BLD20110422.pdfOF EOM
STATUS: ISSUED 7/11/2011
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Expiration Date: 1/11/20
Parcel No: 27031300404700
.LI
BARB MACDONALD RON JOHNSON YIOME07NER EXEMPTION TAKEN
9921 WATER ST 19601 23RD AE NW
EDMONDS, WA 98020-2361 SHORELINE, WA 98177
( ) - EXT: (206) 546-2288 EXT: ( ) - EXT:
LICENSE #: EXP:
BRING FILL MATERIAL ON SITE FROM ADJACENT SITE & MAYBE FROM OFF SITE. 499 CUBIC YARDS MAX.
VALUATION: $0.00
PERMIT TYPE: Residential
PERMIT GROUP: 28 - Fill/Grade/Excavate
GRADING: Y CYDS: 499
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP: Alk AP. Lq m
OCCUPANT LOAD:
FENCE: N ( 0 X 0 FT.)
CODE: 09
OTHER: N ----- OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
FRONTSETBACK SIDE SETBACK REAR SETBACK
tE UIRED: PROPOSED: RE UIRED: PROPOSED:RE UIRED: PROPOSED:
-lE1GHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
;ETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S
COMPENSATION INSURANCE AND RCW 18:27,
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
MCA N J f 'ev it
Signat Print Name Date Released By Date
jtQ r5 * z�
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10/ IRCI 10.
r
�r
= ONLINE = APPLICANT = ASSESSOR = OTHER
STATUS: ISSUED
BLD20110422
• Engineering final approval subject to:
• a) Permanent stabilization of exposed soils
• and/or
• b) Continuous monitoring of temporary erosion sediment control under a separate issued permit for redevelopment prior to
expiration of this grading permit.
• 1. Fill of 500 cubic yards or more will require SEPA review.
• 2. Height calculations of any future residences on the subject property will be taken from original grade, not the average grade
following the fill activity.
• Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check the job card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
• Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been
specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays,
excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must
comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City ""s ability to enforce any
ordinance provision.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 1
PUBLIC WORKS 425) 771-0235 1 PRE-TREATMENT 425) 672-5755 1 RECYCLING 425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
being reauested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
• E -Erosion Control/Mobilization
• E -Engineering Final
• B -Building Final
°F E°MInspection
0ti
Comments
BLD20110422
28 - Fill/Grade/Excavate
Applied: 06/06/2011
Issued: 07/11/2011
Expires:
01/11/2012
Address: 9921 WATER ST, EDMONDS
INSPECTION
DATE
INSPECTOR
ACTION
1001 - E -Erosion Control/Mobilization
01/11/2012
ZULAUF
CMP
Comment: ok to final
1077 - E -Engineering Final
01/11/2012
ZULAUF
CMP
Comment: ok to final
1158 - B -Building Final
01/09/2012
LAWLER
CMP
Comment:
2/29/2012 8:01:22 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1
f'?C. 1890
CITY OF EDMONDS DAVEEARUNG
MAYOR
121 5th AVENUE NORTH • EDMONDS. WA 98020 • (425) 771-0220 • FAX (425)1771-0221
www.edrhondswa.gov
DEVELOPMENT SERVICES DEPARTMENT
February 29, 2010
Bank of America
Assistant Manager
306 Main Street
Edmonds, WA 98020
Re: Performance Frozen Fund Account #5319853148, Barbara MacDonald at
9921 Water Street, Edmonds WA
Dear Sir or Madam:
The City of Edmonds hereby authorizes the release of $2,000 from the above referenced
Performance Frozen Fund. All interested City departments have approved the release of
the Performance Frozen Fund.
Sincerely,
c
Mari H son
Senior Permit Coordinator
Cc: Applicant
File
a
L/remp/DST's/MasterL,etters/ReleasePerformance02/01
• Incorporated August 11, 1890 •
Sister City - Hekinan, Japan
a A
OVA EDA,�rO
t!1
-L. 10
Edmonds Building Permit
Project Address
Owner/Developer
Date Posted
Date Expires
Account Number
City of Edmonds
121 5`h Avenue North • Edmonds • WA 98020 • (425) 771-0220 Fax (425) 771-0221
Website: www.ci.edmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
Planning • Building • Engineering
PERFORMANCE FROZEN FUND
With reference to the above identified project, this will certify that this Banking Institution has
a frozen fund account/savings account (or loan) for . the above -referenced developer/owner for the
project so identified. In consideration of the permitted development of the property this institution
hereby_ agrees that it will freeze the sums of money for the indicated site improvements pending written
authorization for release of said funds by the City of Edmonds in the amount of
$ *Zwo r 00
The total sum indicated will be withheld by this Banking Institution from any disbursements of
any kind until written authorization has been received by the institution from the City of Edmonds to
release the sum of money indicated by the written authorization from the City.
The design, location, materials and other specifications for the indicated site improvements are
those required by the City of Edmonds and appear in the above -referenced Edmonds building permit
file and are in compliance with the Edmonds Community Development Code of said City.
In the event the owner/developer fails to complete the indicated improvements within
�Q Ml+MW weeks/months, (not to exceed 24 months) the City of Edmonds may demand,
and the institution shall make, payment to the City of said funds so that the improvements can be
installed or completed immediately to City standards. The institution shall not be liable to the owner
for any disbursement of said funds to the City of Edmonds.
It is hereby specifically agreed by and between the parties hereto that in the event that any legal
action must be taken to enforce the provisions of this agreement or to collect said frozen fund, that the
prevailing party shall be entitled to collect its cost and reasonable attorneys' fees as a part of the
reasonable costs of securing the obligation hereunder. In the event of settlement or resolution of these
issues, prior to the filing of any suit, the actual costs incurred by the City, including reasonable
attorneys' fees, shall be considered a part of the obligation hereunder secured. Said costs and
reasonable legal fees shall be recoverable by the prevailing party, not only from the proceeds of this
frozen fund account, but also over and above said body as a part of any recovery in any judicial
proceeding, in addition to recovery of the funds.
L:\TEMP\BUILDING\FORMS\BONDPerformanceFrozen.DOC
City of Edmonds Performance Frozen Fund Account
Page Two
Of, I�WO M
Financial Institution
Officer/Title
ft MA 10 ;- �6n�A
Mailing Address
Account Number
Print Name
qy& qq I- I
(,(IAS <;t'
Mailing Address
Te ephone Number
FINANCIAL INSTITUTION ACKNOWLEDGEMENT
STATE OF WASHINGTON)
) ss
COUNTY OF )
On this `' day of dA M before me, the
undersigned, a Notary Public in and for the State of Washington, duly commissioned and sworn,
personally appeared AY VAM M� � , tome known to be thelgAW
ofthe corporation that executed. the foregoing instrument, and
acknowledged the. instrument to be the free and voluntary act and deed
',ofesaid corporation, for the
uses and purposes therein mentioned, and on oath stated that 1JV Kl was
authorized to execute said instrument and
WITNESS my hand and
Notary Public
State of Washington
KATHRYN A SINCLAIR
MY COMMISSION EXPIRES
j* j0, 2014
seal affixed is the corporate seal of said corporation.
affixed the day and year first above written.
NOTARY PUBLIC in and for the
State of Washington, residing at
Mph Sfi VUA 000
L:\TEMP\BUILDING\FORMS\BONDPerformanceFrozen.DOC
City of Edmonds Performance Frozen Fund Account
Page Three
DEVELOPER/OWNER ACKNOWLEDGEMENT
STATE OF WASHINGTON )
ss.
COUNTY OF )
On this , day of , before me, the under -signed,
a Notary Public in and for the State of Washington, duly commissioned and sworn, personally appeared
to me known to be the
of
the general partnership that executed the foregoing instrument, and
acknowledged the said instrument to be the free and voluntary act and deed of said partnership, for the
uses and purposes therein mentioned, and on oath stated that
was authorized to execute said instrument.
WITNESS my hand and official seal hereto affixed the day and year first above written.
NOTARY PUBLIC in and for the State of .
Washington, residing at
L:\TEMP\BUILDING\FORMS\BONDPerformanceFrozen.DOC
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORM D
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to.the City of Edmonds that:
❑ Value of work under $500.00. The aggregate contract price of labor and materials and all
other items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that lie/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090(9).
Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 18.27.090(11).
❑ Work performed personally on own. property. Anyone personally working on property
he/she owns, or at which he/she resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
❑ Use of own employees. Property owner using him/herself or his/her own employees to
perform maintenance, repair, and. alteration work in or upon his/her own property. RCW
18.27.090(13).
❑ Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
❑ Other. Specify which provision of RCW 18.27.090 applies:
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this I day of jwie:
PROPERTY OWNER/AUTHORIZED
PERSON
Signature
5MUO
Print Name
2011.
WITNESS
� n �
Signature
L114 `7hotnywd
Print Name
L:\TEMP\BUILDING\HANDOUTS REVISED IN 2009\PREVIOUS HANDOUTS\FORMS\CONTRACTOR EXEMPTION FORM
D.DOCREVISED 7/07
�y OV EQ4,j
° CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 9/12/2011
Expiration Date: 3/12/2012
Parcel No: 27031300404700
BARBARA MACDONALD RONALD D. JOHNSON ARCHITECT TT & E LLC
9921 WATER ST RON JOHNSON PMB 402
EDMONDS, WA 98020-2361 19601 23RD AVE NW 16910 92ND AVE NW
SHORELINE, WA 98177 STANWOOD, WA 98292
( ) - EXT: (206) 546-2288 EXT: (425) 754-8315 EXT:
LICENSE #: TTELLEL901CQ EXP:2/18/2012
DEMO 2161 SQ FT HOUSE AND 672 SQ FT GARAGE
VALUATION: $0.00
COMPLETED
PERMIT TYPE: Residential
PERMIT GROUP: 23 - Demolition
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY: N
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: N 0 X 0 FT.)
CODE: 09
OTHER: N ----- OTHER DESC:
ZONE: RS -12
NUMBER OF STORIES: 0
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
LOT #:
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK. 0 OTHER. 0
3RD FLOOR. 0 GARAGE. 0 DECK. 0 OTHER: 0
FRONTSETBACK SIDE SETBACK REAR SETBACK
ZE UIRED: PROPOSED: RE UIRED: PROPOSED: RE UIRED: PROPOSED:
IEIGHT ALLOWED:O PROPOSED:O I REQUIRED: PROPOSED:
iETBACK NOTES:
J�q�Et- TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO
WIJATION
SON WILL BE EMPLOYED M VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S
COMPENSATION INSURANCE AND RCW 18:27.
T NOT A P MIT TIL SIGNED BY THE UIL WG OFFICIAL OR HIS/HER DEPUT AND ALL FEES ARE PAID.
nature
Date
Date
U ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR
OTHER
STATUS: ISSUED
BLD20110652
• *Pre -inspection required.
• *Street to be cleaned of debris.
• *Side sewer must be capped at property line.
• *Water Service must be disconnected from Water meter and or hose bib with AVB installed.
• *Dump at approved dump site only.
• *See demolition inspection checklist on back of job card for inspection requirements.
• Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check the job card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
• Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been
specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
• SoundMoise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays,
excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must
comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City """"s ability to enforce any
ordinance provision.
• Maintain erosion & sedimentation control per city standards.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)
BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 1
PUBLIC WORKS 425 771-0235 1 PRE-TREATMENT 425 672-5755 1 RECYCLING 425) 275-4801
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
being requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
• E -Pre -Demolition Sewer Cap
• E -Pre -Demo Water Sery Discnct/AVB
• E -Pre -Demo Erosion Control
• E -Engineering Final Demo
B -Final Demolition
• B -Building Final
°F "A'I Inspection Comments
v �o
,f
BLD20110652 23 - Demolition
Applied: 08/15/2011 Issued: 09/12/2011 Expires: 03/30/2012
/ Ral Address: 9921 WATER ST, EDMONDS
INSPECTION DATE INSPECTOR ACTION
1078 - E -Pre -Demolition Sewer Cap 09/23/2011 MCCONNELL CMP
Comment: Twist plug installed in line. Okay to final.
1079 - E -Pre -Demo Water Sery Discnct/AVB 09/23/2011 MCCONNELL CMP
Comment: AVB still in place. Okay to final.
1080 - E -Pre -Demo Erosion Control 03/23/2012 LAMBERTJ CMP
Comment: & J.McConnell - Final Approved
1081 - E -Engineering Final Demo 09/23/2011 MCCONNELL COM
Comment: Approved.
1081 - E -Engineering Final Demo 03/09/2012 MCCONNELL COM
Comment: with J.Lambert. Slab from basement was not removed. Having water issues on site. Not sure if this is
contributing or not, but the slab needs to be broken up/removed. Exposed soils to be covered. Ground
water needs to be pumped to settling pond or baker tank and then released to storm system.
1081 - E -Engineering Final Demo 03/13/2012 MCCONNELL COM
Comment: JM working with Ron to get documentation that slab was broke up by excavator and also to show how
Ron will be dealing with dewatering the site. Demo permit not to be finaled until these items addressed.
1081 - E -Engineering Final Demo 03/14/2012 SIBREL COM
Comment: Site visit. Verified stockpiles covered. Ron Johnson (contractor) not onsite to discuss site dewatering.
1081 - E -Engineering Final Demo 03/14/2012 LAMBERTJ PAR
Comment: Received email from Ron Johnson stating bthat the concrete footings walls and slabs were broken up
and removed from its place during demo.
1081 - E -Engineering Final Demo 03/23/2012 LAMBERTJ CMP
Comment: & J.McConnell - Final Approved - see attached email regarding the dewatering.
1104 - B -Final Demolition 03/09/2012 LAWLER COM
Comment: Building okay to approve after engineering okay
1104 - B -Final Demolition 03/12/2012 LAWLER COR
Comment: Awaiting engineering approval
1104 - B -Final Demolition 03/27/2012 LAWLER CMP
Comment:
3/28/2012 7:37:02 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1