20041057.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF EIVEKNESS
MAILING ADDRESS
CITY
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NAME
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ZIP TELEPHONE
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CITY ZIP
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NAME
ADDRESS
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TELEPHONE
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ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
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PROPERTY TAX ACCOUNT
PARCEL NO.
00.:�_ &�, 9- �70
11
NEW
13
RESIDENTIAL
A. I bl�fr,
ADDITION
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REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
El
DEMOLISH
El TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINES OR ACTIVITIO EXPLAIN:
NUMBER
OF V.
NUMBER OF
DWELLING Ajl!-�
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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Q1HPR
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�IRE 9PRINKLER
FIRE ALARM
NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
N U M BE R - llx)I)1117
ii;�
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE S
TESCP Approved
E3
RW Permit Required
13
Street Use Permit Roq'd
Q
Inspection Required
E3
Sidewalk Required
13
Underground
wiring required
PRV REQUIRED
YES C3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
ENGINEERING REVIEWED BY
DATE
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ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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REMARKS
CHECKED BY ITYPE O��ONSTRUCTION COUE OCCUPANT
CRITICAL I 1_45�4� 10 3 GROUP
SPECIAL INZPE;TION AREA OCCUPANT
AREAS IV/s.7' LOAD
NUMBER REQUIRED X YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
e I A A A.:,
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LA ��E�/C�H NO: VEST
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1BO DAYS
W
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
fn
�j IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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
C1 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_j
0 NOR LIMIT IN ANY WAY THE CITYS 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 AGR�E 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 18.27.
SIGNAT7E �OWNER OW21�p� ) —6, 91
I DATE SIGNED
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VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
�2 Z�2
Landscapelns
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
FOR INSPECTION
This application is not a permit until signed by the
Building Otficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
0FFJ0I S SIGNAT)URE DATE
1 11
(4rlr—%
2.51
771.0220
I
REF . ED BY I CrATE
'? /I
ATTENTION I I / i EXT 1333 1,/ 4 ...
TURE UNTILA FINAL
IT IS UNLAWFULTO USE OROCCUPYA BUILDING OR STRUC
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FlI E YEI I ffi�PE��Ofl
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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111
EXEMPTION FROM SHORELINE
MANAGEMENT ACT SUBSTANTIAL
DEVELOPMENT PERMIT REQUIREMENT
To: Christopher W. Keuss, Port of Edmonds, 336 Admiral Way, Edmonds, WA 98020
(Name and address of the applicant)
The proposal b Port of Edmonds to undertake the
(Name of applicant)
the following development (please be specific):
Replace the concrete dock on the north and east side of the floating bait house, which is between
H dock and I dock (fuel dock), with new floats which will be half the depth of the existing floats and
will have new connector pieces that will provide some "give" during the extreme low tides when
the new docks do bottom out
upon the following property (please list legal description, i.e., section to the nearest quarter
section):
That portion of Government Lot 3, Section 23, Township 27 North, Range 3 East. Willamette
Meridian, in Snohomish County as further described on the attached legal description.
within Puciet Sound and/or its associated
(Name of water area)
wetlands is exempt from the requirement of a substantial development permit because the
development:
Consists of normal maintenance or repair of existing structures or developments, including
damage by the elements, and the repair being done is the common method of repair, and the
structure shall be restored to a state the same as its original configuration, and the repair is being
done (or permitted) within a year of.the damage per WAC 173-27-040.2.b.
(Identify exemptions as outlined in WAC 173-14-040)
The proposed development is consistent or inconsistent with:
CHECK ONE:
Consistent
inconsistent
&--- -L' -�M4
(Date) '
I " "IGROFILM
V1
FORM: SHORELINE EXEMPTION
UTEMPIFORMS�SMEXEMP. DOC
Policies of the Shoreline Management
Act.
Edmonds Shoreline Master Program
(see 23.10.160 — Use Regulations —
Moorage structures and Facilities)
(Sign9tur"f Authorized
Local Governmental Official)
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The project at
11 u Inber
R,5cEiVED
CITY OF EDMONDS NOV 0 5 2004
SPECIAL INSPECTION AND TESTING AGREEMENT
1'sz L' i rj 6 14el- 5 PERMIT CoUNTER
'ai4 ( ssued under building permit
13 (,52 AwM i Et
complete list of special insp
7 requires special inspection and/or testing per I13C Chapter 17. The
ons is attached to this document.
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor an([ special inspector shall complete
this agreement and the attached structural test(s) and inspections schedule including the required
acknowledgenients.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector sliall be approved by the Building
Official prior to performing any duties or inspections. Each special inspector shall submit Statement of
Qualifications to the Building Official for review. Special inspectors shall display identification when
performing special inspections on site. Special inspection and testing shall meet the minimum requirements
of IBC Chapter 17 and the following:
A. Duties and Responsibilities of the Special Inspector
I . Observe Work
The special inspector shall observe the site work for conformance with the approved (stamped) plans
and specifications and applicable workmanship provisions of the IBC. Architect or Engineer
reviewed shop drawings may be used only as an aid to inspection. Special Inspections are to be
performed on a continuous basis—ineaning that the special inspector is on site at all times observing
the work requiring special inspection. Periodic inspections, if an),, 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.
2. Report Non -conforming Items
The special inspector sliall bring non -conforming items to the immediate attention of the contractor
and note all such items in the daily field report. Any item not resolved in a timely manner shall be
immediate cause of the special inspector to notify the Building Official of the plan deviation, error,
change or omission. It shall also be the duty of the special inspector to promptly notify the engineer
or architect.
3. Complete Daily Reports
Each special inspector shall complete and sign both the special inspection record and the daily report
form for each day's inspection. These records sliall remain at the jobsite with the contractor for
review by the City Building Inspector.
4. Furnish Weekly Reports
The special 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 copied on
reports. Weekly reports must include the following:
Description of daily inspections and tests made with applicable locations
List of all non-conforining items
Report on status of non -conforming items (resolved or unresolved)
Itemized changes authorized by the Architect, Engineer and City if not included in non-
conformance items.
5. Furnish Final Construction Report
The special inspector or inspection agency shall submit a final signed report to the City stating that
all items requiring special inspection and testing were fulfilled and reported. And, to the best of
L:VI'EMP\BUILDING\SpeciaiiiispectioiiAgreciileiitIBC.doc 7/04
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his/lier knowledge the project is in conformance with the approved plans and specifications,
approved change orders and the applicable workmanship provisions of tile IBC- Items not ill
conformance or unresolved items or any discrepancies in inspection coverage, (i.e., inissed
inspections, periodic inspection when continuous inspections were required, etc.) shall be specifically
itemized in this report.
11. Contractor lZesponsibilities
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 oil the attached schedule and as noted on the approved plans and
specifications are required to have special inspections. Adequate notice sliall be provided by tile
contractor so that the special inspector has time to become familiar with tile 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 inspection records submitted by tile
special inspector. These records are to be provided to the City building inspector upon request.
C. Citv of Edmonds Buildinl! Department Responsibilities
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 requiring special inspection and the performance of special inspectors shall be monitored by
the City Building inspector. His/Her approval must be obtained prior to placement of 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 Responsibilities
The project owner or the engineer or architect of record acting as the owner's agent shall fund
special inspection services.
E. En2incer or Architect of Record Responsibilities enients oil the plans and
The engineer or architect of record shall include special inspection requir
specifications. ACKNOWLEDGEMENTS
I have reati and agree to comply ivith the terms and conditions of this agreement.
Owner
Special inspector
� —
Date
Date CD
/*
ate —113-5,Z
General Contractor
C� Date
City Building Official
L:VrEMP\BUILDING\SpccialltispectionAgreciiieiitIBC.doc 7/04
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SPECIAL INSPECTION AND iESTING SCHEDULE
--�7
e2l�
ECrNAME ;PERMrT
W BUTI-DING 'Vo.
�,Z-7"+01 , Ilk :JL4 5,0-11 1 r--l- L'-' ,
PROJECTADDRESS TEsmNGaNsPEcn0N AGENCY . SAOAL INSMCrM
REINFORCED CONCRETE, GUNITE, GROUT AND MORTAR: STRUCTURAL STEELfWELDING:
Co�e Gualte Grout Mortar — Sample and Test (list specific members below)
Aggregate Tests — Shop Material Identification
Reinforcing Tests — Welding Inspection 0 Shop 0 Field
Mix Designs — Ultrasonic Inspection OShop 0 Field
Reinforcing Piacenwnt — High-sti-ength Bolting
Bitch Plant Inspection Inspection 0Shop D Field
Inspect Placing 0 A325
Cast Samples 0 A490 0 0 0 F
Pick-up Samples — Metil Dock Welding Inspection
Compression Tests — Reinforcing Steel Welding Inspection
— Metal Stud Welding Inspection
PRECAST/PRESTRESSED CONCRETE: — Concrete Insert Welding Inspection
FIREPROOFING:
— Placement Inspection
— Density Tests
—ThicknessTcsts
— Inspect 132tching
INSULATING CONCRETE:
— Sample and Test
— Placement Inspection
— Unit Weights
FILL MATERIAL:
— Acceptance Tests
MASONRY:
— Placement Inspection
— Special Inspection Stresses Used
— Field Density
— Preliminary Acceptance Tests (Masonry Units. Wall Prisms)
— Subsequent Tests (Mortar. Grout. Field Wall Prisms)
STRUCTURAL WOOD:
— Placement Inspection of Units
— Sheu Wall Nailing Inspection
— Inspection of Glu-Jam Fab.
— Inspection of Truss Joist Fab.
ADDITIONAL INSTRUCTIONS OR OTHER TESTS
— Sample and Test Components
AND INSPECTIONS:
Form completed by:
Telephone No.: —
JTnr=WAW.1r-3VJRX VAU MIMAUANWARIZ
1117�
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14005
02/24/2005 15:11 FAX .125 774 7837 PORT OF EDNIONDS
FAX NO) 425*04�(14
FE��18-2005 FRI 11!52 AM M
FIELD AND LABORAToRY CONCREETF_ TEST REPORT
M A.7.C31.C39,C7@,CI4�',CI72,C23i,cic,64,CI231 HWAGEOSMENCES INC
F7 AASHTOT73,T2Z-TI19-Tl4l.Tl52,"MOD TESTLS�#.9�1
CLIE T. port of Edmoq�t:�__ DATE CAST: 1/2112005
PROJECT: Rop!qccrnent. DATE REC'D'. 1/22/2005
0:��O_ 04-23
HWA PROJECT NC 13Y TH15 I
DESCRIP I ION OF tON ;—�t�t_�7CEMtNTREFRF-rENT5-0
EEPier DeCkS
%I PRE SIVE -TRENGTH TIES;FDATA
ING TEST CY1_ DIA ETER X-SECT. MAX. COMPR. FRAC, TECH.
CYLINDER AGE tq0TES DATE TYPE ARSA LOAD STRENGTH TYPE
I.D. (mmlddfyy) (d"xl" ()nchOS) (sq. In.) (lbs) sl EJ8
NUMBER (CSOYS 112alo5 6x12 6.00 28.27 93190 3300 GM I
005-1004-23-C-1 7 2118106 6x12 6.99 28-18 122230 4340 Gh4
005-004-23-C-1 28 2118105 6X12 .00 28-27 125680 4450
005-004-23-C-1 28
..................... .
4
FLEXURAL STRE GTH TEST DATA MAXI UPI NiODU
13EAM AGE TEST AVG, AVG. SPAN FRACTURE LW
T ')AT
T R
A
�AT:A
TP A N] I L�R UR
MAM M Ni()()ULUS OF TECH
IM
F
C 'TIO f- AIU) R�P,TURE
C U F I
DATE WOT DEPTH LOcATION sl
ill
I.D. I'- I I (inA a (tin.
NUMBER (dayr) (mmiddlyy) b (In.
i led Mlr�JZ
M.
sled in 3 rno*lst surface mndolon usin leather �hl; S. speci led Minimurn:
unless other -Ise ln(114-114 ��"'Plt)�' art 'a
--INFO.-FROM sul�_PLIER _nCKET
Time Batched: 6: 13 -
Max: Agg, size (iin). 318 1. P '
N cLiacler NW -nme:'7.'l - 0
supplier Name:. CementType'. 1-11 Arrival
um
;x1arrit �Number- Kenmorc Plan Start Unloading: 7:15
Load401UMB Nd); 6
0 of Mo, 3). 6 End Unloading: Unknown
Mix Code I Cum. volume (yd —
Truck Number: 7035_.,.
Ticket Number: 5661 . 76 Admixl&lra�: AEA Fiber Reinforcino
Time sampIsd:.7;.35....._
slum; (Inches): 4 Speciri9d -Slump (min -max)! Time CYI,s Cast: _D5-0—
Spec(fied Ent. Air (irnifli-MWO' ------------- HW
Entrained Air (%): 6.0 Cast 13y: AJPJP
Conc. Temp. (F)-. 66 Ambient Air Temperature (F): 50
Initial Curin TomP (min-m 53al OF Mold e, Plasric.
Density (Pcfl'.
?��js(;ELL&NEOUS INFORMATION I ComMENTS
Contr7j�or/ SubConimcior. -------
concrete Placement Method,. (Contral;tor Representative on S',tA-)
Field test lresulLs raparted to _Eny Johnson (Client/Owners Rep. on 5110)
Field test results reporled to --------
Additanal slump tests on the following truckloads: none
JHWA also visually assessed the following inickloads! none
none
Reviewed BY:
oducadIn full. with wdtion approv-al of HWA GEOSCICNICES INC-
Ttlis apart appliL-s onry to the Urn. Lnuted. and mry ba ropr
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02/24/2005 - 15:10.FAX 425 774 7837 PORT OF EDMONDS
FAX NO
003
42577412114 116. U L.
JpIN-2i-2005,FR1 10126 Atl H�R GEOSO'ENCES
10
'Field Report NO-: FR-001
J9730-64%h Avenue Wast, SulLQ 200
Date (mmiddlyy): V21/2005
KV LWnwoad. WA 98036
HWA Project No.- 21305,04�23
U -r*L 42.5-77"10B
HWA Task NO-:
HWAGEOSCIENCES INC. r---- 42s.774-2714
Loc3lion or drtSS Of P101eCt
Permil No.
Project Narne Pier Rer%1:3rmmPnt Edmonds, WA
Edmonds Flontino cl�grq epra3entauyc
Wenther
Cloyd 50* F
citem Rav Johnson
Port of Edmonds us an WrIanty Represen e
tirchitem c, recor
H A Project marwqL-,
Pat Pierce
Dearon AulhoritY (ungineer or
live
Ont Plprce
General CantTWOr
FIELD REPORT
SLj MMARY OF FIELD TINAE SPENT ON P ROJECT TODAY:
at site: 0655 Departed Site: 0805 EndTrUveI:0B`I5
0645 �krrlved
d ement.
pp -TED, Concr delivery an ploc
01-C, I'llw,'[' S I. _r
ITEM BEING CONSTRUCTED: Floating Pier Der-kri
TYPE OF INSPECTION* PariOcilc
The concrete was being placed by
t9ligating. Consolidation wav acco mplished.by
OF MATERIAL:
STATUS AND DETAILS OF PLACEMENT vl-.IL Concrete PlacOmOnt ended after our departure.
about 4 y63 w3E? placed dur(ng our tory Concrete -rest Report for Set Ci for a summary Of
'Field Labora
scmeding. A total of and
HVVA INSPECTION ACTI\A71ES RELATED TO THIS ITEM: See HWNs
with approved plans.
Inspine,6om and test dsta. ted was found In conformance
CONFORMANCE OF THtS rrEM-. To the best of tha;nspectoes knowledge, the Item inspec
L''U''i"j,''I E0"US'j1`1.0 1141111 C)BSERVAT NS ANWOR ��OIVIMGNTS:
7—
SIGNATURES,,
RevIew
4 C
Signed: HWA Prqa gInw or
Reviewcr
HWA Field Ropresentab
SU ARY OF UNRESOLVED ISSLIE�
ReportO IIOM# St3tus
na There are no outstanding insues at this trne.
nz
Thl, In Ks ontircty. Report is not final until aIgnod by I.AVA field roPMrerTW6V6 amd HWA leviewer. Page 1 of 1
. repon should only be raProduccd
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM- FIRE DEPARTMENT DATE
P 4'9S E S; G N
ENGINEERfNG DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
111.1EASESIGN
PROJECT
SITE ADDRESS- 3
PERMIT #-2Aw 9 - 46,S -7 ADB# DATE INSPECTED 2 s-
DES CRTTfON 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:
X,- 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
D Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:r6rms: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:
GasTest ....................
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
OCCUPANCY ..................
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