20040438.pdfI
DATE RECEIVED
PERMIT EXPIRES
__F 4�L�_
I USE PERMIT
CITY OF EDMONDS 70NEC 6- NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OFOUSINESS
PLAT NAME]SUBDIVISION NO. LOT No. LID NO.
LID FEE $
MAILING ADDRESS TESCIP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW permit Required
Street Use Poenit Rocrd
inspecurin Required
EXISTING - PROPOSED Sidowelk Required
CITY ZIP TELEPHONE underground
C_j , REQUIRED DEDICATION� FT Wiring required E3
[C /_ f�0101 '7-X�3Sc/� ME NESIZE PFIVREQUIRED
NAME YES13 NO
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REMARKS
ADDRESS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 0
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CITY ZIP NE
)ITELEPHO
NAME CBL#
L L7� 0 C ENGINEERING REVIEWED BY DATE
ADDRESS
REVIEWED BY DATE
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CITY ZIP TELEPHONE
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e�O A -Co Lj'iq-� d/n 2,cl VARIANCE OR Cu SHORELINE OR ADS# INSPECTION BOND
go L/ IS E ON BOND
POSTED
S
CT I i POSTED
EXPIRATION DATE CHECI��D BY REO'D
STATE LICENSE NUMBER S 6
[3YES ONO S
HEIGHT
SEPA REVIEW SIG AREA
EMPT ALLOWED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EX D , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
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Ro U H
NEW 11 RESIDENTIAL ALLOWED PROPOSED FRONT St 8 8 z
El PLUMBING MECH SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
COMMERCIAL
ADDITION CHANGE OF USE
F-1 PARKING LOT AREA PLANNING REVIEWED BY DATE IL
REMODEL. MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE
REPAIR CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY -FIRE ALARM
(TYPE OF USE, QUSINESS OR ACTIVITY) EXPLAIN: 1CODF OCCUPANT I
?4? 1 . / - CHECKED BY GROUP
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76"C C . U . PA
NUMBER NUMBEROF CRITICAL SPECIAL INSPECTION JAREA NT
OF DWELLING AREAS A"A_ LOAD
/\�,!Al I NUMBER REQUIRED A/0
STORIES UNITS UL YES
DESCRIBE WORK TO BE DONEP _t_ REMARKS
C 108/FINAL INSPECTION RE01101 i
PROGRESS INSPECTIONS PER UB
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Ar? VALUATION
FEE
Description FEE Description
;!��x i,�zn vA.4 (�ULI.,WAN25-A26�
Plan Check State Surcharge
HEAT tOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECKNO: VESTED DATE Plumbing Base Fee
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
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
M SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Rec ipt H
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
I a: 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 Landscapelnsp. Total Amt. Due
C DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording F Receipt ft
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION APPLICATION APtIMUVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DUI.� 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 VIOLATION OF THE LABO - R CODE OF THE STATE OF WASHINGTON RELATING TO .1 D TE
WORKMEN'S COMPENSAT�GN INSURANCE AND RCW 16.27. OF I NA
SIGNATU, 11 RE (91WNER OR GEN DATE SIGNED (425) Az)
14/ 771 0220rflEi -ASED BY
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Af*N ION UNTIL /, _?) (LA
IT IS Ut4l, FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
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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TO PERMITTEE AND/OR OWNER
St. DO NOT REMOVE
ENFORCEMENT VIOLATION
PARTIAL APPROVAL CORRECTON RE, QUIRE, D
Permit Number 4J
Owner
IN
Job Address `�s ite, Contact
El WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED
E3 APPROVED PLANS AND JOB CARD MUST BE AVAILABLE TO INSPECTOR ON SITE
CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE NEXT PHASE
OFWORK IS STARTED
RECALL FOR INSPECTION L1 $50 REINSPECTION FEE MUST BE PAID PRIOR TO INSPECTION REQUEST
STOP WORK -UNTIL AUTHORIZED TO CONTINUE BY CITY INSPECTOR
NO PERMIT -STOP WORK-REmOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY WITH
ALL APPLICABLE CITY CODES
ICATED ABOVE ARE REQUIRED TO BE CORRECTED WITHIN
T��ACTIONS OR CORRECTIONS IND CTION CALL 425-771-022,0
CALENDAR DAYS OR PENALTIES MAY BE APPLIED. FOR INSPE
Building Planning Engineering Fire 13 Public Works
I pecto Date
ns
White: Pennit File Pink: Enforcement Buff: Applicant
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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: wwwde dmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building Engineering
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June 20"', 2006
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Harbor Square Athletic Club
160 West Dayton St
Edmonds, WA 98020
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RE: Building Permit #2004 -0438
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For Steel Floor Support Column Replacement in Pool Area
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Site Address 160 West Dayton St
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Expiration Date 6/8/06
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To Whom It May Concern:
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According to the City of Edmonds Building Division records and the Edmonds
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Community Development Code Chapter 19.00.005 A.6.c Section 105.5, the above
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referenced building permit expired on 6/8/06. Our records indicate that work has not
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begun on this project and we are closing the permit.
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if you wish to pursue this project in the future a new application, new plans under the
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current code, and new permit fees will be required.
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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Pernlit Coordinator
Incorporated AUgLISt 11, 1890
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MAY-26-2004 13:46 P.03/05
CITY OF EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
The project A- VL f-4� L f<-71 (---- CL� issued under buildm'l
permit number Mf-1 - P? requires special ir!spqction and/or testing per UBC Chapter I
and WAC Amendments 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 a&reement and the attached structural test(s) and inspections schedule including the
required acknowledgments.
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APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the
Building Official prior to pedormig apy duties or inspections. Each special- inspector shall submit
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Statement of Qualifications to the Building Official for review. Special inspectors shall display'
identification when perfornuing special inspections on site. Special inspection and testing shall meet
the minimum requirements of UBC Chapter 17 and the followifig:
A. Duties and Rpql;nnNIWIUW a1W SgWal InNUkeW 0 M
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1. Observe Work 0
Ile special inspector shaU observe the site work for conformance with the approved 0
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(stamped) plans and specifications and applicable workmanship provisions of the UBC. I --I K
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Architect or Engineer reviewed shop drawirigs; may be used only as an aid to inspection. M Z
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.ecial inspections are to be performed on a continuous basis --meaning that the special ID --I
�nspector is on site at all times observing the work requiring special inspection. Pexiodic C _Z
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inspections, if any, must have prior approval by the City based on a separate written plan
reviewed and approved by the Building Official and the engineer or architect of record.
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2. Report Noo-conforming Items -n
The special inspector shall bring nonconforming items to the immediiite attention of 'the
contractor and note all such items -in the daily field report. Any itern not resolved in a timely
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manner shall be immediate cause of the special inspector to notify the Building Official of the 0 U5
plan deviation error, change or omission, It shall also be the duty of the special inspector to 0
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promptly noti?y the engineer or architect.
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3. Complete Daily Reports
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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 Z
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pecial 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 Cn
copied on reports. Weekly reports must include the Following: Z
Description of daily ins
pections and tests made with applicable locations 0
List of all nonconformifig items i
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Report on status of nonconforming items (resolved or unresolve M
Itefilized changes authorized by ihe Architect, Engineer and &y if not included in
nonconformance items
5. Furnish Final Construction Report
The inspector or inspection agency shall submit a final igned report to the City stating
that allct'As requiring special inspection and testing were fulfilled and reported. And, to the
best of his/her knowledge the project is in conformance with the �pproved plans and
specifications, approved change orders and the applicable workmanship provisions of the
TJBC. Ite-ms not in conformance 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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MAY-26-2004 13:46 P.04/05
B. —Conti: QrResposibilities
1. Notify the Special Inspector
It is the duty of the contractor to notify the special inspector when work is ready for special
inspection. Note, the items listed on the attached schedule md as noted on the approved
plans and specifications are required to have sp ecial inspections. Adequate notice shall be
provided by the contractor so that the special inspector has time to become familiar with the
project.
2. Provide Access to Approved Plans
The contractor is responsible for providing the special inspector access to approved plans at
the jobsite.
3. Retain Special Inspection Records
The contractor is responsible to retain at the jobsite all special mius.
.pection records submitted
by the special inspector. These records are to be provided to the City biiilding inspector upon
request.
C. City of Edmunds Nuilffing Department Reglionsibifts
1. Approve special inspectors or Inspection agencies
The building department shall approve all special inspectors and special inspection
requirements.
2. Monitor special inspection and approve weekly reports
Work " Wring special inspection and the erfbrmance of special inspectors shall be
monitorel b
the City Building Inspector. Wis/her approval must be obtained prior to
placement o concrete or other similar activities in addition to that of the special inspector.
3. Issue Certificate of Occupancy
The Building Official may issue a Certificate of Occupancy after all weekly special inspection
reports including the final report have been submitted and accepted.
D. Owner-ReqUonsibilities:
Thep�oject owner or the engineer or architect of record acting as the owner's agent shall fund
special inspection services.
F. Engineer or Archftegt of Record Responsibilities
The engineer or architect of record shall include special inspection requirements on the plans and
specifications*.
ACKNOWLEDGEMENTS
I have read and agree to comply with the terms and conditions of this agreement.
General
City Bui
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MAY-26-2004 13:47 P.05/05
SA uaiz rF -17A F-)-) e- 6 L, 18 �Jf'(--
BUUJXNO MMMIT Mo.
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PRO11WTAVORM TESTINGFUMECTION AGENCY at SPECL^L INSPECM
REINFORCED CONCRETE, GUNITE, GROUT AND MORTAR- STRUCTURALSTEELIWELDING:
CAacrrte Gunhe Grwa Mortitir — Sample nd Test (list specifle members below)
AI[M!! Te=
Rzinibircitig Tesu
Mix Dirsipm
Peitsforcing Placement
Ditch Plant Inspection
laspectPlacial
cut Samples
Pick.up Samples
compricssiOnTests
— Shop Material Identification
— Weldiq Inspitiction 0 Shop 0 FKW
— UlnscWc IMPection 0 Shop 0 Field
— High-strcnLph Bolting
Inspection 0 Shop 0 Field
0 A325 ON C)X 0 F
0 A490
— Metal Deck Welding Inspection
— Reinforcint Steel Walding Lupection
Metal Stud Welding Inspection
PRECASTIPRESTRESSED CONCRETE: Conemic Insert Welding Inspectiltin
ra" Pod -Tents PMTMS Owdift
Terwon Tests
Mix Dmilins
kcinfiorciar Placement
Inserr PLACeincrit
Corwrete Baichlng_
Concrete plaverriefit
installation Insepiction
Cast Samples
Pick-up Samples
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jCoMMionTesis
FIREMOOFING:
— Placemirnt Inspection
— Density Tesu
— 71tickricu Tc&Ls
— Inspect Balching
INSULATING CONCRETE-
- Sample &W Test'
— Placement Inspection
— Unit Wcights
FILL MATERIAL:
Acceptance Tests
MASONRY; — Placement Inspection
— Special Inspection Stresses Used — Fiew Density
— Preliminary Acccpunce Tests (Masomy Units. Wall Prisms) STRUCTURAL WOOD:
— Subwqmt Tem (Mortar. Grout. Field Will Priam)
PLKe=nl InIpOctiOn Of UllitS — Shw VAN Nailing Inspectim
— Inspection of Glu-lam Fab.
— Inspection of Truss Joiss Nb.
ADDInONAL INSTRUCTIONS OR OTHER TESTS — Sionpie &PATeSt Components
AND INSPECTIONS;
F( ri-A '�'p i�-'voc'x
Form completed by: Title:
Telephone NO.; Dow
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3 4 5 6 71, '0'1'0'1'0 BAKER ENGINEERS INC21 P.S.
3 1 V1 t
0 01101
'010010 STRUCTURAL DESIGN
'p L6'713!190001001
123 4TH AVE. N. Phone: (425) 771-6666 SINCE 1977
EDMONDS, WA 98020 Fax: (425) 771-6558 www.bakerengineers.com
Email: mailbox@bakerengineers.com
DATE: June 3, 2004
CLIENT: Wilcox Construction, Inc.
Ave. S
2345
Edmonds, Wa. 98020
ATTENTION: Jeff Eckstrom
SUBJECT: Harbor Square Atheletic Club
160 W. Dayton Street
Edmonds, Wa 98020
Job No. 04-060
Dear Jeff -
Baker Engineers, Inc., P.S. will provide inspection for epoxy all thread bolt installation.
If you have any questions please call our office.
Sincerely,
BAKER ENGINEERS, INC., P.S.
Edwin F. Baker, P.E., S.E.
Principal
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/P6rch . .................
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 40) 1
OCCUPANCY ..................
NO C5011hed.
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