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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.
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PERMIT APPLICATION: 1BO DAYS
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'APPLICANT, ON BEHALF OF HIS 08 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 ANo
ALL CLAIMS FOR DAMAGES OFINHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMIT SHALL NOT 13E
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
Fire Inspection
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Receipt #
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Total Anit. Due
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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
WORKME��OMPENSATION URANCE AND RCW ILL27.
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APPLICATION AP 3ROVAL
CALL This application is not a permit until signed by the
Building Official or his/tier Deputy: and Foes are paid, and
FOR INSPECTION receipt is acknoy�Vdgcd in space provided.
&_FICLAIA�TUR DATE
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771-0220 7RELEA$1713 BY 'DATE
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ORIGINAL - FILE YEL1_Z_V IN/PE_C_TO_R`
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SIG R (OWNE R E
DATE SIGNED
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU
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MEMORANDUM
Date: 2/23/04
To: Debbie Karber, Accounting Assistant
From: Marie Harrison
Subject: REFUND
Debbie, please prepare a refund check in the amount of $91 .00. Please mail the check to
Edmonds Retirement Community, 385 Erickson Avenue, Suite 123, Bainbridge Island, WA
9 8110. The plan check fee was collected twice. I have enclosed a copy of our receipt #24141 for
your records. Thank you.
Sincerely,
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Development Services Division Director's Signature
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City of Edmonds cze Community Services
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: wwadedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
May 18, 2005
ATTN: Michael Hickey
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Edmonds Retirement CO111111Unity LLC
180 2`1 Avenue South
Edmonds, WA 98020
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RE: Building Permit 2004-0362
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Site Address 180 2"' A*,enue S.
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Expiration Date 05/14/05
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Dear Mr. H ickey:
We have received your renewal check for the amount of $54. Though it was received
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after the expiration date of the pen -nit our Building Official has made an exception in
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Your case and waived the additional fees. Your permit has now been ren ewed for I year.
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The new expiration date of Permit #2004-0362 is 5/14/06.
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If You have any qUestions please don't hesitate to contact me at 425-771-0220.
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Sincerely;
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JoAnne Zulaur
Permit Coordinator
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Development Services Department
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(425) 771-0220 x 1336
Enc: Receipt 926485
Incorporated August 11, 1890
Sister Citv - Hekinan, Japan
Letter of Transmittal
Washingtoii State Departinent of
April 21, 2006
Health
Construction Revie%v Services
3 10 Israel Road SE
Tuinwater, WA 98501
PO Box 47852
Olympia, Washington 98504-7852
%v%v%v.doh.%va.gov/crs
tel. 360-236-2944
flax. 360-236-2901
Project Info:
...
CRS# 8532
Project
180-2 Avenue South
The Edmonds Landing
location:
Edmonds, WA 98020
Chapter 388-78A WAC Boarding Homes
Removal of door openings
Key People:
Assigned DOH
Richard Swanson, R.A.
Reviewer:
ricilard.swanson@doli.wa.gov
Facility
The Edmonds Landing
Facility Contact:
Same as Administrator
Administrator:
Mr. Michael Hickey
180 - 2nd Avenue South
Edmonds, WA 98020
(206) 817-5781
michael@edmondslatiding.com
Architect
JHB Ltd.
Building
City of Edmonds
Engineer:
Mr. Darryl Stumpf
Official:
Ms. Jeanine Graf
12414 Hwy 99, Unit 6
151 - 5"' Ave N
Everett, WA 98020
Edmonds, WA 98020
(425) 710-0650
(425) 771-0220
N/A
graf@ci.edinonds.wa.us
Sprinkler
N/A
Fire Alarm
N/A
Contractor:
Contractor:
Other:
N/A
Other:
N/A
Copies To:
• Local Building Offlicial: City ol'Ednionds
• Washington State Patrol, Fire Protectiori Bureau
• Architect / Erigincer: JI-IB Ltd.
El Sub -Contractor: N/A
F� Sub-Coritractor: N/A
Z Dept. of'Labor and Industries, Electrical Section
El D01-1 Child Birth Center Licerising
D01-1 Office of Acconiniodations & Res. Care Survey
El D01-1 0J'J1ce or I-lealth Care Survey
Z DSI-IS, Deb La Rose, Aging & Adult Services Administration
[:1 DSI-IS, Div. orAlcoliol and Substance Abuse
El Other:
N CRS File
Page I of 5 Plan Review Comments for Project #8532
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The Edmonds Landing
Chapter 388-78A WAC Boarding Homes
Removal of door openings
Memo:
- Authorized to Begin Construction -
The construction documents have been reviewed per Chapter 388-78A WAC Boarding Homes (BH) and
found acceptable. The stamped approved copy of the documents shall be kept and available for the licensing
staff on site. Please note the following:
Any changes/deviations (incl. change orders or addenda) from the approved documents must be
submitted to the Department for review and approval. Please include your CRS number on all
communications to Construction Review Services.
You must notify the department when construction is complete, either by the included "pink"
card or by completing the form on the CRS website. Additional instructions may be printed on
the pink card. When we receive notification, we will notify Department of Social & Health
Services (DSHS) Boarding Home licensing that you have completed the review process and are
ready for licensing.
Boarding Home regulations do not allow occupancy of the completed project area until
authorized by Department of Social & Health Services (DSHS) Boarding Home Licensing.
The local building official is responsible for building construction permitting and occupancy.
Final licensing approval is subject to a site inspection by DSHS Boarding Home Licensing and
the Office of the State Fire Marshal to verify compliance with Boarding Home regulations and
your approved documents.
If you have any questions please feel free to contact Construction Review Services. You can monitor project
status and fill out our online survey at www.doli.wa. OvIel's.
Page 2 of 5
Plan Review Comments for Project # 8532
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Facility Data Certificate:
Facility Name: The Edmonds Landing
Site Address: 180 - 2nd Avenue South
Edmonds, WA 98020
DOH Facility ID: 010270
Critical Access Facility: El Yes
Z No
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occupancy Group: LC
c c u p a n c y p
Construction Type:
4-HT
Applicable Code: 2003 IB
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Number of Beds: Current:
u in b e r 0 f B e d s
Added:
0 Removed: 0 Total: 41
F r e S rink er
Automatic Fire Sprinkler
u t 0 in a t c p
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E] No
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Type
S Yes
Automatic Fire Alarm System:
u t om a t Ic F r eA larm y
�No
U r t .1 Yes
on req ' dC"
Compartmentation req'd:
JNo
Smoke Control System Provid Yes NNo
;T.,
pecial Dela ed ess Co 11 t 1:� D 1: V 0
S c I y Egress
�No
Location:
Yes
Certificate of Need Required: El Yes
Ic 0 e u
rt f f
ZNo
CON Approval Granted: Yes EINo
CON Number:
Number of units: Private occupancy: Two person occupancy:
> 1
� Based on size of rooms used for sleeping
Residents
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*;Ted on size of common rooms
Residents
Maximum allowable licensable beds:
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Qualifies for Assisted Living Funding Program
Yes E]No Number of qualifying units:
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The data above is based on the information presented to CRS. Ally change in tile facility or facility program that
review by CRS. Approval for construction is not
causes the above information to be incorrect is subject to to tile licensing agency.
approval for licensure. A copy of the facility data certificate will be sent
Page 3 of 5
34
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Plan Review Comments for Project # 8532 1 , 1- 0
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The Edmonds Landing
Chapter 388-78A WAC Boarding Homes
Removal of door openings
Plan ReOew Comments
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The DOH/CRS Plans Review Specialist has reviewed and approved this project two M
remove the door assembly connect units 150/152 and 173/175 for compliance with
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applicable regulations and codes and has no review comments for which additional
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information is required. M,
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2 Note: Material used to infill openings to meet the size and typ of material of existing C
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adjoining surfaces. New construction to meet the fire rating of adjoining walls.
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it(s) until all construction and clean-
3 Note: Existing resident(s) to remain out of the un >
up work has been performed. This shall include the elimination of paint odors. 3:
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I n Revieiv Services, are necessagfor thisfacilily to ineel 0-0)
Compliance ivith the comments above provided by the Departmew of Health, Construc io
dininisiralive Code and associated references. These 0 r,
the requirements of the applicable liceiising regulationsfound in the Washington State A OM
in the responsibility to ineel the requirements of any other applicablefederal, slate or local regulations. C W
comments do not relieve thefacifilyfi-o
stringent shall apply.
-jurisdictions and these wrillen comments, the most
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In the event of conflicts between othet O�
Page 4 of5 Plan Review Comments for Project # 8532
�Sv FINAL PROJECT APMOVAL FORM
ry
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLE.ASE SIGN
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT_rZ,P�e)A,0
SITE ADDRESS
PERMIT #90 0 ADB#______�DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
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
GIANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
R-E-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:teii1p:b1dg:ronns:oca1)rv1 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 4— 4:-- a.
OCCUPANCY ..................
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