20050005.pdfDATE RECEIVED
PERMIT EXPIRES ,'
CITY OF EDMONDS
USE
ZONE PERMIT �y r
NUMBER 7L��
CONSTRUCTION PERMIT APPLICATION
JOB i SUITE/APTN
OWNER NAME/NAME OF BUSINESS ADDRESS
GI,q.II�Gc% � )Lb "� PLAT NAME//SUBDIVISION NO. LOT 140. LID NO.
MAILING ADDRESSLID FEE E
TESCP Approved
�� L•� ,/ PUBLIC RIGHT OF WAY PER OF
STREET MAP
RW Permit Required 0
CITY I ZIP r Street Use Permit Roq'd�
TF EP ONE EXISTING PROPOSED Inspection Required
n e Sidewalk He
de L 6 ti REQUIRED DEDICATION FT Underground
Wiring required Q
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
��t /� �', •� YES ❑ NO ❑
= ADDRESS I au
REMARKS z
�� r OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
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CITY ZIP I TELEPHONE
NAME
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— ENGINEERING REVIEWED BY DATE
C ADDR SS •�.+
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FIRE REVIEWED BY DATE
C CITY ZIP. TELEPHONE . Q
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STATE LICENSE NUMBER EXPIR TIO DATEBY VARIANCE OR CU SHORELINE OR ADE INSPECTION BOND
ED
REO'D POSTED
❑
YES $ _
PROPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
1--
EXP
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECHLOT COVERAGE REQUIRED. SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
1:1ADDITION 3a COMMERCIAL ❑ COMPLIANCE OR. Z
CHANGE OF USE _
PARKING LOT AREA PLANNING REVIEWED BY DATE S
E3 REMODEL ❑ MULTIFAMILY ❑ SIGN REO'D PROVIDED a
❑ REPAIR ❑ GRADING ❑ CYDS FENCE
( X FT) REMARKS
DEMOLISH TANK�n��/��(I� OTHER
C ❑GARAGE ETAINItJG WALL / ElFIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
R CHECKED BY TYPE I�P]¢�N�RbaH(jN C OCCUPANT
U ��[T�7 ►�JJIy`� GROUP
I w NU BER NU ER OF C ITICAL
m OF YY DWELLING AREAS ��%1. SPECIAL INSPECTION AREA OCCUPANT
O STORIES 1 UNITS 10 NUMBER ff'�// REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109FINAL INSPECTION REO'D 9
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^ 1 VALUATION
$.
Description FEEDescription FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit 1 City Surcharge
PIAN CHECK NO: D 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 7 Gradin DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g
SEPARATE PERMISSION,
Engr. Review
WPERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Q EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
i FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE �ndsca e InS
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE P P• Total Amt. Due
= NOfl LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
� Recording -Fee Receipt #
1 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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THF. WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
(425) OFFICIALS SIGNATURE DAT
N R GENT) DATE GNgED `7y/��
M • / 1 ��22o RELEASED B 4D*AE
ATTENTION `r Y06r, � VG 'y LA 1 r-/ ) ) r�2+ EXT 1333 �-
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRU TURE ONTILAFINAL 1 )
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109 / IBC110/ IRC110. ORI N L • F YELLOW - INSACTOR
PINK 0 N GOLD -ASSESSOR
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SOUND TESTING, INC ;
P.O. BOX 16204 SEATTLE, WA 981164 CHEMIST CERTIFICATE
(206) 932-0206 FAX (206) 937-3848 SERIAL NO 44666
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Survey Requested by Vessel Owner or Agent Date
Uoi eiy "76 StA-7riaYr Z_7G l Ate ; 9c.�,i,cza_„O Lc1/�.ri
vessel Type of Vessel l' _ Sped c Location of Vessel -
lri,C ,�J► L1 ijok/ .3 G�' S�L/LC. �!� ��C- H )' (j i L
Last Thr a (3) Loadings OF Tests Pe meed If Time Survey Completed
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doubt,in the event of any physical or atmospheric changes adversely affecting the gas -free condition of the
above Spaces, or if in any Z
QUALIFICATIONS: Transfer of ballast or manipulation of valves or closure equipment tending to alter condillons in pipe lines, tanks or compartments
subject to gas accumulation, unless specifically approved in this Certificate, requires Inspection and endorsement or reissue of Certificate for the spaces so m
affected. All lines, vents, heating coils, valves, and similarly enclosed appurtenances shall be considered "not safe" unless otherwise specifically designated.
STANDARD SAFETY DESIGNATIONS
SAFE FOR WORKERS Means that in the compartment or space so designated (a) the oxygen content of the atmosphere is at least 19.5 percent by volume, and that, (b) toxic
materials in the atmosphere are within permissible concentrations, and that, (c) the residues are not capable of producing toxic materials under existing atmospheric conditions while
maintained as directed on the Marine Chemist's Certificate
Ng.T,5AEEfQBAyQBKEBJ Means that in the compartment or space so designated, the requirements of Safe'for Workers has rat been met.
SAFE FOR HOTWORK: Means that in the compartment so designated: (a) oxygen content of the atmosphere is at least 19.5 percent by volume, with the exception of Inerted
spaces or where external lot work is to be performed; and that, (b) the concentration of flammable materials in the atmosphere is below 10 percent of the lower flammable limit; and that,
(c) the residues are rat capable of producing a higher concentration than permitted by (b) above under existing atmospheric conditions in the presence of fire, and while maintained as
directed on the Marine Chemist's Certificate; and further, that, (d) all adjacent spaces have been cleaned sufficiently to prevent the spread of fire, or are satisfactorily inerted, or, in the
case of fuel tanks, or lube oil tanks, or engine room or fire room bilges, have been treated in accordance with the Marine Chemist's requirements.
f:
NOT SAFE FOR HOT WORK Means that in the compartment so designated, the requirements of Safe for Hot Work have not been met
CHEMIST'S ENDORSEMENT This is to certify that I have personally determined that all spaces in the foregoing list are in accordance with NFPA 306 Control of Gas Hazards on
Vessels and have found the condition of each to be in accordance with its assigned designation. i
•The undersigned acknowledges receipt of this Certificate under Section 2.6 of NFPA 306 and This Certificate is based on conditions existing at the time the Inspection herein set forth was completed
understands conditions and limitations under which it was issued' and is issued subject to compliance with all qualifications and instructions.
'I f � /to 1P
(���.�— J GF 1iri�1 �'w�'L �� Ct� Signed
Signed_ �� Company ate anne hemrst Ani to No.
Name p y
VFStRFI Pt-1STINt;
ERTIFIED 2103 EALST 112TH STREET
LEANING TACOMA, WA 98445111,3729
ERVICES (253) 536-6500
INCORPORATED FAX (253) 536-5900
6366
SHIPPER e Itt
kL ADDRESS G' �-� PHONE
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U.S. D.O.T. DESCRIPTION Wt. Vol. '
Including Proper shipping Name, Hazard Class £t I.D. Number No. Type ;
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PHYSICAL STATE (CIRCLE): SOLI LIQUI SLUDGE OTHER
THIS :MATERIAL IS NOT REGULATED UNDER WAC 173-303 OR 40 CFR PARTS 261 AND 761.
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SPECIAL INSTRUCTIONS AND ADDITIONAL INFORMATION v
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IN THE EVENT OF A SPILL, CONTACT EITHER THE DEPARTMENT OF ECOLOGY 1-800-258-5990 AND/OR _
THE NATIONAL RESPONSE CENTER, U.S. COAST GUARD 80024-8802 FOR EMERGENCY ASSISTANCE. I Z
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This is to certify that the above named materials are properly classified, described, packaged, marked, i
labeled and are' in proper , ondition for transportation accordingto the applicable regulation of the U.S: N
Department of Transportat
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SHIPPER SIGNATUREC- m
TRANSPORTER: Certified Cleaning Services, Inc:
PHONE: (253) 536-5500
ADDRESS: 2103 E 112th St., Tacoma, WA 98445-3729
SIGNATURE ='��
PHONE - A 7 j
DESTINATION
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ADDRESS 7 � n by ez
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SIGNATURE
TIME INTO SITE: TIME OUT OF SITE
Distribution: Return to Shipper: White copy, Transporfer,Pink copy, Consignee: Canary copy, Shipper: Goldenrod copy
L,kewood Priming 6041802 ` --
02/116/2005 WED 19:07. FAX 12539226828 Joe Hall Const 008/023
Sever-Rcdmoad Pwjcct: Phillips 66 41096 Edmonds
PO Box 230, 12034 -134th CtNE Ste 102 Pwiect Number. 0IC?.11096,NL Partial Rtpurt
_ Redmond, WAlUSA 98073 Projcet Marngcr: Marc Same . Issued: Ai/14/05 16:23
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Semivolatile Petroleum Products by NWTpH.Ds (w/o Add/Silica Gel Clean-up)
North Creek Analytical - Bothell
Rcpor�i , .
Analyse RaulLimit Unih piletioo Batch Prepued haalyied MetSod Not 2
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5P 1 11SA02113.04 Soil Sam Itd: 01/13/05 08:50 ReSSIVEI: 01/1 VOS 12:00
Diesel Range Hydrocarbons 124 10.0 mvkr dry
i . SAf3048 01/13/05 Of/L3lOS NWTPH•Dx D-09 INTI
Lube Oil Range Hydrocarbons 429 SO.0 " 2 ^ D1/14/05
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Slfrr»gf>rc• IMP891 % J0 -ISO " . 01/11105 . —1 'f1
5zr►rogatcr t�c/ocosalc 95,4% M50
5X.1 SA0283•#Suit Sar• Ind: 01/13105 10:45 Received: 01/13/K 12:00 rn 13 "
Dk sd Range *dmxrboas 3Z.3 10.0 my7cg dry
0 D
! SAI3048 01/13/05 1/13105 NWTPIi x D-09
Hydrocarbons
All 23.0 O C
Lube Oil Rao&e Y
.S5f1/+O." 2•PaP 88,2% JO IJO
104 SS JO IJO " • " Z
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'IBX 2 SSA0283.061 Soil Saar led: 01/1310510:45 Rcaclved101/13/0512:00 D
Diesel Range Ilydwarbtme ND 10.0 mWI(adry 1 SA 13048 01/13/05 Ol/14/OS NVi�[PiI•Da ,,.
R 1p
Lube Oil Range Hydrocairboas _..N_ 25.0
Sir►rOgare: MBP$7.! •/. JO 1J0 "
107!0 SWISO "
$rfAt�Olr: (J6frKOSOlC '
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FX 3 A0283.0 Soil Sam ed: 01/13103 llls4S Rectived: 01/13/05 IZ:00
ND 10.0 m dry l SA13048 01/13/03 OI/lA'OS NW ITH-Dz fIl m
Diml usage Hydwcaftm 8�8 p �
NO 25.0 ^ "
Luba Oil Range Hydnxuhoas _ • . _.
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Sftrrogirle: 2 -FS!'. 76.3% J41J0 C In
lt: QlcloOoxmx97.190 SS/! ►SU " . r " r N u►rogr r m n
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EX 4 A02d3-Ooil Sampled: 01/13/05 10#45 Received: 01/1310512:00 ' r'
DicalRange Hydmcvbum NO 10.0 mglkgdry i 5A130U 01/13/03 011latos NWl•PH-tJa
Lube Oil Range Hydrowuboos NO 2560
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5urrogau: ZnP =
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NOl'111 Ciroe1C Atlalylietll- BothCll The rrSultr to rhir nrporl apply to the. sarr+plds analyterl in accordnnoc with tlw chain of
csorody doeu�nenr. ThA o»dvlkal r�lroq Maul lw nyrodiu a<7in ifs entirety.
_ - Page 5 of ZO � .
Sjudm Yakanuvich, Project Manager
02/16/2405 QED 14010 FAX 12539226828 Joe Hall Const [015/023
IF
Sewr4tedmood Pruject: Phillips 66111096 Gdmonds
PO Bax 230,12034 -134th Ct NE Ste 102 Project Number: 01 CR 11096,NL Partlsil Report
Redmond, WA,USA 98073 Project Mwwvcr. Marc Saozc Issued: UI/14105 ]6:23
IF 4F
Gasoline Hydrocarbons (Benzene to Naphthalene) and BTEX by NWTPH-G and EPA 8021B - Quality F
Control
Horth Crock Analytical - Bothell
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RCPoRU►g Spike Soume %REC RIND
Fwrtc Rcsu;t Limit Units Level Result •/,REC Limits RPD Limit Notcs M
Balt SA.13060• Prcpared 01/13MS Usbg E. A 50, 308 (MeOU)
Moak (SA130WOLK1) !n "1
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NO 0.0300 C Q
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NO 0.0500 0 C k
7rylwr� (u!ta1) ND 0.100
A _ _ _ ,.___ 4.32 • 4.00 108 50.150 it Z i
Swrropk.: 4•BFB (FID)
I-8FB (PID) 3.04 " . 4.00 .. .. 126 53-142
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• LGS (3A 17060'BS� 1:111. ..,. r = !' .
Gatoliaeltallgelbdcocasbws 74A 5100 mg/kg 27.5 90.2 75-125
>&azde 0,291 0,0300 0.340 85.6 75-125 N
LGO 010100 1192 113.3 75,125 D T
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Elhylbsarwne 0,423 0.0300 0.460 92.4 7S-l2S
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Sun+ogpa: 4-i1PA (FID) 1:00' 44:3 Srl rsU Ov (/}
4 tilrr!(r70) 3.2d " 4.ou d2.o $3•x42 - 0 Rrl
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0.320 0.0300. 0.340 94.1 75 125 .9.49 23 Z r
Tolotae 1.77 0,0500 L9x 92,2 75.123 - 10.1 2.S �.
i P,tlryfbc�cnc 0,471 0.0900 " 0.440 100 75.125 10.3 25 �,
Xyltrw (gin 2J! 4 0.100 21x'. 105 7S -12S. 10.3 xs
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is SwnbYoia: I -BFB (FID) 4.3K 4.00 110 34130 j
Stinro�poic.l•UFd (P!D) i, 73 " 4.00 y3 7 37 142
Mstria Spike (SA130f0-MSI) Sourcr. BSA0263-03 Co
GawlineRmwHAOCK6002 29.6 5x00 ssy1Udly 229 O.SIt2 97.1 47A25 ZO
$esrr •e 0.374 0.0300 0370 ND 90 , 45-125 �
Totucnc 1696 0'Mw • 2:08 0,00827 89.0 S5•l2S (j
yl 0.497 09500. • 0.501 NU 99.2 53.132. tTi
XYWOU (�1) 2.47 0.100 "
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2,40 0 0128 102 59.125
Swogak+: 4•BFB (FID) 3.76 4.35. 8G4 30,150
North Creek AL:+l 11=1- Bothell Tnr nwlre JM Ihrs rrpa! aq�1y w d� twVigt anahcad ie accordowe whit the. chain of
cu�roQy docxmc!ni, Tbir wnalyfieaf rrpwf ix i by nprodws rd in It? enlln!!y.
1dR^'wu Pa 12 of 20
Sandra Yakamavich, Project Manager
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