20041038.pdfDATE RECEIVED
t
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Briar Development Co.
2211 Rimland Drive
CITY ZIP TELEPHONE
Bellingham 98226 1360-650-8360
NAME
ADDRESS
CITY
ZIP
NAME
Donovan ExcavatiLng
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ADDRESS
26322 79th Avenue South
CITY ZIP
Kent 98032
STATE LICENSE NUMBER
JDEXC**02002
PROPERTY TAX ACCOUNT 7A'RCELNO.
5807-000-040-06-00
TELEPHONE
CBL #
TELEPHONE
253-852-1775
EXPIRATION DATE
1/427/2005
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN:
Demo existing
structure
NUMBER
NUMBER OF
OF One
DWELLING One
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
Demo building,slab
and fo
sewer line, salvage parrot
to drain.
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
E] PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
411' 1 1 PERMIT EXPIRES
USE PERMIT
ZONE(�('_ /
NUMBER
JOB
ADDRESS ;r)
PLAT NAME/SUBDIVISION NO. I LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING __ PROPOSED
1-1111.1FIN r
REQUIRED Lfticl?fok- .41 ;qwl; I
METER SIZIG IS' jqt,1gl4I7E ) (_) I I i tjO(.qfIfXATf5
SUITE/APT#
LID NO.
LID FEE $
TLSCP Approved
HW Permit Requited
Street Use Permit Roq'd
Inspection Requarid
Sidewalk Haquired
Undeiground
F DIA UIRED
YESWR NO 0
1 REMARKS
OWN ER/CONTRACP80V;�6k4M P6� EROSION CONTROLJDRAINAGE
0 WAI'ER NiETFIR TO B13 RPMOV13D Cit
ENGINEERING REV12W11D BV LIM ULI L 1UN INSFEL—noWTE
0 CHECKLIS-F ON BACK OF JOB CAM
pni? 1NizPPr"QbT uv QW! MrIMENW8
FIRE REVIEWED BY DATE
VARIANCE OR CU HORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , P80POSED
1EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING
REO'D I PROVIDED
REMARKS
LOT AREA I PLANNING REVIEWED BY DATE
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CHECKED BY
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OCCUPANT
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GROUP
CRITICAL
AREAS
04-146
SPECIAL INSPECTION
OCCUPANT
NUMBER
REQUIRED [:] YES
JAREA
LOAD
tings., cut and cap
REMARKS
PROGRESS INSPEC11ONS PER USC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D
head and grade areal
/) A A
133
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT: I 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 SUCCFSORS
Err
W IN INTERE�T.' AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 'THE CITY OF
_j
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALT NOT HE
a, DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-.1
0 NOR Limi r IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
X
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 OWNEI'T 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
1�
SlGfUvrb,f+&.QWNER C)KAGEt!Lf�� DATE SIGNED
2-
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
—1:5
Plumbing
Base Be
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt It
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt It
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
rF1I IALS SIG A URE DATE
V41911JIlk)
RFLEASED BY DAT/
ATT ENTION E)ff 1333
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
091�03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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American
Environmental
Co
206
522
4099
American
Environmental
Cc
206
522
4099
l—'I —' AN AIR
I11JGET SOUND CLC
1.t.CiENCY
Union Sircel. Suite 5(jo
.... . . St:. -2039
qS101
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Company
t\,. Bellingham
Ci
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rill -an EnvironMental CC
P.O. Box 81005
WA
Seattle
21904 H191"l 99
I d1resls: I I I I I I I ''I M M I M 1 11
site . Michele Lo
Manav,cr-
-C or No. of
E. Asbestos Sur Structures,
0 lill Presto e
AHFPA Building Nickolas NOVI
Inspector.:
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ired bcfnrt! all detno 1110
4li A 14CRA Survcy is requi
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1)11-11101,1131 11-15-04
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10 Date ----d-M-MMIMM�1 -
on * ` : -
InflormatiOn: loll co"Iraclar
Moll
EDernolition rl
L:
Contractor: Donovan Excavating
..........
FG"FriableA!! ion: start Date:
Prnl Inforni2t.
108-1005 1 Fax:
AgencY L, - Wont',
360.650,8382
rc.--,7�vw�
John Asselin
(206) 522-33-_,4-4"41L
............
(206) 522-4099
p. 2
P. 1
98227
Contractor
job NO.'
4338
Call Edmonds � zi 99026
Local `---360.65�
W s Friable Asbestos identified
Ide-niii-ted?
Date of Asbestos 7-15-04 w Is Nlonfriable Asbestos asbestos
of the survey %vhcn fi-liable
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A ch r ed.
Certification 9: 1-rjAJ-04-OV243-05 h
rxn. Date: -------
Ls"'"00 '
��cresd '
"10 0i 1 1
ctur -5. bestos b left n Pact
Str�o o fr �b ic asd
a an
all Nick I�
iryes, ist P c
re (List Fire Dept.)
h of OTdu(
,triolition (atlac SOPY �
No
Days;
H Hc
ours,
V
Date. .111 friable asbestos
in
- Ft. rnl ia—
I I 1 1111 111111 11111111 ".
Is 1, 1 1 ''1 Other:
Li Is 1,! � 111 � � 11 1 1 1 11 Ilipc Ins.
Tou"I OtV. to be Retlilimied: [)�uct '1115.
1�33oilcrlli--tirnacc Ins. 13"' Other
I TI Ccll
Thermal SyStOrn insulation-. .1 plascr other:
ton
surfacing Mat'l: Friabic Flociri g or Roofing M ''T—P
3-C--e-m--en-1 �PiPC
e
r 11
Mir ccment Btl Notific' Fee
sc. Mat'i Categories: I \7"I -s—ur—ah—UM
Asbestostr)cmolitinn P oiect A. Prior Notice
S,n,I,_Fam1lv Residence: B. 10 DaYsIll'
. enjoval Project Only
A Q Asbestos R IjLct (With orvitliout asbestos remoVal PrOje't) sinticile. I se, abo,,e bo,015
Ca Dill -deMoIiti0Trnustwa2. residence as 01 buildin -
_Molition Pril --llll"""— -I"` . -14$e
B. .(I n noTificatio FIn jgz Ili I
,mo\.al can be -in uuol -I ivill'be u. r am, 11I
Asbestos eflistsily, _W$1,0 flas been or er nrulti-fairlill, units, 0
1cfarnity residence i.v owned by,L to
.Note: if Ilse si . 119 - clseck�d. A sin le fanii1v l-I nce does not iltclude rental 10 Da Is
A or 1B inal' h�:e� Removal Pro Cct Asbestos Demo sin()
11 r Dicniolitlons With No Asbestos Fgmil-*. Residence)' prior -Notice 1 (0) D, s Sloo $100
2. All 0�ha I I Q�l invie
Lcts (other th: I I S is S250
Friable Mbestos Pr d1or >- 48 - 159 IS uare feet of asbestos 10 Days 5750
3 10 9 linear feet an, 9 luarc. feet of asbestos 0 Days
11 1-- di 160 - 4l9 .; '' -rwice projcct Fee
260 - 99C linear feet an or ::=-. III'' I I riot Notice
�-, 1 --5 0()n square feet of asbestos
4 >1.0 0 line-dr feet and/or-l-Ill I 'I'lllty 'y project writtenemer nc f u5st'
,Mergency Demolition videa
- ownersmilst TO Age MY
a ncy Asbestos Project 01 ho\%-CVCr. PIC, rrs", Use
6. Line w - n1i eltirigency I-cl, comPicle. PC
sin.1c.ramitV RL;idcnt:cS arc c"emPt flo knowledge, Occura 1
ica ion & SuPPICme"I data is. to the bc5t 01 my
t1iis rill
"ItV at r information contain , )nstruc:tlon LI
nvironmental C(
American E 11 1 1 11
RepfcJenfing
Sa 6u
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66,160(Rcvn;cd9/0';)T*l
Ijil Sound C1,I Alt Agency Form
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29 04 11:013a American Environmental, Co 206 522 4099
Page 3 Septemoer 29, 2004
Proposal and Contract - 21904 Highway 99, Edmonds. WA 98026 Haggeninc.DOC
ACCEPTANCE
You are hereby authorized to furnish all materials and labor required to complete the work
mentioned in the above proposal for which I agree to
pay the amount mentioned in said groposal, and according to e terms thereof.
of 20
ACCEPTED this day
A0By: P�4-1
Print Name
sign—a-ture
if accepted, please complete and return the following information with the signed
proposal.
The following information is required to apply for various State required permits. These
agencies may require up to 10 days to process the applications.
When would you like to schedule the job? Demolition Start Date?
November 5, 2004 November 15, 2004
Address of the building
21904 JE[ighway 99 zip
WA --1198026
city State
1.2 Edmonds. I
- Age of the building Size (SFT) Number of Flcors
1.3 56 years 1,475 One
Client's Name
2.1
Briar Development Company
-
Billing Address
2.2
P.O. Box 9704
—
Billing City
State
I
2.
Bellingham
WA
1
Client phone number
'lient fax number
2.4
360-650-8382
366-732-6432
---
Owner's name (if different from the Client)
3. 1
Owner's address
3.2
city I
State 72i�_-
zip
3.3
-
Owner phone number
Owner fax number
3.4
Name:
Site contact name & telephone number. Phone
4.1 (The person we will call to schedule the
job and let us into the premises. Cell:
p . 3
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN 42�'U) L��.ENGINEERING DIVISION DATE :::!�Z7
V
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS
PERMIT _ADB#
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final 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:
, V_ GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
o Copy of CONDITIONS given to owner/contractor by inspector
I -
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvi.doc.l:temp:bldg:fomisIO/OI
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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 S-L,
OCCUPANCY ..................
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