20040045.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
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CITY
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LICENSE NUMBER
TAX ACCOUNT PARCEL NO.
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TELEPHONE
EXPIRATION 6ATE F —CHFXKED BY
NEW
RESIDENTIAL
ADDITION
XCOMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING
CYDS
DEMOLISH
TANK
GARAGE
r.ARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUS�_NkSS OR ACTIVITY) EXPLAIN
w NUMBER NUMBER OF
Q OF DWELLING
0' STORIES Cp_ UNITS AM
DESCRIBE VIORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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PERMIT EXPIRES
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ZONE 0 PERMIT
NUMBER C
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO
LOT NO,
LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Requited
Street Use Pararil Roq'd 13
EXISTING — PROPOSED
inspection Requited 13
Sidewalk Required 13
REQUIRED DEDICATION— F1
Underground
-Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 0 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE FIEV44WE43—HY DATE
PAWD
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
kYES
POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE I _1/0/c
R E! O'D PROVIDED
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SPECIAL INSPECTION JAREA OCCUPANT
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PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECTION REQ-D 5
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN TICK NO: 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, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. 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 DIRECTLYORINDIRECiLY
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.
W1111111111;
SIGNATURE (OWNER OR d6INT) DATE SIGNED
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp..
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
FEE Description FEE
State Surcharge
?Z/ City Surcharge
Plan Chk. Deposit IlK. .1
Receipt #
Total Amt. Due
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Receipt # �� :!�Z///
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided
�Ncl GNrA
DATE
�LCASE:D 13Y DATEI
ll�ls UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I - --t-t _'k- ( A_ 4 - — I I Z/ I'l
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OF31GINAL-FILE YELLCJINSPEC!TC
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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JRN-IE-2004
le. 1 .41
"A C. 189"'
Frozen Fund
Fund Expi
Fund Number
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS. WA SM20 - (425) 7�1-0220 - FAX (426) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning , Building * Engineering
Edmonds Building Permit No.
PrqJootAddress-------J,32--3i- H 1117 40 1
Owner/Developer--�L--7 i'l
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With reference to the above iden�fied prqieA:t, this Niill certifl� that this institution has a savings
0 ec en Be& In
account (or loan) for the above -referenced dev" loper/owner for the Pr i t so id ti
consideration of the permitted devolopructnt of the property, and in lieu of a pefformance bond, Us
institution hereby agrms that it will fteeze the suras of money fbr the indicated site improvements
pern� en 4u1horfiiu7A1ioa, for release of said ftruis by the City of Edniouds in the amount of
The total suin indicated will be Withheld by tilis institution fmm any dUburs=ents of any kind
until written authorization has bsen received by the iastitution from the City of Edmonds to release tile
sum of money indicated by thowitten authorization from the City.
The desiga, location, materials and other Specificationi for the indicated site improvements are
those required by the City of Edmonds and appear ia the above-ref"erenced Edmonds building permit
f3le and are in compEance with the Edmonds Coinmunity Development Code of said City.
In the event the oNmedeveloper fails to complete the indicated improvements %ritbin
—weeks/months, (not to exceed 24 months) the City of Edmonds may demand,
and the institution shall make, Payment to the City of said Amds, so that the improvements can be
installed or completed Immediately to City standards, 'ne institution shall not be liable to the ommer
for any disbursement ol'said funds to the City of Edmonds.
It is hereby specificaily agreed by and betwm the parties hemto that in the event that my legal
action Must be taken to enfbree the provisions of this agreement or to colleot said frozen fund, that the
prevailing party sball be en6tled to collect its cost and reasonable attomeys' fees as a part of the
reasonable costs of seouring the obligation hereunder. In the event of settlement or resolution of t'liese
issues, prior to the 61ing of any suit, the actual costs incurred by the City. including reasonable
atiorneys' fe*s, shall be considered a part of the obligation herewader secured. Said costs end
reasonable legal fees shall be recoverable by the pmvailing pw-ty, not only from the proeoeds of this
frozen ftd account, but also oveT and above said body as a part of any recovcry in any judicial
proceeding, in addition to recovaq of the fands.
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171
RMffcQf AMEMA N.A.
Lynnwood Banking Center
5727 - 196th St. aW
LM@oi& 98036-6107
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Mailhig Address
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Account N=ber
JAN-122-22004 14! 41
City of Edmonds Performance Frozen Fund Accouat
rage LWO 1 /'11
OwnerAD eloper
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Title
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Maifing Address
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Telephone
P 1 0311104
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A�,cepted by Developmemt Service Technician Dat�
E119ANCIAL 1,LNSTITUTION�ACKNOINLEIDGLMZNT
STATE OF WASBINGTON)
COTJNI'Y
before me, the
On this day of
undersigned, a Notary Public in and for the State of W�sLgton, duly cornmissioned and swQrn,
penonally appeared GO-YNr,�--- eheA' V�nA to Mekao'%M to be
Of " tA-r. J-k the cMeration that executed the foregoing instrument, and
acknowledged the d inStrument to be the free and Nioluntary act and deed of said corporadon, for the
u,qes and purposes therein mentioned, and on oath statrd that k-�f' was
authorized to execute said InMument and that the seal 0fixed is the corporate seal of said corporation.
d and official seal hereto affixed the day and year first above writtm,
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MEMORANDUM
Date: 1/27/04
To: Debbie Karber, Accounting Assistant
From: Marie Harrison
Subiect: REFUND
Debbie, please prepare a refund check in the amount of $657.60. Please mail the check to
Connie Kim at 15928 26fl'Avenue SE, MillCreek, WA 98012. Ms. Kim has decIded not to
pursue her building project. I have enclosed a copy of our receipt #23464 for your records.
Thank you.
Sincerely,
//MharVie/ 4asdV
Development Services Division
Director's Signature
City of Edmonds cze Community Services
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwacLedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
1 B 9 11 Planning - Building 9 r-ngineering
January 28, 2004
GARY HAAKENSON
MAYOR
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Bank of America N.A.
Lynnwood Banking Center
Evey Bushman
5727 196th Street SW
Lynnwood, WA 98036-6107
Re: Performance Frozen Fund Account #73619314 for Yong Hwa Kim at 23931
Highway 99, Edmonds WA
Dear Sir or Madam:
The City of Edmonds hereby authorizes the release $6,048.00 from the above referenced
Performance Frozen Fund. This project has been withdrawn, no construction will take
place. In the future if the client wishes to complete this project, a new permit and new
bond will be required.
Sincerely,
a e
rie amson
Permit Coordinator
Cc: Applicant
File
L/Temp/DST's/MasterLetters/ReleasePerformance02/01
Incorporated August 11, 1890
Sister Citv - Hekinan, Japan
CITY OF EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
The project at AL-LL�z� ? - � -_ issued under building
permit number equires special mspection and/or testing per U13C Chapter 17
and WAC Amendments 1702. The complete iisf of special inspections is attached to this document.
BEFORE A PERNUT CAN BE ISSUED: The owner and contractor and special inspector shall
complete this agreement and the attached structural test(s) and inspections schedule including the
required acknowledgments.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by thp
Building Official * t ' fffl i any duties or mi7ections. Each special inspector shall subrnit
,gr o p orniml, I
Statement of , __ --- ____W .__ or review Special inspectors shall display
Vh ; on site. Speciiti inspection and testing shall meet
identification w en performing special inspection!
the minimum requirements of URC Chapter 17 and the followifig:
I
1. Observe Work
The special inspector shall observe the site work for conformance with the approved
(sta!nyied) plans and spScifications and applicable workmanship provisions of the UBC.
Architect or En$ineer reviewed sho drawings may be used only as an aid to inspection.
Special inspections are to be Pormed on a continuous basis -meaning that the special
inspector is on site at all times observing the work requiring special inspection. Peiiodic
inspections, if any, must have prior approval by the City based on a separate written plan
reviewed and approved by the BiiiiainiNficial and the engineer or architect of record.
2. Report Non -conforming Items
The special inspector sW bring nonconforn i L items to the immediate attention of the
p
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el
contractor and note all such items in the dail . 11 report. Any item not resolved in a timely
manner shall be immediate cause of the special inspector to notify the Building. Official of the
plan deviation- error, change or omission. It shall also be the duty of the special inspector to
promptly n�Oy the engineer or architect.
3. Complete Daily Reports
Each special inspector shall complete and sign both the special inspection record and the daily
epo form for each day's i -ection. These records shall remain at the jobsite with the
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contractor for review by the City Building Inspector.
4. Furnish Weekly Reports
'Tbe special inspector or ins of tests
. pection agency shall furnish the City with weekly reports
and ifispections. The p;oJect engineer or architecl� and others as designated shall also be
copied on rts. Weekly reports must include the following:
D f dail ins,
escriplon o r . pections and tests made with applicable locations
'o .
Dg
List of all noncon., I mg items
Report on status of nonconforming items (resolved or unresolved8
Iteinized changes authorized by ihe Architect� Engineer and ity if not included in
nonconformance items
5. Furnish Final Construction Report
The srial inspector or inspection agency shall submit a final si ned 0'rt to the City stating
I il a,
that I items requiring spect inspection and testin were fulfilC anTreported. And, to the
best of his/her knowledge the pro)ect is in co3ormance with the approved. plans and
fications, app�oved change orders and the applicable workmanship provisions of the
Jiscrepanci i * tion
N;Ci Items not in conformance or unresolved items or any es in Mspec
coverage, (i.e., rriissed inspections, periodic inspection when continuous inspections were
required, etc.) shall be specifically iteinized in this report.
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CASCADE TESTING LABORATORY, -1 N
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TESMNG & 1 NSPECTION / ENGINEERS
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12919 N.S. 126TH FLACK
KIRKLAND. WASHINGTON 96034 (425) 823-91000
(425) 259-W17
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CASCADE TESTING
425-623-2203
contrarjar Raganillhumn
L No" the SP"W Inspector
It is the duty at the contncwr to notify the special inspector whien work Is ready ibr special
insPOOtion. Note, the items Usted on the iduchad s4iodule Ud as noted on the approved
plaw and spccificatiow at rcqWred to have spedal inspections. Adequate notice sball be
PrOvid0d by the cQutwtor so UW the apedd inapactor has tim to become farWiiar with the
project.
2. Provide Acw# to Approved Plans
TU contractor Is responsible for providing the %modal inspector access to approved plans at
thajobsite.
3. RetaLs Special Inspiectica Retards
MW contractor is mponsJ'ble t* rot&W at Iblo jobsite a cc by tam records submitted
by the special .4 so ial '_%w
reque*L hapeefor. Them recortiz an to twe provided to the CRy building inxpeckm upon
Q CillofEdWandiiBuildinzDepgjameotTtZM&ADAUILm
1. Approve. $pedal Impecten or ftspecdon aloncia
71he building departnent sW1 approve all op*oioj inspector; and opeoial inspection
requirtmontL
L Mon Itor apecial Inspection and approve wookly roports
Work requin sPecial EMectdicu and the perfonnance of special Il "I be
.y nT
n2onitored b c City Laspect". His&qr approval must be q = prior to
PIWCMcnt of Wn"O or otbar si&flar kctivides, In addition to that of the special impector.
3. Issue C#rdfWxto of Occopnq
Tbc Building Offivial ma ISSILD a cer"Cats oroccupmey after an weewy "ial inspection
reports hwlaimS the = aport have been stibmitted knd accepted.
D, 01mer HapitygodbMflys
Ile M=t owner or the enemcez or &diiW of ro=d acting as the ownees agent ahs.11 Amd
Special hupection services.
Z- &13&fn agr or ArC&JJlCZ Qt Bec-rd RwWWd=JU
ne enginear or wrliftect of record abid include spocial inspcction requirezuents on the plans and
sped ffw.&SonL
ACKNOWLEDGMENTS
I haw read and asp" to comply sWth k4e 1ww and wndifions of Wx agreement.
own Data-
47
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special inspw
General Contractor �st
,mew,
City Building Official 17-41
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SPECIAL INSPECTION AND TESTING SCHEDULE
mofficrNAME BUILD11,40 PERM" Na
PROXa ADD"M TEST'INGINSPECT71ON AGENCY or SPECIAL INSPECTOR
REINFORCED CONCRETE, GUNITE, GROUT AND MORTAR:
CoDcreu GoWte Grout Mortar
Aggrvg2tcTesu
Reinforcin Tests
Mix Designs
Reinforcing Placement
Bitch Plant Inspection
Inspect Placing
I
Cast Samples
Pick-up Samples
Compression Tests
PRECASTIPRESTRESSED CONCRETE:
Piles Posi-Tens Pre-Tew Cladding
Aggregate Tests
Reinforcing Tests
Tendon Tests
Mix Desians
Reinforcing Placement
Insert Placement
Concrete Batching
Concrete Placement
Installation Insepction
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Cast Samples
Pick-up S&m.ples
_Compression
Tests
MASONRY:
- Special Inspection Stresses Used
— Preliminary Acceptance Tests (Masonry Units. Wall Prisms)
— Subsquicni Tests (Mo=. Grout. Field Wall Prisrus)
— Placement Inspection of Units
ADDITIONAL INSTRUCTIONS OR OTHER TESTS
AND INSPECTIONS:
STRUCTURAL STEEL/WELDING:
Sample and Test (list specific members below)
to' Material Identification
:?'Welding Inspection 0 Shop 0 Field
c Inspection El Shop 0 Field
�2ffig=stmngth Bolting
Inspection 0 Shop 0 Field
0 A325 0
C) A490
— Metal Deck Welding Inspection
— Reinforcing Steel Welding Inspection
— Metal Stud Welding Inspection
— Concrete Insert Welding Inspection
FIREPROOFING:
— Placcnxnt Inspection
— Density Tests
— Thickness Tests
— Inspect Batching
INSULATING CONCRETE:
- Sample and Test
— Placement Inspection
— Unit Weights
FILL MATERIAL:
— Acceptance Tests
— Placement Inspection
— Field Dcasity
STRUCTURAL WOOD:
— Shear Wall Nailing Inspection
— Inspection of Glu-jarn Fab.
— Inspection of Truss Joist Fab,
— Sample and Test Components
Form completed by: Title:
Telephone No.: Date:
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
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 ...
SPECIAL INSPECTION ... lee 1116,
a A I 9j 0 90A /9�1 wlee 10 v 4P_
.!lSGE6IzANEG6t& . ....... w1#Av,0111ve ?
FINAL *10PROtYct-"M
OGG4~15Y . ...............
Side Sewer It'
'p4
J.,.CC,,,
Amout Pc�d
,:2,-!rcs
Date
Water Mlctcr S,
Amount
Date Purc'.=z,1!.._....____._
I -,ow
t.mcunt Paid $,—'-7- 27 e c 2 t
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