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20030900.pdfDATE RECEIVED 1j.a 1 -1 PERMIT EXPIRES USE PERMIT ZONE CITY OF EDMONDS NUMBER JOB Vflfi SUITE/APT# CONSTRUCTION PERMIT APPLICATION ADDRESS �11 1�u OWNER NAME/NAME OF BUSINESS 9 Loa] 2- PLAT NAME/SUBDIVISION NO. LOT NO. L D NO. lyi:12� CC, MAILING ADDRESS —2- u 7 CITY ZIP e�) �,,o P, 1 TELEPHONE -4 c1q 0 NAME M ADDRESS '�WD 15Dnc\ SA- �;u,4-6_s CITY 9'315TzIP TELEPHONE jfp�c LV --5(0j.�nci-a NAME jCBLN -TO P?_JS�A F 6i�:)AJZ5'j_ 1 130 1 cc ADDRESS 0 rg� I Ll ILL) CITY ZIP TELEPHONE —7q STATE LICENSE NUMBER r N 11T E ,,WECKEq T cis 1w, I -OM MCI, ft NO 1:4 1 PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL E] PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR 1:1 CHANGE OF USE REMODEL MULTIFAMILY [] SIGN REPAIR G CYDS Ei FENCE X FT) DEMOLISH TANK OTHER / IGARAGE 3 o RETAINING WALL F RE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE. BUSINESS OR ACTIV" EXPLAIN: NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit Roq'd EXISTING — PROPOSED Inspection Required E3 Sidewalk Required 13 REQUIRED DEDICATION- FT Underground wiring required C3 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0 4- 1NSPECT`ITN REQUIRED YES 13 NO 13 z REMAR z NE I NTAARTSPT09SIRN r0�690CWTOWGE OW RA 0 SIDE SEWER MUST BE CAPPED AT - HOSE BIB WITii AVB INSTALLED ENGINEErG WIEWD BY DATE DUMP SITE ONLY U P AT APPROVED FIRE REVIEWAIW 'JV-M MIM319 1Nbrr_U1,1UN CHECKLIST OF JOB eATRED cc ON BACK 0 cc FOR INSPECTION REQUIREMENTS VARIANCE OR CU SHORELINE OR ADBN I INSPECTION BOND I REO'D POSTED 1$ 13—YES ONO t SEPA REVIEW SIGN AREA HEIGHT COMPLETE_, EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR z z PARKING LOT AREA PLANNING REVIEWED BY DATE 5 REO'D I PROVIDED I REMARKS CHECKED BY 1=10N CQPF_. OCCUPANT GROUP R-3 SPECIAL INSPECTIOR' AREA OCCUPANT REQUIRED LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D all HESOURCE GLAZING % LOI - OPE % _I , C %L A 475 z7v PLAN CHECK NO: VESTED DIE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT UMrP 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 MODIFX 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; T14AT 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIPMAT.VRE (OWNER OR(AMV DATII� SIGNEDi VALUATION Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge la Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapelnsp. Total Amt. Due A5V Recording Fee Receipt # CA-967,1? CALL FOR INSPECTION (425) 771-0220 EXT 1333 APPLICATION APPROVAL This application is not a permit until signed by the Building official or his/her Deputy: and Fees are paid, and receipt Is acknowledged In space provided. OFFICIALS StGNUF E rRELEfeD BY f DATE 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 ITI =i 9 V5;j 0 M C M 0 —10 0 C � C . M M 0� �z 0 _n n � �! ic ITI 1711 0 (6) 0 o Fn C (j) ic V) M 0 Z X z z 0 4 0 ITI Agency Case No. PUGET SOUND CLEAN AIR AGENCY Date Received 110 Union Street, Suite 500 r Sta"Itle, WA 98101-2038 www.pscleanair.org OCT 1 4 2003 200300884 NOTICE OF INTENT .x. Project Type: 1. El Friable Asbestos Removal 2. Friable Asbestos Removal & Demolition 3. __ Demolition Only __�h7o 3. Property Owner: L ­7 o4v ,4,, r n e: failing Address: .-;L �/J - �z Z City: IT — I State L,b,k Zi2: rlfl_�T C. Asbestos PLEASE PRINTCLEARLY. THIS WILL BE YOUR RETURNMAILING L4BEL Contractor: Owner/CEO: 'vlailing Address: _e' Phone:Ju Contractor Job No.: City: State* L-VV ZiE: 61 Z Fax: D. Site Address: S -t '-A TZ i 7wy Site Manager: E. Asbestos Survey or No. of Mat'l Presumed Structures: AHERA Building Inspector: L, -7rojects in AHERA Survey is required before all demolitior 7 Demolition Start Information: I Date: Demolition Insert demolition conitacturts mailing Contractor: i" uk, I '4� --�'7 ', , i (�.: TLocal Phone: ;t Date of Asbestos Was Friable Asbestos Identified? WYe—s- :!Vo Survey: Was Nonfriable Asbestos Identified? 51Yes UNo Certification #: )c, 6 Li Attach a copy of the survey whenfriable asbestos Exp. Date: Af-'L has not been identified d 2/0 No. of 1. U Training Fire (List Fire Dept:) f e6f I Structures: 2. 0 Ordered Demolition (attach copy of Order) -ess on back. Will nonfriable asbestos be left in place during demo? U Yes Jd No If yes, list type and qty. G. Friable Asbestos Work Days- M T W Tji Hours: F Sa Su Pro_ject Information: Start Date: 7AV�+ Completion r Will all friable asbestos ar Yes Total QtY. to be Removed: Linear Ft. 97;�C_ Square Ft. materials be removed? El No Thermal System Insulation: UBoileffurnaceins. U Duct Ins. LJ Pipe Ins. Other: Surfacing Mat'l: i L1 Fireproofing LJ Paints Ll Plaster LJ Textured Coatings Other: Misc. Mat'l �gCernent Bd. LICementPipe 10 Friable Flooring ora29,fqgMat'I Other: 0 H. Asbestos/Demolition Project Categories: Notification Period I Project Demolition 1. Single-Farrdly Residence: 0 I Fee Surchar A. Q Asbestos Removal Project Only T.�.!r) - lw* A. Prior Notice A. $25 B. �@ Demolition Project (with or without asbestos removal pr�ject),.% -lit B. 10 Days* 7"0 *(Asbestos removal can begin upon notification; demoliticki� a s) Note: If the singlefamily residence is owned by onefamily who has been or will be using the residence as their dom icile, the above boxes 1A or 1B may be checked. A single family residence does not include rental property, multi -family units, or any mixed -.use building. TJ_AII Other Demolitions With No Asbestos Removal Project 10 Days $200 Friable Asbestos Projects (other than Single Family Residence): Asbestos Demo I $100 $100 LJ �: 10 - 259 linear feet and/or -a 48 - 159 square feet of asbestos Prior Notice 10 Day� _ 1 $100 -3. 4. Ll 260 - 999 linear feet and/or 160 - 4,999 square feet of asbestos 10 Days $200 —7-- 0— 5. >1,000 linear feet and/or >5,000 square feet of asbestos 10 Days $750 $250 60 Ll Emergency Asbestos Project or Ll Emergency Demolition Project Prior Notice Twice Project Fee r__ r­ t--ver rn e nwnem mtmt nrovide a written emergency request) I certify that the int'o co ined in this notification & supplemental data is, to the best of my knowledge, accurate & complete. Agen7e 041Y Bv Dale Re,,i,.ed Bv /0// puget Sound Clean Air Agency Farm No.: 66-160 (Revised 9/03) TS 1� z 0 4 0 M M C M 0 80 C �c . M M Z 0 _n M M a V5 0 0 Fn C (J) C 0) Q 0 z z z 0 4 0 M The Puget Sound Clean Air Agency requires advance notification . bZfbre%ny person commences a friable asbestos project involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects (regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation III, Axticle 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and demolition proiects involving materials and structures below the notification threshold are still subject to all other requirements of Regulation III, Article 4. 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 PLEAsEpMrCLEARLY. MIS WILL 8E MA RETLAYMAILING LAM. Contractor: Owner/CEO: - L C, -v\v ng z5 L,� ra Mailing Address: -D ( . J Phone: '�66 - 1'30 - loq Contractor's Job Ci!x: State: Zig: C1'9 Fax: & 5-33, C12--�Y_? GUIDELINES FOR SUBMITTING AN ASBESTOSWEMOLITION NOTIFICATION Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcom ceiling material, sheet vinyl flooring, cement asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing materials. 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 project, in Box C. Print clearly this is your return mailing label. Step 4. Enter the site address for all notifications in Box W For multi -structure projects, attach supplemental sheet with a site map (include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure. Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency Response Act (AHERA) asbestos survey be conducted by a certified AHERA building Inspector. Attach a copy of the survey to the notification of a demolition nroiect when onIv nonfriable asbestos or no asbestos is identified on the survey. Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire requirements are contained in Regulation I, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition, check yes and list the type and quantity of material. I Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as popcom ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc. Step 8. For Single -Family Residential projects; check BOX HIA for renovation projects, BOX H1B 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 I Oh day after the notification is received. Note: If the single family residence is owned by one family who has been or will be using the residence as their domicile, boxes 1A or 1B may be checked. A singlefamily residence does not include rentalproperty, multi -family units, or any mLved-use building. For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 - 5 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 — 5 and the applicable emergency box in H6. All emergency requests must be accompanied by a letter from the propeM owner demonstrating the need to conduct the project immediately in accordance with the requirements in Regulation III, Section 4.03 (c), Step 9. Please certify 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 changes to start date, 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 $25.00 processing fee is required for all amendments. Puget Sound Clean Air Agency asbestos regulations and fon-ris can downloaded from the 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 Form No.: 66-160 (Revised 9/03) TS Z 0 4 0 M ,4--6 V5 � 0 M C: rn 0 0 0 C: � C IT! M 104 0 _n �n 9 MIT! a 6) 0 0 Fn co) V) M 0 Z CA Z 0 1 0 IT! FINAL PROJECT APPROVAL FORM TO. DATE: MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: FIRE DEPARTMENT DATE -ENGINEERING DIVISION DATE. PLANNING DIVISION DATE KEMP SIGN PROJE T C SITEADDRESS-LIU 7 PERMIT 4 P�03_ t)70() ADB# DATE INSPECTED :3/4 1d4 DESCRIPTION OF WORK TO BE INSPECTED Delmz A field 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 Copy of CONDITIONS given to owner/contractor by inspector 1 . FAILED FINAL INSPECTION - OUTSTANDING ISSUES E3 Copy of CORRECTION NOTICE given to owner/contractor by inpector 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature 1:temp:b1dg:fbrms:ocaprv1 3/25/04 z 0 1 0 R1 =i =n- M C M 0 0 -40 0 C -4 K X M M Z r cl) 0 -n n M M 0 0 0 M Q 0 Z r- .AT X z 0) z 0 M 046.1 RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ................... FOUNDATION: Opoting....................... Pier/Porch ................... Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. -in ................... Rough Commercial Final ...... HEATING: Gas Test .................... Gas Piping ................. Equipment .................. Commercial Final ....... EXTERIOR SHEATHING NAILING .......................... FRAMING ........................ FIRST FLOOR FRAMING... INSULATION ................... Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... ECIAL INSPECTION ... MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. 07 o 0 ,qDATE RECEIVED ERMIT EXPIRES [P IL USE PERMIT CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT# ADDRESS LO 0—I OWNER NAMEINAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. ADDRESS MAILING I LID FEE $ IN TESCP Approved PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Perm,, R:qu:,,ed Ph-) Sir.., Us. P rm R&q'd CITY 9 ZIP ;�JTELEPHONE EXISTING — PROPOSED IneWdon Required [3 Sidewalk Required [3 4�: REQUIRED DEDICATION- FT Undatilround 3 wiring required 13 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED L,-v -7 1 1 YES 13 NO 13 M szjNSpE;r_:P izw ADDRESS k �,- CITY I NAME — Tomu ADDRESS C�fq -3 CITY STATE LICENSE NUMBER _r C)f \4_ UT", PROPERTY TAX ACCOUN REMARKS TELEPHONE 2 U G Cl CBL ZIP I TELEPHONE jb 133 NO. NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR G CYDS AI DEMOLISH TANK oiGARAGE [3 RETAINING WALL CARPORT ROCKERY (TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN: V�) FD11 \,n NUMBER NUMBER OF OF DWELLING I STORIES UNITS DESCRIBE WORK TO BE DONE PROPERTY LINE WATER METER TO BE R13MOVED OR ENGINEERINGRFP9WWWD W11H AVB INSTALLERE 0 Dump AT APPROVED DMIS133 QkILY FIRE REVIEWEFnj3.]DEMCjLjT1- i - ' i DATE ON' INSPECTION 0 CHECKLIST ON BACK OF JOB CARD VARIANCE 08 ............. tMA"U4ffEW BOND 1[3y R=Mf POSTED ES 13NO Is SEPA REVIEW SIGN AREA HEIGHT COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED EXP PLUMBING / MECH LOT COVEMUE on.. k 0 1 ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR COMPLIANCE OR CHANGE OF USE I I PARKING LOT AREA I PLANNING REVIEWED BY DATE SIGN REO'D PROVIDED FENCE I I ( _x FT) REMARKS OTHER F RE SPRINKLER FIRE ALARM I CHECKED BY I TYRE.OF CONSTRLIQTION LIU OCCUPANT GR CRITICAL AREAS SPECIAL INSPECTION' AREA OCCUPANT NUMBER REQUIRED [:] YES LOAD REMARKS z IlIPROGIFIESS SPECTIONS PER UBC 108/FINAL INSPECTION REO'D VALUATION 74911 Imid $ 1 Description FEE Description FEE Plan Check State Surcharge HffSOURCE GLAZING % LOIALOPE % _I I Cf 61 Building Permit City Surcharge k4_�, D ZO/0 1:2 Cp PLAN CHECK NO: VE ED DATE Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. t Engr. Review PERMIT APPLICATION: 180DAYS M. PERMIT LIMM I YEAR - PROVIDED WORK 15 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 CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. Total Amt. Due P-5D DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." x Receipt # k / Recording Fee C I HERE13Y 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 IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/her Deputy: and Foos are paid, and receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGN�JURE If DATf SIG�E ER I: 41 DAT SIGNED 1A'05) 6AG L) 771-0220 _q7EfeD 13Y ATtEATION 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 - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING t z 9 0 ITI :q 9 V5 � 0 M C: In 0 -40 0 C: -4 C r rn M Z Cl) 0 _n n -4 2: M M 0 0 0 M C (j) C (1) M 0 z I X z 5� 0) z 0 IT!