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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNERJ��E7USIN SS
'I C,
MAILING ADDRES
CITY ZIP E�
TELEPHION
NAME
Cr)V;t4C-t" � -, Rod 51 CC5 tc, LIZ 1
PERMIT EXPIRES
PERMIT
-NUMBER pj�Z_%7
JOB
ADDRESS
SUITE17
PI -AT NAME/SUBDIVISION NO, Lof 6.' LID NO,
1ID FEE S
PU11I 1111TOI—PER0111CIALSTIEITRA, T111'111111
a. IS— a-1.
EXISTING PROPOSED
REQUIRED DEDICATION ___ FT
METER S;TE� I NO, 01 IIXTURES EPRV REQUIRED
3 s 13 No 0
REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTSOUDRAINAGE
13 151160, 1
x ADDRESS A CYCLE REVIEWED By DATE
.51400 Ave STE
gCITY ZIP I TELEPHONE PUBLIC WORKS REVIEWED BY ATE
147-5 Lit 18 5-�57
§ I Z-703
2 5 00 250 92,00
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NEW
RESIDENTIAL
PLUMBING / NECK
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COMMERCIAL
COMPLIANCE OR
0 STUDY
ADDITION
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MIXED USE
1:1 CHANGE OF USE
COVERAGE
I RE
SETBACK' I T
OPOSED SETBACKS JET,)
0 "MODEL
0
MULTIFAMILY
SIGN
AULDLOWTED PROPOSED
EDUINTED
no SIDE FEAR
REPAIR
GRADING CYDS
FENCG X FT,
PARKING
LOTAREA
PLANNING REI�IINFO
By DAT
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TANK
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6bxiyCV_ AA,
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CARPORT
RETAINING WALL
IT OCKERY
FIRE SPRINKLER
LJ FIRGAI-ARM
REMARKS
(TYPE OF USE, BUSINESS
r
OR ACTIVI I.FFLAIN:
TYPE OF CONSTRUCTION CODE 0 CUPANT
Ye2 2t->D GROUP 52-
SPECIAL INSPECTION I CONSULTANT OCCUPANT
LOAD
REQUIRED 13 yes
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hew dfsve>,5e,1ArC:--xj5,7) PIV, ft
Description
'an reck
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Plan Check
FEn
FEE
Description
State Surcharge
FEE
HEATSOU13CE
1
—1
PLAN CHECK NO:
lu'k, g
City Surcharge
lumbing
P ,l.mbmg
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Mechanical
2 DOMAIN JCURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMIISION*
Grading
PERMIT APPLICAT Grit SEE ECDC I9.00XQS(Al(S)
EngE Review
Recording Fee
T PERMIT LIMIT'. SEE ECDC 19,00.005(Attu
Engr, Inspection
Plan Chk. Deposit
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HINFIS, ASSIGNS AND SUCCESSORS
IN NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
Z&
Receipt #
0
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
NORUMITMANYWAYTH CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROW I
Fire Inspection
To
91
Landscapeinsp.
[Receipt N
F)RMATION APPLICATION APPROVAL
AT
AT
AT
AT
AT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE IN 0 AT
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED � SENT OF CALL ThSs n., A p—K .01 SqO.d V,v,.
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC, Sulld.19 Or,-- h-11 DIP11Y Ord FOOS All pO,d, Ild
TION; AND IN DOING T E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION
IN VIOLATION OF THE LABOR CODE 01 THE STATE 01 WASHINGTON II�LATING TO
WORKMEN'S COMPENSATION INSURANCE AND HOW fl1:27. DATE
1 (425)
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�IWNER O(AGSNT�) ATE SIGNED 771-0220 4 :I/1_7/1/)�
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10 EXT. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
it
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLO . INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBCIl0 / IRC110. PINK -OWNER GOLD - ASSESSOR
610S PRESS HARD - YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
NlEMOTO: PE LDING DIVISION
FROM: FIRE DEPARTNIENT DATE
,ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
PROJECT A-4e-r-
SITE ADDRESS_
PERMIT #-0(- - —ADB# DATEINSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with approved plans. Final approval
denotes that (here are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
QV� GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspcctor
I
FAILED FINAL INSPECTION- OUTSTANDING ISSUES
0 Copy ofCORRECTION NOTICE given to oxvncr/contractor by inpector
I
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:1emp:bIdg:fbmis:ocaprvI Y25104
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05/31/2006 04:40 2532721190 SME CONST SALES PAGE 01
CORPORATION
Station Maintenance and Equipment
'2302 "A" Street - Tacoma, WA, 98402
(25S) 572.3B22 FAX (253) 572-0978 yyww�srnecorp,con
FWAL REPORT
TO:
DATE: 5"-Zr-�04-
on 5-ze..
006, Petro-tite Line System Tests were performe
at waft
mim ~1�_-+ 6(.6 4rjW0..b
ed
A description of the line system test results is as follows:
Product Line
Volume Change
Bleed Back
eats minimum
olerances Accepted
By Petro-Tite
YES �C) No
41-00M
YES NO
YES No
YES NO
YES No
The following line test tolerances are accepted by Heath Consultants Inc
o rated:
SUCUON SYSTFM: One hour indicated leak rate of+,!. 0.025 gallons.
Bleed Back Tolerance + 0.050 gallons,
Acceptable Test Pressure: Not more than 15 p.s1g, and not less than 5 p.sJ S,
SUBMIERS]BLE SYSTEK One hour indicated leak rate -*.I'- HI 0 gallons�
Bleed Back Tolerance + 0.050 eallons.
Acceptable Test Pressure: 150 percent of operating pressure but not less th 5 p's.i.g'
A line test must be performed for a minimum oforin hour to be considared , alid.
est date is enclosed. Please do not hesitate to call us ij you have any questions or ifwe
A copy ofthe actual te
can be of farther senice to you.
SMF Signature: Printed Name: aaa AukftTi-
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CONTRACIORCERTIFICA71ON
-A at-M.1y
bt�I/De 7:12AM; 2532721190 — MBE1478; P.O. 4
05/31/2006 04:40 2532721190 SME CONST SALES
Underground Storage Tank Tightness T
Tim art-bcd UlldefgrOmd Stores, TatLL, (UST) chmUst is require� for
..... ..... C'It1b,
thal thc Tghtness T"Ung zctilitieS we -'dllr=d end md-ted
r C 0 L 173.360 WAC,
Sae back of form for inatruCbgns,
1. UST SYSTEM LOCATION AND OWNER
N.Mb.l.
USI Number, sit. tD
(A.116M ft. Ee��r
Sit-/Busl-sys N.rre: rA;K, !nnntXet-
Sil- Addresc (.(,>o camcras
Ir "i": 0"As W',� C.Um,
Ufly staft ZJ�4 freqdd)
US70mer/Opemmr,
Mallinp Address:
P.O.
2jp-4 frequied)
T slephorte:
I. FIRM PERFORMING WORK
S—loo Company" — SMS CORPORATION
SeMce Oo. Address: -7302 "A" STREF7,
TACOMA. WA 9L4C-�-2 9 11
Zp-4 frequitd)
Certiffied Supervisor mialnexaL A weetm ;y I,
Address: -,302 "A" STPr-BT
S,-r . � w—
TACOM6—.WA CZ�i2
Car ZjP-1
Me.
!COO CVdIlCation NwmDen 6j3C3t%--L)% issue tiate JMormhfYear
Tejepn.na:
PAGE 04
est ng Checklist
'IM11' umdabo�., J-hjs�h,.kji,
In = TdkZ.e "tb Chpu,,
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R...Ivad: 6131/06 7:12AM; 2532721190 MBE147e; Page 5
05/31/2006 04:40 2532721190 SME CONST SALES PAGE 05
Underground Storage Tank Ill. Ad,
rightness Testing Checklist
For more tbatiour UST sysup,,. You may Photocopy this form prior to com, 1-ting,
"' Photocopy - form P' re t
1. TIr.HTNES9 TESTING METHOD 2�&
Date of-T. ast: -45 OG
1, Tightless testing mathoci used (indicate 0 more than'One method "wass =uved):
T
test method nam&Nerssor, ag-tf-d - T . ie.
'rest method nusimifisouirer .-Hft-.tja, eowtsLjHq"
Now ..k tank sause be memo up to the product 1wel limited by the Overfill prevBadost dai.., If 1-ifill Prevention d-i.. is
not instalitd, a t4ra mum be wriedi up w the 95% full lsvcj� Wbtn udr&l volussurric Ion " "had. are us the pal,
ad.
on be; 1) filled ith product as the portion of the ewnl: Above the radiset Isle, munt be tested
Using a nonvolurnarric mabod Which for tighm"s, testing.
2. lr�diosna the method u"d on disuirmina, If ground.juir mts pressent above the bottom of the is ik during the test (mqvj,,d
for single �11 mnKs):
3, Method waad far miss- detection: 4. Risawn for I condu--�bnog rightness at
Q Weekly manual gauging -D Required for release d.tiscit, requirement
20 Dally manual inventory control [D Bfirg temporarily _10and tani b.ok into asarvi.e
Automatic tank gauging (ATG) Z5 TanK Or piping repair
Int-niftel monitoring Othe,(dsisclilbe)
Other (daiscirlba)
5� -1 YP* of teat corriu-cmd:
6, TW in.thod Me:
0 Tank lipmeasnert.niy 0 Overfillvolumusno
�ing tighIrliva mat only 0 underfill V-1-metric
1 coal systarn mat (tank and lines named together) N.1—lumstric
V.1—arint,
11, TEST METHOD CHECKLIST
The following items lball be, initialed by the Cartifled Supervisor ividote sipartere- appears or) rid form
Ya No NA,
I - Ii- the tighweve, leading method =cd base tictroomirated to meet the ptifo-fMarIze
standard st,"cilied in the IJST rules ior the conditions underAbich the Test -as
poinducted'? derocliag a 0.10 gallon per hourl-fthrate Imth proisabilin, o
d4neCtiOt Of At Iran 95% and a probability of false ahmin oftso more than 5%'.
I Have a wrinen testing procemir-5 d-eitipee by th.- marsufacercr of the testing
equipment and method be= foliowedwaile the test as being se! up and conducted?
3 Was the Product 1-MI in the t4a. during the = withim the linitalions ofthe tesi
methods performance standards?
4, L�groundwawTwwt)restWfDCI."Tll-bOttOmo,".b-mn�
accounted far its presence, irzil,.artil io,, smale W&:� iamw
if the rightness ter. is -orisidered a fafled Essa, has the owmerlo:i-nuir beer, notiripti of
th. tM.'r--sulus? (liow �A.L Ovn2- MuStl"POr. . fadSdt�gh=SS test as
release witbir, 24 hours ic, 'JS- sus�'w, int ap ropreste, Ecology regional offi�e.*)
J— .peh.bl� White Copi! (Zwlvgv)� YcUo,,- C(,,,t Pik Ces,,- 6, p-Md-)
Permit Inspection Details
Permit: BLD20060276
PCRMITTI"i—',
06101/2006 MS 20 APPROVED
y
Total Time: 20
to
1986 4-Fl Final
05/31/2006 WESTFALL 26"AP'PROVED
y
Total Time: 20
Total Inspections:
2 Total Time:: 40
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5/29/2009 10:17:03 AM
Page I of I
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing................
Wall ..........................
Pier/Porch ...........
Retaining Wall ...........
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Slab Insulation ..........
0
PLUMBING:
M
Underground .............
Rough -in ...................
M
Commercial Final
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0
I=
HEATING:
IT!
Gas Test ....................
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Gas Piping .................
Equipment .................
(j)
Commercial Final
EXTERIOR SHEATHING
x C
NAILING ..........................
M M
FRAMING ........................
0
C.) ITI
FIRST FLOOR FRAMING_
C 0)
K 0)
M 0
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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