20030938.pdfI
Were741:-E ge'" v 4 11 �
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
FJVAf,7Wj,�;P �1�1 9�1�ft
MAILING ADDRESS
CITY ZIP I TELEPHONE
ADDRESS
CITY ZIP
NAME CBL#
owoe'r
ADDQESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
IROPERTY TAX ACCOUNT PARCEL NO.
i670 -7
0 Of2 - 0 1
0'5�
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
MPUANCE OR
COANGE
OF USE
REMODEL
MULTIFAMILY
SIGN
0 REPAIR
GRADING
CYDS
0 FENCE X
I FT)
DEMOLISH
TANK
[:] OTHER
oGARAGE
CARPORT
o RETAINING WALL
ROCKERY
0 FIRE SPRINKLER
FIRE ALARM
UWE OF USE, BUSINESS OR ACTMM EXPLAIN:
AAgviAA-,& a
Vie— ja�' 4/' k
NUMBER
OF
NUMBER OF
DWELLING )VIA_
CRITICAL
AREAS
I
STORIES
UNIT$
NUMBER A//)+
DESCRIBE WORK TO BE DONE
— R PS —
HEAT SOURCE GLAZING % LOT SLOPE %
I - -_ _ ---
PLAN CHEC:n.'_,,��� VESTED DATE
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. DRIVIIEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN7, 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 FO DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
RE
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
mift
S NE=_ DATE SIGNED
uh? 10s,
7 '�3 1 1 PERMIT EXPIRES I YJ �J W—L,
USE PERMIT ;xo --) _�q�
ZONE NUMBER :�) -6
JOB SUITE/APT#
ADDRESS %C71_ gpo+� Z't '�' N
PLAT NAMEISUBDIVISION NO. LOT NO, LID NO.
LID FEE S
TESCP AP "Ov"d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Parm"Req.ired
Street Use Parrnh Req'd
EXISTING — PROPOSED inspection Roquired
Sidewatic Required
REQUIRED DEDICATION— Fr UndergrMod
Wifing required 13_
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES C3 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
DATE
FIRE REVIEWED BY DATE W
cc
VARIANCE OR CU SHOFIEUNEORADB#j INSPECTION BOND
REQ'D POSTED
0YEs 13NO is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE - EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSEDd
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
I z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I I
CHECKED BY ITYPE gECMTRUCTION CIE OCCUPANT
GROUP
�7
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED 0 YES 52, -sv-- LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
161,Lz ____*
I
Description
-
FEE
—
Description
FEE
Plan Check
State Surcharge
Building Permit
1-7+
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Den-1
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION[
(425
771-0220
APPLICATION APPROVAL
This application Is not a permit unfll signed by the
Building Oificial or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
7.
SIGN \\�A
RELEASED
A-17TFENTION EXT 1 3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A 11dk It
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- IGINAL - ILE Y LLOW - INSPECTOh
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OW E GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
I
11/07/2003 09:25 425-670-7258 ESD MAINTENANCE PAGE 01
V
EDMONDS
EDMONDS SCHOOL DISTRICT Maintenance
2927 Aldetwood Mall Blvd.
Operations
Lynnwood, Washington 98036 Center
(425) 670-7244 (425) 670-7258
SCHODL
D 16 T R I C T MICROFILM
Includes Brier. Edmonds. Lynnwood. Mountlake Terrace and Woodway
ar
FAX TRANSMITTAL MEMO No. of Pages Including transmittal 5 Today's Date-1 1/07/03
Company: Ci!y of Edmonds From: Nick Chou
To: Mike Smith
Project: Westgate Elementary School
Fax IV: 425-771-022)
Re: Plan Check No. 03489
essage:
Please call me if you have any questi
ons, thank you
Nick Chou
Edmonds School District No 15
URGENT
NO REPLY NECESSARY
REPLYAS SOON AS POSSIBLE
ORTGINAL OF FAXED DOCUMENT TRANSMITTED VIA MAIL: YES 0 NO
if you have any problems or questions regarding the FAX transmissions, please call (425) 670-7244.
OUR MISSION
To AbVOCATE for all students by PROVIDING a leaming environment which EMPOWERS students.
staff. and community to MAXIMIZE their
penonaL creative and 3c3&mic potential in order to BECOME lirelong letimeirs and tesponsible world citizens,
2,
ize
0( . . . . . . . . . . .
C.
11/07/2003 09:25 425-670-7258
12/12-102 11:36 FAX 425 It-707WIL-
ESD MAINTENANCE
90kONDS15 STU SVCS
EDMONDS SCHOOL DISTRICT NO. '16
WESTGATE ELEMENTARY
USE OF TIME-OUT ROOMS
PAGE 02
11002
MICROFILM
Definiti Alad-RAIL90-ale
Time-out is a procedure that may be used with your child during the school year. it has proven to be an
eftctivs technique for decreasing Inappropriate behavior. it is our intent to explain the procedure to YOU,
as a parent, so that you will understand and support us In the use Of Tim"ut Procedures.
Ths definition of a Tim"ut 11s; Removing the student from a situation that seems to be
reinforcing and malintalintno Inappropriate behavior. In the most extreme behavioral circumstances,
r calisa the Time-out Room. Some WOMP189
this means the student YAII be sent to a shull, Almlng room
of behaviom that might result In a child being sent to the Time-out RoomInclude physical. aggr . ession,
d93trUction of property, and sevare tantrum behavior$. 0. 1 % #I I . .
For a Tim* -out Room to be eftctive In reducing Inappropriate behavior, the onvironriwnt from vAiich the
student is vAthdnwm must be mom Invtting than tie Tlmwout Room. There is * structured incentilve
program to encourage the student to use appropriate behavior In their classroom.
Designathd Time-out Rooms may be used. only for students who have a behavior management program
and Aversive Intervention Man *3 part of their IEP. This written plan has been developed as part of the
IEP, which.detalls the conditions'undar which to student vAll be sent to the Time-out Room.
q
omriptiow-of the Rown
The Time-out Room at I Wattgats Elementary Is located iri'Roorn 5. For the rOOM to b8 specif . Ically
designated for Time-out. it must most " folkywing conditions:
be adequately lighted with the light switdh outside of the room
be at least 50 square feet In SIZO
be adequately ventilated
be maintained at a normal. comfoftble temperatute
have provisions for a staff person to be able to observe ft interior of trio room sharp edges,
be. free of potential hazards to students such as breakable glass. 01OCtOC&I Outlets,
Ott
from the'Inalde
d6o
p0d'10th a: r. ii�hich may be easily opened
be free ef toys, matedels, or other potentially irewarding objects
ht" no km*on'
pair
1. � 11 Ijj:i�'" �.' . ... . -or, day
heoutside thi.iriii
no.,"y "t the door, Maybe, locked from elther I
Staff should routinely inspect the room to ensure it meets the above standards.
M
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11/'07/2003 09:25
425-670-7258
ESD
MAINTENANCE
'STU
12/12/02 11:41
1 7339
FAIL' 425 OTO _7_
EDK ONDS15
SVCS
PAGE 03
9005
MICROFILM
(e) Either the student shall be Capable of releasing himself Or herself fTom ft restraint Of
the student shall continuously mmain within view of an adult responsible for supervising the
mdent.
.24-137. 6 392- t72.394, filad 12/1M.
(StsUcryAudolity: RCW2$A.155.090(712&A.3oo,D7OsW20US.C, 1400alseq. 99
of%alve 1/1100. SWUWy Authority- ChWw29A.155 RCW. 9S.21435 (01dw 95:11). j 392-172-394, 00d 10/1 im,
effective
WAC 392-172-396 Aversive int"velitions—bdividualized education program
requirements. If the neod for use of aversive interventions am detemined appropriate bY the
IEP team, the individualized educAtiOn WOW= shall: -
(1) Be consistent with the mcommendations of the IEP team which includes a school
psychologist and/or other certificated employee who understands the appropriate use of the
avenive intetventions and who concurs with the rewnimended use of the avetsive interventions,
and & person who works directly vAth the student.
(2) Specify -the aversive intWvCn1iOn3 that may be used.
(3) State the reason the avenive interventions is judgW to be appiopriate and the
behavioral objective sought to be achieved by its use, and shall describe the positive
interventions aftmpted and the reasons -they failcd� if known.
(4) Describe the circumstances wider which the aveTsive interventions my be use&
(5) Describe or specify the trisatimurn duration of any isolation or restraint
(6) Specify any special precautions that must be taken in connection with the use Of the
aver'sive interventions ted1wque.
(7) Specify the person or persons permitted to use %he aversive interventions exid the
current qualifications and required training of the personnel permitted to use the aversive
interventions.
(8) Establish a means of evaluating the effects of the use of the aversive interventions and
a schedule fdr periodically condftfing ft evaluatiOm
ISIAtuLory Autborhy- RCW 21K 13$.OW7), 28PL300.070 ad 20 US.C. 1400 ot aq. 99-24-137. § 392-172-396,, filed 12/1M,
ciredin I/110D. StedW Authority. ChWff 29A.155 RCW. 9S.2L-035 (order 9S.1 1). § 392-172-396, filed 10111195,
catclive I In v9s.)
Student Records
WAC 392-17240 Definition of "educatIoDal recordi" as used in records. rules. (1)
'For the purpose Of WAC 392-172-400 through 392-172426 and consistent %ith the Family
Educational Rights and Privacy AM the tem "educational records" shsll mean those records
that:
(a) Are directly related to a "ant; and
(b) Are maint4ined by a school district or odwr public agency or by a party acting for the
school district or other public agency.
(2) The term "educational rwotds" does not lDcl e:
(a) Records of instructional, supervisory, administrative personnel, and educa' nonal
personnel ancillary to those persons if those retards-
(i) Are in the solc possession of the maker of the record, and
(6) Are not accessible or revealed to any other individual except a substitute. For the
r In I
II/e7/2003 09:25 425-670-7256 ESD MAINTENANCE
19/12/02 11:40 FAX 423 670 7319 ED6PN1D
51 -STU SVCS
PAGE 04
Q 004
MICROFILM
(12) Water uwment, No student's head may be PanifillY Or wholly submerged in water
oTany other liquid.
3eq. W24-137.4 392472-392, fikd 121!199.
Eswulmy Authosity: KCW 28A-1s5.090(7),29A300.070 ud 20U.S.C. 1400 at
effusive 111M. StakAwy Av&wily: Chopwr 28A. 153 RCW. 95-21-055 (Ordw 1 392-172-392, fdad 10111/95,
affewV4 1111119S.)
WAC 392-172-394 Aversive intervention&-43tber form w—Conditions. Use of
various forms of aversive intervWiOnS which are not prohibited by WAC .192-172-392 wwrant
met, isolation,
cJose scrutiny. Accordingly, the use of aversive intervenbons involving bodily con
or physical restraint not prohibited by WAC 392-172-392 is conditioned upon compliance with
certain eguards, as follows.
pr000dural andsubstantive saf
a ns ad by WAC
(1) Bodily contact. The use of any form of aversive int rventio not prohibit
dent shall be vi ed
392-172-392 which involves contacting the body of a special education sm pro d
tablished in accordance
for by the terms of the studenf s individualized education program es
with the req ts of WAC 392-172-396.
bo, ation. The use of avcrsive interventions which involves excluding a special
education student from his or her general instructional am mid isolation of the stutlent within.a.
room or any other fonn of enclosure is subject to each of the Mowing conditions:
(a) Tha isolation, including the duration of its use, shall be provided for by the t=s of
shed in accordance with the roquit=ents
the saxlent's individualized education program establi
of WAC 392-172-396.
OR
ur ontr ed fiom inside or
(b) The enclosure shall be ventilat4 lighied, and tempew e c
outside for purposes of human occupaticy.
nt from outside
(c) 7be enclosure shall permit continuous visual monitoring of the guide
the enclosure.
auditory
or supervising the student sbnll remain in visual or
(d) An adult responsible f
range of thelstudent.
fiom the enclosure
pable of releasing himself or herself
(e) Either the student shall be c%
the
or the student shall continuously remain within vimv of an adult responsible for supervising
student
(3) Physical restraint. 11he use of aversive interventions which involves physically
restraining or immobilizing a specia.] education student by binding or otherwise amhing the
student's limbs together or by binding or otherwise attaching any pavt of the student's body to an
objeict is subject to each of to following conditions:
(a) The restraint sMll only be used when and to the extent it is reasonably neoessary to
protect the student, other persons, or property from serious ham.
(b) The restraint, including the duration of its use. shall be provided for by the terms of
the student's individualized education program established in accordance with the requirements
of WAC 392-172-396.
(c) Tbe restraint shall not interfere with the student's breathing.
ible for supervising the saxlent shall remain in visual or auditory
(d) An adult responsi
range of the student,
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PAGE 05
9.003
MICROFILM
1AW Ap
Z& v r - squires teacher autho
ice
a . 3 pa rt , 6f:an
u
Aversive Intervention Plan included In the studenCs IEP.
minutes and no student
Iva
-cut ikoom for more then 20 consecuti
tween
No student will be restricWd to the Time
placed in"nme-out for more than one session, without Ot least some time passing be
vAll be
sessions.
Averslys Intervention Plan as Part Of
Every student in the Westgate Transitlon Program must have an
rvention. (See Aversivs Inte(vention Plan
me -ow Room can be utilized aS an Into
their IEP before the TI
10
room to document:
A written log will be kept no)d to Me tinwout
ant to the 900m
a what time a student is 8
0 the total length of tima in the room
the reason the student was sent to the r0Om
-out shall bR maintained as part of
A3 and aftotiveneas of Timo
Monthly progress reports on the Incidenc
the students IEP data
lowed and approved by the
To most Me above requirements. use of the Time-out Room Wit be rev
at basis.
r and Director of Special Programs an an annL
Building Administrato
FINAL PROJEQ ORM
1"BWALL
APR 0 2 2004 TO:
DEVELOPMENT SERVICES GTR- DATE:
CITY OF EDMONDS
MEMO TO: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE—
nEASESM
PLANNING DIVISION DATE—
MZ=WH
.'?ROJECT C226::��
SrrE ADDRES
# DATE INSPECTED
PERNgr 617 9 7Y ADB#
p.
":�`.DESCRUMON OF WORK TO BE INSPECTED
'.A� fleld inspection was ponducted. to determine, rmal compliance with approved plans. �F no. approval
that . there are , no � objections from the above signed Department to tbe',� ase of
PE C _DS and
]g BQN the granting of
GRANT FINAL PROJECT APP ROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
QL''C of CONDMONS given to owner/contractor by inspector
.0py
FARED FINAL INSPECTION - OUTSTANDING ISSUES
j3 Copy of CORRECTION NOTICE given to owner/contractor by inspector.
2.
3.
R&INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
I
Date Si I . . .
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USE PERMIT 11no?
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CONSTRUCTION PERMIT APPLICATION
JOB SUIMAPT#
ADDRESS -N4 ��
OWNER NAMENAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS
LID FEE
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCIP Appralf4d
RW Penrill Required
Street Use Permit RKd
CITY ZIP TELEPHONE
EXISTING — PROPOSED— InspectionRequilred
Sidewalk Required
[,iij V 9)o� 4 z 5 -7 V44
Underwound
REQUIRED DEDICATION— FT wiritioreq6ired 13
NAME
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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REO'D POSTED
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PROPgRTY TAX ACCOUNT PARCEL NO.
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NEW 0 RESIDENTIAL PLUMBING MECH
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ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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0 C:
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CHANGE OF USE
ADDITION Pk
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0 0 SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
RECYD PROVIDED
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REPAIR 0 CYDS 0 X—FT)
-ALE
REMARKS
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OTHER
DEMOLISH TANK
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GARAGE RETAININGWALL F RE SPRINKLER
CARPM ITROCKERY FIRE ALARM
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CHECKED By QF-CONSTRUCTION CBE OCCUPANT
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NUMBER NUMBER OF CRITICAL
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DescrIption FEE Description FEE
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Plan Chec State Surcharoe
0
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HEAT SOURCE T
Building Permit' 4- City Surcharge t5-
1711
VESTED DATE
PLAN CHEC:n,,W,?
Plumbing
=
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEVAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERHnrAPPUCATION: 1180DAYS
PERMIT UMM I YEAIR - PROVIDED WORK 19 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 SUCCESO RS
Fire Review Plan Clik. Deposit
IN INTEREgi AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection Remipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
F OM THE ISSUANCE OF THIS PERMIT.
R
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY RrQUIREMENT OF ANY CITY ORDI NANCE
NOR LIMIT IN ANY WAY THE CITYS 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-
CALL This application Is not a permit unfill signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official of 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 acknovAodged In spare provided.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFF( SIGN DA��
BIG ( 14ER DATE SIGNED
iA031112% (
4"
771-0220 X
RELEASED7 DATE
ATTtNTION
EXT 1333
Z
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - IfILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNgl3/ - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING