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METER GIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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REMARKS
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Building Permit
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ECKNO: A VESTED DATE
Plumbing
A/7 16� 05
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
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT 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
FROM ANY AND
Fire Inspection
Receipt it
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due 4�2
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CrrY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
5760
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
7—
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
Building Official or his/her Deputy: and Fees are Paid, nd
a
FOR INSPECTION receipt is acknowledged in space Provided.
WoAffN'S,COMPENSATION INSURANCE AND RCW 18.27.
FFICI 7SIGN T B DATE
kIG RE NER OR AGa DATE SIGPED
(425)
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771-0220
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RELI�APED BY
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW. SP TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - A SESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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LOT COVERAGE (ACTUAL� 1.568 S.F.17,800 S.F. - 20% 19725 &Vd KAM W.
EDMONDS. WA 98026
IMPERVIOUS SURFACE CALCULATIONS HEIGHT CALCULATIONS ZONING 425-774-Un
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GUTTERS/DOWNSPOUTS APPHOVED AS NOTE[)
BY ENGINEERING
TO CONNECT TO EXIST. SYST-
SITE PLAN Date:
20' :3q?_ tV Nf;W IMPIF,9"V-S
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RECEIV5D
NOV 17 2003
0EVELOPM041 SERVICEb (;T[�
Drawn By: STEPHEN KERN PROJECT JOB NO. PAGE
Patrick and Tracey Higgens 0304 1 of 1
2126 Westlake Avenue Addition SHEET NO.
Seattle WA 98121
p 206 622 1156 Edmonds, WA
f 206 622 1158 DATE
c 206 605 5330 November 10, 2003 S P
steve@stephenkernarchitect.com
REVISIONS DRAWING TITLE
Plot Plan
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwwb.edmondsmams
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building , Engnee, nq
July 16, 2004
Attn: Patrick and Tracey Higgins
19725 83rd PI W
Edmonds, WA 98026
Building Permit: 2004-0240
Site Address: 19725 83rd Pl W
Expiration Date: 4/2/05
Dear Patrick and Tracey Higgins:
The purpose of this letter is to inform you that the last remaining inspection on your
project is a final inspection(s). The final inspection(s) detennines that there are no
outstanding life -safety issues and approval allows the City to close your pen -nit file.
The City considers the final inspection to be one of the most important inspections
conducted on a project. In order to grant final approval the following must be complete:
smoke detectors, house numbers, guardrails, handrails, self -close doors between garage
and residence, egress from sleeping rooms, safety glazing, weather-stripping, any
Engineering department requirements etc. Of course not all of these things may
specifically apply to your project but it does give you an idea about the kinds of things
that must be complete as well as some items that do not need to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be advised permits expire one year from
the date of issuance. if you will need more time to complete the work, permits can be
renewed priot- to expiration for one half fees. If the permit expires without a final
approval grante&by the Building Inspector, full fees are required in order to renew the
permit. This can' be very costly to you and we strongly encourage you to check your
permit expiration date and call for the required final inspection(s). Note: If more than
one department is required to final your project, this is noted on your Job Card.
Please feel free to contact me at 425-771-0220 if you have any questions.
Sincerely,
Pennit Coordinator
Incorporated August 11, 1890 0
Sister City - Hekinan, Japan
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CITY OF EDMONDS GARY HAAK
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 , FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
0 :1,4; * 1: ;
C. 9\3 Planning * u ng "V "Vul "V
December 10, 2003
Patrick & Tracey Higgins
19725 83" P1 W
Edmonds, WA 98026
p,E: Plan Check #03-517 - Addition/Remodel/Deck Application
Dear Patrick and Tracey Higgins;
The City of Edmonds Finance Department has notified me that you have put a "stop
payment" on the check given to the City to pay. for your permit application plan review
fee. In order for the City to continue the review process we require re -payment of the fee
(Finance will be charging a "returned check" fee of $30). If you have decided to
withdraw your pen -nit application and not carry forward with any of the work proposed
please send us a letter stating your intent and whether ornot you wish to have your plans
returned to you.
Please pay the fees directly to the financing department and respond in writing with your
intent on this permit application within five (5) days of the postmark of this letter.
If you have any questions please don't hesitate to contact me at 425-771-0220.
Sincerely;
Theresa Umbaugh
Permit Specialist
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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05/13/2004 08:02 14254812510
"-N-�NELsoN GEOTECHNICAL
GA '� ASSOCIATES9 INC.
GEOTECHNICAL ENGINEERS & GEOLOGISTS
NELSON GEOTECHNICAL
PAGE 02/04
FIELD REPORT.
17311-135th Ave. NE, A-500
WoodirrAla, WA D6072 Project: File No. -59
Tel (42$) 486-1669
Faxor ev F_ I v D Owner: Date: 5LZ2_1�
mAy 1 -7 2004 Location: Report No i I —_
Weather: Page: of
Purpose
DE ELopMENT SERVICES CT8. of V-15i By; Ja-L
CITy OF EDMONDS t:
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05/13/2004 08:02 14254812510
NELSON GEOTECHNICAL
PAGE 03/04
N A �NELSON GEOTECHNICAL FIE . LD REPORT
Assoc:IATES� INC_
GEOTECHNICAL F-14GINCERS & GEOLOGISTS
17311-13SIh Ave. NE, X500 Project' 1' 7'7 7- 5-' -7 &/ffsti FileNo.
yVv*dnville, WA 98072
Tel (42S) 406-1669 Date:
Fax (425) 481-MiO Owner: Report No
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05/13/2004 08:02 14254812510 NELSON GEOTECHNICAL PAGE 04/04
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Jun 07 04 02:42p IMR Renovatior-s 425 774 9210 P.1
ENGINEERING
M Ir �k-e
FIELD OBSERVATION
Project: Higgins Residence Structural
Job No.: 04045.10
Inspections
Field Rep.: Ryan Koch
Report No.: 1
Date of Observation: May 26, 2004
Date of Report: May 26, 2004
Location: 19725 83'd Place W, Edmonds
Purpose of Site Visit: Special inspection
for anchor bolts
Client/Owner: IIVIR Renovations
General Contractor: IMR Renovations,
I
Dennis Hopkins
ASSESSMENT REPORT
On May 26, 2004, we were called to the above address to provide a special
inspection of 16 anchor bolts epoxied into the new and existing foundation walls. 5/8
inch diameter threaded rods were installed into the foundation walls for the ledger.
The holes were cleaned out with compressed air. Simpson Set 22 was the epoxy
system used. The bolts and embedment matched the requirements of the structural
drawings.
DISCLAIMER
250 4th Ave, South This observation was performed on May 26, 2004 and is the professional opinion of CG
Suite 2GO Engineering PLLC based on the information available during this assessment or evaluation.
This report does not warrant or guarantee that all conditions were discovered at the time of
Edrnonds, WA 98020 the observation or evaluation. This report was prepared subject to the standard of care
Phone: 425.778.a5OO applicable to professional services at the time the services were provided.
Fax: 425.778,5536
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CITY OF EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
5 issued under building
The project at 77-- 3'32-v 1-)1-4 ion an c)r testing per UBC Chapter 17
permit number vv' - e�" 4V requires special inspect' n an I
and WAC Anien ments 1702. The complete list of special inspections is attached to this document.
BEFORE A PERMIT 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 the
Building Official prior to performing any duties or inspections. Each special inspector shall submit
Statement of fications to the Building Official for review. Special inspectors shall display
'Ie6n'i performing special inspections on site. Special inspection and testing shall meet
identification w
the minimum requirements of UBC Chapter 17 and the following:
A. Duties and Responsibilities of th Special Inspector
1. Observe Work
The special inspector shall observe the site work for conformance. with the approved
(stamped) plans and spqcifications and applicable workmanship provisions of the UBC.
Architect or En�ineer reviewed shop drawings may be used only as an aid.to inspection.
§pecial inspections are to be perlonned on a continuous basis --meaning that the special
!nspector is on site at all times observing the: work requiring special inspection. PeHodic
inspections, if any, must have prior ap)roval by the City based on a separate written plan
reviewed and approved by the Building g fficial and the engineer or architect of record.
2. Report Non -conforming Items
The special inspector shall bring noncOnfon-ning items to the immediate attention of the
contractor and note all such items in the daily field 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 notify the engineer or architect.
3. Complete Daily Reports
Each special inspector shall complete and sign both the special inspection record and the daily
report form for each day's inspection. These records shall remain at the jobsite with the
contractor for review by the City Building Inspector.
4. Furnish Weekly Reports
The special inspector or inspection. agency shall furnish the City with weekly reports of tests
and inspections. The project engineer or architect, and others as designated shall also be
copied on reports. Weekly reports must include the following:
Description of daily inspections and tests made with applicable locations
List of all nonconforming items unresolve
Report on status of nonconforming items (resolved or tty if not included in
itemized changes authorized by the Architect, Engineer and
nonconformance items
5. Furnish Final Construction Report
The sfecial inspector or inspection agency shall submit a final signed report to the City stating
I qu' ' ial inspection and testing were fulfilled and reported. And, to the
that a I items re iring spec ect is in confonnance with the approved. plans and
best of his/her knowledge the proi of the
s ecifications, approved change orders and the applicable workmanship provisions
UBC. Items not in conforinance or unresolved items or any discrepancies in inspection
coverage, (i.e., missed inspections, periodic inspection when continuous inspections were
required, etc.) shall be specifically itemized in this report.
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SPECIAL INSPECTION AND TESTING SCHEDULE
775-
PROJECr ADDRESS
- t'o' -
REINFORCED CONCRETE, GUNITE, GROUT AND MORTAR:
Concrete Gunite Grout Mort2r
Tests
iz Tests
ix Designs
Reinforcing Placement
Bitch Plant Inspection
Cast
PRECASTIPRESTRESSED CONCRETE:
rues rost-lens rre-jens Ltaciaing
Tests
Aggregate Tests
Reinforcing Tests
Tendon Tests
Mix Desiens
Reinforcing Placement
Insert Placement
Concrete Batching
Concrete Placement
Installation Insepction
Cast Samples
Samples
ssion Tests
MASONRY:
— Special Inspection Stresses Used
— Preliminary Acceptance Tests (Masonry Units. Wall Prisms)
— Subsequent Tests (Mortar. Grout. Field Wall Prisms)
— Placement Inspection of Units
ADDITIONAL INSTRUCTIONS OR OTHER TESTS
AND INSPECTIONS:
Form completed by:
Telephone No.: —
r -
BUILDING PF"rr NO.
TESTINGIINSPECTION AGENCY or SPECIAL INSPECrOR
STRUCTURAL STEEL/WELDING:
— Sample and Test (list specific members below)
— Shop Material Identification
— Welding Inspection 0 Shop 0 Field
— Ultrasonic Inspection 0 Shop 0 Field
— High -strength Bolting
Inspection 0 Shop 0 Field
0 A325 0 N 0 0 F
0 A490
— Metal Deck Welding Inspection
— Reinforcing Steel Welding Inspection
— Metal Stud Welding Inspection
— Concrete Insert Welding Inspection
FIREPROOFING:
— Placement Inspection
— Density Tests
— Thickness Tests
— Inspect Batching
INSULATING CONCRETE:
— Sample and Test
— Placement Inspection
— Unit Weights
FILL MATERIAL:
— Acceptance Tests
— Placement Inspection
— Field Density
STRUCTURAL WOOD:
— Shear Wall Nailing Inspection
— Inspection of Glu-Jam Fab.
— Inspection of Truss Joist Fab.
— Sample and Test Components
Title:
Date:
9
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02/13/2004 13�55 FAX 4257785536
menovistions
jAM-05-2004 10: 12
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425 774 92!10 P.4
I I P. 04/05
Ik- ran a I
nk INIPmaw
1. 0:09Y!=bsip�m� Cff to notib the qmdal hWGcW When wwk is ready for spegial
it is the duty or the conum USW on ft xUadwed schedule Md as noted an the appmed
inspectim MOtIv tht itma to have spodftl iGVGCt0M8- A&RUMS fMcc GhMlI be
plus and spocificatiOus am Muimd ime to boome fbmWBf with the
provided by the contractor so tba the WOW !=PCGWr haa t
projea.
7. provM@ Access to Ap]PV*VSG Flu$
The MBUWW is reopum1ble for pmviding the special inepc0o, accam to appmVed plans at
thejobsite.
3. Retpla speciffil Insomfin P.Mr*
a j8dal impectian nicurft submifted
Df is respomible to nWU 'it dw - blite 81 1
The ccatf%0114 we pcors as 11M provid fm the City building impectm uPOM
by the spcdW iRSPOGm- Th
request.
1. A raw spectol JUNPOMM or vaspej
C' bmilding depUftent @ball
requirements.
2. Momitor specid iWIP"Ibli Md aPP1
Work Wel
monitamobc%mly alwasn
Placemmt ojr@on=vw or other dftb
3. issue Certificaft of OCMPMCY
The BUjldjn2 0—frIC461 MY issm a C
TCP0 Iclujime—g the final Mort hav
The
spe,
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ovociffications.
I bave read and mrw 10 COMMY
special bspector
City BuildJug Wicial
ussmicies
1, all spodma ingpectors no VmW inspecdon
Ive VV00%jY reports
shall be
ad the bmance of t: To1=1 prior to
VORW.F. T.IWIdbor aypmval
kctMties in addition to 0M Of the sPedal inaPoct"'
to of OCOWLUr
y dW Oil Wftkiy gpedel inqHZ60n
mUmitted Wid accepted,
acting as the awfles agent dall fund
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LNUUM&MMIN A bi
die term and cOnditiO"s Pf'" Wee"ant'
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
WMO TO: pERNff COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE-------�
..FROM:
PtXASSSM
ENGINEERJNG DIVISION DATE—"'-,-/[
PLANNING DIVISION DATEL --------
MAN
pRojEar
SITE ADDRESS_ /1 '72-S--
B# INSPECTED —
PERMIT
DESCRUMON OF WORK TO -BE INSPECIW
A fleld inspection was condu'cted to determine rinal compliance with.approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
the granting of
CE BONDS and
PERFORM —AN
GRANT FINAL PROJECT APPROVAL
GRANT pRojEcT APPROVAL wrrH commoNS NOTED
0 Copy of CONDITIONS given to. owner/conftwtor by i . n-VectOr
FAILED FINAL INSPECTION - OUTSTANDING ISSUES ctor
C * of -CORRECTION NOTICE given to owner/contmetor by inspe
OPY
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL.
Si
ocaprvLdoc.l:tcmp:bldg:formIO/OI
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... d4;
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 .......................... C6_
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR -------
OCCUPANCY ..................
Tile Initials MT are Milton
Thompsort, a temporary Contract
inspector ror the City.
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