20030654.pdfa----------
DATE 116CEIVEDJ
1c, 65 ERMIT EXPIRES
1 —1 LP
USE P. PERMIT
CITY OF EDMONDS
ZONE
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
JUITE/APTO
ADDRESS
C-A,j
O= OF SUPINESS
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'PLAT NAMEISUBDIVISION No.
LOT NO.
LID NO.
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LID FEE S
MAILING'ADDR
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CITY zip
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CITY
NAME
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NUMBER
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REQUIRED DEDICATION Underwound
FT Wiringrequired 13
METER SIZE LINE SIZE 1-70. OF FIXTURES PAV REQUIRED
YES E3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
VARIANC!WR
SE
'ROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE
EXP
NEW
13 RESIDENTIAL
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CHECKED BY
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NUMBER
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NUMBER L
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DESCRIBE WORK TO BE DONE
REMARKS
$
Description
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
Plumbing
6HO
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
:1 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
t: SEPARATE PFRUISSION.
Engr. Review
PERHITAPPILICATION: 1601kAYS
PERMIT LIM[r I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAUT, 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 DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM
Landscape Insp.
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.-
21
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 W[TH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
RE (OWNER OR AgEKT) DATE SIGNED
771-0220
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Description
FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
ATTENTION EXT 1333 1 V
Total Amt. Due
Receipt #
APPLICATION APPROVAL
(ppplicallon is not a permit unm signed by the
)k0ifielal or his/her Deputy: and Fees Oro paid, and
rqeipt 13 aCkn2!!!!�Ld in space prgded.
DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 011 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
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ASBESTO-TEST� INC.
ASBESTOS SURVEY
8512 Main St. Edmonds, WA 98020
Page I of 5
IN023100S
October 10, 2003
Sundquia Homes
P.O. Box 958
Lynnwood, WA 98036
Attn: Manson Kerner
Ph: 425-77"663 x115 Fax: 425-778-0822
On October 6, 2003, Asbestci-T6st personnel conducted an Asbestos survey (per
US.EJ?.AJAJLL1LA. guidelines as designated and specified by Puget Sound aean Air
Agency and Washington State) goLfhe house Q 8512 Main St, Ednwndi� Snohomish Countp
WashiWon 9802& This survey purpose is to idenLify any Asbestos Containing Materials that
may be present.and will require professional renwvalprior to densofidon.
NARRATMEOFFMMS
BASIC CONSTRUCTION: The house is one story wood frame with an attic dormer. The
everior siding is wood. The roofing is composition. The wood siding vapor barrier and
composition roofing materials were sampled. The rolled composition roofing was also sampled
ftoin the'attached car port.
INTERIOR CONSTRUCTION9 FINISHES, AND FLOORINGS: The interior is drywall
and wood. The drywall/taping materials were sampled. Vinyl and tile flooring materials with
relating backings and mastics were sampled per each located homogenous area. The countertop
fbrinica mastics were sampled from the kitchen and bathroom areas.
ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM and
was not sampled. Any additional suspect electrical wiring insulation or any suspect TS1
(Zhermal &stem Insulation) found in, around, or behind any locatedfiese or breaker boxes
should be considered to be ACM (Asbestos Containing Materlao, unless determined otherwise
by laboratory analysis.
ATTIC/WALL INSULATION: There was no suspect ACM visually located.
CONTINUE 70 P44GE 2
1429 Ave. D. PMR #187, Snohomish, WA 98290 ph: 206-914-SSOO fax: 360-563-2469 page: 206-540-2401
dGS:10 ED 11 %Do
Oct 11 03 01:56p 425-489-4040
Page 2 of 5 October 10, 2003
IM231005 Asbesto-Test, Inc. (206) 914-5500
',J
8512 Main St., Edmonds, Snohomish CountP Washington 98020
HEATING AND VENTMATION SYSTEM: Heat is baseboard/wall electric. There was no
twa
visible suspect ACM located associated with the electric heating units. Note: I s not possible
to dismantle the electric heating units.to locate andlor evaluate any add tiona su pect
ACM which may be concealed, inside 1he units, or associated in hidden areas, It is our
opinion anyfurther handling of the heating units should be coordinated by the project
manager andlor abatement contractor. If any additional relating suspect materials are
locatedprior to andor during any demolition or renovation, any and all additional
related suspect materials should be considered to be ACM (Asbestos Containing
Material), unless determined to be otherwise by laboratory analysis.
Miac.. The window glazing was sampled.
# of structures included in survey: one house
I
A-F
continue to pago 3
oct 11 03 01:56P
R'.'AQ:
Page 3 of 5
J70231005
425-4189-4040
October 10, 2003
Asbesto-Test, Ina (206) 914-5500
Any and all materials identified as ACM " PACM in this report (and/or additional materials
associated with the structure that way be discovered and later identified as ACM or PACM), must
be professionally abated prior to demolition. ASSESSNMNT AND QUANTIFICATION OF ACM
FOR ABATEMENT PURPOSES AND/OR PRICING FOR REMOVAL SHOULD BE
DETERM1NE D By ON SITE EVALUATION, AS LISTED QUANTITIES ARE NOT
GUARANTEED AND ARE AN APPROXIMATION ONLY.
1.0) VIN`YL FLOG UNG yes H chrysotile fl 2-5% non -fibrous materials
Ititchen & batbroon bottom layer -color: brown ACM
VLM IS NON-F1 UBLE
Note: The asbestos In the hard vinyl surfime material. (the vinyl Boozing may be old
linoleum 9" x 9" file
APPROX. 120 SQ. - 4-r. ON TAR PAPER ON WOOD
1.1) MAMC NAD adhesive,.celltd0se, tar
2.0) VEWL FLOG UNG yes # chrysotile // 2-5%
hall & north bedroc nj!-color. brown ACM
VIM IS NON-N jABLE
Note-- The asbestos i s in the hard vinyl surface material-
APPROX. 120 SQ.E —1. ON TAR PAPER ON WOOD
2.1) MASTI 7 NAD
3.0) FLOOR TELE yes fl chrysotHe fl 2-5%
back entry bottoam � yer-color: red ACM
3.1) BLACK MWAS C yes fl chrysotile fl 2-5%
MASTICAND IS NON-FRL4BLE ACM
1) 1
APPROX. 95 SQ. ON CONCRETE
NOTE: Any addi
discovered In this
contain asbestos i
non -fibrous materials
adhesive, cellulose, tar
non -fibrous materials
adhesive, cellulose
colors or ldnds of floor tile and/or mastics bacl&gs that wem not
y and may later be located in this structure am also presumed to
tested otherwise by laboratory analysis
continue to pace 4
d,
act 11 03 01: 56P
425-489-4040
Page 4 of 5
Odober 10, 2003
B0231005
Askesto-Test, Inc. (206) 914-5500
8512 Main St. Edmondy, Snahondsh County Washinton 98020
THERE WAS NO ASBESTOS DETECTED IN ANY
QF THE REMAE41NG SAMPLES
ANALYSIS I)D_ ASBEST0SHff_WIFJ/0UANTff Y OTHER MATKR—IAL
4.0) drywall
NAD
non -fibrous materials
cellulose, fiberglass,
paint� (gypsum)
4.1) drywall tapleg; compounds
NAD
non us matetials,
-fibro
SAMPLED PER AHERA PROTOCOL
cellulose, fiberglass
4.2) -surface paint (homogenous throughout)
NAD
paint, cellulose
5.0) tile flooring
NAD
non -fibrous materials
Idtchen surface1211 x 12" tile -color: off white
5.1) mastic
NAD
adhesive
5.2) tile flooring
NAD
non -fibrous materials
1itchen 2 d layer12" x 12" file -color. brown
53) mastic
WAD
adhesive
-1V
6.0) sheet vinyl flooring
NAD
non -fibrous materials
bathroom surfine -color: white w/green diamonds
cellulose, fiberglass
6.1) mastic
NAD
adhesive
7.0) shed vinyl flooring
NAD
non ib rous materials
back entry-calor. cream square design
cellulose, fiberglass
7.1) mastic
NAD
adhesive
8.0) formica mastic
NAD
cellulose, adhesive
Idtchen countertops
8.1) formica. mastic
NAD
cellulose, adhesive
bathroom countertops
9-0) window glazing
NAD
non -fibrous materials,
cellulose
10.0) composition roofing
NAD
ccllulosc� tar, fiberglass,
& underlying materials -over house
non -fibrous materials
10.1) composition roofing
NAD
cellulose, tar, fiberglass,
& underlying materials -over attached car port
non -fibrous materials
11-0) wood siding vapor barrier
NAD
cellulose, tar
material beneath wood siding exterior
A-T
continue to page 5
IU
P.
is of Individual and separate samplings and analysis of
rVresentative analys
be a
Some sample analyses listed may
J materials, asprescribed by A.H.F-P.A. Protocol.
homogenous
fasbestos is detected, those samples containing asbestos
Samples taken are listed with their correspondimg OnalYses- I
"ACU".
Irb the Initials
are i1stedfirst and noted w
to( so identified in
or ho
tr. during demolition or renovation. any additional hidden or covered suspect materials simil ngs or
wall or ceiling tafuri
include but not limited to.' sheet vinyIJ700ring, 1"eJ700ring,
survey are located [may
the
Ent pipes, cement wallboard, electrical cloth, electrical wiring insulation,
:�A paints, concrete siding or skirting,
cem
Inyl wall coverings, spackling compounA or any other suspect TSI
thermal paper, wallboard, joint compounds. v
as Asbestos Containing Materials unless determined to be non-
(rh I System Insulationg they should be treated
erma
asbestos by laboratory analysis
otities of ACK which may be Usted with
otee approximations of qua
Note: Asbesto-Test, Inc. does not guara
and/or disposal quotes be obtained by
d professional abatement price
ende
It Is therefore recomm
the analyses erial (Lt. square or linear foot, etc.), or by an site assessment
u: ACM mat
fees per area of specir
Inquiring as to
renovadonor
repod must be abatedpriortbACMifisturbance
Any andall materiars idettdfled asACUln dds
by owed as os aba ement
a 11 bat
deindidom All niatMafs idendfled as ACM must be prafessionaLrY abided
prior to any dUturbance.
contrador
VDAKnnn ill 16so fln-M); WAC 296-62-07753 App. J
anLWt" test mCWUU. Rio
A CM signifies "Asbestw COntaillft Material"
FACM significs"FmMedAsbesto s co"ning Material-
C B sigWiles "Conade Asbestos Boad'
A
'ZV
signifles "lea tbaW
TSI lignifies"Th =21 System baulatioe
HVAC signifies -Heating Ventilst ins Air-Canditin"inEr
NAD signIfies --No Asbcstos Deteded"
gtogy limit for wbe9w in bulk samplea
*sow per=i Is the USEPA regul lifive pLM results =nnot be
thus neg
tages orsome SaMPICS, W hich eDnIzin asbWos'
pLM has been know to Mfg z3befts in sfnlll P"m --cy *4*n r"WrW in =all p6mentABOL
be tested VAlh SEM of TEM, to i0sure analytics, a
suargateed. Floor dies and ygipes should
sib*)Iity for sample content only.
ASbcsto,.TeSt, Inc. ClaIMS Tespon
glyD oFREPORT
ArLynn Hammond
Analytical Chemist, LSc-
AM PfOfi cient
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APPROX. DEMOLMON CALCULL
HOUSE: 1100 SF
DRIVEWAY: 700 SF
FOLLOW PRE —DEMOLITION PROCEDURES PER CITY OF
i It.
\400
N I �
8512 MAIN STREET
Im DEMOLITION PERMIT PLOT PLAN
R�r_ Lovell—Sauerland & Associates, Inc.
MADRONA COVE PRD 02-171
no e 4ww" TA am - (MMII-lul a (=Pw-m CITY OF EDMONDS WASHINGTON
FILENAMEs 4486\dwg\deno
UPDATED AUG L8 2003 jpo
LSA JOB NO. 4486
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
rozen Fund Account #571359S for Phoenix Development� Ince
Re: Performance F
Demolition at 85129 85169 852% 85269 8528 Main Stree4 Edmonds.
...... Dear Sir or Madam:
ds hereby authorizes the release 10,000 from,the above referenced
The City of Edmon
W, poop
ved the release of
ity
Performance Frozen Fund. AllinterestedCi departments have appro
the Performance Frozen Fund.
X
Sincerely,
Je er Readwi
Permit Coordinator
Cc: Applicant
UTemp/DST's/MasterLctters/ReleasePerformanceO2/01
Incorporated August 11, 1890
Hekinan. Javan
Sister Citv
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................
Wall............ .................
Pier/Porch ................
w1i
Reta n ng Wall, ...........
0
M,
Slab Insulation .....
IN
PLUMBING:
Underground ...
R
Rough -in ................
m
Commercial Final . ......
m
HEATING
�as Test ........ ..........
Gas Piping ...... ...............
Equipment .....
Commercial Final
to:
EXTERIOR SHEATHING
NAILING ..........................
0
FRAMING .......................
FIRST FLOOR, FRAMING...,.
... ..... ..........
INSULATION ........
12.
Floor Insulation .........
bATe R9CE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
E OF BUSINESS
vv�
MAILING MDRESS,
CITY zip TELEPHONE
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NAME�
ADDRESS
CITY ZIP TELEPHONE
NAME CBLN
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'I ADORES
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STATE LICENSE NUMBER
EX
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL.,
0, ADDITION
[3 COMMERCIAL
REMODEL
13 MULTIFAMILY
REPAIR
0 GRADING CYDS
DEMOLISH.
13 TANK
IGARAGE
3
0 RETAININGWALL
CARPORT,
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAI%
'NUMBER
NUMBER OF
OF
,-STORIES
DWELLING L
UNITS
DESCRIBEWORK TO BE DMNE
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V. C
PERMIT EXPIRES.'-.
USE PERMIT
ZONE NUMBERIZ D3
JOB
ADDRESS
A 'S
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Parrral Required
Stmat u" Peffn Wd
M P
EXISTING — PROPOSED
Inspection Requited
Sidewalk Required
REQUIRED DEDICATION— FT
IOWNER/CONTRACTOR
Undergmund
13
wima required!
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
ES 13 NO
REMARKS
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWEDISY . r I DATE
FIRE REVIEWED By DATE ull
rL.
VARIANCE OR CU SHORELINEORADS# INSPECTION BOND
REO'D POSTED
IL 13YEs PNO
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COM SEPA RIWIEW E
PLETE . UJPT\l /LOWPRO OPOSED
EXP
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LOT COVERAGE
REQUIRED SETBACKS (170
PROPOS EDISETBACKS (FT)
PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT.."ILM REAR
COMPLIANCE OR
,,SIDE
CHANGE OF USE
Ll
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
116
El
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FENCE
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REMARKS
12
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OTHER
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F RE SPRINKLER
FIRE ALARM
CHECKED BY
TYPE Or
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SPECIAL INSPECTION
REQUIRED [3YES
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PROGRESS INSP
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OCCUPANT
LOAD
PER UBC 108/FINAL INSPECTION REUD
ME mmmm, . 11
$
6
7,7.
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit
City Surcharge
VESTED DATE
PLAN CHECK!40: Plumbing
Mechanical
THIS POWIT AtrrHORIZES OW THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
2
DOMAIN (CURSS, SIDEWALKS, DRMVAYrh MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PER ITAPPLICATIOM' 111110DAYS
UROVIDED WORK 18 STARTED WITHIN 180 DAYS
PERMIT ILIMM I YEAR - P E nr. Ins— on�
SEC "PK OF PINK PEnMff Fon MORE INFORMATION
N BEHALF OF HIS OR HER SPOUSIF.* HEIRS. ASSIGNS AND SUCCESORS
FIre'Review
Plan Chk. Deposit
;AP
N 1=01AGREES TO INDEMNIF4 DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OfnCIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
N.L CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS fERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. D a
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUInEMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN 13 CORRECr 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
CAL
Icallonia not a permit unit signed by the
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
ECTION'.
FOR INSPEL
�
I
W14C
let or hi.1her Deputy: and Fees are paid. and
Ipt Is ackricyMBOW In spaoe proVded.
-
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
ICI
IG4-�URE DATE
,MFRE (OWNER OR AqEZ�
DATE SIGNED
I
1A05)
TE113,16Y
PE
771-0220
11
DATE'
ArMNTION
EXT 1333
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-ASSESSO.R'
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN -ACCOUNTING