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20030824.pdfDATE RECEIVED��j, PERMIT EXPIRES L _3 CITY OF EDMONDS USE PERMIT ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/A T# ADDRESS OW2! NAME/NAME OF Bust S 7c" 11 Af 6 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.CA!j a M MA!IL%G ADDRESS Uj LID FEE $ k— 0 TESCP Ap to PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrnItPR.vV1,ed Lolly /hP J�ELEPHONE Street Use Permit Roq'd EXISTING - PROPOSED Inspection Required [3 Sidewalk Required 0 REQUIRED DEDICATION- FT underground 12 11 (equ to E3 METER SIZE LINE SIZE NO. OF FIXTURES RV REQUIRED YESM NO 13 z ADDRESS REMARKS x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE CITY ZIP EPHONE TEL Ev, PIL NAME &12 It F1 JCBL��> ADDRESS ENGINEERING REVIEWED BY DATE C, FIRE REVIEWED BY DATE Lu CITY ZIP TELEPHONE qr f't , V/ YY14;71-1 7 VARIANCE OR CU HORELINEORAD11111 INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE K D BY 0 PR4fNS PECTION R POSTED 3 71L 0701-1� &YESPANO $ _IUSHH-A-010ANED PR PERTfTAX Ac 0 C L SEPARVIE01ML111- OF D� 4T NO. COMPLETE LLOW EXEMPI ALLOWED PROPOSED ALLOW PROPOSED 0 6f X 0o SIDE S13WER UST BIBB PPED ATI , 11 EXP RR INIMP T.A. -_ NEW r"VRESIDENTIAL 1:1 PLUMBING MECH LOT COVERAGE REQUIRE6'S"ETBACKS (FT) PROPOSED SETBACKS (FT.) 1114N ALLOWED CVROW&Ebt F#ftjI% JVR FRONT UR SIDE REAR COMPLIANCE OR 0 ADDITION COMMERCIAL 1:1 qMOVED OR HOSH JBIB WITH M INSTALLEn CHANGE OF USE 1:1 REMODEL MULTIFAMILY 13 SIGN PARK LOT ARE PLANNING REVIEWED BY DATE RECrD I MKOVI P AT A DUMP SrM coLy 1:1 REPAIR 0 GRADING FENCE 13 _+ROVM) :61VtUr.MULI&70f4 1NSP=Of4 CYDS ( X FT) REMARKS OTHER DEMOLISH 1:1 TANK 1:1 — it Qlarx"ex nN BJCK Olt J()a C&RD FOR INSPEC71ON REQUIPXMEN73 ,__t ARAGE I RETAINING WALL FIRE SPRINKLER 1:1 1:1 0 CARPORT ROCKERY F RE ALARM (TYPE OF USE. BUSINESS OR AVJ�IM EXPLAIN: "T i-C CHECKED BY TYPFOF CONSTRUCTION OCCUPANT GROUP 1 -1/2 47F NUMBER NUMBER OF, C RITICAL - OF DWELLING' AREAS SPECIAL INSPECTION OCCUPANT STORIES UNITS NUMBER JAREA LOAD REQUIRED 0 YES DESCRIBE WORK TO BE DONE REMARKS z PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D iIo�g jqz/ clet C9- Oki 'ZO VALUATION $ Description FEE Description FEE Plan Check State Surcharge HEAT SOUR6�_7 GLAZING % LOT SLOPE % Building Permit City Surcharge PLM CHECK NQj VESTED DATE Plumbing Mechanical THIS PERMIT AUTHORRES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPUCATION: ISO DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 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 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 CLAJMS 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 Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt # 1 HEREBY 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 REGULATING CONSTRUC- CALL This application is not a permit until signed by the % TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'SWMPENSATION INSURANCE AND RCW 16.27. 94I)IALS S.IANATURE DATE SIG E WNER) OR A Ile DATE SIGNED 47— (425) W —6 771-0220 .11111me VTE ATTENTION EXr 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 -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 9 0 M 1. =i:fl 55 � OM C ma 0 0 0 C —i K 3: M ITI 0 Z 0 n M M a Vi 0 o Fn a to C V) M 0 Z z z 0 M Eric Sunquist Viking Properties PO Box 1034 Lynnwood, WA 98046 RE: Viking Property Asbestos Abatement Job No. 2038888061 Dear Mr. Sunquist: R CT: 71,1,7` E OCT 0 6 2003 11 A". LONG SERVICES A AtAsion oftong PaWing Cony"iy 21414 - 68th Avenue South Kent, WA 98032-2416 (253) 234-8050 Fax: (253) 234-0034 www.longpainting.com LONGP**230MA Hazardous Material Abatement Long Services is a leader in the asbestos abatement field using the latest technology and strict quality control that meets or exceeds all local, state and federal regulations. In order to do our work successfully, it is imperative that others in the area stay clear of the regulated work area. Signs and barricades will be posted to maintain security. We request your assistance to ensure that no unauthorized personnel enter the asbestos abatement work area and that materials suspected of containing asbestos are not disturbed, no matter where they are found. Federal regulations require that we notify all other employers who may have personnel in the area and advise them of the nature of our work. We request that you transmit the names, addresses.and phone numbers of any,pmpl.oyers on.the premises so that we may properly inform them. These employers are required to inform their employees of the dangers involved. We are enclosing a copy of Appendix G, WAC 296-62-077-47, "Substance Technical Information for Asbestos," for your use. We have established an outstanding record of performance in our asbestos abatement work and intend to perform to your expectations on this project. Please call us if you have any question's or problems. We thank you for the opportunity to serve you in your asbestos abatement needs. Sincerely, LO SERVIC7ES, DIVISION OF LONG PAINTING.COMPANY. CF IV FM Sean'Graig Project Manager OCT 2 3 '13'ul SC:dh "Your Partner in Safety, Quaiit� & Service" DEVELOpMENT SERVICES CTR- r,11Y OF EDMONDS �,o WAC 62-07747 APPENDIX G - SUBSTANCE TECHNICAL INFORMATION FOR ASBESTOS H E 1 PX47 1 M 71* ME rem, 4 go- I am, a. Substance: "Asbestos" is the name of a class of magnesium -silicate minerals that occur in fibrous form. Minerals that are Included in this group are chrysotile, crocidolite, amosite, anthophyllite asbestos, tremolite asbestos, and actinolite asbestos. b. Asbestos, tremolite, anthophyllite, and actinolite are used in the manufacture of heat -resistant clothing, automotive brake and clutch linings, and a variety of building materials Including floor tiles, roofing felts, ceiling tiles,- asbestos -cement pipe and sheet, and fire-resistant drywall. Asbestos, tremolite, anthophyllite and actinollte are also present In pipe and boiler insulation materials, and in sprayed -on materials located on beams, In crawlspaces, and between walls. c, The potenbal for an asbestos -containing product to release breathable fibers depends on its degree of friability. Friable means that the material can be crumbled with hand pressure and is therefore likely to emit fibers. The fibrous or fluffy sprayed -on materials used for fireproofing, insulation, or sound proofing are considered to be friable, and they readily release airborne fibers if disturbed. Materials such as vinyl -asbestos floor tile or roofing felts are considered nonfriable and generally do not emit airborne fibers unless subjected to sanding or sawing operations. Asbestos -cement pipe of sheet can emit airborne fibers if the materials are cut or sawed, or if they are broken during demoliflon operations. d. Permissible exposure: Exposure to airborne asbestos, tremolite, anthophyllite, and actinolite fibers may not exceed 0.2 fibers per cubic centimeter of air (0.2 f/cc) averaged over the 87hour work -day. 2. Health Hazard Data a. Asbestos, tremolite, anthophyllite, and actinolite can cause disabling respiratory disease and various types of cancers if the fibers are Inhaled. Inhaling or ingesting fibers from contaminated clothing or skin can also result In these diseases. The symptoms of these diseases generally do not appear for 20 or more years after Initial exposure. b. Exposure to asbestos, tremolite, anthophyllite and actinolite has been shown to cause lung cancer, mesothelloma, and cancer of the stomach and colon. Mesothelioma Is a rare cancer of the thin membrane lining of the chest and abdomen. Symptoms of mesotheliorna, include shortness of breath, pain In the walls of the chest, and/or abdominal pain. 3. Respirators and Protecti a. Respirators: You are required to wear a respirator when performing tasks that result in asbestos, tremolite, anthophyllite, and actinolite exposure that exceeds the permissible exposure limit (PEL) of 0.2 f1cc. These conditions can occur while your employer Is In the process of Installing engineering controls to reduce asbestos, tremolite, anthophyllite, and actinolite exposure, or where engineering controls are not feasible to reduce asbestos, tremolite, anthophyllite, and actinolite exposure. Air -purifying respirators equipped with a high -efficiency particulate air (HEPA) filter can be used where airborne asbestos, tremolite, anthophyllite and actinolite fiber concentrations do not exceed 0.2 f1cc; otherwise, air -supplied, positive -pressure, full faceplece respirators must be used. Disposable respirators or dust masks are not permitted to be used for asbestos, tremolite, anthophyllite, and actinolite work. For effective protection, respirators must fit your face and head snugly. Your employer is required to conduct fit tests when you are first Page 1 Z; 0 M W am a ma ..10! oc� C m m 10 C z 0 Sn m R C Cft z 0 q 0 m WAC 62-07747 APPENDIX G - SUBSTANCE TECHNICAL INFORMATION FOR ASBESTOS, CONT'D 5. Access to Information a. Each year, your employer is required to inform you of the information contained in this standard and appendices for asbestos. In addition, your employer must instruct you in the proper work practices for handling asbestos -containing materials, and the correct use of protective equipment. b. Your employer is required to determine whether you are being exposed to asbestos. You or your representative has the right to observe employee measurements and to record the results obtained. Your employer is required to Inform you of your exposure, and if you are exposed above the permissible limit, he or she Is required to inform you of the actions that are being taken to reduce your exposure to within the permissible limit. c. Your employer is requi ' red to keep records of your exposures and medical examinations. These exposure records must be kept for at least thirty y6ars. Medical records must be kept for the period of your employment plus thirty years. d. Your employer is required to release your exposure and medical records to your physician or designated representative upon your written request Page 3 0 0'' M;. C 0 C" On i67 C 21 0 M At 4' C tat.: Ac Z 01' October 2, 2003 Eric Sunquist Viking Properties PO Box 1034 Lynnwood, WA 98046 RE: Viking Property Asbestos Abatement Job No. 2038888061 Dear Mr. Sunquist: P. 97V 7" "17- 7 V1 I... — v Ita D OCT 0 6 2003 LO NO 17SERVICES A Di[Asiol, OfLOV PUi?Mmd C'011ymlly 21414 - 68th Avenue South Kent, WA 98032-2416 (253) 234-8050 Fax: (253) 234-0034 ww1ongpainting-corn LONGP**230MA Hazardous Material Abatement Th . ank you very much for allowing Long Services to meet your asbestos abatement needs. We are writing to confirm your verbal order and instructions to proceed. As agreed we will remove 800 SF popcorn, 135 SF sheet vinyl, 160 SF 9x9 tile/mastic and 12 windows, for the Jump sum of $5,437.00, plus all applicable sales taxes. Terms are net 30 days, no retention. We understand that work is to start on October 9, 2003 and be completed as soon as possible. We will be working on the day shift starting at 8:00am. . We appreciate your business and guarantee that all work will be done in accordance with local, state and federal regulations. If asbestos materials are found in excess of the above outlined scope of work, arrangements for additional compensation and time must be worked out before we can proceed with any extra work. When it is necessary to tape visqueen to walls or other surfaces during abatement, the existing surfaces may occasionally be damaged when the tape is removed. Long Services will not be responsible for this damage if it should occur. Should you require any additional information or have any questions, please call me at 253- 2M-8050 Sincerely, LONG SERVICES, A DIVISION OF LONG PAINTING COMPANY Sean Craig project Manager SC:dh "Your Partner in Safety, Quality & Service" 0, M1, M. M�i M M rn M'. Fn ��4m@ 0 0, M -Z, L SEP-30-2003 14:57 VikinA PropertY &oc)'� 4tMQ0 Use Cwy LONCI,,PAINTING 138888061 PUGET OURD —CLEAN AIR Date RecCived AGENCY 110 Union strem Wtr 500 _1 1 9601-2039 ..r. www.pscicanair.ors odzawy Uff 011ty NOTICE OF RMNT P. 01 A. F.Egiec Fdiihle Albtstpa Ro=Rval 2. 23 Friable Alhatoff H=2vAl A 21NO"11100 1 61 Remill"an UGLY — Pro= owner: Viking Properties Phom: 425 70-271 - 1,206-90 I ci Lynnwood 98046 Mailing Addrm: PO Box 1034 ry. state WA I zig: c, A'b"t" Long S - ervices OALF Nova ow./CEO:John Fisher. Contnctor: ...... Conuutor Mailing Address: 21414 68th Ave. S. I Phone: 253-234-BQSO Job No.; K . ent statc:WA -zi .98032 1 Fax:253-234-0034 2038888 Ci!X: -ee i D. Site Edmonds _77z�- 98026 Addrc-: 9015 240th St SW Citv: 253-234-8050 site Sean Craig Lwal Phone; Date of Jubestos wa Friable Asbestos Mazitified7 Wes Ugo� ETZ A No. ckf I le Asbeaw Identified? OYes QNo s== 9/26/0_-3--- Was Nonfrisb certificaticat. Aawh a copy of the swwy wkenfriabld arbevos A"'� Bu"d'm Elaine Hagerdorn hm nai baer idmiffied Impectm Exp. Dau. M---. -- MI.Al-t No. of 1 1. U F. D4M0Hti0h .2 12. C3 Information., I=, 10-12-03 Structures. __ Demolition ew.%V&ddpw*4hWL_ Will lionfliableasbc3tosball Cowractor Viking PropertY if yes, jig type &W qty. G. Fdable Asbestw Prpject larormatIOD: Start Date: 1010912003 CoMEleti Date: 1013112 Total Qty. to be Removed: Linear Ft. 935 Ft. Other:. mnaw Ins. LJ Dw Ins. LJ Pipe Ins. I 7iW—Mal Systern Insulation: I LJ B011 I Surficinj �Mao: I LJ F -proofing 0 Paints _Mlsstcr W Tcxwrcd Cos - As I Otbw. ra~flt RrL LJ CCMWnt Pi= W Friable Floating or Rooft Mkt'1 X VA 01 RM (List FUC LXV WijkDayc M T W 11h X Sa 513 HOW31 Will ]p Yes H. AsbesM/DemdWon PrOe" C"Orift: NQdflgggLte1Lod Project Demolition Eta sumbare 1. Single -Family Residence: A. Prior Notice A. S25 A. 0 Asbestos Rwnov-al Project Only B. L1 Demlition Project (wM or withoat asbcs= removal project) B. 10 Days* B. 550 m(Asbestos removal can begin upon notification; demlidan mwt wait 10 days) it owncd ky onefun* who bay ken or *W be agog the Foldewe as their donsick, the abo We ba=F Nale:,ff the iftlefanity reddeme IA or IS may be checkeA A !k& poldence doo not include nnyd prWape J—dw-A zui�;�U�ftlb or air, - mixed -we bwllalinz. S200 2. U All OtlierDmolitiom With No Asbestos Rernoval Project — I 10 Days Friable Asbestos Projem (other than Sinkle Fatnl!Z Reildence), Albeffton Demo Prior Notice 10 MY$ SIDO I Ll ;-), 10 - 259 linear feet Lndtor 2! 48-159 square fect of asbestos l0Day9 slou') 4. KI 260 - 999 linear feet an&or 160 - 4.999 sgimm reet or Lsbestos 10 Days :S750 _T15T 5. U >1,000 lill and/or >5,000 !quare feet of asbestos —prior N"cc Twice Project Fee 6. LJ Emergency As Project or LJ Emergency Demolition Proi= (sinAle-Family "Wom NE ezemi" 00m4grgeney ftt: bowever. 2="Yowne" Mug pmvide a I %winen of my knowledgr- L=UrU PWC. I ocni infon"14 comainrd in thL& notA=mn A 3uPP1cn=tW dum il. 10 the bcst c 97M Long Services IR, Y�L ued,9, PuSen Sound CIrAn Air Agcney Forni Wo-t 66-160 (&cv1vd 9,W) TS RECEIVED OCT 2 3 2003 DEVELOPMENY 'SERVICES CTR' C1,ry OF EDMONDS z 0 M 0) 01 M C: r1l 0 80 C M M 10 � z 0 X M M 0 o Fn C 0) C 0) M 0 Z r- X z 0) z 0 M SEP-30-2003 14:58 LONG PRINTING Viking Property 2038888061 P. 02 The Puget Sound Clean Air Agency requires advance 110fifIC41601D before any person commences a friable asbestos project car C r feg wW all demo ro involving materials equal to or greater in size than 10 lin f et or 48 squa e for lition p jects (roprdless of asbc3tos content) involving sattcrum with a projected roof area greaw t&n 120 square feet OlegUl9tiOD M, Article 4). All asbestos ranoval and dcmolidon notifications must be submitted to be Agency on current Agency forms. A&bestos remoxil and dcrnolition prdects involving materials and autictures h9low the notification threshold are still subject to all other MoiM=ts of - Article 4. Afta receiving a complete notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition contruttir by mail. The returned copy will be your validated notification. D—Coolld" Vileinn i7r �;W; Eric Sunquist contractor's MailingAddrew. PO Box 1034 ?how: 425-670-2711 Job #-. 1 -670-2711 2038881 stai� WA 98046 Fax: 425 City; Lynnwood zig:_ kwfflw� GUIDELINES FOR SUBMITTING AN ASBESTOMEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Eriah1r, ASW= ' include$ popcorn ceiling material, sheet vinyl flooring, Cement asbestos board siding, urd duct insulation. Nonfriable mbegtos is normally found in vinyl floor tiles, window piny and most roofing materials. Stop 2. Eater property owner infortration in Box B. Stop 3. Enter tbc asbestos contractor or property Owner WOMIA6011, if tbc property Owner is conducting a single-family residential project, in Box C. Print cl=dY d1b is Your return Mailing I" - Step 4. Wer ft site address for all notifications in Box D. For muld-structure proiccb, suad SUPPICRICatill sheet with a site MOP (include an address f�r cwh site) and a list of ft type and amount of f1dible asbestos to be renbovad ftm each suw=e. Stop 5. Chock either asbastos survey or material presumed in Box K. All demolitions rcquirc that an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by a codified AHERA building Inspector. AnNh A coRY Of the surygy to th Stop 6. Enter the project information in Box F. arid ckmck the uslaing fire or ordomd demolition box if appropriate (a COPY Of tht official order must bc attached). All asbcsWs must be rcmvcd Prior to cOn&wting 9 training fire. Additional gaining fire requimmeats are contained -in Regulation 1, Section 8.08. If any nonfiiablc asbcows tnaterials will be left in place during darnolitiOn, check yes and lirA the type and quantity of maserial. Step 7. Enter asbestos project inforniation in Box G. List types of Lri&le ashestal material to be ramowA; surfacing materiapsuch As popcom ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, corrumt asbestos board siding or pipe, etc. Step 8. For Singlo-Family Residientiall projects, chock BOX HIA for renovation projects, BOX HID for demolition projects with or without asbestos removal. Asbastas rernovid may be conducted after a complete notifiCati011 is received, but demolition aciivities can only begin on the 10' day after the notification is received. Note. If the singkfamily re3idewe Is owned by onefoWly who has beex or wiU be using the raidence as Ikeir domicUes boxes ]A op 1B may be c1secAwd A singlefoally raidence do" not ineWe rejualpropeny, muld-family units, or any ni;wd-use bug&ng- For Commercial asbestos projects (or projects that do not quatify am Single Family Residential), check the project category H2 5 Oat niatchas the amount of friable asbestos that will be removeid. If a dernolition Ls involved, include the appropriate surcharge (additional fee) in your payment. To rile for an arnergency asbestos or demolition Project, Chock the appropriate box I — 5 and the applicable emergency box in H6. All cragmencY MQUests mgmt bg V& MpWC4 by t, letter frum-the proycm owner dMDgnMtin& the . . . . . . -1 . TIT A 11-2 /.-1 step 9. Please ewify the accuracy and completeness of the infonnallon provided by signing the notification in Box I. Mandatory arnandments to the notification are required for changes that increase the pwJect category, change the 41X$ of asbestos materials to be removed and changes to stan due, 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 amondrnonts. Puget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agency web page at www,pscicansir.org. For technical MiSWTICC contact (206) 689-4058 and ror administrative in_quiries contact 2066689-4090. REC FuLml Sound Clczn Air Alcracy Forrn No.: 66-160 (Rcvaod 9103) TS 0 CUT 2 3 2003 r-E--iVICES r-T-q- CITY OF DMONDS TOTAL P.02 z 0 -4 , I � 0 M M M 0 0 M M 0 T1 M M 6 Fn C CA (a 0 z z 0 M FINAL PRWECT APPROVAL FORM TO: DATE: 4j-- qLal MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: FIRE DEPARTMENT DATE MASE SIGN ENGINEERING DIVISION DATE(� PLANNING DIVISION DATE PUWP SIGN PROJECT9 s� da , _&t SITE ADDRESS- V 0C A DTj# (?W3 PERMIT # DATE INSPECTED &W DESCRIPTION OF WORK TO BE INSPECTED A fleld inspection was conducted to determine compliance with -approved plans. Final approval denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of GRANT FINAL PROJECT APPROVAL GRANT PROJECT APPROVAL WITH CONDITIONS NOTED 0 Copy of CONDITIONS given to owner/contractor by inspector FAILED FINAL INSPECTION - OUTSTANDING ISSUES 0 Copy of CORRECTION NOTICE given to owner/contractor by inpector I . 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature 1:temp:b1dg:fbrnis:ocaprv1 3/25/04 z 0 M :; 9 0 M a MO 0 80 C i K x M MZ 0 -n n --I 3:9 M M 0 0 0 M C Cj) 9 0) Q 0 Z X z 0) z 0 1 0 M . . .... .... RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall................. I ......... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. .. Rough -in ................... Commercial Final ...... .. GasTest ...................... Gas Piping .................. ... Equipment ................. Commercial Final ....... EXTERIOR SHEATHING NAILING ........................... FRAMING ........................ FIRST FLOOR FRAMING... INSULATION ................... Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION ... JIS CELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. DATE RECEIVFP CITY OF EDMONDS -CONSTRUCTION PERMIT APPLICATION OW?f,R NAMEINAME OF BUSINESS J�_— * L- / - r , � � ( f /,7 /4' CITY, ZIP 11rELEPHONE (& I 1v N Rt—' AME L_ L�2: �__f_cc ADDRESS CITY ZIP TELEPHONE NAME k-9, / i 0- USE ZONE JOB ADDRESS PERMIT EXPIRES PERMIT NUMBER,� SUITEIAPT# PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.CVW LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit R*Wd EXISTING — PROPOSED inspection Requited [3 Sidewalk Required 0 7// REQUIRED DEDICATION— FT — I underground Wiring required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED f YES 13 NO 13 25 z REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE -hip, ,i --:, ,-t u i,,w /0 a?/ 77LA I �Wj P1 It w5d5 CBLV 2d I — 0 ENGINEERING REVIEWED BY ADDRESS 1 POA L05Y _fTELEPHON FIRE REVIEWED BY CITY ZIP E t//, " (,t 0,;P, 1 STATE LICENSE NUMBER EXPIRATION DATE C7KED BY . VARIANCE OR CU JSEPA I REVI PROPERTY TAX. ACP0 CEL NO. COMPLETE1 E&I 0 o o EXP 6 NEW RESIDENTIAL 0 PLUMBING / MECH LOT COVERA2ft ALLOWED PROP59 ADDITION rl COMMERCIAL COMPLIANCE OR 0 CHANGE OF USE W REMODEL MUL171FAMILY 1:1 SIGN PARKING 80 REO'D I PROVIDED D REPAIR GRADING [3 FENCE X CYDS ( Fr) REMARKS _ _ SE DEMOLISH TANK OTHER 2;—GARAGE o RETAINING WALL F RE SPRINKLER CARPORT -ROCKERY FIRE ALARM PC 11.1—On ^0 A CV13A AlKlo IL �/DATE DATE W rL SHORELINEORADBN I INSPECTION BOND REO'D POSTED mspllenONI REk"EMNO 1$ BACKS (Fr.) PROPOSED SETBACKS (Fr.) FRONT TOYNKE REAR.6 LIR SIDE REAR ME= 79t BE 0VI3D CM WAITM14ANN NbIv = DATE XT AOPPJDVM DUMP SrM ONLT IRMOLMON INSPEMON - to CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT I I GROUP NUMBER OF NUMBER OF DWELLING CRITICAL AREAS SPECIAL INSPECTION OCCUPANT STORIES UNITS NUMBER 3 REQUIRED [] YES JAREA LOAD DESCRI BE WORK TO BE DONE . REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D //_21�1 11.1"r 4 A r. 1,12M _rka.1 � ---a VALUATION $ Description FEE Description �/C/ L=-A FEE Plan Check state/Surcharge HEAT 8 GLAZING % LOT SLOPE % Building Permit city surcharge ECK VESTED DATE Plumbing 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 2 Grading 3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS 916 PERMIT UM[r 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT; ON BEHALF OF HIS OR HER SP - OUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND 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 HE Landscapelnsp. Total Amt. Due 9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # I HEREBY 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 REGULATING CONSTRUC- This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. G TURE DATE 0491ALS 8) 89� E (OWNER OR A DATE SIGN D IA-35) T FK" 771-0220 RELEASED BY TE "ATTENTION M 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 - iNSPE60A CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLO-ASSESSOR 04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 0 11 0 M :; 9 3: M 0 0 0 C M Mz g) --I C 0 n x M M 0 0 0 M W Q 0 Z 7-1 X --I x z __4 X V; z 0 1 0 M