20041047.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
to ltiiiiWA ��Dnli
MAILIN� ADDRESS
ZIP TELEPHONE
NAME
AU") 0\
CITY
TELEPHONE
ZIP TFLEPHONE
A(ft\ I q�c� -
I- ( lr�-
I DATE
6 t.)
PROPERTY TAX ACCOUNT PARCEL NO.
q�� UP 0 0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPF; OF USE, BUSINESS OR ACTIVITY) EXPLAIN
U WtrAA-\
LU NUMBER NUMBER OF
C' OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DVOCARR �' —4 MS DrCTI ON-AEQUM
METER SIZfj9 $Wfliff E TO t)ft?AMTeff
I
SUITEiAPT#
LID NO.
LID FEE S
I ESCP Approved
[3
RW Perruil Required
13
Street use Permit Requiied
C3
lospection Required
0
Side&alk Requifea
13
Underground
13
witing tequaed
13
rD9
@&UIRED
YES NO [3
REMARKS �A&A� %,a
OWNERICONTRAcil�ROPP-MICLUOMROSION CONTROUDRAINAGE
6 WATER METER 70 BE REMOVED
HOSE BIB WITI-f-AVYINSTAII,
7BL# DUMP AT APPROVM) DUMP SrM ONLy
ENGINEERING REZfM EDEMOLITION INSpp
Cno?f ATE
0 CHECKLIST ON BACK OF JOB CARD
wa wwror,;iwoi Fweyj Hell! Eli"
FIRE REVIEWED BY DATE
1�
CHECKEQ BY
El
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
F�
SIGN
FENCE
I — X_
OTHER
FIRE SPRINKLER
FIRE ALARM
HEAT SOURCE I LOT SLOPE% I VESTED DATE
PLAN CHECK NO:
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION SEPA
REO'D COMPLETED I EXEMPT
OYES ONO I
CArr ZONE SIGN AREA H EIGHT
WAIVER 13 ALLOWED I PROPOSED ALLOWED I PROPOSED
STUDY 13 1 1
LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING TAREA PLANNING REVIEWED BY DATE
REQ'D , PROVI I IL
FT.) N REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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
WORKMEN'S COMU14SATION INSURANCE AND RCW 18:27.
DATE SIGNED
TYPErDF CONSTRUCTION CODE OCCUPANT
290i 2 1 ®r 3 GROUP 40
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED C I I OAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr Inspection
Fire Review
Fire Inspection
Landscape Insp
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTEN,TION * t:,& 1. 1 11-jj
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC1110.
FEE Description FEE
State Surcharge
City Surcharge
ki
Base Fee
Plan Chk. Deposit
Receipt #
Total Anit. Due
11 Receipt #
APPLICATION APPROVAL'
This application is not a perion until signed by the
Building official or his1her Deputy and Fees are paid, and
receipt is acknowledged in space provided
Ft&LS SIGNAVURE DATE
FLE
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
0
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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Msr 17 05 02t2Op American Environmental Cc 206 522 4099 p;3
C
'PUGET SOUND CLEAN AIR Date Received5UZ
rO�f� V'6. 2 6 AGENCY '00 AIR MAP 82005
I 10 "nion Street. Suite -
Seattle, WA 98101-2039
7W. -'4
www.pscitanair.org
Age".-Y We 01"y
111�wAlli�.
'Airileeii
ASonvI Use Only
Property 0%ynar- Eaglewood Homes Inc I Phone' 206.227.468
Mailina Address: 18607 Olympic View Drive I-Citv- Edmonds State WA ZiP.L..96020
sbcstos
ontractor* Arnerica
Mailing Address: P.O. BOX 51005
rirv! Seattle -
hn Asselin
Phonc:
(2 06)
523-4441
Job No.:
—WA Zip: 98108-1005 Fax:
(206)
522-4099
5081
D. Site ci : Edmonds zie: 98020
Addres,s.- 722 Daley Street - I
Site Local Phone: 206.227.4682
Manager: Craig Reimer
E. W Asbestos Survey or
AHEKA Building
Inspector: munaf Khan
—�Vas —FHnblr- Asbestos Identified? gy" WN0
of Dale o-%AsbcStQ15
Surviev: 2-9-05 Was Nonfriable Asbestos Identiffied? UdYes ONo
Ctrtification "�: .411ach a copy ofthe Surtsey wharifilabste asbestos
Exp. Date; 1014584/2-2-06 has not been identY'red
,1" 1 HEp �J.
,4 Sw)lvy 1$ rwouired oqvrr ass ucrommipm p 4
Fi
No. oir i.'.L Training re (List Fire Dcpl.)
F. Demolition Start
3-21-Os
Stru=res., 7. C3 Ordered Demolition (attach copy 9T2rder)
Information: Date.
Demolition lttzg?r, denrestition contractor 'i mailing addrimt oil back. Will nonfriable asbestos be left in place during demo? U Yes VJ No
Contractor E&elbarger Excavating
If yes, list type and qty. Note disposal requiremcrits in Stcp 6 (on baXkk).
Work Days: .0 Sa -�u
sbestos
tformfttion.. Start Date: 3-17-05
Completion Date: 3-17-05 Hours-
Will all rriable asbcstos 5f YC3
Total Qty. to be Rernoved: Lincar Ft.
235 S aeFr- mat&r1als be removed? 13 No
IF
7Auar Cr__ W Plaster LJ Textured Coatings
Ci
PC in
f rta P
of
—BoiIcr\Furnaq;c Insulation Ll Duct insulation Ll Pipe Insulation W Fireproo ing
UT . --
cirent Sonrd -ZI Cement PIN iriible Ficioring
U Friable Roofing Material Other SHEET VINYL
1pp�;nrl t priniewt Dernoliti6n I
H. AstiestasiDemolition rrOJCCZ 16�21CT.UFIU�a
I . Single-Ftimily Residence (owner -occupied): Eee
A. C2 Asbestos Removal Project Only A.PriorNotice A. VS
13 :
B. Q Delrolilion ProiCCI (With Or without asbestas removal pmject) B.10 Days"' B. S50
*(Asbestos removal can begin upon notifleatiom. demolition must wait 10 days)
Nate: tf the single Jamily residence is owned by onefamily who heis beerr or will be using the residarice as their domicile. the abinve boxes
1.4 or 13 may be checked If this is riot an OwflerlOccupied residence, one of the C ries fisfed bel6w must beused instead. A single!
1 .1 �- -- --. r—i ... mrilit-67i"f/vitnisry -- -
I jurrutv rtr4iuu,,�u �w�a
2 U Ail Ot cr Demolitions W th no Asbestos removal orq.onrriable Asbestos
10 Days
slog
0 T
oniy
L
or less than 10 linear fiect and/or 49 square feet of friable Asbestos) —
- - -
— - -
Frinble A.59'est0s Projects (other thnn Single F2MilV Residence):
A�SbestOS Demo
J
3.
LJ[ �: 10 - 259 linear "ect and/ora 48 - 159 square feet ofasbcsios
Prior Notice 10 Days
I Sion
11.
9 166 . '999 qnear feet andlor 160 - 4.999 square fact of risbestas
10 Days IrS290
"e, ��Stoo
I 40
�-.%I.000
linear reetandjor>5.000 square fectof asbestos --F--Prior
10 Days
N - olicc
)--Woo
S50 Emergency Fee
U Emergency Asbestos Project or LJ Eme ru,,ency Demolition Proje I
I
I6.
-rcm eirter2ency fee-. hommver. prosserwo%%wric must provide a
I writtenerners
inrormoonric
on & supplemental d2in 6, to the bevoCrny knovvicd9e, =tumte
American EnvironmentW ConsbtKtion LLCI-22
sciand C:
.enn Air Ati:ncy rom NO: 56-160 (Revised ZiOS) TS
RECEIVED
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Mar 17 05 02:20p American Environmental Co 206 522 4099 p.2
Job Number
Labor and Industries NOTICE OF
Industrial Hygiene Compliance ASBESTOS ABATEMENT
(Regional addresses and phone PROJECT
numbers on page 2) Today's Date FMarch 8, 2005
THIS NOTICE MUST BE RECEIVED NO LATER THAN 10 CALENDAR DAYS PRIOR TO THE START OATE
COMPLETE ALL APPLICABLE BOXES — rNCOMPLETE OR ILLEGIBLE NOTICES WILL NOT BE ACCEPTED
MAIL OR FAX TO';TH�E, RONAL OFFICE — CIRCLE CHANGES ON AMENDED NOTICES
4
I t ended C1 Site Work Hours Su Mo Tu We Th Fr Sa
Noticedate: 03 /08/05
am K
Start date: 03 ! 17 / 05 On'Hold Off Hold [1 8:00 am to --- X I X
22q pm 5..00 prn .1 project Dates and Work Hours must be Exact
PCOMRple6on- 0.4 / 30 / 05 Emergency 11
�, I. %I-Irwr L- enrcw)q TO RIF.- V REMOVED I_] LNUAI-bULA I L11
%,ZVCI,LN A& A
Quantity 235
Fireprooflng
square fect
Boiler insulation
Indoors C] Outdoors
CONTROL MEASURES
Popcorn ceiling
Duct paper
Neg. pres. enclosure
Wrap& cut
CAB
VAT
Glove bag
Wet melhods
Sheet vinyl
C] Roofing
13 Minienclosure
REPA vacuum
Asbestos paper
Other
Critical barriers
Manual methods
Quantity
Mag. pipe insulation
linear feet
Cement asbestos pipe
Other Other
RESPIRATORY PROTECTION
Air cell Pipe insulation
Ducting/duct irsulation
Mudded pipe ins.
Duct tape
[] I/, mask APR
0 Full face APR
Type C continuous flow
Type C pressure demand
other___.
C3 01her
rl ?APR
C3 Other
F413-025-000 notice of asbestos abaiementproject 11-01 For clean copies go to http://w%vw.ini.wiLgov/forms/
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Mar 17 05 02:21P
Rmerican Environmental.Co 206 522 4099 p.4
FIVI ))02 r. i
MAP.. 11, 2005 i2:4j%j4S7)NVL LA6VKAlUHlt6 INU
BATCHID
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Job Location:
Time:
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Sam le 10, 60
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Rate- End Litelz Meld ice
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fee
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ate: End Uters /Wd
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Sample Type*
Vhck AcULY:
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ObservRtlffls:
Cert#:
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Time: Stwt
Rate' r-bm Fibers
Environment:
Time: End
Rate: End Utem Ifield /cc pe
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observations:
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F.nvironment
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Sample Type:
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protection:
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Mnn 17 05 02:20p Rmerican Environmental Co 206 522 4099
P. 1
PO Box 81005, Seattle, WA 98108-1005
Phone: (206) 267-0746 or (800) 367-2760
Fax: (206) 622-4099
WA State Conimctor# AMERIEC996MB
March 17, 2005
Eaglewood Homes Inc
18607 Olympic View Drive
Edmonds, WA 98020
Fax: 425.775.8395
--- Letter of Completion ---
(AEC Job # 5081)
Re: Asbestos Abatement Services at: 722 Daley Street, Edmonds, WA 98020
This Is to certify that American Environmental Construction LLC has removed all of the
asbestos containing materials from the above referenced address per the Asbestos
Survey conducted by NVL Laboratories, Inc., dated February 9, 2005 per our Proposal &
Contract dated March 7 2005.
Clearance Air Monitoring (Sample Type = CL) as reported on the attached Air Sample Data
Sheet indicates that the airborne asbestos level is below the EPA established standard of
.01 fibers/cubic centimeter for clean air after an abatement project. Accordingly, the work
area is safe in regard to asbestos exposure for re -occupancy and/or demolition.
Please call me at 206-523-4441 if you have any questions or comments regarding this
Letter of Completion
Respectfully submitted,
Am i in Environmental Const tion, LLC
1— -7-7 0�- " 77
Bellows -4-difiinistrAtive Assistant
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEA= SMW
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DESCRIPTION OF WORK TO BE INSPECTED ZO
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign,
ocaprv1.doc.1:temp:b1dg:fonns 10/0 1
U.,
RECORD OF INSPECTIONS
INSPECTOR
SETBACKS, . ......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
V�N 0-1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
DATE APPROVED
F111111111110w ,
IN11110
I&V7
The Initials MT are Milton
Thompson, a temporary contract
inspwol. 1101- the City.
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