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20030376A.pdfDATE RECEIVED 6-) CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 414 o5111_1395MT MAILING ADDRESS 23W5 TfMD0PjAV0 CITY - ZIP ITELEPHONE 9::?Jp f0020 4-W-11 7/ NAME ADDRESS NIA ZIP TELEPHONE NAME CBLN 45;/f-50)Vr (rdON51- Ace, ADDRESS a-3w/5 -r1maox4-+A10 x CITY ZIP TELEPHONE j -cl - 7 t t STATE LICENSE NUMBER PROPERTY TAX ACCOUNT PARCEL NO. 004 [3 NEW �j;7RESIDENTIAL PLUMBING MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE muLnFAmiLy REMODEL SIGN GRADING FENCE REPAIR CYDS ( FT) X 120SEMOLISH TANK [] OTHER .V11___ — oGARAGE RETAININGWALL 0 FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE. BUSINESS OR ACTIV" EXPLAIN: NUMBER OF ER OF LING CRITICA�& AREAS q NUMBEZ&j -STORIES DESCRIBE WORK TO BE DONE jaw in I) I fA ()S g: HEAT SOURCE GLAZING % LOT SLOPE % !C221 PLM CHECK NO: VESTED DATE THis PERMIT AUTHOR= ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO tz BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMITAPPLICATION: 180 DAYS ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION APPLICANIT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND ALL CLAIMS FOR 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 CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HERE13Y 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 M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. R A DATE SIGNED 1 4, — 2. 17 f 40 1 1 PERMIT EXPIRES USEE,O, PERMIT ZON ...... JOB ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO, I LID FEE$ 4j 7ESCP Approved PUBLIC RIG%T OF WAY PER OFFICIAL MEET MAP MY ParrNt Required EXISTING 'PROPOSED . , I I � a "'Reced lam, Sidevratk Required REQUIRED 4§EDla&jj9N_,.FT =%jd d METER SIZE JQWI�349 N'40. OF FIXTURES PRV REQUIRED 63 NO C3 Ll ]FtZ -rn RE RRIVI&M99im REMARKS OWNERICONTRA(YOORS16SP8USlBNY�TAt 140VA NAMAGE Dump AT APPROVED DUMP SrM ONLT SEP, D'EMOLITION INSPEcrm G!IEeR1=if;'F 8?4 BAelE eF 4eB GARB FOR INSPECTION REQUIREMENTS ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE I VARIANCE OR CU SHORELINE OR ADBN I INSPECTION 1$ BOND REQ'D POSTED 13YEs 13NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE . EXEMPT ALLOWED . PROPOSED 1. ALLOWED . PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRO NT L/R SIDE REAR z PARKING LOT AREA rPLAl;NING REVIEWED BY DATE REO'D I PROVIDED I REMARKS CHECKED BY ITYP&OF CONSTRUCInON CODE OCCUPANT 1 �X7 GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [3 YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 11?7r �5054.00,1�1 n5oni Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapeinsp. Total Amt. Due I Recording Fee Receipt # Mldo CALL FOR INSPECTION 771-0220 EXT 1333 APPLICATION APPROVAL This application is not a permit until signed by the Building Offlcial or his/her Deputy: and Fees are paid, and receipt Is acknoWedged In space provided. OF LS SI URE DATE kLiArSf[f BY ..... f,WUNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING Agency Case o. Agency Use Only !—A—­�o ect �4 B. Property Owner: Property owner', M.0inc, Address: Asbestos PUGET SOUND CLEAN AIR AGENCY treet, Suite 500 110 Union S Seattle, WA 98101-2038 www.pscicnair.org NOTICE OF INTENT n -1 2. rT Asbe val stos Removal & Demolition 3. [1 De puget Sound Clean Air Agency Fom No.: 66-160 (Revised 9/02) TS State: Date �gency Use Only No Asbestos Rei The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project invq1ving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects (regardless of asbestos content) i nvolving structures with a projected roof area greater than 120 square feet (Regulation III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and demolition Rrojects involving materials and structures below the notification threshold are still subject to all other reguirements of Regglation 111, Article 4. The Agency notification form must be used to submit a notification for an asbestos project, a combined asbestos and demolition project and a demolition project where no asbestos is required prior to demolition. 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. J. Demolition PLEAMPAWCLAQUE THIS KUM r"JU'WM"LML01EL Contractor: Owner/CEO: Contractor's Mailing Address: Phone: Job #: d I city: State: ZiE: Fax:_ GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Step 2. Enter property owner information in Box B. Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential prcjec� in Box C. Print clearly this is your return mailing label. Step 4. Enter the site address for all notifications in Box D. For multiple -structure projects, attach supplemental sheet with a site map (include an address for each site) and a list of the type and amount of fiiable asbestos to be removed from each structure. Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by an AHERA certified building Inspector. Attach a c2p-y of the MM Ue results to the notification submittal for projects where nonfriable asbestos is identified and proiects where no asbestos was identified on the smelt Step 6. Enter the project information in Box F. and check the mining fire or ordered demolition if appropriate (a copy of the official order must be attached) if appropriate. All asbestos must be removed prior to conducting a mining fire. Additional training fire requirements are contained in Regulation 1, Section 8.08. If any nonfriable asbestos materials win be left in place during demolition, check yes and list the type and quantity of material. Step 7. Enter asbestos project information in Box G. Step 8. For Single -Family Residential projects; check BOX H1A for renovation projects, BOX HlB 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. For Commercial asbestos projects; 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 file for an emergency asbestos or demolition project, check the appropriate box I - 6 and the applicable emergency box in H7. All emergency requests must be accompanied by a letter ftom the pEggpM owner demonstrating the need to conduct the 1proiect immediately in accordance with the requirements in Rezulation III, Section 4.03 (c). Step 9. Please cer* 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 work schedule changes. No fee is required for work schedule changes if the contractor is participating in the Agency work schedule fax program. A $25 processing fee is required for all amendments. Puget Sound Clean Air Agency asbestos regulations and forms can dovniload from die Agency web page at www.pscleanair.org, For technical assistance contact (206) 6894058 and for administrative inquiries contact (206) 6894090. Puget Sound Clean Air Agency Fonn No.: 66-160 (Revised 9/02) TS C)! M, R 0 M 10 Z "41 Is FINAL PROJECT APPROVAL FORM z 9 0 m am c ma 0 80 c � r. m m 10 � z 0 -n n M m 0 0 0 M C 0) c co M C) Z X z co) z 9 0 m 3. RE_INSpECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL Date— Si ocaprvl.doc.l:temp:bldg:formsIO/OI A t 1, �- An I Fina mm arcial ....... m HEATING: Gas Test,,.. ................... . G Pi Ind as p ... .............. "n 47'. Equipment ................. m Comr�erclal' Final-., EXTERIOR SHEATHING NAILING� ..................... FRAMING . ....... . ......... .......... FLOOR FRAMING..; JL. ,FIRST INSULATION, ................. A C�DATE RECEIVED_ Cirl OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS '�:J- o 0 N Cj, I t- r3 r.:7 rZ I MAILING ADDRESS 23A-11,S TfM8)FV-i14Nj:- CITY ZIP ELEPHONE o 6 -7 / 7 NAME ADDRESS 1231011 USE PERMIT EXPIRES PERMIT AL , A ­0; JOB SUITE/Aiq# ADDRESS PLAT NAME/SUBDIV161ON NO. LOT NO. LIO NO. LID FEE $ 7EGFP App—d PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw ParrrA flacriked 8"M Uss, Pormk Rsqd EXISTING 0 12' -PROPOSED 1,7^.,T fll�r%yvfnn ir"sceon rlsqhred SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED DE SEWE [j MUST BE CAPPIM-MM NO 13 Z npF-RTV tjE A 01 WkftHoftftWy& CITY ZIP TELEPHONE HOSE BIB WITH AVU INSTAIJM Dump AT APPROVED DUMP Sf= OW NAME SEE D.r.MOLITION INS PEM011 1-787/ 26 ENGINEERliSRE03%Xt'S' UM ISACY% Ur MODEM IADDRESS FOR INSPECTION REQUIREMENIS ,;2.9 -r11nj2r-'R 4,4&h5 1011 FIRE REVIEWED BY DATE MA CITY ZIP ;1TELEPHONE -7/ -o e z o & 15�fa Jb. Vovo 71 STATE LICENSE NUMBER DATE CKED B VARIANCE OR CU 1 SHuRELINE OR ADS# I INSPECTION REO'D I BOND OSTED L 8 r-ee776 AD .1 ?. -;?I -o 5 I --- 13YES 13NO $ SEPA REVIEW -0 SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO COMPLETE EY4EMPT ALLOWED PROPOSED ALLOWED PROPOSED 4 /.2_ 0 7 3 -0 // -0a , --FeFESIDENTIAL EXP NEW [:] PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR ADDITION COMMERCIAL ci COMPLIANCE OR CHANGE OF USE PARKING LOT AREA PLANNING REVIEWED BY DATE Lj nrMUUML L-I MUDIFNAILT L —j SIGN REOD i PROVIDED REPAIR GRADING cyos FENCE X F-1) REMARKS 1;2-VEMOUSH TANK OTHER o GARAGS o RETAININGWALL FIRE SPRINKLER CARPORT ROCKERY ----FIREALARM (ME OF USE. BUSINESS OR ACTIVTM EXPLAIN: CHECKED BY TV �01` CONSTRUCTION OCCUPANT -7 IV GROUP NUMBER V NUMBER OF CRITICAW,.fli OF 13WELLING AREAS I I SPECIAL INSPECTION JAREA OCCUPANT jTORIES UNITS NUMBE REQUIRED [] YES LOAD DESCRIBE WORK TO BE DONE REMARKS E: LIA PROGRj9SS INSPECTIONS PER UBC 108/FINAL INSPECTION RECV10 AwsE -7ed lo $ 0V Description FEE Doscriptlon FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT 8 OPE % !0.- Building Permit City Surcharge VESTED DATE Plumbing CHECK 140: Mechanical THIS PERMIT AUTHORMED ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURB% SIDEWA WAYS. MARQUEES, ETC.) WILL REQUIRE 3 16=2PERMISSION. Engr. Review PERMIT APPLICATION. 160DAYS PER.ITUMM, YEAR- PROVIDED WORK IS STAITTED WITHIN 180DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION *APPLICAK ON BER41F OF HIS OR HER SPOUSE. HEIRS.ASSIGNS AND SUCCESOR6 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 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due A. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE I 4.Vno NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording Fee I Receipt # wiem I HERESY 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 REGuLAnNG CONSTRUC- CALL This application Is not a partnit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED 1N OF THE OF THE STATE OF WASHINGTON RELATING TO INSPECTION Building Offlclal or histher Deputy: and Foos are paid, and receipt Is acknowledged Inspaco VIOLATION LABOR CODE WORMEICS COMPENSATION INSURANCE AND RCW 18.27. F6R provicind. 0 S SI()NAjURE ATE SKINATU R AgIhM DATE SIGNED TAW 771-0220 A '!' ION M. 1333, NLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL PINAL F L IN� INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 04102 PRESS HARD -YOU ARE MAKI ........ ......