20030429.pdft
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Eft NAME"E OF BUSINESS
IM-1
CITY zip
Me
NAME
CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE I GMFMW BY
PROPERTY TAX ACCO PARCEL NO
2. 6- 1 — =._.0 a — 0 101111 W�t_
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NEW
0 RESIDENTIAL PLUMBING/MECH
ADDITION
COMMERCIAL 0 COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
REPAIR
GRADING CYDS
FENCE X
FT)
DEMOLISH
TANK
OTHER
[3GARAGE
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
ME OF USE BUSINESS OR tCTWM
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NUMBER
OF
KBER F
NWU
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AREAS
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UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
...................
THIS PERNIrT AUTHORIZIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CUR13S, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOL&WN OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKWWS C(KPENSATIONI INSURANCE AND RCW 18.27.
PE_
[PERMIT EXPIRES a
U PERMIT
ZONE NUMBER &02.
JOB
ADDRESS
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
JESCP Alp,=ad
'W ". R
Stmal Use Parmh Rsq`d
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underilrourid
wiring required
METER SIZE
LINE SIZE
I
I NO. OF FIXTURES
PRV REQUIRED
YESO NO El
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0 PRE -INSPECTION REQUIRED
0 STREET TO BE CL13ANED Oi
E-INIGINEERWRISIMP99WER MUST BE CAPPEDPXf
PROPERTY LINE
FIRE REVOVEDWATM MMR 10 BE RBMOVJDTQM
moss sis wiTH AVB iNsTAum
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FE)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
CHECKED BY
JTYPPJ:��JON
Cein
UULiUrANP,
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
JAREA,
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 081FINAL INSPECTION REO'D
VALUATION
$
I
-
Dewription
FEE
Description
FEE
Plan Check
State Surcharge
Building Per
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPKOVAL
This application is not a permit until signed by the
Building Otocial or his/her Deputy: and Foos are paid, and
receipt Is acknowledged In space provided.
OFFICMfij; 7T &E
�_ j (�' '4 ). �v & 40
f 1 11%1' W , N hk
RELIt-ASED BY U f D-ATf
IT IS UNLAWFUL 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
is
auv OS 03 02:13P Rmerican Environmental Cc 206 522 4089
P. I
Posoxaiom suft.wA saimloos
Phoro;(206)267-0746 or (800)367-2760
Fax: (206) 622A092
WA State CWraMr 0 AMERIEC996MI3
August 6, 2003
--- Letter of Completion ---
(AEC Job # 3156)
Re: Asb"to*Abst9m*ntS9rVIC0*at: 20214 Maplewood Drive, Edmonds, WA
This Is to certify that American Environmental Construction LLC has removed all of the
asbestos containing materials from the above referenced add ress per our Proposa
Q2ntra dated JMIY 1 2903
Clearance Air Monitoring (Sample Type CL) as reported on the attached Air Samy12 Q
W,
V
a ta
§hW Indicates that the airborne asbestos level is below th EPA es blished standard of
.01 fibersteubic centimeter for clean air afte r an abatement project. Accordingly, the work
area is safe fbr re -occupancy.
Please call me at 206-523-4441 if you have any questions or comments, regarding this
M
Letterof Co pletion
RECEIVED
AUG 0- 8 2003
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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—7,
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I OWNER NAMENAME OF BUSINESS
PERMIT EXPIRES
ZONE PERMIT loo
NUMBER Z-V
JOB SUITE/APT#
lh�4A�
PLAT NAME/SUBDMSION NO. I LOT NO. LID NO.
LINGIADDRESS
LID FEE S
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7ESC? Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW P@nM ReWired
Use Permh RW
CITY
2M
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Street
EXIS71ING — PROPOSED Inep"Vort Foqtdr6d
Sldowa* Requk*d
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UrAwWound
REQUIRED DEDICATION— Fr WkIrigrettLOod 13
NAME
METER SIZE LINE 131ZE 0, OF FIXTURES PRV REQUIRED
I
N
YES C3 NO C1
ADDRESj
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY
ZIP TELEPHONE
I
PMINspECTION REQUIR
*
EMMU-13V
ME
CBL#
STRE13T TO BE CLEA
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ENGINEERING
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ADDR�Sq
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FIRE REVIEWED BYWATER METER TO BE REM
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CITY
I 1
0
WITH AVB INRWab
iWkh
100
10�_M
HOSE BIB
is %W
_ VARIANCE J@RffEfip GtWK
STATE LICENSE NUMBER EXPIRATION DATE c BY OR& D REO'O POSTED
AM P,ARCEL NO
7ROPERTY TAX ACCO
- 01hy-
I
SEPA REVIEW N nAgL OF
COMPLETE, IVMCH rug PROPO
RC ION Ij SEDI
%601
a
FO NS
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
ADDITION
0 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
r] REMODEL
0 MUL11FAMILY
SIGN
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ`O I PROVIDED
06
REPAIR
GRADING
CYDS
FENCE X
FT)
REMARKS Aft
MDEMOLISH
TANK
OTHER
oGARAGE
RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
OVE OF PSE, BUSINESS ?R tCTIVrM EXP_kMN;
CHECKED BY JTYP:�ON OC PANV—
GR up
NUMBER
OF
UMBERPF
DWELL 13
CRITICAL
AREAS
SPECIAL INSPE171ION JAREA occu PANT
LOAD
STORIES
UNITS
U
NUMBER
REQUIRED
1:3
DESCRIBE WORK TO
BE DONE
REMARKS
PROGRESS INSPECTIONS PER 11,113C 1108/FINAL INSPECTION REGM
P 1A
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LAZING % LOT SLOPE %
Building Permit
'oe City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PEWrr AUTHORMES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLZ ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAV% MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PMMITAPPLICATIOW 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engir. Inspection
SEP BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk, Deposit
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
BMGNDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL%AIMSFORoAMAGESOFWHAMER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
1
FROWTHE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Lf I
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY crry ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fee
Receipt #
Zcj_
Recording
/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APP FIOVAL
GWEN - 18 CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH Crry AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a parmil UnI11121WIed by th6
TION; AND IN DOING THE WORK AUTHORIZE THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION F THE LABOR CODE OF T%%STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hielher DeputY: and Fees are paid, and
receipt Is acknoMedged In space "Ided.
IND 2!PENSATION INSURANCE AN RCW 10.27.
OFFIq&&B NAT E 0 E
DATU7NEO %�_ r—
I UV, JQo
8 IA95) 0
-_ / DATI! 3
-.771-02 RELEASED BY
20
A 1410=N
TTE EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTIONMAS 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 EFN - A��NTING
PRESS HARD ;YOU ARE MAKING 5 COPIES
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