20050424 PERMIT AND INSP.pdfTE RECEIVED 1;7�
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CONSTRUCTION PERMIT APPLICATION JOB SUIT PTO
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STATE LICENSE NUMBER 7' EXPIRATIOV DATE OUY RECID TED I EXEMPT
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
4 IA- Building Per . mit City Surcharge V
PLAN CHECK NO- Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORkNOTED. THIS PERMIT COVERS WORK TO Mechanical 71) -L—
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. �ngr. Revi
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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116 PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
Or 'APPLICANT, ON BEHALF OF . HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_1 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 0
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4 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
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 . NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Be Receipt # e
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisihor Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
f WORKMEN'S COMPENSATION INSURANCE AND RCW 13:27. OFFICIALS SIGNATURE DATE
SIGNATU HE DATE SIGNED (425)
771-0220 RELEASEDBY E
AYTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 15
VIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGI A -FILE YELLOW I I IN - SPE(ITOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 III IRC110. PIN -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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JDATE'. 00-29-04
IDRAWN BY: jm.
PECKED BY: RUH
RMSIONS
SrTE
WA-875-03
CHASE LAKE
22510 76TH AVENUE W.
EDMONDS. WA 98020
SHEET PRE
PARCEL PLAN
SHEL7 NUMBER
Al-1
an& Associates, Inc. 19501 144th. Avenue NE W-300, Woodinville, WA 08072, (425) 485-5519
_�_raz
Project No. 096-05173 Cyl. Code 19458 Pour Date 6/16/05 Report No. 01
Weather Sunny Jurisdiction City of Edmonds Permit No. 2005-0424
BUILDING
Project Chase Lake Cell Tower Engineer
Location 22510 76th Ave W Architect J U L 2
client Wren Construction Contractor
inspector Douglas Kos.tal
Laboratory Data Design Strength 4,000 @ 28 days Date Specimens Reed.. 6/17/05
Cyl. Test Field Max. Comp. Tested Break Laboratory
Code Date Cure Age Dim. Area C.F. Load Sir. (psl) Sot# -By Type Test Methods
19458-1 6/23/05 7 3.99G 12.50 1.0 63520 5,080 1 Cm 2 ASTM C39
19458-2 7/14/05 28 3.991 12.51 1.0 79580 6,360 1 Cm 2 ASTM C109
19458-3 7/14/05 28 3.991 12.51 1.0 81460 6,510 1 Cm 2 ASTM C617
ASTM C1231
19458-4 H
ASTM C780
Other
19458-6
19458-7
19458-8 Test Results
Remarks X Conforming
Results Reviewed By Date Reviewed os Non -Conforming
Codes for B k Types: 2: Cone & Split 3: Cone 8, Shear 4: Shear 5: Columnar (Split)
reak Types: 1: Cone
Measurement Uncertainties: ASTM C-39 8%
Forin 03101
Revi5lon 2
Effectlye Data 12102102 a an Associates.
The Infonnation provided on this report is prepared for the excJusive use of the diOnt. This MOM may not be reprod I uced in any format without the wrttten peffnission of t.h dent anci Kraz
ociates, Inc.
19501 .144th Avenue NE
#F-300, Woodinville 9 WA 980720
Nor 096 -05173 CYI. Code
19458 Pour Date
6/16 Report No.' 06M
6 Sunny Jurisdiction City of Edmonds
r
Permit No.'2005-0424
r ect Chase Lake Cell Tower
Engineer
22510 76th Ave W
Architect
ai n
c t 0
st uction
client Wren Con r
Contractor
"Rl' "'i.'
Id Data
CYLINDER REPORT
oncrete
Other
I I I ler.
u
Rinker PlantNo. 1800
Site Mix
!p
Mix
Air Unit
Slump
Temp.
Temp. Wt.
_T1 me
Truck# Ticket # % Air (in.)
(F)
(F) (pcq
3.
5648 21775550 9.9 5.
75
66
-1045
Water lbs. I U41
Placement Area Air Ent. (oz) 35 .35
Location Communication pole foundation. HRWRA (oz) 523 528
WRA (oz) 232 234
Other(oz)
Other(oz)
Water Added on Job (gals.) 0
..--inspector Douglas Kostal
Laboratory Data Design Strength 4,000 @28 days Date Specimens Rec'd- 6/17/0.5
Cyl. Test Field Max. cornp. Tested Break Laboratory
Cure Age
Code Date Dim. Area C.F. Load Str. (psi) Set# By Type Test Methods
19458-1 6/23/05 7 3.990 12.50
1.0 63520 5,080 1 Cm 2 ASTM C39
19458-2 7/14/05 28 ASTM C109
19458-3 7/14/05 28 ASTM C617
19458-4 H ASTM C1231
19458-5� ASTM C780
19458-6 Other
19458-7
19458-8 Test Results
(7 JL
Remarks
Conforming
Results Reviewed By Non -Conforming
Date Reviewed
Codes for Break Types: 1: Cone 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 8%
Form o3lot
Revision 2
Effective Date 12107J02
V The Information Provided on this report 13 Prepared for the exclusive use of the client. This report may riot be reproduced in any (a twit the
ima hout written permission of the client and Krazan & Associates.
�kQKrazan &A s s o c i a t e s�-,:A-nt. FIELD REPORT NO: 50849
GEOTECHNICAL ENGINEERING - ENVIRONMENTA� ENGINEERING
CcNSTRUCTION TESTING AND INSPtCTION
DATE: CONTRACTOR: 6-ve-�j ro'�-rrxvo�
P IROJ ECT m.--ew 6-5 ?J' JURISDICTION: 0, f
PROJECT. C&&C-:-' aeF�Q;-L 'ROLe PERMIT #: F�,
INSPECTOR:
LOCATION: ZZ-5-le- -7ela' 11441165� /J-
KRAZAN PROJECT MANAGER: r, WEATHER:-- TEMPL
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To the best of my knowledge, the abov(.W:AS)/ WAS NOT performed in accordance with the approved plans, specifications, and regulatorygmi"M
Superintendent/Representative: Technician: JUN 2 9 2C
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�"4�ea azoev
215 West Dakota Ave., Clovis, CA 93612 (559) 348-2200 4221 BrickellSt.,&.ri., CA 9)761' (909j- 974-4400
2205 Coy Ave., Bakersfield, CA 93307 (661) 837-9200 1501-15- St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
1025 tone PaInn Ave. #2E, Modesto, CA 95351 (209) 572-2200 20714 Stato Hwy 305 NE Suite X Poulsbo, WA 98370 9 (360) 598-2126
545 Parrott St., Son Jose, CA 95112 (408) 271-2200 19501-14,C Ave. NE 0-300, W6",-,ville, WA 98072 a (425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652 .(916) 564-2200 Remion 0
FlYcom Date 81 1610.
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FIELDREPORT NO: 56089
'%MKrazan & Associates, Inc..
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: z e�) :5 CONTRACTOR: A�e
PROJECT #: (2?4� n '-5 z ;z -3 JURISDICTION:
PROJECT' Cg& 7Ck4l,44 PERMIT#:-
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To the best of my knowledge, the/bOVIE )/AS NOT performed in accordance with the approved plans, specifications, and regulatory requirements.
Superintendent/Representative: Technician:
#...AA All -- -
(909) 974-4400
St.. Ontri,
215 West Dakota Ave Clovis CA 612 1559)348-2200 �;BrickefiSt. C1nt.;Z&W76.I
2205 Coy Aye., Bakersfield, CA 93307 (661) 837-9200 1501 - 15' St. NW Suite 106, Auburn, WA 98002 0 .(253) 939-2500
1025 Lone Palm Aye. #2E, modesto, CA 95351 (209) 572-2200 20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 0 .(360) 598-2126
545 Pon -on St., Son Jose, CA 95112 (408) 271-2200 19501-144' Ave. NE 0-300, woodinwile, wA 98072 0 (�25) 485-5519
5808 Price Aye. Bldg. 10 16, McClellan, CA 95652 (916) 564-2200 Revision 0
Effective Date: 9/16/02
The infainuition provided on this report is prepared for the exclusive use of the client. This report may not be reproduced in any Forniat without the written perotission ofthc client and Krazan & Associates
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
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Date Signature
1: tenip:bldg: forms: ocaprvl 3/25/04
HNAL PROJECT APPROVAL FORM
TO:
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MEMO TO: PERMIT COORDINA,roR,.BUILDii4G*D[VISION
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Date Signature
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT. COORDINATOR,, BUILDING DIVISION
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ocaprvl.doc.l:temp:bldg:fonnsio/oI
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ....................
FOUNDATION:
Footing .......................
Wall ..........................
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