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CITY OF EDMONDS
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MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
2-6
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Applicallon: 180 Days
Permit Limit: 1 Year - Provided Work fa Started Within 180 Days
STORM DRAINAGE FEE
'Applicant. on behalf of his or her spouse, heirs, assigns and
v, Successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its Dilicials,
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modify, waive or reduce any requireent of any city ordinance
any ordinance
_ nor limit in any way the City's ability to enforce
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given is correct: and That I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
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state laws regulating e 9
be employ in violation of the Labor
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INSPECTION
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aoknowletlged in space provided.
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
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ORIGINAL - F� 1 YELLOW - inspector
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CHAPTER 7
loner
PINK - O.:.re, GOLD - Assessor
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CITY OFF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OVINEA NAML NAME OF BUSINESS
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MECHANICAL
Plan
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
etc will require separate permission.
STATE suRCHARGE
,.+.
C.+
driveways, marquees, -I
Penult Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Stalled Within 180 Days
Er ur.4
EN&HNSPEBFISN+E5'
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••Applicant, on behalf of his or her sipouse, heirs, assigns and
its oflicials,
successors in interest, agrees to IntlAify, delend and hold�.��i�,�Nr
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harmless the City Of Edmonds, Washington,
ford 9 of
employees, and agents from any. and all claims a
nature, arising directly or -indirectly from the issuance
PLAN CHECK DEPOSIT
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whatever
of this permit. Issuance of Is permit shalt not be deemed to
waive or reduce any requirement of any city ordinance
0
modlly,
nor limit in any way the City's ability to enforce an ordinance
TOTAL AMOUNT DUE
•;ItL ;,��..7.ir.
provision."
I hereby acknowledge That i have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
authorized agent of
state laws regular Ing construction; and In doing the work authoriz-
be employed in violation of the Labor
AUTHORIZES
ONLY TH
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
ed thereby, no person will
Code of the Slate of Washington rela(Irig to Workmen's Compensa-
WORK NOTED
acknowledged in space Provided.
to.. Insuranl:e and R 18.27. /
SIGNED.
INsvecTloN
DEPARTMENT
DATE
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SIGNATURE IOIYNEP OR AGENT(„.
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JDATE
CITY OF
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771-0220
ORIGINAL - F.I. YELLOW —Inspector
UNTIL ALFINAL INSPECTION
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK - Ov,cer GOLD - Assessor
CHAPTER 7.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ................... '
FOUNDATION:
Footing .................... '.
Wall ....................... � r o-CH 9zPZ3
Pier/Porch................
Retaining Well............ J
Sla61 nsulation ............
PLUMBING:
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Underground.....J
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NAILING .................... sv
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INSULATION: ,
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Wall Insulation ...- `y
Ceiling Insulation.........
SHEETROCK NAILING, i �---� __. Z• ' ��
SPECIAL INSPECTION ......
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RADON MONITOR ATSITE .
FINAL APPROVAL
FOROROCCOCCUPANCY.......
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ................... '
FOUNDATION:
Footing .................... '.
Wall ....................... � r o-CH 9zPZ3
Pier/Porch................
Retaining Well............ J
Sla61 nsulation ............
PLUMBING:
_ s
Underground.....J
Rough -In ................. , t�
Commercial Final ........;�
't
HEATING:
Gas Test ................. •„ Cc.4S Tom"' T'
Gas Piping ................ 1_.Gb
Equipment ................ %% ' • % rr
8
Commercial Final.........
.a
EXTERIOR SHEATHING
NAILING .................... sv
j FRAMING ................... —��-..` �l • lam' 9� '?
ni
INSULATION: ,
s.
Floorinsulation .......... ;
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Wall Insulation ...- `y
Ceiling Insulation.........
SHEETROCK NAILING, i �---� __. Z• ' ��
SPECIAL INSPECTION ......
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RADON MONITOR ATSITE .
FINAL APPROVAL
FOROROCCOCCUPANCY.......
0 0 I* ,
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Im
GeoEngineers OCT 1 5 1997
PERMIT COUNTER
September 10, 1997 Consulting Engineers
and Geosclentists
Offices in Washington,
Oregon, and Alaska
Snare Construction Company
107 - 148th Avenue Northeast
Arlington, Washington 98223
Attention: Ron Snare
Summary
Construction Monitoring
Ruggiero Residence
16010 - 75th Place West
Edmonds, Washington
File No. 3475-002-10
This letter summarizes the results of our monitoring of the geotechnically related aspects
of construction of the Ruggiero residence located at 16010 - 75th Place West in Edmonds,
Washington. The construction monitoring was authorized by Phil Ruggiero on May 1, 1996.
Our initial services consisted of an evaluation of the soil moisture conditions at the site and
submittal of our field report to the City of Edmonds documenting our opinion that soil moisture
conditions were such that site grading activities could begin. A copy of that field report, dated
May 6, 1996, was transmitted to you. A copy is attached to this report for your files.
After site clearing was completed, grading of the site began with the installation of the
H-pile/timber lagging retaining wall. Numerous difficulties were encountered during the
installation of the retaining wall, including equipment access and unusually heavy rains. At our
recommendation, a change in design was completed and a rock buttress consisting of quarry
spalls was placed behind the wall to prevent movement of the uphill slope. Field Report Nos.
2 through 6 document our observations during the construction of the retaining wall and the rock
buttress. Copies of these daily reports are also attached for your records.
V Geolingineers, Inc
8410154th Avenue N.E.
Redmond, WA 98052
Telephone (425) 861-6000
Fax (425) 861-6050
wm-geoengineers.com
� rrr ■r µ
32XIC
Snare Construction Company
September 10, 1997
Page 2
The final construction activities which we monitored at the site included the placement and
construction of the rockeries upslope of the retaining wall and the subgrade excavation and
preparation for spread footings for support of the house. Our monitoring of those activities is
documented in Field Report Nos. 7 through 11, copies of which are also attached.
In summary, it is our opinion that geotechnically related activities during construction of
the subject residence were completed in general accordance with our recommendations and the
plans and specifications.
A O ►
Please contact us should you have any questions concerning this summary letter or the
results of our monitoring activities.
KGBmd
Document ID: 3475002.SUM
Attachments
Two copies submitted
Copyright m 1997 by GeoEngineers, Inc., All rights reserved
G a o E n g i nears
Yours very truly,
GeoEngineers, Inc.
/�C--"--J -
Kenneth G. Buss, P.E.
Associate
File No. 3475-M-10-1130
d
Geo Engineers
RECEWED
0 C T 0 11 10.95
PERMIT COUNTER
September 28, 1995
Consulting Engineers
and Geoscient Isis
Offices in Washington,
-y..� ,
f
Oregon, and Alaska
Mr. Phillip John Ruggiero
Y
®�
6126 - 140th Court Northeast
Redmond, Washington 98052
Geotechnical Consultation Services
Proposed Residential Construction
Meadowdale Beach Area
Edmonds, Washington
File No. 3475-001-R02
INTRODUCTION
This letter provides additional geotechnical information that the City of Edmonds requires
relative to your proposed Meadowdale Beach residence. Our current services on this project
were requested by Mr. Vince Ojala, your architect, during a telephone conversation with
Mr. Gary Beckham of GeoEngineers on September 13, 1995. We understand that you have
authorized our preparation of this letter.
Our current services continue our involvement in your project, which include our
March 29,1994 "Report, Geotechnical Consultation Services, Proposed Residential Construction,
Meadowdale Beach Area, Edmonds, Washington," and our "Statement of Risk Letter ..." dated
September 6, 1994, and "Letter of Response :.." dated May 17, 1995.
We understand that the City of Edmonds requires further clarification relative to the
statistical probability of earth movement at the site. According to Mr. Ojala, the city wants
GeoEngineers to provide an exact number for the probability of earth movement the -Site within
a 25-year period.
SCOPE
The purpose of our services is to respond to the city of Edmonds' request for additional
information. Our scope of services included a review of our files and previous reports for this
project and reevaluation of the probability of future earth movements at the site.
32XIC
0
rom
Im
0
7-1
Mr. Phillip John Ruggiero
September 28, 1995
Page 2
DISCUSSION
Our May 17 Letter of Response included a discussion of the statistical probability of earth
movements within a 25-year period at the site (page 2, item 1. Slope Stability). We concluded,
at that time, that
"the probability of earth movement within a 25-year period should be less than 30 percent,
providing that the city utility drain systems are maintained. It is also likely that the
proposed construction will further improve the existing slope stability conditions. This may
result in a further decrease in the actual risk of slope movement."
If the city maintains the utility drain systems, the risk of slope movement within a 25-year
period is less than 30 percent, as stated above. Thus, the upper boundary of the probability of
slope movement should be 30 percent (likely less).
The proposed development of your property will include removal of much of the colluvium
on the site, reconfiguration of the upper slope, construction of a pile -supported retaining wall,
and installation of new surface and subsurface drainage facilities. These improvements will
decrease the amount of soil and water available to contribute to slope movement mechanisms.
The retaining wall will restrict further movement of soil.
We have estimated improvement of slope stability (in percent relative to the probability of
slope movement within a 25-year period) for each of the proposed elements of site development,
as summarized below:
Estimated Slope Improvement*
Remove colluvium
2 percent
Reconfigure upper slope
1 percent
New retaining wall
2 percent
Drainage improvements
2 percent
Sum of Improvements
7 percent
*Estimated percent of improvement of slope stability based on the probability of slope movement
in percent within a 25-year period.
As indicated above, a seven percent improvement in the existing slope stability condition
may result from the development of your property, as currently planned. As such, the seven
percent improvement should reduce the overall probability of slope movement over a 25-year
period to about 23 percent.
Goo E n Q i nears
_,�
�.
c ra ,
File No. 3475.001•R02
_ ... 10
32XIC
M
Mr. Phillip John Ruggiero
September 28, 1995
Page 3
ASSUMPTIONS
We have made a number of assumptions to estimate the amount of slope stability
improvement on your property. The conditions upon which these assumptions are made must
not change over the next 25 years or the estimate of improvement of slope stability stated above
may be invalid. These assumptions include:
• The city maintains the utility drain systems in the vicinity of the site.
• The water levels in the existing ground water monitoring wells in the vicinity of the site
remain at their current elevations or drop to lower elevations, indicating that the City's
utility drain systems are functioning.
• The site is developed as currently planned and as indicated in the drawings approved by the
city, including (1) construction of the cantilever retaining wall, (2) reconfiguration of the
upper slope area and installation of rockeries, (3) installation of rockery and yard drains in
the upper slope, (4) installation of house foundation wall drains, and (5) removal of
practically all of the colluvium and surficial soils at house foundation subgrade elevation.
• The soil and water conditions encountered during construction are essentially the same as
encountered during our field explorations on February 2, 1994 and in previous studies on
the site for others, as described in our March 29, 1994 report.
CONCLUSIONS
In our opinion, providing that the above assumptions remain valid and that the existing soil
and water conditions on your property after construction are the same or better than existing
conditions, the probability of earth (slope) movement on your property within a 25-year period
is about 23 percent.
LIMITATIONS
We have prepared this report for use by Mr. Phillip John Ruggiero in evaluating the
potential for future slope movements on his property located in the Meadowdale area of
Edmonds, Washington. This report is not intended for use by others, except for a
design/construction team retained by Mr. Ruggiero, and the city of Edmonds. The information
contained herein is specific to the Ruggiero property and is not applicable to other sites or the
Meadowdale area as a whole. The same limitations as presented in our March 29, 1994 report
and September 6, 1994 letter also apply to the conclusions presented in this letter.
The scope of our services does not include services related to construction safety
precautions and our recommendations are not intended to direct the contractor's methods,
techniques, sequences or procedures, except as specifically described in our report for
consideration in design.
a e o E n g i n e e r s File No. 3475.001•Ro2
°
A
32 x E
li»�
i7
Mr. Phillip John Ruggiero
September 28, 1995
Page 4
Our letter, conclusions and interpretations should not be construed as a warranty of the
subsurface conditions. Subsurface conditions will likely vary across the site and may also change
over time. These variable conditions and changes may affect the probability of occurrence of any
future earth movements and could influence construction activities. Therefore, a contingency for
unanticipated conditions should be included in the construction budget and schedule.
Sufficient monitoring, testing and consultation by our firm should be provided during
construction to confirm that the conditions encountered are consistent with those indicated by the
explorations described in our March 1994 report, to provide recommendations for design changes
should the conditions revealed during the work differ from those anticipated, and to evaluate
whether earthwork and foundation installation activities comply with contract plans and
specifications.
Within the limitations of scope, schedule and budget, we have accomplished our services
in accordance with generally accepted geotechnical practices in this area at the time this letter was
prepared. No warranty or other conditions, express or implied, should be understood.
O ►
If there are any questions regarding this letter, please contact us.
ii
Yours very truly, .
G•
o� wnsy
Ge{oEngineers, Inc.
�,�, a J' o � � a^"l � . (��✓�.�.-�---
/ w Gary D. Beckham
Project Engineering Geologist
EXKenneth G. Buss, P.E.
Associate
GDB:KGB:cmt
Document ID: 3475001.E
Two copies submitted
cc: ✓Mr. Vince Ojala, Architect
7703 - 33rd St. N.E.
Seattle, WA 98115 e
Mr. Greg Gilda
Victor H. Kimsey Engineers
1818 Westlake Ave. N., Suite 308
Seattle, WA 98109
G e o E n y i n e e r s File No. 3475.001-R02
o e10
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32X I I
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%A i r CLERK I I �� sRECEIVED
6ITY OF EDMONOS
505 BELL STREET Mhv 9 1996
EDMONDS, WA 98020
EDMONDS CITY CLERK
COVENANT OF NOTIFICATION AND INDEMNIFICATION/HOLD HARMLESS
Under the review procedures established pursuant to the State
Building Code, incorporating amendments promulgated by the City
of Edmonds, and as a prerequisite to the issuance of a building
permit for the construction of a residential structure and
attendant facilities, the undersigned OWNERS of property do
hereby covenant, stipulate and promise as follows:
1. Description of oub:aat 2-^ Er`-. This covenant of
notification and indemnification/hold harmless relates to a tract
of land at the street address of O( O/O 757'7 P/A4� k�Sr (insert
Lf�
street address), Edmonds, Snohomish County, Washington and
legally described as:
LQ t h-c �c-ems � pZ s—z3-9d -Catz
J �
u I PfX 116C7 /°N44e L ,�# 5/3i 059- vice3
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Ol J C
2. Notification and Covenant of Notification. The above
referenced site (hereinafter "subject site") lies within an area
which has been identified by the City of Edmonds as having a
potential for earth subsidence or landslide' hazard. The risks
associated with development of the site have been evaluated by
technical consultants and engineers engaged by the applicant as a
part of the process to obtain a building permit for the subject
site. The results of the consultant's reports and evaluations of
WSS52079A/0006.040.034
WSS/klt 02/08/90
VOI. 3159PAGE2S 53
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BUILDING
FEB 9 - ;°90
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the risks associated with development are contained in building
permit file number �� (insert number) on file with the
City of Edmonds Building Department. Conditions, limitations, or
prohibitions an development may have been imposed in accordance
with the recommendations of the consultants in the course of
permit issuance. The conditions, limitations, or prohibitions
may require ongoing maintenance on the part of any owner or
lessee or may require modifications to the structures and earth
stabilization matters in order to address future or anticipated
changes in soil or other site conditions. The statements and
conditions proposed by the OWNERS' geotechnical engineer,
geologist, architect and/or structural engineer are hereby
incorporated by reference from the contents of the file as fully
as if herein set.forth. Any future purchaser, lessee, lender or
any other person acquiring or seeking to acquire an interest. in
the property is put on notice of the 'existence of the content of
the file and the City urges review of its contents. The file may
be reviewed during normal business hours or copies obtained at.
the Planning Department, City of Edmonds, 505 Bell Street,
Edmonds, Washington 98020.
3. Indemnification and Hold Harmless. The undersigned
OWNERS hereby waive any and all liability associated with
development, stating that they have fully informed themselves of
all risks associated with development of the property and do`
therefore waive and relinquish any and all causes of action
against the City of Edmonds, its officers, agents and employees
WSS52079A/0006.040.034 -2-
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96050803159PAGE 2554
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arising from and out of such development. In addition, the
OWNERS on behalf of themselves, their successors in interest,
heirs and .assignees, do hereby promise to indemnify and hold
harmless the City of Edmonds, its officers, agents and employees
from any loss, claim, liability .or damage of any kind or nature
to persons or property either on or off the site resulting from
or out of earth subsidence or landslide hazard, arising from or
out of the issuance of any permit(s) authorizing development of
the site, or occurring or arising out of any false, misleading,
or inaccurate information provided by the OWNERS, their
employees, or professional consultants in the course of issuance
of the building permit.
4. insurance Requirement.. In addition to any bonding which
may be required during the course of development, the Community
Services Director has/h(s Xt (strike one) specifically required
the maintenance of an insurance policy for public liability
coverage in the amount and for the time set forth below in order
to provide for the financial responsibilities established through
the indemnification and hold harmless agreement above:
f} oN� �,/pia✓ �6//.�ti ��s�� �e o%�y s!�!/ ,� ��,�v��
Aye aW,'eA.- ,nV.L 41614 /Yd r� c�,rcc�a' t,✓ y� ,�s .
�affwl Copy ,//At Arst vf.✓zr s�/� �e CuirPti� �osk d Wed Cr�I
[insert insurance requirements and tim& period,
if any --if no insurance required, so state.]
WSS52079A/0006.040.034 -3-
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.9605080386 von. 31-59PAGE2555
32XC
2A
5. Covenant to Touch and Concern the Land. This covenant
of notification and indemnification/hold harmless touches and
concerns the subject tract and shall run with the land, binding,
obligating and/or inuring to the benefit of future owners, heirs,
successors and interests or any other person or entity acquiring
an interest in property, as their interest may appear. This
provision shall not be interpreted to require a mortgagor or
lender to indemnify the City except to the extent of their loss
nor to obligate such persons to maintain the insurance .above
required.
DONE this (2-tk day of
OWNERS)
By:
By.
STATE OF WASHINGTON )
) ss:
COUNTY OF _�/06 )
I certify that I know or have satisfactory evidence
er that f h1 1;pJ_ �,n ',rn_„ signed this instrument and acknowledged'
WSS52079A/0006.040.034 -4-
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9(605060 3 f? VOL. 3 1 59PAGE2556
�' p.:
it to be (his/her) free and voluntary act for the nuip
mentioned in this instrument.
DATED this 0 day of &'Q4 .n. u"e , 199V. _
//�� 16 f IM•^
• b-f,+,...��%h ��cJ Q���-tom.-✓ • r ,; ; <<� •
NOTARY PUBLIC
My commission expires: 4-I-y7
STATE OF WASHINGTON )
) ss:
COUNTY OF )
I certify that I know or have satisfactory evidence
that signed this instrument and acknowledged
it to be (his/her) free and voluntary act for the purposes
mentioned in this instrument.
DATED.this day of , 199_.
NOTARY PUBLIC
My commission expires:
STATE OF WASHINGTON )
) ss:
COUNTY OF )
I certify that I know or have satisfactory evidence
that signed this instrument, on oath
stated that (he/she) was authorized to execute the
instrument and acknowledged it as the (title)
of (name of party on behalf of whom instrument
was executed)- to be the free and voluntary act of such party for
the uses and purposes mentioned in this instrument. ,..,
DATED this day of , 199_.
NOTARY PUBLIC
My commission expires:
WSS520.79A/0006.040.034 -5-
WSS/klt 02/08/90
9605080986 voi. 3159PAGE 255'7
t,� r� w
NZ
C
ACORD_ CERTIFICATE OF INSUFtANCtID C2' °ATE`MIA0 :.
.LIABILITY
.. .... ;,.., ... ..OGGP81 ' .'. 12/10/97 :.
9
_ .:.....
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Unity Group - Lynnwood HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 36608 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynnwood WA 98036 COMPANIES AFFORDING COVERAGE
Christina Anthony COMPANY
Pnona No. 425-774-5622 FOXNo. 425-776-5996 A C N A
INSURED
COMPANY
B
COMPANY
Philip J. Ruggiero
C
19609 27th Ave. NW
Shorelline WA 98177
COMPANY
D
COVERAGES.:::
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MMRIGIYY) E
EXPIRATION
PDATE(MMMDNY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
S
COMMERCIAL GENERAL LIABILITY
PRODUCTS•COMPIOPAGG
$
CLAIMS MADE ❑OCCUR
PERSONAL S ACV INJURY
S
EACH OCCURRENCE
$500,000
OWNER'SSCONTRACTOR'SPROT
A
X
Comp Pers Liab
US 145304B86
06/26/97
06/26/98
1 FIRE DAMAGE (Any one&e)
S
MED EXP (Anyone p-)
S
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
S
ALL OWNED AUT05
SCHEDULED AUTOS
BODILY INJURY
(Perpe n)
5
HIRED AUTOS
NON -OWNED AUTOS
(Pat aeutl) INJURY
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY -FAA CGDENT
S
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
5$1,000,000
A
X UMBRELLA FORM
US 145304886
06/26/97
06/26/98
AGGREGATE
S
5
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WCSTATU- OTH
TORV LIMI ER
EL EACH ACCIDENT
S
THE PROPRIETORI
PARTNER Sl 1ECUTIVE !NCL
T
EL DISEASE - POLICY LIMB
S
EL DISEASE - EA EMPLOYEE
S
OFFICERS ARE: EXCL
OTHER
A
Homeowners
US145304886
06/26/97
06/26/9B
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS
Single family home located at 16010 75th Pl W, Edmonds, WA 98020. City of
Edmonds also listed as additional insured
CERTIFICATE HOLDER ;.: :;: :. - �..-CANCELLATION
-
X7iXXXIX
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL
City of Edmonds
Building Department
250 5th Ave N,
Edmonds WA 98020
3 -OGs WRTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
AUTHOR2E° REPRESENTATNE
ACORD:26S:(196). .'
- :. .- - wGACOROCORPO
RATION`.1888 i'>
1. a
® e.eF� 1 eaeeae.eaw�
TO: Permit Coordinator, Building Division
FROM: FIRE DEPARTMENT
--iJ'r,ENGINEERING DIVISION
PLANNING DIVISION
OWNERT� { Y"U ADDRESS
PERMIT# ` 6 D2 00/ ADB# INSPECTED ON 67C'1' 3� `
A field inspection was conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the granting of:
_Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
Other inspected
PASSED FIRST INSPECTION - CONDITIONS NOTED
1.
2.
FAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR INSPECTION
I.
2.
3.
4.
J` OCCUPANCY APPROVAL
FAILED FIRST INSPECTION
RE -INSPECTED - APPROVED
RE -INSPECTED - FAILED
RE -INSPECTED APPROVED
OCCAPRVL/TXTRECEP/October 13, 1993
DATE (U! 3 7 BY
DATE
BY
DATE
BY
DATE
BY
DATE
FEES
RECEIPT#
t
32 x E
11 M®oa�m
W.-Im
1'. "nuno
Is]
PROJECT REVIEW CHECKLIST
PROJECT NAME:— PLAN CHECK #:
PROJECT ADDRESS:_/601) RECEIPT DATE:
]REVIEWfl) B,Y:,
COMMENTS (1"i!!aI/qa1e..
PLAN: IWATE
FIRE BLDG. SEWER STREET - ENG.
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
a - .
Requireme ts
3�
Ot he Z Dning Requirements
Underground Wiring Required
e
Lot S&
.6
iiEPA Environmental Checklist/H
Tree Cutting Plan
Plat/Sub division Requirements
Le al escription Verification 5-29- 'Fa
1 O�.
Quit Claim/Street Dedications
L47—
12
Easements - Public/Private
Engineering Storm Drain Review Fee
-13:
19
��20'
Enqineering 2.2 Inspection Fee
Drainage Plan (On -Site)
Setback - To of Bank, Stream, Water Courses
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch BisinRequired A-L-
. . . . . . . . . . . . . . . . .
Driveway Slope & Vehicle Access Oc- —</�-/,
Sidewalk Required Y6-,
24:
Curb & Gutter Required
.25
Curb Cut For Driveway Required
Street �aving Required
26
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
: IL
30
'ght_ If -Way Construction Permit Required LIE-)
Street Name Sign Required
Other Si nin Re quired . .
Bond r Public Improv
--A Re For
F EM Table
Side Sewer Availability LJC15
Calculate Sewer Connection Fee If No LID #010
-Create —Street
File
lExIsting Water Main Size
A
Water Meter Size
Rw
-39:
Service Line Size
Water Meter Charge Required
H ,dra I Required
!
Ent
F iYa Size Existing
Fire Line Charge Required - Sprinkler
-'42:
Street Cut
Miscellaneous S M.
43
Reviewed By:
FIRE PLANNING ENGINEERING PUETLIC WORKS
0
a
0
M