20050073.pdfI DATE RECEIVED
PERMIT EXPIRES r
SE PERMIT
CITY OF EDMONDS ZONE i NUMBER C" %L� rf e0 75
CONSTRUCTION PERMIT APPLICATION. �O° SUITE/APT"
ADDRESS r C
OWNER NAME/NAME OF BUSINESS
�'
NeXT. / ' ` ✓! �-�,, PLAT NAME/SUBDIVISION NO. LOT NO. I CID NO.
is MAILING ADDRESS LID FEE $
W
ta6O
, TESCP. Approved
a ^q �� I /I
IV ` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required p
O l Cl WJ Street Use Permit Req'd O
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Required p
_ Sidewalk Required Q
�+ (1 � •jqt\j0 WA� $ REQUIRED DEDICATION FT Wiring
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
'C /�L.�O .% C!\Ci�%rvLrcJ G YES❑ NO ❑ Q
W
ADDR SS REMARKS 2
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
LYNN �7b _� • qs�5�!
NAM CBL M
A r^ GL 6 ENGINEERING REVIEWED BY DATE
ADDRESS
FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
L, VARIANCE OR CU SHO ELINE 0 ADB INSPECTION BOND
STATE LICENSE NUMBER "x:✓ EXPIRATION DATE ECKED Y RE POSTED
1 10YES O $ "��
SEPA REVIEW SIGN AFIEA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALQLOWED PROPOSED Q EXP � f D / �J '
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR _
❑ ADDITION COMMERCIAL ❑ CHANGE OF USE z
PARKING LOT AREA PNTNG RE DATE a
13 REMODEL El MULTIFAMILY ❑ SIGN REQ'D PROVIDED n//�
GRADING FENCE `
1:1 REPAIR [3 CYDS ( X FT) REMARKSL► N �, r 1klf t�1krC
nL
1:1 DEMOLISH 1:1 TANKRAGE I
T CCI I L
i,
1:1 CARPORT RPORT ❑ ROCKERY VA TW
RETAININGWALL El ALARM SPRINKLER (,p
E OF USE, BUSINESS OR ACTIVITY) EXP IN'
L,A
rc /-e j 0x ped. dr�,� C�� 41jol? /,, 7' CHECKED BY TYPE a CONSTRUCTION CODE GROUP C• / l jE ,I„Y� / L�L• EQLLt� . 103 GROUP
ONUMBER NUMBER OF (TICAL
OF�/4 DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT/
p STORIES I • UNITS NUMBER REQUIRED ❑ YES LOAD / yp
DESCRIBE WORK TO BE DONE REMARKS
/ PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109FINAL INSPECIION REO'D 9
%v1 v G'Ari 01) en 3 a�t/1/tb95/S VALUATION
Description FEE Description FEE
Plan Check State Surcharge �d
HEAT SOUR GLAZING LOT SLOPE —
�/IVt/ �/r7' Building Permit � City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
M Mechanical /� .f
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Gradin
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
SEPARATE PERMISSION.
It Engr. Review
W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
/ SEE BACK OF PINK PERMIT FOR MORE INFORMATION
De Chk
Plan i
Revew an .
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire posit 05i
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY A-
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landsca a Ins Total Amt. Due �ci
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE p p'
= NOR LIMIT IN ANY WAY THE CI1Y8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALLThis application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees 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,
C OFFICIALS SIGNATURE DATE
SIGN A AGE DATE SIGNED (425) r 12L� vrdz �ov L
Mj77 1 0220 SE / C✓DATE
ATTENTION EXT 1 333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALORA CERTIFICATE OF OCCU• ORIGINAL - FILE YELLOW - INS CTOR
PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110, PINK - OWNER GOLD - ASSESSOR
09/09 PRESS HARD -YOU ARE MAKING 4 COPIES
FA
02-17-'05 15620 FROM. T-755 PO4/04 U-827
FIELD REPORT N0: 48094
04',iZa1 8, Assoclat0s, 'InC. ;
GZOTECNNICAL ENdNHFUN6 •. EWIAONMINTAL ENGINUNNG
CONSTRUCTION TESYugt3 AND INSPECT10N
DATE: / "� Z �S CONTRACTOR:.
PROJECT :gQ t -- Q Z JURISDICTION: 1M2* d;Lca0!s_
PROJECT: ` PERMIT #: C3u 7
or
LOCATION: INSPECTOR:
KRAZAN PROJECT MANA(3ER: -, rc WEATHER:_ Q�,�� TEMP:
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To the best of my knowledge. the 0b0v W /WAS NOT peftmed in accordance with the approved plods, specificatlom and regulotory requirements,
sWgdnW4gnt/RMNsenlaMe: Tec Ions 6
215 Woo Dakob As., Cbvis, CA 93612 (559) 318.2700 4221 WA S►., OnAvio. CA 91761. • (909) 974•"00
2205 Coy Avmo Boit"ie)d. CA 93307 • (661) 837.9200 1501.19' St. NW Suits 106, Aubum, WA 98002 • (253) 939-2500.
1025 Lone Pokn Am. 02E Modesb, CA 95331 (209) 572.2200 20714 Sbiv h%vy 305 W Suite 3C, Poulsbo, WA 98370 (360) 598.2126
5l5 Parvo Sr., Son low, C4 95112 • 1408) 271 -2200 19$01.144'` Aw. NE #17.300, Woodinville, WA 98072 • (425) 485.3319 i
5808 Pricv Am. Bldg. 1016, McC)elkm, C495652 • (916) 564.2200 Rav iwe a
69wir Dau: MGM
Thr tnronntan pnviaW an Nw tt port if PrNaroe fa the •ahnive ttDe of the diem. T%4 report may m be rcor wocod in any format withwt ft "un oenririon of tha taws ad Xrtan k Assee ae�.
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Laboratory Data Design Strength ,41000 0 28 daysData Speolmens Recd. 1/31/05
Cyl. Test Field Meoc. Comp. Tested Break
Coda Dab Cum Ape Dim. Aryl C.F. Load Str. (psi) Sato By Type
18293-1 2/3/05 7 3.989 12.50 1.0 42730 3,420 1 CM 3
18293-2 2124/05 28 1
1$293-3 2/24/05 2$ 1
18293.4 H 1 .
18293.5
18293-B
1$293.7
19293.8
Remarks
Results Revlewed By Dab Reviewed
pft l� Mr Anal Tuw�. •. ^--- - - -
Laboratory
Test Methods
ASTM C39
ASTM C109
ASTM C817
ASTM 01231
ASTM C780
Other
Test Results
Conforming
Non-Conformin
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0
0
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Laboratory Data Design Strength ,41000 0 28 daysData Speolmens Recd. 1/31/05
Cyl. Test Field Meoc. Comp. Tested Break
Coda Dab Cum Ape Dim. Aryl C.F. Load Str. (psi) Sato By Type
18293-1 2/3/05 7 3.989 12.50 1.0 42730 3,420 1 CM 3
18293-2 2124/05 28 1
1$293-3 2/24/05 2$ 1
18293.4 H 1 .
18293.5
18293-B
1$293.7
19293.8
Remarks
Results Revlewed By Dab Reviewed
pft l� Mr Anal Tuw�. •. ^--- - - -
Laboratory
Test Methods
ASTM C39
ASTM C109
ASTM C817
ASTM 01231
ASTM C780
Other
Test Results
Conforming
Non-Conformin
O
Wn
rnm
0
m
ii ai�/ifWf ■" PMI 1 III/�CI � �%!
r m0
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j
Laboratory Data Design Strength ,41000 0 28 daysData Speolmens Recd. 1/31/05
Cyl. Test Field Meoc. Comp. Tested Break
Coda Dab Cum Ape Dim. Aryl C.F. Load Str. (psi) Sato By Type
18293-1 2/3/05 7 3.989 12.50 1.0 42730 3,420 1 CM 3
18293-2 2124/05 28 1
1$293-3 2/24/05 2$ 1
18293.4 H 1 .
18293.5
18293-B
1$293.7
19293.8
Remarks
Results Revlewed By Dab Reviewed
pft l� Mr Anal Tuw�. •. ^--- - - -
Laboratory
Test Methods
ASTM C39
ASTM C109
ASTM C817
ASTM 01231
ASTM C780
Other
Test Results
Conforming
Non-Conformin
Everett Office
MAYES TESTING ENGINEERS, INC
917 - 134th Street SW
Suite A-1
,., r ,•t- , �, Everett, WA 98204
p6 425.742.9360
fax 425.745.1737
LABORATOWi TEST REPORT
Project : Campbell Nelson Nissan Signs Project No: E5071
Site Address: 24329 Highway 99 Issued on: 4-22-05
Edmonds,WA
Permit # (s): 2005-0192
Client: Berry Neon Sign Company original
El
Engineer: West Coast S.E. Revised:
Contractor: Berry Neon Sign Company- ZO i
FIELD DATA
(ASTM C31 and C172) n
Air Temperature: 55 ° F - m
P Design Mix Proportions:
Weather: Cloudy mn t
Product: Concrete
vm
Supplier: Cadman e
My
Ticket Number: 5536224
O n
MixDesign ID : 501020
Sample Temp. Initial Storage Entrained Air rn
(ASTM C1 m64
p Temp. (ASTM C31) (ASTM C231) m Z
10 t ,
650F INR % C Z
Slump (ASTM C14 ' iSample(s) Recd CA k
J 3 @ g days O .
i 4�� 3-25-05 Required Strength (Pc):J 000 PSI 2
Placement Location and N j
m m
Sign footing. Batch weights not available. vCa
O
COMPRESSION TEST RESULTS Fn
(ASTM C39, C1231, and C617 when applicable)C C0
Dale Made Sample # Lab # Date Tested Age (day) Load (Ibs) Size (in)
Dia (in) Surface Area Strength (psq Failure Code
7 85170 6 x 12 600 28.27 3010 NA r
_ 3/24/2005 0002 5467 3/31/2005 ��� _
3/24/20050002 5468 4/21/2005 28 122990 6 x 12 6.00 28.27 _] 4350 NA
3/24/2005 0002 5469 4/21 /2005 28 127990 6 x 12 6.00 _28.27 L4530J NA ? D
Remark: `
Z }
Inspector(s): Lisa Pyper
Tested by: Scott J Johnson d Reviewed by:
Z
Timothy G. a erle, P.E. O
Branch Manager --I
'm
NOTES: Failure descriptions for samples tested with neoprene pads are not required per ASTM Std.
NA Not Applicable, S = Shear, C =Cone, CSp =Cone and Split, CSh = Cone and Shear, Col = Column FC -Field Cure NR = Not Recorded
F ACEI �/ E'sQI id
APR 2 9 2005
BUILDING DEPARTMENT I>
CITY OF EDMONDS
Information in this report applies only to tho actual samples tested and shall not be reproduced without the approval of Mayes Testing Engineers, Inc.
MTE Fo+m #150• Rey 3, 7.0