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[PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF ED NDS
NUMBER a2-003:1���
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS e6 j.;4, AAa (n 51-
OWNE!ME OF BUSINE S
AJ
FIAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
15
MAILING ADDRESS
TIESCP APPFO"O
MAP
N(07?
PUBLIC RIGHT OF WAY PER OFFICIAL STREET RW Permit Required
Street Use Permit Req'd
CITY ZIP ITELEPHONE
Inspection Required 13
EXISTING — PROPOSED sidewatkRequirod 93
Fr Underground
REQUIRED DEDICATION Wiringfoqu4ed 13
METER SIZE OF FIXTURES PRV REQUIRED
NAME
YES E3 NO 13
ADDRESS
REMARKS FOR EROSION CONTROLIDRAINAGE
OWNER/CONTRACTOR RESPONSIBLE
r_.Yvi, PAZ,
CITY ZIP TELEPHONE
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NAME CBLO
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ENGINtERING REVIEWED BY DA�
ADDRESS
NINE
—F
FIRE REVIEWED BY
76ITY ZIP TELEPHONE
0.07
M 6_177
BOND
VARIANCE OR CU SHORELINE OR ADBO INSPECTION STED
PO
STATE LICENSE NUMBER
REO'D
OYES S
-7)rD
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AREA
SEPA REVIEW SIGN HEIGHT
PROPERTY TAX A C NO.
COMPLETE EXEMPT ALLOW.E04PROPOSED ALLOWED PR OPOSED
ou �5 0
EXP
NEW RESIDENTIAL 0 PLUMBING/MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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- COMPLIANCE OR
COMMERCIAL
ADDtnON 1-1 CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED 13Y DAT
0 REMODEL MULTIFAMILY 1:1 SIGN
REQ`D I PROVIDED
o FENCE
GRAJIbN
11 REPAIR DS X FT)
F
REMARKS
OTHER
0 DEMOLISH 0 TANK
RETAINING WALL FIRE SPRINKLER
oGARAGE
CARPORT' ROCKERY FIRE ALARM
(ME OF USE, BUSINW& OR ACTIV" EXPLAIN:
V10\11-
CHECKED BY 0 0 TRU11:11ON OCCUPANT
0 0 GROUP
U VA CA i
14P
NUMBER NUMBER OF CRITICAL ft-)2
OF DWELLING AREAS
��JUNITS_
-OCCUPANT
SPECIAL INSPECTION JAREA 0 LOAD
STORIES
REQUIRED [3 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 100/FINAL INSPECTION REGID
0nd_f.6&1 na =MV Ask V41 J36
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit City Surcharge
—
.
VESTED DATE
PLAN C1
--
Plumbing
sessee.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORKINOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY omLx ANY CONSTRUCTION ON THE PUBLIC
Grading
VAYS. MARQUEES. ETC.) WILL REQUIRE
DOMAIN (CURBS, sioEwALKS,DRM
SEPARATE PERMISSION-
Engr. Review
PERMIT APPLICATION: 180 DAYS
L PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspect1QAj
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk, Depos,
'RPROVAL
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 MATURE, ARISING DIREC1`1Y 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
Landscapeinsp.
Total Amt. Due
0 NCE PROVISION.'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPR
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPetwfw rrY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicaUcin Is not a permit until signed by the
Building otficial of hisihor Deputy: and Fees are paid, and
TION: AND IN DOING THE LITHO IZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE WOR 'DE ; THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowl space pZded.
WORKMERS COMPENSYION INSURA E AND RCW 18.27.
OFFICIALS SIGNATURE
11 TURE (OWNER E
DATE JIGNED
Mal
771-0220
R DATE
ATTENTION
EXT 1333
L/ d /0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFi-
ORIGINAL - FILE YELLOW - INSPECTOR
A
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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M
i GARY HAAKENSON
Ilk I '' 1 4
CITY OF EDMONDS MAYOR
Inc, 1891,
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121 5TH AVENUE NORTH e EDMONDS, WA 98020 * (425) 771-0220 9 FAX (425) 771-0221
Website: wmdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning* Building* Engineering
August 20, 2003
@ Sundquist Homes
Too Tern' McGuire
From* Lara Palmatier, City of Edmonds
Rea Demolition Bonds for 8512, 8516, 8520, 8526, 8528 Main Street, Edmonds WA
Tern,
The City of Edmonds requires a demolition bond in the amount of $2000 per
)lased
single family residence be posted prior to permit issuance and will, be rele
when the demo pernuits are finaled by all required City Divisions. You may post
if you wish. Thank you. If you
one bond for a total of $10,000 (for all five houses) i
have any questions please call us at 425,771,0220.
It
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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Date Signature
I:temp:bldg:forms:ocaprvl 3/25/04
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ATTN:
ASCADE TESTING LABORATORY, INC:
TESTING & INSPECTION / ENGINEERS
12919 N.E. 126TH PLACE
KIRKLAND. WASHINGTON 98034 (425) 823-9800
EVERETT (425) 259-0817
FiaD REPORT
(2)
INS CTION PERFORMED
7RESTEEUCONCRETE
RESTEEUMASONRY
OTHER
PREVIOUS
REPORT No. No. 119367
DATEA'j CERT. NO.
WIM
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PROJECT
Alo�M
LOCATIO
7_
BLM. PERMIT NO. OWNER
WEATHER TEMP. AT AM
AT PM
ENGINEER
FOUNDATIONS
7s'LAB
COLUMNS
2WALLS
BEAMS
(4)
LOCATION (AREAS) Yj&a=-2Ad&
NCRETE114AGONA41 MIX NO. DESIGN STRENGTH 0'0*1�
SUPPLIER A19 -61b TOTAL CU. YD. PLACED
-e- SPECIMENS CAST A Aqalca
SLUMP (INCHES) FAve-y
A&
AIR CONTENT 64 SEE CYLINDER REPORT NO.
RESTEEL ONLY
STR.STIWELDING
STR.STIBOLTING
(3)
ITEMSINSPECTED
FOOTINGS
AUGER CAST PILES
DRILLED PIERS
I —YES —NO —ITEMS INSPECTED WERE IN CONFORMANCE WITH BLDG. DEPT. APPROVED PLANS
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TEST FkE$UI.T5.APLlLY ONLY TO THE ITEMS - - . . — I... 1 1, - .4
HERgIN'TESTED. THIi REPORT SHALL NOT INSPECTORP, NAME(S) PRINTED
BE REPRODUCED EXCEPT IN FULL. WITH-
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY. INC. INSPEC T OR SIGNAT U
R EVISED G= SIGNED BY
COPIESTO:w/_'a. q." -
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EDCASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
12919 N.E. 126TH PLACE
KIRKLAND, WASHINGTON 96034 (A25' a 23:9:OC
EVERETT (A251 259 0 1;
COMPRESSION REPORT
A-
ffAW
ATTN:
THE FOLLOWING WAS NOTED:
FIELD TEST DATA
I AIR TEST METHOD: 0 PRESSURE ASTM (0-231 OR 0 VOLUME ASTM C-173
EQUIPMENT USED I.D. THERMOMETER CCOTHO -AQ!#—
SLUMP CONE CSLCOOAalf—
AIRMETER CCOAIO� OTHER
in% Cone d Shear
TYPE OF BREAK: (A) Cone (d) Shear (e) Columnar COMPRESSIVE STRENGTH
(b) Cone and Split
CYLINDER DATE DATE AGE SIZE
NUMBER MADE TESTED DAYS
7
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7 '17��3 ze
FIELD I I 47.qb 7 - 51'
REPORT No.__. No. 4. 71 �' -
TOTAL —STRENGTH I TYPE
LOAD PSI I BREAK
CONCRETE COMPRESS10 MACHINE I.D. #CCOCOOO-- 0 ASTM C-1 231 SAMPLING IN ACCORDANCE WITH
0 ASTM C-617 APPLICABLE CODES 9 SPECS. —
SAMPLE PIU DATE TEST METHOD
ler"M-2"r— CU. YARDS PLACED
SUPPLIER I CEMENT TYPE
IS.469 DESIGN STRENGTH
— CACr2 %
A ADMIX.
PLACEMENT AREA& NOTES
TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHAL 'L NOT INSPECTOR(
BE REPRODUCED ExCEPT IN FULL, WITH-
OUT THE WRITTEN APPROVAL OF cAS4::ADE INSPECTOR
TESTING LABORATORY- INC. I
REVISED 8=
COPIES TO:
SIGNED BY
A
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ASCADE TESTING LABORATORY, INC.
JL INSPECTION I ENGINEERS
1��12919 N.E. 126TH PLACE .9800
KIRKLAND, WASHINGTON 90034 14251 823
EVERETT IA251 259-0817
COMPRESSION REPORT
AT'rhl
THE FOLLOWING WAS NOTED:
cm n TFqT nATA
FIELD /Z., g0jA
REPORT No. lu -No. 51907
DATE
4�
MT. -NO.
LO
BLDG. PERMIT NO.
OWNER
WEATHER
TEMP. AT AM
41S T ?
ENGINEER
ARCHITECT
CONTRACTOR
7Z
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TRUCK PLED
TRUCKTICKET 0.
M NO.
TIME SLUMP
UNIT
% AIR WEIGHT YIELD
TE P.
CEMENT 64
FACTOR ASTM C-10(
ASTM C-1 43
ASTM C-138
CONC A IR
2.'.00
AIR TEST METHOD: [3 PRESSURE A5TM fj-ZLil UM u vuLumr- rw t
EQUIPMENT USED I.D.
SLUMP CONE CSLCOO 17 THERMOMETER CCOTHO-12—
AIRMETER CCOAI0_ OTHER
TYPE OF BREAK: (A) Cone (C) Cone and Shear
SATCH DATA FOR
cu. Yo.
DESIGN
WEIGHTS
%
MOIST. —
ADJUSTED
CEMENT
cr 0
FLYASH
C.A. 3.1&
C.A.
.3c)6-
-1 1
C.A.
FINE AGG.
WATER
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ITOTAI
DATE
ii
-TESTED
CONCRETE COMPRESSION MACHINE I.D. ff %j%.0%J%j%Juv_ 0 ASTM C-1231 SAMPLING IN ACCORDANCE WITH
SAMPLE pjU DATE TEST METHOD 0 ASTM C-617 APPLICABLE CODES & SPECS.
SUPPLIER CEMENTTYPE CU. YARDS PLACED
t* % DESIGN STRENGTH
AEA ADMIX - IS- 46 - 0 CAG12
11-7.20 Zf 6
PLACEMENT AREA& NOTES 40
TEST RESULTS APPLY ONLY TO THE = I
HEREIN TESTED. THIS REPORT SHAL INSPECTOR(S), NAME(S) PRINTED
BE REPRODUCED EXCEPT IN FULL, YATH-
OUT THE wRITTEN APPROVAL OF CASCADE
TESTING LABORAMRY. INC. INSPECTOR SIGNATURE
REVISED 1102
COPIES TO: A-14- &ME" ILE5 -
SIGNED BY
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