18104 84TH AVE W15381
18104 84TH AVE W
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS': DETERMINATION.: E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID #:
SHORT PLAT FILE:- LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PEkMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERA41T #:
FOR:
WATER MEETER. TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fbnns\Sbxxt File Checklistdoc
6 PROJECT REV4EW CHECKLIST
PROJECT NAME:
PROJECTADDRESS: lg�loy
PLANCHECK#: �97-ILS
RECEIPT DATE: -7
REVIE D BY: (Initial/Date)
PLAN. WATER
-COMMENTS-
FIRE
'o
BLDG. SEWER
STREET-... ENG.�..
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
N
. . . . . . . 05.:
4.*:
ADB Requirements
- ------ ------
.3
.4
Other Zoning Requirements
Underground Wiring Required
............ . . . . . . . . . . . . . . . .
Lot Slope IS%
SEPA Environmental Checklist/Hydraulics Permit
........ . . . . . . . . . .
Tree Cutting Plan
8-
Plat/Subdivision Requirements
..........
9
Legal Description Verification
. . . . . .
. . . . . . . . . . . _R
10-
Quit Claim/Street Dedications
Easements - Public/Private
12::
Engineering Storm Drain Review Fee c:,
13
Engineering 2.2 Inspection Fee
Drainage Plan (On -Site)
Setback - Top of Bank, Stream, Water Courses
. . . . . . ..... .....
Setback - Storm Drain Line
1:17-
Open Ditch - Existing
18
Culvert Required
.... 1.9...
Culvert Size
�b
Shoulder Drainage/Shale Open Runoff
'All
21
Catch Basin Required
...........
22
Driveway Slope & Vehicle Access
.....23.
Sidewalk Required
mo W.
Curb & Gutter Required U
. . . . . . . . . . . . . . . . . . . . .
-24.
Curb Cut For Driveway Required
-------
M., /Aj
Street Paving Required
. . . . . . . . . . . . . .
Right -Of -Way Construction Permit Required
MEN. "* - m.
—28...
Street Name Sign Required
29-
Other Signing Required
. . . . . . . ..........
.............
Bond Required For Public Improvements
31
FEMA Map Check/Water Table
...
Side Sewer Availability
. . . . . . . . . .
-3?,
33
Calculate Sewer Connection Fee If No LID #
Create Street File
.............. ...
Existing Water Main Size
_g
Water Meter Size
.... ..
37
Service Line Size
Water Meter Charge Required
760.
Hydrant Required
Hydrant Size Existing
Alm. * W''0111-1
41 -
Fire Line Charge Required - Sprinkler
N/A
0
.......... ............... . . . . . . .
... 42-
Street Cut
Miscellaneous
44
Reviewed By:
FIRE
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PLANNING —m bfNEERING IC WORKS
MAY 2 9 1997
?UBLIC WORKS DEPI
R E C 0 R D OF C 0 N T A C T S
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22
3
23
4
24
5
25
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26
7
27
8
28
RW PERMIT # DATE ISSUED RECEIPT #
9
29
10
30
31'
12
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT E(73:� DATE ISSUED3//-7/9? REcEipT #
14-
PAID $ RECEIPT # DATE
34
35
36
37
METER SIZE3// PAID $7(,0 DATE IL,-W'29 RECEIPT #
38
19
39
20
40
OV ED4f
A co
BUILDING I
ov OF
148 CITY OF EDMONDS - ENGINEERING DIVISION
�OA4SPECIAL INSPECTION AND TESTING AGREEMENT
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PERMIT # BLD20140204
DATE: 10
0
PROJECT SITE ADDRESS: 1814084 1h St SW, Edmonds WA, 98026
PROJECT NAME: Jacobson Retaining Wall
SPECIAL INSPECTION AGENCY
*One form must be completed by each Special Inspection Agency or Inspector.
SPECIAL INSPECTIONS REQUIRED: Special inspections are required for this project, as
applicable, in accordance with Title 18 Edmonds Community Development Code (ECDC). When
required, the project must be installed/constructed per approved plans and specifications. The owner or
the registered design professional in charge shall employ an independent testing/inspection agency/special
inspector to perform required special inspections. The special inspector shall be a qualified person with
competence for inspecting the specific type of construction or operation requiring special inspection. The
owner, registered professional, contract6r and special inspector/agency shall provide a special inspection
report detailing compliance with approved plans and specifications directly to the Engineering Division.
WORK REQURING SPECIAL INSPECTION: Special inspections will be required for the following
categories of work: FOR SPECIFIC INFORMATION REGARDING REQUIRED SPECIAL
INSPECTIONS SEE THE STATEMENT OF SPECIAL INSPECTION NOTED AS A CONDITION ON
THE BUILDING PERMIT AND/OR ON THE APPROVED PLANS.
Temporary Erosion and Sediment Control
Drainage Installation for Wall
Redirection of Drainage for Existing Impervious Surfaces
Permanent Erosion and Sediment Control
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor and special inspector shall
complete this agreement and return to a Permit Coordinator prior to permit issuance.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the
Engineering Division prior to performing any duties or inspections. The credentials of the specific person
performing the inspection shall be submitted. When applicable, the company performing inspections
must be accredited by the American Association of State Highway and Transportation Officials
(AASHTO) RI 8.
A. Duties and Responsibilities of the SpeciAl Inspector
1. OBSERVE WORK ET FILE
Page 1 of 3
The special inspector shall observe the site work for conformance with the approved (stamped)
plans and specifications. Special inspections are to be performed as needed, to confirm that the
work being completed meets specifications and approved plans.
2. REPORT NONCONFORMING ITEMS
The special inspector shall bring non -conforming items to the immediate attention of the
contractor and engineer of record. The special inspector shall provide a report to the Engineering
Division notifying of any items not resolved and/or not installed per the approved plans and
specifications.
Items not constructed per the approved plans and specifications will result in a review of the plans
to determine what requirements will be needed for the project to meet the necessary stormwater
requirements; such as removal and reconstruction, re -design of the stormwater management
system(s), etc.
Final approval for the project will not occur until installation of all required improvements is
complete and accepted by the Special Inspector and the City.
3. FINAL CONSTRUCTION REPORT
The special inspector or inspection agency shall submit a final signed report or Certificate of
Compliance to the City stating that all items requiring special inspection and testing were fulfilled
and reported. The report shall also include a statement from the inspector stating to the best of
his/her knowledge the project is in conformance with the approved plans, specifications, and
approved plan revisions, if any. Items not in conformance, unresolved items or any discrepancies
in inspection coverage (i.e., missed inspections, periodic inspection when continuous inspections
were required, etc.) shall be specifically addressed in this report.
B. Contractor Responsibilities
1. NOTIFY THE SPECIAL INSPECTOR OF ALL REQUIRED SPECIAL INSPECTIONS
It is the duty of the contractor to notify the special inspector when work is ready for special
inspection. Note, the items listed under the statement of special inspection on the building permit
and as noted on the approved plans and specifications are required to have special inspections.
Adequate notice shall be provided by the contractor so that the special inspector has time to
become familiar with the project. All work requiring special inspection must be approved prior to
concealing or covering said work.
2. PROVIDE ACCESS TO APPROVED PLANS
The contractor is responsible for providing the special inspector access to approved plans at the
jobsite.
3. RETAIN SPECIAL INSPECTION RECORDS
The contractor is responsible to retain at the jobsite all special inspection records submitted by the
special inspector. These records are to be provided to the City Engineering inspector upon request
and upon completion of work.
C. City of Edmonds Engineering Division Responsibilities
1. APPROVE SPECIAL INSPECTION
The Engineering Division shall approve all Special Inspectors and special inspection requirements.
2. MONITOR SPECIAL INSPECTIONS AND APPROVE REPORTS
Page 2 of 3
Work requiring special inspection and performance of special inspectors shall be monitored by the
Engineering Division Inspector. Engineering Inspector approval must be obtained prior to
placement of concrete or other similar activities in addition to that of the special inspector.
3. FINAL APPROVAL
The Engineering Division may provide final inspection �tpproval after the special inspection
report(s) have been submitted and accepted by the City.
D. Owner Responsibilities
1. The project owner or the engineer or architect of record acting as the owner's agent shall ftind
special inspection services.
E. Eneineer or Architect of Record Responsibilities
1. Prepare Statement of Special Inspections.
2. Review the special inspection reports and provide corrective action for work that may not conform
to the approved plans.
. ACKNOWLEDGEMENTS
I have read and agree to comply with the terms and conditions of this agreement.
Owner name
(please print or type)
Date 5-- 3 —'14-
General Contractor Company/O ne nameXe--.Lor- "C-// P1,4 P. - /6 L - ', 5
(please print or type) U
Signature Date
Special Inspector/Agency
Engineer of Record name
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(please print
Return the original signed agreement to:
City of Edmonds Development Services Department
121 5th Avenue North, City Hall Second Floor
Edmonds, WA 98020
ACCEPTED BY CITY OF EDMONPS EN
City Official
type)
DIVISION:
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