20040982.pdfDATE RECEIVEI i
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N EINAME OF BUSINESS
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MAILING ADDRESS
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STATE LICENSE NUMBER
EXPIRATION DAIE
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A10471-11C_�Dl 5-0 *b,4
7
PROPERTY TAX ACCOUNT PARCEL NO.
-7 00? 0 `3
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NEW RESIDENTIAL
PLUMBING MECH
ADDITION F-1 COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
F1 SIGN
GRADING FENCE
REPAIR CYDS ( — X FT)
DEMOLISH E] TANK
OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
ROCKERY FIRE ALARM
ZICARPORT
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(TYPE OF USE, BUSINESS OR ACTIN
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NUMBER N 4BEA OF q Lr—
U& LL 'AREA
OF DWE IING S
U IT UMB
STORIES UNITS N ER
DESCRIBE WORI? TO BE DONE
_(7— 51
-7
HEAT �O_URCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO:_Aa_+5=_ I VESTED DATE
THIS PERMIT AUTHORIZES ON'LY 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: 180 DAYS
PERMIT LIMIT 1 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 DIRECTLY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMIT SHAI 1. 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 '
__PERMIT EXPIRES
TSE _T PERMIT
ZONE NUMBER '2, 0o o q,�
JOB SUITEIAPT#
ADDRESS
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PLAT NAME/SUBD)VISION NO. LOT NO. LID NO
74 VA1,E LID FEE $
7 L SIP �Iplllld
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Required
street use Porma Roq'd
inspection Rociturod
EXISTING — PROPOSED Sidewalk Harivired
Underground
REQUIRED DEDICATION� FT wiring required
METER SIZE LINE SIZE T�NO. OF FI�XTURES PAV REQUIRED
QU
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I I E SPE03 NO 1:1
REMARKS
OWNER/CONTRACfOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERflMR2MFr%M1?5T
0 SIDE SEWMt MUST BE CAPPED AT
FIRE REVIEWEd%Lft'bK11 U1415 DATE
WA7= METER M B8 REMOVED 0
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AT APPRZED11DUM
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BOND
POSTED
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PROPOSED
LOT COVERAGE . RE_Q_UI5FAih7_D' Efarc)k9'�fft"W60idt SET13ACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION
REQUIRED [] YES
LOT AREA I PLANNING REVIEWED BY DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
City Surcharge
Building Per it
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
2
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 Otticial or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERS014 WILL BE EMPLOYED
IN VIOLATION OF_jHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S 9&Mp-NSATION INSURANCE AND RCW 18.27. OFFICIALS TGNAT& DATE
SIGNATURE ($WNER (�R AGENT) DATE SI ED (425)
1//7/ 771-0220 RFLFAS�'
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
I
BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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214th Street
N 90* 0' 0" E 340' ..............
............................................ --------------------------
......... ......
..... .. . ...... CW
s7 Southwest
16.04'-*
11 Edge of pavement 51 - 0*
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N 90* 0'0* E 95' N 90* 0' 0' E 93.81'
N 900 0' 0' E 105'
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Lot 1
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SubdIvIslon Requirements
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Existing Lot area:
28,386.95 sq. ft.
Proposed Lot area of Lot 1:
Proposed Lot area of Lot 2:
9,942.0 sq. ft.
9,006.8 sq. ft.
W0'0'0"W 105'
N90*0'0'W 95'
N 90' 93.85'
Proposed Lot area of Lot 3:
8,887.3 sq. ft.
5 Foot Street Dedication:
475 sq. it. .
Parking Stalls:
At I east 1 stall I Lot (8.5'xl 13')
Roy Robinson
Kathleen MacPherson
Topography:
Less than 3' change across lot
Loren L Teresa Angiono
Grading:
None Proposed
Typical Setbacks:
Street 25-Feet
Side 7.5-Feet
D 15-Feet
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Nonconformities All three structures are nonconforming
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in reg
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FOR RE-COPIDING by th,
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subdivision, and no new nonconform
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ication request.
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Property location: 21402, 21404, and 21408 80th
L L 19706 80th Ave. NE Ave W
EXPIRES 2 Bothell, WA 98011 Section/Township/Range - NE 30-27-04
3 — r2 —T-7— I Date: July 4, 1996 rev. January 8, 1998
31-11 =l0,kinvn03Hi013na si ii
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Agency Case No. PUGET SOUND CLEAN AIR AGENCY
10 Union Str�ct, Suitj 500
Seattle, WA 98101-2038
200400945 www.pscleanair.org
NOTICE OF INTENT
I.- U
NOV 12 2004
A. Project Type: 1. El Friable Asbestos Removal 2. EI Friable Asbestos Removal & Demolition 3.,Q DemblifibIrOATV�
B. Property -1)—V- Co Phone: (Q0 77 3 1
Owner:
Mailing Address: c2 '340 City: G:bWl OA11)5 iState: Zip: '�OZ6)
C. Asbestos
PLF_15EP81,VTCLE,4RLY, THISRUL BE YOUR REMMMAILINGLIBEL
Contractor:
Owner/CEO:
Contractor
Mailing Address:
Phone: Job No.:
I City:
State:
Zip:
Fax:
_Tzip:'7TV2zP
D. Site
Address: 'E0 14- ZI L44k FLI.
Site
Manager:
V-�AA'P-&
LocalPhone:" 5-9;)-LIZ-4/57 I
__F_
E. Asbestos Survey or
No. of
I Da se
te f A b tos
)l
Was Friable Asbestos Identified? Yes No
Was Nonfriable Asbestos identified? Yes No
Mat'l Presumed:
Structures:
Survey: I I -z'
A ttach a copy oJ'the survey when ftiabe asbestos
A.HERA Building Certification #-' 10 1 02� 41f
Inspector: 'BiLi.
Expl kt,-�' to I ;C) 05,_
has not been identified I
An AHERASurvey is requirea oelore att aemourion pruirca
F. Demolitfon S= No. of Training Fire (List Fire Dept.)
Information: Date: 17- (1 0 Structures: 2. Ordered Demolition (attach copy of Order)
Demolition Insert demolition contractor's mailing address on back Will nonfriable asbestos be left in p ace during demo? Yes 0 No
Contractor: CAJtAKI e7�4�q4yA-rWC_-,- If yes, list type and qty� �i 14 1
G. Friable Asbestos
Project Information:
Work Days: M T W Th F Sa Su
Start Date: Completion Date: Hours:
Will all friable asbestos material D Yes
Total Qty. to be Removed: Linear Ft. I Scivare Ft. be removed'! L_J iNO
Thermal System Insulation: Boiler\Furnace Ins. Duct Ins. El Pipe Ins. 0 Other:
Sur -facing Mat'l: Fireproofing 0 Paints 0 Plaster El Textured Coatings El Other:
Misc. Mat'l: I E] Cement Rd [J Cement Pipe U Friable Flooring or Roofing Mat'l F-1 Other-
H.
Asbestos/Demolition Project Categories:
Notiflcation Period
Project
Demolition
Fee
Surchar2e
1.
Single -Family Residence:
A. Prier Notice
A.S25
A.
Asbestos Removal Project Only
B. 10 Days*
B.S50
B
Demolition Project (with or without asbestos removal project)
-(Asbestos removal can begin upon notification; demolition must wait 10 days)
iVote: If the singlefamily residence is owned by onefamily who has been or will be using the residence as their domicile,
the above
box or IB
may
be checked. A single family residence does not include rental property, noulti-family u its, or any mLred-use building.
$200
2._Z.
All Other Demolitions With No Asbestos Removal Project
10 Days_
Friable Asbestos Projects (other than Single Family Residence):
Asbestos Demo
3.
> 10 - 259 linear feet or > 48 - 159 square feet of asbestos
Prior Notice 10 Days
$100
$100
4.
El 260 - 999 linear feet or 160 - 4,999 square feet of asbestos
10 Days
$200
$too
[] 1,000 - 9,999 linear feet or 5,000 - 49,999 square feet of asbestos
10 Days
$750
$250
6.
[1 Emergency Asbestos Project or LJ Emergency Demolition Project
Prior Notice
Twice Project Fee
I
(Single -Family Residences art exempt from emergency fee; however. property owners must provide a
written emergency request)
I certify that the information contained in this notification & supplemental data is, to die best of my knowledge, accurate & complete
Q E I Wklk �C--Y,5 t Pev- aK70 - , -, /P �(
Ronroxontinp ' �rj , ". 1 111 ' Daie
DEC 14 2004
Puget Sound Clean Air Agency For-m No.: 66-160 (Revised 9/03) TS
DEVELOPMENT SERVICES CTR.
CITY OF EDMONI)S
I �! - - __ — C) C.
JIT C,
ai L i L_
R G
Reviewed
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The Puget Sound Clean Air Agency requires advance ' notification before any person commences a friable asbestos project
involving materials equal to or greater in size than' 10 line�r feet or 49 squa�e feet Ind for all demolition projects (regardless of
asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation 111, Article 4). All
asbestus removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal
and demolition proiects involving materials and structures below the notification threshold are still subiect to all other
requirements of Regulation 111, Article 4.
After receiving a complete notification with the appropriate project fee, the Agency will review the ronn and return a copy to
the asbestos and demolition contractor by mail. The returned copy will be your validated notification.
J. Dernolidon PM4SEPRINTCLEWY
Contractor: A J W �J E -/-CA V,47-1
Owner/CEO: ROL�
15 OvEU-1 t&Yf
Mailing Address: -Z-0 (a ( 1 13 Y,_(eW47r H�.� #Zqq 9�gO12,
Phone: (qz4 L4q 1 5& 5,q
Contractor's
Job
rCi;7 B (7-T R 0 LL-
State: t,4)+
I Zip: 9�,C>17_-
I Fax: (1&4- 4 � -3 4L'� I
GUIDELINES FOR SUBMITTING AN ASBESTOS\DEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement
asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multiple -structure projects, attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure.
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require an Asbestos Hazard Emergenc�
Response Act (AEERA) asbestos survey be conducted by an AHERA certified building Inspector. Attach a COPV of the survey result
to the notification of a demolition project when only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training Fire or ordered demolition if appropriate (a copy of the official
order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire requirements are
contained in Regulation 1, Secdon 8.08. If any nonfriable asbestos materials will be left in place during demolition, check yes and list
the type and quantity of material.
Step 7. Enter asbestos project information in Box G. List types of friable asbestos material to be removed; surfacing material such as
popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step 8. For Single -Family Residential projects; check BOX 111A for renovation projects, BOX H1B for demolition projects with or
xvidiout asbestos removal. Asbestos removal may be conducted after a complete notification is received, but demolition activities can
only begin on the 10' day after the notification is received. iVote: If the singlefamily residence is onwed by onefamily 010 has been
or will be using the residence as their domicile, bo.ces L-I or IB maj, be checked. A singlefami1j, residence does not include rental
properrj,, multi-fami/j, units, or any mLved-use building.
For Commercial asbestos projects (or projects that do not qualify as Single Family Residential); check the project category H2 -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition project, check die appropriate box I - 5 and the
applicable emergency box in H6. All emergency requests must be accompanied by a letter from the properry owner demonstratinp the
need to conduct the �roiect inunediately in accordance with the requirements in Regulation III, Section 4.03 (c).
Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Box 1.
IN-landatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule changes if the contractor is participating in die Agency work schedule fax program. A S25.00 processing fee is
required for all amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can download from the Agency web page at www.pscleanair.org. For
technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689-4090.
Puget Sound Clean Air Agency Fonn No.: 66-160 (Revised 9/03) TS
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PLEASESiGN
PROJECT
0- S'vV
SITE ADDRESS-59361
PERMIT # 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
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:rbnns: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
PIE f— IV\ (a - so
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
(j, a rwo 44"
The 111it""'s Contract
T110111I)SO"' tcmporar)
illspCetor Cot t1le City.
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