20040082.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NU161BER EXPIRATION DATE CP�PCRTD70Y
SE: qu. t4 C-t- LA
PROPERTY TAX ACCOUNT PARCEL NO.
15 0407-71, `irqz30;P
NEW RESIDENTIAL PLUMBING if MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
13 REPAIR CYDS I X FT)
91 DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z 1:1 CARPORT ROCKERY FIRE ALARM
I
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CRITICAL
0 OF DWELLING AREAS
M UNITS NUMBER
01 STORIES
W
uj NUMBER NUMBER OF
PERMIT EXPIRES
M 6 / I
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION� IFT
METER AZE I LINE SIZE NO OF FIXTURES
SUITEJAPT#
LID NO.
LID FEE $
TE—SCP Approved I
RW po,Mlt Hequired
street Use Portnit Roq'd
inspection Required
sidewalk Requited
Undefrifoind
Wiring triquit"d
PRV REQUIRED
YES 0 NO 11
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED B OAT E
0 i`RE-1NSpr.cT10N REQUIRED
VARIANCE OWCU -SI`1OHhL1r4t u" t%uc"`
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VAR AN ' 10 1 POSTED
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SEPA REVIE EA HEIGHT
COMPLETE EXE;M�PT. ALLOWED PROPOSED ALLOWED PROPOSED
'as RMCINFED
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LOT COVERAGE0___T �_EdUIRED SETBACK (Fr.) PROPOSED SETBACKS (FT.)
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ALLOWED NOPq%jkjn Fj*NTAV#jhVMRD
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PARKING �01TKI'IS CARD
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REO'D PRQVIDE I CC
R INSPE TION REQUIREMENTS
REMARKS
"TYPET ON
CHECKED BY �7r..DNST CYT CODE— OCCUPANT J
7 GROUP
_jAiR6A OCCUPANT
SPECIAL INSPECTI LOAD
REQUIRED [] S
3 YE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
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Description FEE Description FEE
-V 1464. 1
f.7
(2-1 i'T"'�;,
Air Plan Check State Surcharge
HEAT SOURCE tLAZING % LOT SLOPE % Building Permi City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
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
SEPARATE PERMISSION.
Engr, Review
cr PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
in "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE,
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j Receipt #
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire inspection
ALL CMMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
0
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 7,
01 NOR LIM11 IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
x 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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building 011icial or his/tier Deputy: and Fees are paid, and
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN V�6LATION OF THE LA130B CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIONA�SURANCE AND RCW IB.27. OFFIC17 Sl� AIURE DATE
SIGNqURE J&NER 09 AbEND_'_.'/ DATE SIGNED (425)
1 771-0220 "1 DATE
0-k. .4 - � I RELEASED BY
mon� EXT 1333
A*ENTIO_ N ------------
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 - INS13ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
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11/27/2042 18:21 425B286326
Mec Is 03 04:22a
Page I of 6
D"231215
Pecen&" 15, 2003
SERENA CONSTRUCTION PAGE 01
425-489-4040 P.2
A-T
ASRESTO-TEST, INC.
ASBESTOS SURVEY
106-11226"' St. SW. Edmonds, WA 98020
Semen Construction
7003 117"' Pl. M
KirklwW,'WA 98023
Atta- Erika
Ph! 42&928-"76 fam 425-82W26
On December 9, 2003, Asbesto--Tcst personnel conducted an Asbestos survey (per
U.S.E.P.AJAJLE.RJL guidelines as designated and specified by Puget Sownd Clean Air
Agemey ajid WaAkingwx State) Qf the hooveAJ0611 22e SL SW, Ed'mnd% SWAPA*h
Coug& y*khQtpM WM This survey purpose is to identify any Asbestos Containing
Nfiterials that may be present and will require professional rewvalpior to
denwiftionlrenovadon.
IVY Of F_,fNDEVGS
RASIC CONSTRUCTION: The house is one story wood frarne� The cxtcrior siding is wood.
There was no suspect ACM located bamth the wood siding exterior. The torch down roofing
and silvcr seal sur&cing materials were ssmpled.
INTMOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior is drywall
and wood. The drywall/taping materials were uniformly sampled. Tile flooring materials with
relating backingr. and mastics were sampled per each located homogenous area. The masonry
splash tile and mastics were sampled from the kitchen and bathroom areas. The "loose lay"piece
of sheet vinyl was sampled from beneath the kitchen sink area.
ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM and
was not sampled. Any .11ttpect electrical wiring in.tulation or on), yuspect 7NI (Thermal System
,insulation).found in, arountA or behind any localedfiuse or breaker boxes should be consfdered
to bg ACM (Asbestos Containing Material), unless driermined otherwise hy laboralory analysis.
ATTIC/WALL INSULATION: The insulation was sampled.
CONTINUF rO PAGE I
1429 Avt. D. FMB #IV, Smobeinish. WA 98296 ph: 296-914-SPO (as; 360-M-240 poKc: 206-50-2491
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11/27/2042 18:21 425B286326
Doc 16 03 04:22a
SERENA CONSTRUCTION
425-489-4040
Page 2 of 6 Dcrtmkr IS, 2003
13#231215 Asbesta-TA14 Iffr— (206) 914-5500
E&w am', r —ACO u m
020
HEATINO A" VENTILAItION STSTSK: There is a P4 forced air fijmace in the crawl
space accessed fi-om behind the fireplace. There is ACM TSI taping on misc. ducting and also
ticked above the ducting in rnise. arms. Note: It wv..r not possible to dismantle the fiffnace
and ducting to locate anWor evaluate any additional suspect A CM which may be
comealed, iatide the unit, or atweiated in hidden areay. It is our opinion anyfurther
jecl manager andlor
handling qf thefurnace system should be coordinated by the pro
abatement contractor if any additional relating suspect materials are located prior to
andlor during any demolition or renovation, any and all additional related suspect
materials should be considered to be ACM (Asbesfos Containing Material), unless
determined to be o(her%ise by laboratory analysis. THERE MAY BE ADDITJONAL ACM
TSI PRESENT ASSOCIATED WITH THE FURNACE AND DUCTING SYSTEM THAT IS
NOT LISTED IN THIS SURVEY. TEE HEATING SYSTEM SHOULD AGAIN BE
THOROUGHLY INSPECTED BY THE ASBESTOS ABATEMENT PERSONNEL. AS
THERE MAY BE ACM PRESENT THAT IS CONCEALED FROM VIEW. Any wMiflOnal
located TS1 inside or outside the fianace an&or ducting system including but not UP*W to
all gaskets, joint cornpound% seakuts, stWor ifnaladons, am FACM unless tested otberwrlse
by labor2tory suWyxis. There was no suspect ACM located a-siociated with the fireplace system.
Misc.: The, window glazing was sampled,
Addition" SUVetures on site included in sumy: Now-
# of sirswimm included in survey; one
Requesied by-, Erfan @ Seirna Construction
certified A.tLE.FLA.
#CLAY 5327 (Expires 19/12/04)
A-T
eftfieft to P*&j 3
PAGE 02
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11/27/2042 18:21 4258286326
-Doc 16 03 04:22a
SERENA WNSTRUCTION
425-48S-4040
Page 3 of 6 December 15, .2003
111#231215 Inc. (296) 914-5500
1"I
Any &VA EU materials as ACM or PACM is this report (210WOr Vidditi"d mAtcrimb
aamigted Witb the s"r-twe tbat may be diacovered and later Watirlmd as ACM or I`ACM� Must
be profmdonany stuatcd prior to deMeNtIM ASSESSMENT AND QUANTWWA'"ON OF ACM
yon ASAIEMENlr pUmOSES AND/OR PRIM(; FOR REMOVAL S130VW BE
I)rMRMMW By ON SM EVALIJATTOK AS L4STED QUANUrM ARE NOT
GUARANTEED AND ARE AN APPROMM �TION �ONLY' ��
,U & M M L-$ A I t E � 98E _570S C 01 MA It, 1 NQ MA r g MA A &
eweo *@ maWAF gyd Md= L4dft MOM* as
ASBESTOS/iTypF
ANALYSIS. ID — J/QUANnTY OTHERX&URIAL
1.0) ACM TST TAMG yes // chrfwvtik // 65-70% Don -fibrous materials
FRL48LE ACM
Taping Is on misc. beat ducting JointL The fumam h xcceswd Amm the crawl spom behind
the fireplace.
1.1) ACM TSI yes it th"ffle // 65-70% noD-fibraw materials
FRIABLE ACM
ACM is twJW above the beat dading in xvisc. areas in (be crawl space between the ducting
and floor joists.
NOTE- THE INSPECTOR WAS N[OT ARIx. To 0FTXRMM QUANTITIES OF ACM
TS1 THAT IS pRESENT AS ADDITIONAL MATERIALS MAY BE CONCEALED
WI 1,HIN THE WALLS, CEILINGS, AN7DJOR FLOORS. QUANTITZ5 OF ASBESTOS
yoR ABATEMENT ASSESSMENT AND/OR PRICINC FOR REMOVAL SUOULD HE
T)ETERMINED BY ON SITE EVALUATION.
ALL TSI ASSOCIATED wrm Tm FvRNAmoucmG sysTEN THAT is NOT
VISIBLY FIBERGLASS MATERIAL IS FRESUMED ASBESTOS CONTAWNG-
ANY FLUE MORTAR FACJQNG MATERIAL THAT MAY BE LOCATED IS ALSO
FRESUMD ASBESTOS CONTAINING UNLESS TESTED OTHERWISE BY
LABORATORY ANALYSIS.
2.4) FLOOR TILE yes // chrysotile // 2-,'--'% nowfibrous materials
ldtcbco 9"x 9" Poor file -color. white streak
ACA1
2.1) BLACK MASTIC yt* It cbry3WIt H 2-5% adbv&t, celluluse
MASTIC AND TILE IS NON -FRIABLE ACM
AFMOX 200 SQ. FT. ON WOOD
A-T
confiame to Mge 4
PAGE 03
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11/27/2042 18:21 4258286326 SERENA CONSTRUCTION PAGE 04
bee IS 03 04122a 425-489-4040 P.5
pecemb" is, 2003
Page 4 of 6
AsbWo-TeS4 life- (206) 914-5500
13#231215
LftU-Vd*,YA,TW, ko
ANALYSIS 10 FSTO—S] - E/1MANTFU
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3.0) FLOOR TELE yes // cbrysotile H 2-5%
non-Abrous maftrialS
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east md 9,,x 9" Boor tile-volor. black intermixed
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ACM
3.1) FLOOR TILE yes It chry3ot0e 2-5%
nowfibrous Materials
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east aid 9"IL 9" floor filo-color- wbkc inttrWixell
ACM
3.2) BLACK MASTIC yes H cbrywARe //2-5%
adhesive, ccftlme
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MASTIC AND TELE IS NON-FRUMV, ACM
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AFMOX 650 SQ, FT. ON wOOD
0
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side entry -color: red brick ACM
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TELE IS NON-FWA13LE
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APMOX 40 SQ. FT. ON WOOD
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NOTE- Any additional colors or Idadi; ol owr tile and/or umstics,
baditaga that Were not
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dimmered in this swvcy and may later be located in this stmdure art Also Prmtmed tO
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5.0) ROOVINC. SURFACE yes /I chryootfle // 2-5%
non -fibrous nmterlals�
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cellujose
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ROORNG AREA AppROX. 7 ACM
.920 SQ. Fr. -SILVER SEAL M&TERIAL IS FRL4JaL)E
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cellulose, ter, fiberglass,
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TEM WAS NO ASAESTOS DZI�ECTEID U4 ANY OF THE MLG SAWLES
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SAMPLED PER AHERA PROTOCOL
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paint cellulose
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11/27/2042 18:21 4258286326
SERENA CONSTRUCTION PAGE 05
bec IS 03 04:22a
425-469-4040 F-6
Omemb& 15, 2003
NI
5 of 6
Inc. (206) 914-5500
ZmWl215
10611220— a Nw. MEAN!&
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FINAL PAOJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
GINEERING DIVISION DATE- 7//
PLANNING DIVISIONDATE_�
PIXASE SIGN
PROJECT
SITE ADDRESS
PERMIT #_..Z 00q- (JJ2:�:___ADB#_________PATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED L
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
0 Copy of CONDITIONS given to owner/contractor by inspector
1 .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
1 .
PA
0
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbm1s:ocaprv1 3/25/04
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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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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