Projects ( , wm
- 159 s are feet of asbestos Prior Notice I 0-Days I S150
3. 10 - 259 linear teet or Z 48 Lu. 5 luu
t 6-0 - 4.999 square feet of bestos 10 Days I S300 —
4. 260 - 999 linear feet 10 Days 1.5750 S250
1,000 - 9.999 linear reet or 5.000 - 49,999 square feet of asbestos
�E7 10 Days 1 52.000 51,UUU-
6. > 10.000 linear feet,or > 50.000 sOuare feet of asbestos Prior' P * ct Fee
_U 9mi—ergency Demolition Project Notice Twice roic
n- I
7. Emercre cy Asbestos Project or cncy irce: however. propem owners must P videa written emergency request)
am exempt finom emerg E2
(single-Farnfly Rcsldcnccs
ledge. accurate & complete. Agen. se y
ry that the information contiincd in this notification supplemental data is. to the best or my know ly
ccrtl .10 IAV7 A161MM
1? wed
rZo
pugct Sound Clean Air Agency Fenn No.: 66-160 (Revised 3103) TS
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APR 25 '03 02:45PM PUGET SOUND CLEAN AIR AGENCY P.2/2
The Puget Sound Clean Air Agency requires advince notifidAtion before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
III, Article 4). All asbestos removal and demolition notificationg must be submitted to the Agency on current Agency
forms. Asbestos Mmoval and demolition proiects involving materials and structures below the notification threshold are
still subiect to all otber requireMents-of My—ulation M. Agtcle 4.
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 copy will be your validated notification.
rLrA1CrAWCLfAAL 1"LL J1 FTWA kM_J_N MAILAVU WW_
J. Demolition
Contractor: klx_�
Owner/CEO: MA*-V&lAJ+
Mailing Address:
1.1) 1� -S-1 -q)A'1& -
Phone:
contractor's
Job -. 'tor's
dnfl
UJW
qg! zn M7—
.1
41g - s-fzt
im.
State:
ZiO.:
Fax: Z-76
GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement
asbestos board siding, and duct insulation. Nogfiriable asbestos is normally found in vinyl floor tiles, window puny and most roofing
materials.
Step 2. Enter property owner information in Box 8.
Step 3. Enter the asbestos contractor or property owner information. if the property owner is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi -structure prqjects� attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure.
Step S. Check either asbestos survey or maumial presumed in Box E. All demolitions require that an Asbestos Ha—rd Emergency
Response Act (AHERA) -asbestos surm;y be conducted by a certified AHERA building Inspector.—AaRch a cogy of tha-survey to th
ngfification gf a demolition aroject when only nonfriable asbes Uo or no asbestos is identified on the sHrycv.
Step 6. Enter the project information in Box F. and check the training rim or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training firc. Additional trainifig fire
requirements are contained in Regulation 1, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition,
check yes and list the type and quantity of material.
Step 7. Enter asbestos project inf6rination in Box G. List types of friable asbestos material to be removed: surfacing material such as
popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step 8. For Single -Family Residential projects; check BOX HIA for renovation projects, BOX HIB for demolition projects with or
without asbestos removal. Asbestos removal may be conducted after a complete notification is received. but demolition activities can
only begin on the 10' day after the notification is received. Note: If the singiefamily residence Is owned by onefamily who has
been or will be using the residence as their domiciI4 boxes ]A or IB may he checked. A singlefamily residence does not include
rentalproperry, muld-family units, or any inkyed-use building.
For'Commercitil asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 -
6 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To rile for an emergency asbestos or demolition. project, check the appropriate box I — 6 and the
applicable emergency box in H7. All emergency reguests must b d by � let= fMm the aroperTy owner dernonstrating1bg
nod, to cgnduct thq
proiect iMmeduaelyjn�ccordance with the reguirements in Kegulatwn 111, beCtIOn 4.03 (0).
Step 9. Please certify the accuracy and completeness of the 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 changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule changes if the contractor is participating in the Agency work schedule fax program. A S25.00 processing fee is
required for all amendments.
orms can downloaded from the Agency web page at www.pscleanair.org.
Puget Sound Clean Air Agency asbestos regulations and f
For technical assistance contact (206) 6894058 and for administrative inquiries contact (206) 6894090.
Puget Sound Clean Air Agency Fonn No.: 66-160 (Revised 3/03) TS
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-tp C. 189 M
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH * EDMONDS, WA 98020 * (425) 771-= - FAX (425) 771-0221
Website: www.dedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning 9 Building - Engineering
April 28, 2004
Blueprint Management
405 P Ave. N.
Edmonds, WA. 98020
Case: # BE-04-024
Subject property: 0925 76h Ave.W., Edmonds, WA. 98026
Dear Blueprint Management,
Your file has been forwarded to this position for enforcement action. On March 5, 2004
you received a letter to request and obtain a final engmeenng inspection (enclosed).
Please attend to the final engineering inspection by May 7, 2004.
Final enforcement action will be initiated after May 7, 2004. Future development permits
could also be delayed for lack of a final engineering approval for the demolition.
If you have any questions regarding this letter please call me at 425-771-0220 x 1716. If
you have any questions regarding engineering requirements, your letter of March 5h or to
schedule your final engineering inspection, please contact Jeannie McConnell at
extension 1338 or the inspection line at 1326. Thank you in advance for your prompt
cooperation and assistance.
Sincerely, d
Mike Thies
Code Enforcement Inspector
jhLes@Lci.edmonds.wa.us
C. J. McConnell, Engineering Technician
J. Graf, Building Official
Incorporated August 11, 1890
Sister City - Hekinan, Japan
4 z5f.."
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-0332
c: Permit file #2003
N
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Incorporated August 11, 1890
sent By: Blueprint Management Inc.;
03 U4 10:19a
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425 776 1519; May-3-04 4:34PM; Page 2/2
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SEPTIC SEFNICE
19604 - o7w AVENUE N.E.
ARLINGTON. WASHINGTON 98223,417M
(36M 435-5531 9 I-SM659-1941 0 FAX (380) 435-857S
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?ATE REq1EIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAM
JAJA)
^Aj Se
ADDRESS
ZIP TELEPHONE
2M2 I gZ`z� 770 �!2,
NAME / , JCBLN
CITY t 1. ZIP I TELEPHONE
I STATE LICENSE NUMBER
�ROPERTY TAX ACCOUNT PARCEL NO.
NEW
]a PESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
[3 REPAIR
0 GRADING CYDS
$(DEMOLISH,'
TANK
0 GARAGE
CARPORT
RETAINING WALL
0 ROCKERY
(TYPE OF USE. BUSINESS OR AIZ3MN:
NUMBER
"UMBER OF
OF
STORIES
OWELL114G
DESCRIBE WORK TO BE DONE
4
P ERMIT EXPIRES /I Z _/ Z 4,�
Its If PERMIT
ZON
NUMBER �2u
J013 SUrM/APT#
ADDRESS
A18- to
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESUP APP-0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Penrit Reclukod
Street U., Penn, riqq�d
EXISTING — PROPOSED Inspecdo" Required
Sidewalk Required
REQUIRED DEDICATION— FT Underwound
Vikingroquired 13
METER SIZE LINE SIZE I NO. OF FIXTURES I PRV REQUIRED
I YESE3 40' E3
REMARKS
OWNER/CO&AJ?gkbgkJMA4EMA;MOUDRAINAGE
* STR TO BE CLEANED OF DM=
* SIDE SEWMt fAUST Bit CAff= IS
WITH AVB RUTAIULED
FIRE REVIEWEDBV_____
Sm Dmmmoii: INSH=ON
0 C-11ploopow4w pqlv MIR
VARIANCE'UR Cfi;jT
1RDMR10R1ffg;1="V4rM66OND .
1, 1 UMM POST,:.,
If
Zeecl
!
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SEPA REVIEW
COMPLETE EXEMPT
EXP
IUYES
SIGN AREA
ALLOWED , PROPOSED
UNO IS
HEIGHT
ALLO WED PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SET13ACKS (FT.)
PLUM13ING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR Sl DE REAR
COMPLIANCE OR
0
CHANGE OF USE
'
PARKING
LOT AREA REVIEWED BY DATE
SIGN
REOD I PROVIDED
FPLANNING
o FENCE
Fi)
REMARKS
OTHER
FIRE SPRINKLER
ILA
FIRE ALARM
of
11111V
CHECKED BY
RO
I
CRITICAL -OCCUPANT
AREAS SPECIAL INSPECTIOIT AREA
NUMBER REQUIRED n LOAD
YES
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FlNAL INSPECTION RECtD
Description
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
&.—I
Plumbing -
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLX ANY CONVMUCTION ON THE PUBLIC
Grading
130MAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISO DAYS
PERMIT LIMM I YEM - PROVIDED WORK IS STARTED WTTHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST. AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CrrrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
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. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THIEF THEREBY. NO PERSON WILL BE EMPLOYED
C
IN VIOLATION OF THE LZ OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN%THORIZED,
WORKMEN'S COMPEN:2 INSU CE AND RCW 18.27.
SU C
Ob AGENT DATE)IGNED
(42 01
771-0220
FEE Description
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPI
do
, _!�Iloatlon is not a permit until
0 9MCW or his/her Deputy: and I
F riftelpt Is acknowlodgeo In sprig,
0%1 1 1�1
'T I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L_7±
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04102 PRESS HARD -YOU ARE MAKING 5 COPIES
NMI
by the
) paid, and
1 4? 1 L .
B ;b P, /�m
ORIGINA�L �FILE YELLOWINSA'
PINK - GOLD - ASSESS
GREEN - ACCOUNTING