BLD20050321(tt"t? of (1b oub
DEPARTMENT OF BUILDINGS
ir IF
kin
to*
1� -f.. International Building Code Section IV,),
I�N
615 441-,
At: Glen Street, Edmondsx —BuildQ 01- in -it #: 2005-0321
No. Stories: I
occupancy established by this Certificate: Dwelling Units: 'N/A**
A3/B/SI/14 I TYR69nstruction: VB Sprinlil Basement: No
1147 M-
Maximurribccu pant Load (Pir IBC 1004)
4040—
ust remain posted at all.'times.
Ro64,,papacity sigo�-,'- #V
WrIA) EVE lu--
Owner of Building: Communitv ChristIAi.RF.#II6WSh1M ub, vvj,,t wou,,u
'S'BEEN tdT.- E D1% AN DTA , P R MPLYING
THE Communitv Christian FellowslilbEftA &E& WITH THE REQUIREMENTS OF THE
01 - S Vlfxitok
i )60iWo", AW, UP AND DIVISION OF OCCUPANCY AND THE
2003 EDITION OF THE INTERNATIONAL BUILDIN,GYCG E A A[
a
USE FOR WHICH THE PROPOSED OCCUPANCY leit, WR SIFIt
D.
Issued this 15th er 2005
0
CHIEF BUILDING OFFICIAL
BY:
This cerifficate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and s .11 be maintained in I legible condition at all times. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
Aft. S.!^%. SIA4. k
Sol
ATE RECEIV7.,
�'PLETEU
PERMIT EXPIRES
7/
CITY OF EDMONDS
USE PERMIT
ZONE
Me NUMBER,,")
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADORES
OWNER NAME/NAME OF BUSINESS
C,WMVUI:U
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
q10 qf`AA%
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW 'ad
Permit R:.
q0:1
CITY
TELEPHONE
EXISTING — PROPOSED
Street Us. P .xi'd
Inspection Requited E3
Sidewalk Required 13
11-yr
7qq- 010
REQUIRED DEDICATION— FT
Underground'
Wiringrequired
NAME
METER SIZE LINE
SIZE
OF FIXTURES
PRV REQUIRED
�3
FN,�C.
F'
YES El NO
REMARKS
ul
z
9
ADDRESP
x
WPM -A
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
UJI
CITY ZIP
TELEPHONE
LYNAWOOP (0
05-770701il
.7603
NAMF
co Iml ji—,
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)
eel
ERING REVIEWED BY DATE
tj
ADWESS
ANY
f
FIRE,40Y DATE
0
CITY ZIP TELEPHONE
M
0
ZVI W__
VA7.CE OR Cu
SHORtLINE OR ADIM
INSPECTION
PBOND
OSTED
STATE LICENSE NUMBER EXPIRATION DATE
C: KED BY
6��je�
I
SEO'D
EeE 13NO
$
,j�Z_7
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
Z7031-40
zzqS0_6_
V,
11`4A
,
Z5,
EXP
F1 NEW
RESIDENTIAL
PLUMBING / MECH
lOT COVERAGE
WED
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALL 0, PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
_A_ 0.7
z
ADDITION
COMMERCIAL
COMPLIANCE OR
;5% 7u�
zo 25-
011L Itz
CHANGEOFUSE
REMODEL
IA
MULTIFAMILY
SIGN
PARKING
REO'D
I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
GRADING FENCJ? 9. 1
r REPAIR CYOS Qa x Fr)
4*1
4
REMARKS
_I�PL
* L e4oj A.
0 DEMOLISH E] TANK OTHER
V
GARAGE RETAINING WALL F RE SPRINKLER
1:1 NE
2:t� ot LV� Ole ft��
CARPORT ROCKERY ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
�f IrU,,rj 04 IA,5,
,Ll(
CHECKED BY
TYPE F CONSTRUCTION
COD
OCCUPANT
15 a
73
GROU
U9
NUMBER
NUMBER OF
CRITICAL
,0
OF
DWELLING
AREAS
Nj,j
SPECIAL INSPECTION JAREA
occu"A"'
0
STORIES
UNITS
N
REQUIRED YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
z
Af'
RWOLXL X)6rikj&
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
w
51NGLC - 6Wy 601oltic-f
-0 CWA4M6-0Ai-r- C.AOMH
&F0 C f _-5
y
VALUATION
LIN& ,VOL CA:NNA15.
$
-60MQ
MIU JSt- 146R,0-43
Description
FE E
Description
FEE
4 54al- Ar *0 4tA"t* Al.)
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
BuIldi . ng,permit
C I ity Surcharge
L57
PLAN CHE�C�NQ-
VESTED DATE
Plumbin
'Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
8 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN SIDEWALKS,
Grading
(CURBS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
IL
PERMIT LIMrP I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
�;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORs
Fire Review
Plan Chk. Deposit
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
6_2
Receipt #
IALL
CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
.455411,
9
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
Landscapelnsp.
Total Amt. Due
0
,I
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMI 10N
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPR0VAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL,
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and -
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
,,WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICI S S G DATE
SIGNATURE (o GENT)
DATE SIGNED
IA95)
771-0220
R ED BY DATE
7ATt
IT IS UNLAWFULTO USE OR OCCUPYA . BUILDING OR STRUCTURE UNTILAFINAL
EXT 13 33
2
INSPECTION HAS BEEN MADE A ND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109,/IBC110/IRC110.
ORIGINAL - FILE YELLOW - "/ePrCT0d
PINK -OWNER GOLD -ASSESSOR
09/03 1 . PRESS HARD -YOU ARE MAKING 4 COPIES
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............. 66
Rough -In ................... 31— 5
Commercial Final ......
HEATING:
Gas Test .................... 01'
Gas Piping .................
Equipment .................
Commercial Final .......
01
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................ ley�
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR /24 ZA C—
OCCUPANCY ..................
SideSewer#_
Amout PhId $ Recelpt-A
Date bsued X
WakrMeterSize_
Amount Palk" fi-4 Reemelpt
DatePweha.ls
ROW#. -j2AZPf-'
Amount Paid $--�ReCelpt*Ak%�"
.e2l_YV4
Dal e Is s u cal,
F1NVqR0JECT APPROVAL FORM
TO:
DATE:
MEMOTO: PER.MITCOOPDINATOR,BLJILDINGD[V[SION
FROM: FIRE DEPARTMENT DATE
FLEA_';f SIGN
ENGINEERING DIVISION DATE—ZZIZ5
A -
PLEASE SWN
MEASE S(GN
PROJECT
PLANNING DIVISION DATE
mamEWS)
SITE ADDRESS
7—
PERMIT n 2=aa 5 —40 _-KZ (—ADB# DATE INSPECTED
DESCRIPTION OF WOW TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final appioval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Cl Copy of CONDITIONS given to. owner/contractor by -inspector.
FAILED FINAL INSPECTION OUTSTANDING ISSUES
0 Copyof CORRECTION NOTICE given to owner/contractor by inipector
2.
3.
RE-IN'SPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date. Signature
1:tenT:b1dg:fbnns:ocaprv1 3/25/04
FINP PROJECT APPROVAL #RM,
Wd
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE 0 S_
PLEASE SIGN
PLEASE SIGN
PLEASE SIGN
PROJECT 6 C_
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
SITE ADDRESS 6 1 S"_ (a L4Z� 3-/—
PERMIT _ADB# DATE INSPECTED
_J_
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
X GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
1.
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvi 3/25/04
FINAP PROJECT APPROVAL ARM,
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
kAX4-11— PLANNING DIVISION DATE
kEASIWGN
PROJECT U. F
SITE ADDRESS
PERMIT# ADB# 04- DATEfNSPECTED 1Z/,9/q1,—
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
9' Copy of CONDITIONS given to owner/contractor by inspector
L_&^A5z*f la 6-e appm,-A
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04
0 0
FINAL PROJECT APPROVAL FORM
TO:
DATE: Alll,?,�,
1 - / - / - —
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE llel-
(f.;Pk. SIGN Z-1 A I
PROJECT
SITE ADDRESS
PERMIT 44��_ j�jj&e —
Z ADB# DATE INSPECTED I 11nog
If - I
DESCRIPTION OF WORK TO BE INSPECTED,-�
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
Ll--' GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp:bldg: forms: ocaprvl 3/25/04
RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Cvm,+fkjt4rr%1 v�4rjsr1hW FfLJ414-51,41
MAILINGADDRESS
,6115 192- 67 /Y .51-117711f
CITY Zip TELEPIrIOqE,
CD MON)> S' 9 dD149 14A? 77, jr- 011*0
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME CBL#
A/t'
ADDRESS
CITY ZIP TELEPHONE
rW 7 LJe rejl)? 9 11�� A 201. - 3 47,3413/1
STATE LICENSE NUMBER EXPIRA
/W ETA LZ 41142
PROPERTY TAX ACCOUNT PARCEL NO.
2 3 ;L4) YA
70
00 2.1 00
E] NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
E] MULTIFAMILY
REPAIR
GRADING CYDS
ri DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
U 7-4
NUMBER
NUMBER OF
OF
DWELLING
STORIES
U
PERMIT
NUMBER
SUITE/APT#
... if JS_ 41fov 7? ir 15 1,
PLAT NAME/SUBDIVISION NO.
LOT NO.
I
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
E3
RW Permit Required
Street Use Pemnit Required [3
EXISTING — PROPOSED
Inspection Required CI
Sidewalk Required 93
REQUIRED DEDICATION FT
Underground a
Wiring required 13
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
YES E3 NO 13 3
Uj
REMARKS uj
OWNER]CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE z
0
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III
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
LL
rION DATE
E CKED Y
ECKED
VARIANCE OR CU
SHORELINE RADB#
INSPECTION01
SEPA
o""GL4 -5
REO'D
I 13 ON
COMPLETED I EXEMPT
K
YES
CA# 04 - 1 (01,
ZONE
SIGN AREA
HEIGHT
WAIVER M
ALLOWED PROPOSED
1
ALLOWED PROPOSED
STUDY El
P
,-*' -
,
1-51 1
CH
PLUMBING MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
COMPLIANCE OR
'I
14 1C,
I
I z
I
CHANGE OF USE
PARKING
SIGN
REO'D PROVIDED
LOTAREA
I
PLANNING REVIEWED BY DATE
I ,-
FENCE
REMARKS
( X FT.)
OTHER
cFIRE SPRINKLER
F RE ALARM
TYPE
SPECIAL INSPECTION CONSUL
REQUIRED
OCCUPANT
GROUP
OCCUPANT
LOAD
Ids, rAl-4 I'P erll!r A
PKQ
�,REM 0
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BY:
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STRUCTURAL DESIGN
BY:
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VALUATION
$
r
i
r
0
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSCOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
B& DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
QONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)( 5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire Inspection
Receipt #
EDMOND S , 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
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 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 STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
APPLICATION APPROVAL
This app.jication is note permit until signed,by the
Building Official or his/her Depuf�: and Fees are paid and
IN VIOLATION OF THE LABOR CODE OF THE ATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided,
WORKMEN'S COMPENSATION INSURANCE AND P.7W 18:27.
OFFICIALS SIGNATURE DATE
(425) �J�s
S jgF0S4"NF.Ft A DATE IGNED
t9T G'
= I �,. 14 -7—� 771-0220 RELEASED BY E
ATTENTION,"' _/ EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI.
IG)IAL - —FILE UY 'LLOJ - INSJCTOR
N
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. �O)FIN - OWNER OLD -ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
4, . 4 'r
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
M5
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING, ........................
FIRST FLOOR FRAMING ...
INsuLAT!ON ....................
Floor Insulation .........
Wall Insulation ...........
Celling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
"V;'
PERMIT EXPIRES
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION.
OWNER NAME/NAME OF BUSINESS
�Z�Nrly 01W n4ty 1TU4W'51--f_1
MAILINGADDRESS
615 5—r
CITY ZIP TELEPHONE
NAME
NAME
lam
ADDRESS
CITY
41vf P
ZTY TAX ACCC
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF
NUMBER
OF
STORIES
TELEPHONE
ZIP TELEPHONE
�J,g APZ�
3ER EXPIRATI57
10911) - .. /Al
LINT PARCEL NO
I
1:1 RESIDENTIAL
1:1 PLUMBING / MECH
COMMERCIAL
COMPLIANCE OR
1:1
CHANGE OF USE
MIXED USE
MULTIFAMILY
1:1
SIGN
GRADING
13
FENCE
CYOS
( X_
TANK
OTHER ,
RETAINING WALL
FIRE SPRINKLER
ROCKERY
f4ft0"tAfbV_
IESS.OWAC�IVI'Fr) EXPLAIN:
NUMBER OF
DWELLING
PERMIT
NUMBER 22225
JOB
ITEJAPTI
ADDRESS
PLAT NAME/SUBDIVISION NO.
OT NO.
-LID NO.
-,LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP-
TESCP Approved
RW Pomil Required
Street Use Ponnit Required
Ell
EXISTING PROPOSED
Inspection Required
13
Sidewalk Required
[3
REQUIRED DEDICATION FT
Underground
13
Wiring required
13
METER SIZE
LINE SIZE
ES
PRV REO
YESO
REMARKS
LU
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
0
z
ENGINEERING REVIEWED BY DATE
F I R E R E V IE V
FIRE REVIEWED BY DATE LU
Ir
r y—
BY
VA R I NC
VARIANCE OR CU
A I
SHORELINE OR ADB11
INSPECTION
SEPA
REQ'D
I
COMPLETED I EXEMPT
E3 YES 13 N 01
A
CA#
C
ZONE
SIGN AREA
HEIGHT
W A IV
WAIVER 13
E R
ALLOWED PROPOSED
ALLOWED PROPOSED
S T U D Y
STUDY
LOT COVERAGE
tREMARKS
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
z
y
PARKING
LOTAREA
Z
PLANNING REVIEWED BY DATE
REQ'D PROVIDED
I
FT.)
M S
UNITS / 117 "�
TYPE OF CONSTRUCTION CODE CM
L=�j:
G
OR /154
SPECIAL INSPECTION CONSULTANT OECL
REQUIRED 13YES I LOAD
�7 A �w 1/71 /1 _7�7_ "VC I &-P
GEOTECH REPORT
BY:
7"
STRUCTURAL DESIGN
BY:
MW MW own a
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO-
7
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
2— DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
i
Grading
t: SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
CL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
Lu
_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
x
Fire Inspection
Receipt #
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
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ TIfIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRO"I
GIVEN IS CORRECT, AND THAT I AM THE OW14ER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This applicatiog,is not a permit until,signed by the
- % -
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or H&her Deputy: and F ass are paid,'and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space.provided,
WORKMEN'S COMPENSATIOWSURANCE AND RCW 18:27.
OFFICIALS SIGNATURE
SIGNATWE. (OWNER OR DATE SIGNED
(425)
DAE
51-1W
771-0220
t63/__0_S'_
gaaia�
RELE DATI
ATTENTION
EXT. 1333
q
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
o
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.
RIGINAL F E - YELLOW - INSPECTOR
I
�W)N
PI`NK - R GOLD - ASSESSOR
10104 PR;:.qq waRn . YnIll I ARI= MAKIMr. A, rnpum
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
root.,
'DATE RECEIVED
EXPIRES
CITY OF EDMONDS
NLUIMBIER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAP #
ADDRESS
OWNER NAME/NAME OF BUSINESS
e
PLAT NAME/SUBDIVISION NO.—
COT NO, LID
NO.
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MAIkING ADDRESS
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Approved iff,
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Required a
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NAME
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t/ escription
FEE
Description
FEE
1; Plan Check 7;
State Surcharge
6V
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK0.
5-
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
a
Engr. Review
0:
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
IL
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
05
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
X
x
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
.(
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt, Due
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPR6vAL
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.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or his/her Depu!y: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
O=F
fl�l 0- NAT7UF DATE
s ROR
DATE SIGNED
(425)
L
771-0220
tff _/1
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T
AT TION
EXT. 1333
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4)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
it 1&��
A FINAL INSPECTI.ON HAS BEEN MADE AND APPROVAL OR A CERTI.
�INSPJTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 / IRC1110.
ORIGINAL -FILE YELLOW
PINK -OWNER GOLD - ASSESSOR
10104
PRESS HARD - YOU ARE MAKING 4 COPIES
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
.Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. r
9
FINR PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLEASESIGN
PROJECT
SITE ADDRESS C91 r C, L(!�FAV-
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PLANNING DIVISION DATE
-
,DATE INSPECTED 1,2 — &
DESCRIPTION OF WORK TO BE INSPECTED EE P,-C Loq t i,_, �—_ C-if t2—
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1: temp: bldg: forms: ocaprvl 3/25/04
ATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
OSE PERMIT
ZONE NUMBERCQ9,5_-� 5,�)'
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNE�R�ME/NAME OF BUSINESS
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CITY ZIP
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VALLIATION $
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building
PLM CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
OF DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
Recording Fee
3
SEPAR ATE PERMISSION.
I 1
Engr. Review
City Surcharge
PERMITAPPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCbESORS
T . raffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND*AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS.OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR. DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
S_/V
FROM THE ISSUANCE OF THIS PERMIT. ISSUA14CE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fi . re Inspection
TbtalArnountDue lop-
0 NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I
Landscapelnsp.
Receipt #
I HEREBY ACK14OWLEDGE THAT -I HAVE REAP THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT� AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY.WITH C17Y AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON -WILL BE EMPLOYED'
CALL
This application Is not a permit until signed by the
.
IN VIOLAT!ON OF THE DEOF THE STATE* OF WASHINGTON RELAT ING TO
F . 0 . R INS PECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt 16 acknowledged In space provided.
WORKMENS.COMPEN * I RANCE AND RCW 18.27.
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SIGN4ATURE (OA"ER OR DATE SIG ED
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BY DATE
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771-0221
k /
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE - YELLOW-INSPE OR
PINK - OWNER - GOLD - ASSESS R
10/01
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test . ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
FINAI PROJECT APPROVAL FIRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
'LEASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT CC�- E
SITE ADDRESS (0
PERMIT #,QLQ Y—ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
V GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
I .
2.
3.
RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten-ip:b1dg:fonns:ocaprv1 3/25/04
IL
ATE RECi1VED
w'.
F�"�FP
ERMIT EXP IRES
CITY OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITE/APT#
.
ADDRESS
0 WNER NAMEINAME OF BUSINESS
4LOT
COMMOA117-Y CHRISTIAM F64 LOW'S Allf / #4
PLAT NAME/SUBDIVISION NC
NO LID
NO.
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u
LID
FEE $
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ADDRKS--
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CITY ZIP
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NAME
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0
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STRUCTURAL DESIGN 11111110'
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VALUATION
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Description
FEE..
Description
FEE
,SO_Z A77-,71CH60 t4a7r-S 4(_4A1
Plan Check
State
Surcharge
SOURCE
LOTSLOPE%
VESTED DATE
City
Surcharge
Building Permit
HECK NO:
Plumbing
Base
Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
2
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT'. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
u,
Fire Review
Plan
Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt
#
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
-76
a DEEMED TO MODIFY, WAIVE O.F(REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
Total
Amt. Due
.j
0 NOR LIMIT IN ANY WAY THECITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt#
2
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. TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building
Official or his/her Deputy: and Fees are bala, and
DIAGREE
TION;ANDIN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSAT5�NCE AND RCW 18:27.
OF5C4IA1t"IGNA DATE
SIGNATURE (OW` 0 Gj��
Df!,j.1fiNEP,
(425)
771-0220
-
5ELEAS
ED BY, DATE
h
ATTE TI ON
EXT. 11333,,;
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND AOPROVAL OR A CgRTI.,
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1.10.) ' IRC110.*
ORIGINAL -FILE - YELLOW -114SPEITOR
PINK -OWNER - GOLD - ASSESSOR
10104 PRF.q.q 114ARn Y011 ARE MAKING 4 COPIES
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
,Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .... ............
FIRST FLOOR..FRAMING..
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
.JOr
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
b 'TE RECEIVEDj
A
:.PERMIT
EX PIRES 9 4 a
PERMIT
CITY OF EDMONDS
NUMBER
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I
JOB SUITE/APT#
ADDRESS
e4l,�176_
OWNER NAMEjfNAME OF BUSINESP
C-440kY
PLAT NAME/SUBDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
WX
MAI NG ADDRE�S
TESCPApproved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW PannhiR..'cul'ted 13
EXISTING PROPOSED
Street . In Required 0
Inspection Required C1
CITY ZIP
TELEPHONE
q8620
P15-7YY-6460
Sidewalk Required 13
Underground E3
REQUIRED DEDICATION FT I
Winno required
NAME
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Description
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VESTED DATE
7
h�
Building'Permit
City Surcharge
PLAN CHECKNO- oq_
Plumbing
B . ase Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Ix
W
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W
_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
0: Fire Inspection Receipt#
< 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-i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.. '42
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Recording Fee Receipt #
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until.signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPEN�PtIW44NWNCE AND RCW 18:27.
A OFFICIALS SIGNATURE DATE
SIGNAyffi NE DAT:7NED
/3 771-0220
tE,&-AsED DATE
ATYEX;609--_� EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 11214V
A FINAL INSPECTION HAS BEEN MADE AND'APPROVAL OR A CERTI-
E YEL 0 - INSP
ORIGINAL - FIL L W EC OR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 / IRC110.
PINK -OWNER GOLD -ASSESSOR
101" PRESS HARD - YOU ARE MAKING 4 COPIES
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ............
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
ED
..... . ....
[PERMIT
EXPIRES
PERMIT
CITY OF EDP40NDS
NUMBER
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JOB SUITEIAPT#
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Inspection Required
70
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Underground 13
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NAME
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NO. OF FIXTURES
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YES C3 NO C3
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ADDRESS
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Build ing Permit
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Plumbing
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Feti
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
Uj
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U)
-APPL CANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan
Chk. Deposit
W
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
0:
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt
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
LandscapeInsp.
Total
Amt. Due
0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
_;
f
Recording Fee
Receipt
#
2�/) n
I
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application, is not a permit until signed lay the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT1691OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNATURE DATE
(0 =NfA G E ln��
DATE SIGNED
;�(425)
1-It-0220
RELEASED,BY
A
ATTENMON
EXT. 1333'
N
r
IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A
FINAL INSPECTION HAS BEEN MADE �AND APPROVAL OR A CEIRTI-
I L/
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
ORIGINA—QFIE --YELLOW-INSIECTOR
PINK ER - GOLD - ASSESSOR
10104 PDF:.Q-q wAon. vni IiAPP MAWIMr. A rt'%PIPQ
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
3- 63,
.............
_ds—
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
i
150,
LA (r 0�x (
'FEB-09-2005 14:02
r�\ Y/ Eb
CITY OF EDMONDS MAR
SPECIAL INSPECTION AND TESTING AGREEMENT
PERM!T COUNTER
The project at 51,,e- e i issued under building permit
number Oq - (pqS requires special inspection and/or testing per IBC Chapter 17. The
complete list of special inspections is attached to this document.
BEFORE A PERART CAN BE ISSUED: The owner and contractor and special inspector shall complete
this agreement and the attached structural test(s) and inspections schedule including the required
2eknowledgements.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the Building
Official prior to performing any duties or inspections. Each special inspector shall submit Statement of
Qualifications to the Building Official for review. Special inspectors shall display identification When
performing special inspections on site. Special inspection and testing shall meet the minimum requirements
of )BC Chapter 17 and the following:
A. Duties and Responsibilities of the Special InsRector
L Observe Work
The special inspector shall observe the site work for conformance with the approved (stamped) plans
and specifications and applicable workmanship provisions of the 111C. Architect or Engineer
reviewed shop drawings may be used only as an aid to inspection. Special Inspections are to be
performed on a continuous basis —meaning that the special inspector is on site at all times observing
the work requiring special inspection. Periodic inspections, if any, must have prior approval by the
City based on a separate written plan reviewed and approved by the Building Official and the
engineer or architect of record.
2. Report Non -conforming items
The special inspector shall bring non -conforming items to the immediate attention of the contractor
and note all such items In the daily field reporL Any item not resolved in a timely manner shall be
Immediate cause of the special inspector to notify the Building Official of the plan deviation, error,
change or omission. It shall also be the duty of the special inspector to promptly notify the engineer
or architect.
3. Complete Daily Reports
Each special inspector shall complete and sign both the special 'inspection record and the daffy report
form for each day's Inspection. These records shall remain at the Jobsite With the contractor for
review by the City Building Inspector.
4. Furnish Weekly Reports
The special inspector or inspection agency shall furnish the City with weekly reports of tests an d
inspections. The project engineer or architect, and others as designated shall also be copied on
reports. Weekly reports must Include the following:
* Description of daily inspections and tests made with applicable locations
* List of all non -conforming items
0 Report on status of non -conforming items (resolved or unrmlved)
0 Itemized changes authorized by the Architect, Engineer and City if not included in non-
conformance items.
Furnish Final Construction Report
The special inspector or inspection agency shall submit a final signed report to the City stating that
all items requiring special inspection and testing were fulfilled and reported, And, to the best of
L:kTE?AP\BUILDING\SpeciallnspectionAgreement!BC.doc 7/04
FEB-09-2005 14:02 P.03/04
1 0
his/her knowledge the project is in conformance with the approf plans and specifications,
approved change orders and the applicable workmanship provisions of the IBC, Items not in
conformance or unresolved items or any discrepancies in inspection coverage, (Le, missed
inspections, periodic inspection when continuous inspections were required, etc.) shall be specifically
itemized in this report.
B. Contractor Responsibilities
1. Notify the Special Inspector
It is the duty of the contractor to nofiiY the special inspector when work is ready for special
inspection. Note, the items listed on the attached schedule 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.
2. Provide Access to Approved Plans
The contractor is responsible for providing the special Inspector access to approved plans at.the
jobsite.
3. Retain SpecW 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 building inspector upon request.
City of Edmonds Building-PApartment Resl!onsibillties
1. Approve special inspectors or Inspection agencies
The building department shall approve all special inspectors and special inspection requirements.
2. Monitor special inspection and approve weekly reports
Work requiring special inspection and the performance of special inspectors Shan be monitored by
the City Building Inspector. His/Her approval must be obtained prior to placement of concrete or
other similar activities in addition to that of the special inspector.
3. Issue Certificate of.Occupancy
The Building Official may issue a Certificate of Occupancy after all weekly special inspection reports
including the final report have been submitted and accepted.
D. Owner Responsibilities
The project owner or the engineer or architect of record acting as the owner's agent Shan fund
special inspection services.
Eneineer or Architect of Record ResDonsibifities
The engineer or architect of record shall include special inspection reqnirements on the plans and
specifications.
ACKNOWLEDGEMENTS
read and agree to comply with the terms and conditions of this agreement.
Owper.
Date
Special Inspector Date
actor ."0000��
Generial Contr Date 3 (05
City Building OMcial Date
L,\TENT\BUELDINGISP,eciallnspectionAgreementIBC.doe 7/04
FEB-09-2005 14:02
P. 04/04
REWORCM CONCIMM GUf4M GROUT AND moitTAR.-
CMM"ft rmk.
L'.1:4.
OEM
PRMASTWRESTRLSSM CONCREM
Poo ha-Tevs rrt�Tms CUdgc
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MASONRY:
— SPCCW IwPgMw Suctsm Uwd
— hthminwy Acmpu-.c Tests (Mmary Unitg. WWI priss,
— SuWtQum TCM (Mor4w. GrouL fidd W hium)
— N--m bopccbm of Umn
ADD11*10NAL INSTRUCTIONS OR WHER TESTS
ANDINSPECT]ONS:
SULDMFERWNQ
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TE5nooeopIcnw^ovcyetsptcL*Lvapfcmk
STRUCTURAL S I' LJWELDING:
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2" MaaW Idenffiscadoe
4We'&4 lm� O-Sb-p PR.W
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0 A490
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FIREPROOFING:
piaccrom invmim
DensityTem
TkkkneuTem
luqmd Bafewns
INSULATING CONCRE'M-
- S=pk And Tea
— Ph —al Impection
— Unh WcjgW
FILLMATEWAL:
A=cpum Test
nwemem w5wetion
FuM Dcu,*y
STRUCTURAL WOOD:
xskwwaHN,j1wsb"ecws
— baparian of Gkp-im Fik
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TOTAL P.04
PMB A- 116216 9 NE - Lake Stevens, WA 98258
Backflow Assembly Testing and Service (425)334-4507 - Pager: (425)438-5316 Fam—t2t�-134-652
_�b
0 E C 13 Wj5
BACKFLOW PREVENTION ASSEMBLY INSPECTION & TEST REPORT BUILDING DEPT.
PURVEYORID# NEW EXISTING Cj REPLACEMENT [:]
NAME OF PREMISE � P COMM.'M RES. El
SERV. ADDRESS — \D 1�r �x "xo C IT �: 4;;� o �Y\ -1 Z I P: "A V t '%- 0
CONT. PERSON
OWNER / PM
PH:
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LOC. OF ASSEMBLY 'S - \N \ �� % y N�'k- "e 0 k V\ u W\.z' V\�
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ASSEMBLY N w,9�_ 5 — -,). % t cj �) — �) 1 -1 �'f Li LAS 4 4
MANUFACTURER MODEL SIZE SERIAL NO.
USC Approval: �Q Currently Approved Not Currently, But Was Approved When Installed Never Approved
LINE PRESSURE AT TIME OF TEST_ PSI NO. OFASSEMBLIES THIS LOCATION
Initial
DCVA I RPHA
DCVA/RPBA
RM
PVBAISVBA
Test
Check Valve No. I
Check Valve No. 2
Relief Valve
Air Inlet
Passed
Leaked ................................
Leaked ....................................
Opened at
PSID
Opened at
PSID
Failed
Closed,rjght ...........................
Closed Tight ...........................
R
#1 Check
PSID
Did Not Open . .......................
PSID
PSID
Air Gap OK?
Check Valve
Held at
PSID
New Parts
and Repairs
Cleaned
Cleaned
Cleaned
Leaked ....................................
Cleaned
E] Repaired
Repaired
E] Repaired
E] Repaired
Fit #
Test After
Repairs
Closed Tight ...........................
Closed Tight ...........................
C]
Opened at
PSID
Air Inlet
PSID
Passed
PSID
PSID
#1 Check
PSID
Check Valve
PSID
Failed
AIR GAP INSPECTION: Required minimum air gap separation provided? [] YES [] NO
F/S: T/A:"2 YES E] NO MONITOR PH: ACCT. #:
CONFINED SPACE: YES rZ NO CONFINED SPACE PROCEDURES: E] YES (] NO
F/S RESTORED: TIME: —OAMOPM DATE:
METER NO.: 4%j �o METER READING:
REMARKS:
PRINT NAMI - EWLS YOU that I used WAC 246-290-490 approved test methods and differential pressure test equipment.
(I certify
TESTED BY: CERT NO. B-3497 DATE: 0--1 3 -04
SICNAIVRV
CL: AACRABA99ODM SPC: PL30YOUNGLW983PT
�n L" , 0 1
KIT MAKE: %^r) -.4,4'k As MODEL: 'A S SN:. k3 1� CAL.DATE:
REPORT TO: _3 �S In -, -i' � -L- FAX:
REPORT RECEIVED BY:
WIIITL-PURVEYOR YELLOW -OFFICE PINK -CUSTOMER
SERV. RESTORED N YES (] NO
PMB A- 11621 SR 9 NE - Lake?Stemns-, f� V825h
Backflow Assembly Testing and Service (425) 334-4507 - Pager: (425) 438-53W��P&: 425) 3311-6526
DEC 13 ZS55
BACKFLOW PREVENTION ASSEMBLY INSPECTION & TESTREP&JLDING DEPT.
PURVEYORID#
NAMEOFPREMISE Qo�,y"yr,\^Y6
SERV. ADDRESS \1\5
NEW t4 EXISTING [] REPLACEMENT [)
f COMM. RES. E]
CITY:V7:-�w\m�j ZIP:
CONT. PERSON PH: FAX:
OWNER / PM
MAIL. ADDRESS CITY: ZIP:
CONT. PERSON PH: FAX:
LOC.OFASSEMBLY
DOWNSTREAM PROCESS
E] RPBA Q DCVA PVBA tKDCDA C] SVBA PROP. INSTA: 5QYES El NO
ASSEMBLY M vy\s-. S 3 0 �) C) '5.�; q. 0 P1 I %j 3 1z' b V 0 � 0 'S
MANUFACTURER MODEL SIZE SERIAL NO.
USC Approval: q Currently Approved [] Not Currently, But Was Approved When Installed 0 Never Approved
LINE PRESSURE AT TIME OF TEST_L�L �_)PSI NO. OF ASSEMBLIES THIS LOCATION
Initial
DCVA/RPBA
DCVA / RPBA
RPBA
PVBAISVBA
Test
Check Valve No. I
Check Valve No. 2
Relief Valve
Air Inlet
Passed
Failed
Leaked ....................................
Closed right
0
tH
Leaked ....................................
Closed Tight
9
Opened at
PSID
Opened at PSID
...........................
...........................
01 Check
PSID
Did Not Open .........................
0
PSID
PSID
Check Valve
Air Gap OK?
Held at PSID
Leaked ............. . ..................... 0
New Parts
and Repairs
Cleaned
Cleaned
Cleaned
C] Cleaned
Repaired
Repaired
Repaired
Kit #
E] Repaired
Test After
Repairs
Closed Tight ...........................
0
Closed Tight ...........................
0
Opened at
PSID
Air Inlet
PSID
Passed 0
PSID
PSID
#1 Check
PSID
Check Valve
PSID
Failed 0
AIR GAP INSPECTION: Required minimum air gap separation provided? El YES [] NO
F/S: T/A: N YES E] NO MONITOR PH: ACCT. #:
CONFINED SPACE: [] YES�k NO CONFINED SPACE PROCEDURES: E] YES [] NO
F/S RESTORED: TIME: []AMt&PMDATE:
METER NO.: METER READING:
REMARKS:
PRINT NAMk-�.LEWIS W. YOUNG I certify that I used �VAC 246-290-490 approved test methods and differential pressure test equipment.
TESTED BY- \K'r-'4 CERT NO. B-3497 DATE:
SIGNATIJI&
CL: AACRABA990DM SPC: PL30YOUNGLW983PT
I -
KIT MAKE: \N_1 \ � VA MODEL: S N! Z -, S t 'i CAT_ I)ATF- 0'j-
REPORTTO: FAX:
REPORT RECEIVED BY: SERV. RESTORED qYES E] NO
WFIITL -PURVEYOR YELLOW -OFFICE PINK-CUSTONIER
0 9
1. Mark D'Amato - Guy A. Conversano
DCI-ENGINEERS Elizabeth A Jensen - Roger I I leeringa - Alarle D Aden
Hanry Jones 11 - Troy E. Bean - Tom C. Xia, Ph.D.
D'AMATO CONVERSANO INC. Richard L. fleminen - Grant C. Buckingham
November 30, 2005 DO Job #04-11-311
Bart Shorack DEC - 8 2005
Broweleit Peterson Hammer Architects
196624A 76 h Avenue West coumTER
Lynnwood, WA 98036
Re: Community Christian Fellowship, Edmonds, WA
Dear Mr. Shorack:
To the best of our knowledge, based on structural observation site visits and our construction support service
process, the primary structural system for Community Christian Fellowship, Edmonds, WA, appears to be
constructed in general conformance to the approved plans and structural general notes. We are not aware of any
outstanding structural deficiencies.
This letter does not address any other portions of the structure other than those areas mentioned, nor does it provide
any warranty, either expressed or implied for any portion of the structure. It shall be understood that DO Engineers
has not provided inspection of the structure.
If you have any questions, or need any finther assistance give me a call.
Sincerely,
DO Engineers
WA4dZ���
Elizabeth Jensen, P.E., S.E.
Principal
FXPIRE����
10900 NE 4TH STRrE'r, SUITE 1200 * BELLEVUE, WA 98004 0 PHONE (425) 827.2238 * FAX (425) 827.8986
BELLEVUE SPOKANE EvERETT PORTLAND SAN DIEGO
"KrazaaAssociates, Inc.
GEOTECHNIcAL ENGINEERING - ENVIRONMENTAL ENGINEERING
DATE:
PROJECT #:
PROJECT.
LOCATION:
CONSTRUCTION TESTING AND INSPECTION
- Y--� -0.
KRAZAN PROJECT MANAGER:
CONTRACTOR:
JURISDICTION:
PERMIT #:
INSPECTOR:
WEATHER:
01ELD REPORT NO: 58798/
0 C I - 3 2005
To the best of my kno\AAedge, the abq e =WAS WAS NOT performed in accordance with the approved plans, speci aflons, and regulatory requirements.
7
Superintendent/Representative: Technician:
t' ---- I- -
215 West Dakota Ave., Clovis, CA 93612 (559) 348-2200 4221 Brickell St., Ontario, CA 91761 (909) 974-4400
2205 Coy Ave., Bakerskeld, CA 93307 0 (661) 837-9200 1501 - ly St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, CA 95351 (2091572-2200. 2071,d State Hwy 305 NE Suite 3C, Pbulsbo, WA 98370 (360) 598-2126
545 Parrott St., San Jose, CA 95112 (408) 271-2200 19501-144Ave. NE 0-300, Woodinville, WA 98072 0 (425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652 (916) 56.4-2200 Revision 0
Effective Date: &/16/02
The inforrnation provided on this report is prepared for the exclusive use ofthe client. This report may not be reproduced in any fornuit without the written peffnission ofthe client and Krazan & Associates.
A
)Krazan & Associates, Inc.
i
Project No. 096-05167 CV. Code 20095 Pour Date 8/27 5 Report No. 09 to
Weather Sunny Jurisdiction City of Edmonds Permit No.
Project Community Christian Church Fellowship Engineer
Location 615 Glen Architect BPH Architects
client Community Christian Church Fellowsh Contractor Ryan General Contracting
19501 - 144th Avenue NE #F-3(
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No.
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F)
2:15
11 8001396 4.5 6.5
80
79
Placement Area
Location Handicap ramp walls.
Remarks Please refer to Field Report No. 52127.
Concrete placed by pump and mechanically consolidated
WA 98072, (425) 485-551 V/
[Re —ported Batch Data
Design
Weights
Mix No. 134901 B
Cem. lbs.
F. Ash lbs.
C. agg. lbs. 1
C. agg. lbs. 2
C. agg. lbs. 3
Sand lbs.
Water lbs.
Air Ent. (oz)
WRA (oz)
Glen (oz)
HRWRA (oz)
Other(oz)
Water Added on Job (gal
Actual
Weights
134901 B
562
1244
1727
34 gal
3.4
33.9
34
Field Test Methods
ASTM C143 ASTM C1 38
ASTM C1064 ASTM C1 73
ASTM C31 Other
inspector Chris Allbee
Laboratory Data Design Strength 3,000 @ 28 days Date Specimens Rec'd. 8/26/05
Cyl.
Test
Field
Code
Date
Cure Age
Dim.
Area
C.F.
20095-1
9/1/05
7
3.995
12.54
1.0
20095-2
9/22/05
28
3.995
12.53
1.0
20095-3
9/22/05
28
3.995
12.53
1.0
20095-4
H
20095-5
20095-6
20095-7
20095-8
Max.
Comp.
Tested
Load
Str. (psi)
Set#
By
44450
3,540
1
Cm
54810
4,370
1
Cm
61280
4,890
1
Cm
I
B MID
ING
OCT
- 3
2005
Break
Type
2
Laboratory
Test Methods
X ASTM C39
3
ASTM C109
3
ASTM C617
X ASTM C1231
ASTM C780
Other
Test Results
Remarks A Conforming
Results Reviewed By Date Reviewed Non -Conforming
Codes for Break Types: 1: Cone 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
. Measurement Uncertainties: ASTM C-39 +/- 8%
Form 03101
Revision 2
Effective Date 12102102
The Information provided on this report is prepared for the exclusive use of the client. This report may not be reproduced in any format without Me written permission of the client and Krazan & Aussoctates.
rA
Krazan & Associates, Inc. Awls, 19501 - 144th Avenue NE #F-300, Woodinville, WA 98072, (425) 485-5519
Project No. 096-05167 WCode 20021 Pour Date 8/1W5 Report No. 13628
Weather Sunny Jurisdiction City of Edmonds Permit No.
Project Community Christian Church Fellowship Engineer
Location 615 Glen Architect BPH Architects
Client Community Christian Church Fellowsh Contractor Ryan General Contracting
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No. 1800
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F) (Pcf)
1:10
5341 21840795 4
69
65
Placement Area
Location Handicap ramp footings at line 1.
Remarks Please refer to Field Report No. 57799.
Concrete placed by chute and mechanically consolidated.
Batch Data
Design
Weights
Mix No.
1337673
Cem. lbs.
376
F. Ash lbs.
94
C. agg. lbs. 1
(#57) 1620
C. agg. lbs. 2
(#8) 204
C. agg. lbs. 3
Sand lbs.
1598
Water lbs.
244
Air Ent. (oz)
WRA (oz)
22.5
Glen (oz)
HRWRA (oz)
Other(oz)
Water Added on Job (gals,
Actual
W eights
1337673
374
94
1589
194
1480
223
22.5
5
Field Test Methods
ASTM C143 ASTM C138
ASTM C1064 ASTM C173
ASTM C31 Other
inspector Tuyen Tran
Laboratory Data Design Strength 3,000 @ 28 days Date Specimens Rec'd. 8/19/05
Cyl.
Test
Field
Max.
Comp.
Tested Break
Code
Date
Cure Age Dim.
Area
C.F. Load
Str. (psi)
Set# By
Type
0.994
12-:53
-.0 6990-2-,950
_GM
3-
20021-2
9/15/05
28 3.995
12.54
1.0 53840
4,290
1 Cm
2
20021-3
9/15/05
28 3.995
12.54
1.0 56220
4,480
1 Cm
2
20021-4
H
1
20021-5
20021-6
20021-7
20021-8
Remarks
Results Reviewed By
1P,,A40,-4
Date
Reviewed
7-2,0 -6��
Laboratory
Test Methods
-X—ASTM-C-39
ASTM C109
ASTM C617
X ASTM C1231
ASTM C780
Other
Test Results
X Conforming
Non -Conforming
Codes for Break Types: 1: Co e 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
Form 03 1 01
Revision 2
Effective Date 121=02
The Inforntation provided on this report Is prepared for the exclusive use of the client. This report May wt be reproduced In any fomat %vithout the written pemission of the client and Krum & Associates.
�A<raZan Alssociates, Inc
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: -21<70-5 CONTRAC
PROJECT #: JURISDIC-I
PROJECT: -Fb.M&N M �A- k tbs' PERMIT #:
LOCATION: i�, L5 INSPECTO
KRAZAN PROJECT MANAGER:
WEATHER
OELD REPORT NO: 57710
To the best of my knoWedge, the abe� WAS NOT performed in accordance with the approved plans, s cifications, and re tory requirements.
Superintendent/Representafive: Technician:
215 West Dakota Ave., Clovis, CA 93612 0 (559) 34-2200 4221 Brickell St., Ontario, CA 91761 100— (909) 974-4"
2205 Goy Ave., Bakersheld, CA 93307 0 (661) 837-9200 1501 - 1Y St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, CA 95351 0 (209) 572-2200 20714 State Hwy 305 NE Suite 3C, Poulsbo, WA �� (360) 598-2126
545 Parrott St., San Jose, CA 95112 0 (408) 271-2200 19501-144' Ave. NE #F-300, Woodinville, WA 98072 (425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652 a (916) 564-2200 Revision 0
Effective Date: a/ 16102
The inforination provided on this report is prepared for the exclusive use of the client, This report my not be reproduced in my forinat without the written pennission ofthe client and Krazan & Associates.
"I
NN KraZan & Associates, Inc.
WEL*G
REPORT NO.: 3188
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRucTION TESTING AND INSPECTION
DATE: 7-24-05
PROJECTA- C)q C--),51
mrkhott'l
PROJECT. /I T ILitl f) CMA. C
LOCATION: 9 1.5 Gu--A -(:�T-
KRAZAN PROJECT MANAGER:
CONTRACTOR:
PERMIT NO: 1 0 PIT%
INSPECTOR- KEwt4 �Iii&'
JURISDICTION: F- () M o N D.5
WEATHER: TEMP:
VFIELID 0. SHOP WELDING 0 M.T [I P.T.
item(s) inspected:
k' Position:
WProcess:
'Weld Type:
Weld Size
k1codes:
=ER I T:C�
HORIZONTAL
OVERHEAD
FCAW
GMAW
SAW
C.R
P.P.
PLUG
Ila
5/16"
3/8"
AISC
TITLE 21
TITLE 24
10-T.
Filler Metal:
0 Other:
El Other
0 Other:
UBC ASME
To the best of m.y knowledge, the aboi�
WAS NOT performed in accordance with the approved plans, s cifica * ns, and re
ory requirements.
Superintendent/Representative:
Technician:
4221 Brickell St., Ontario, CA 91761
(909) 974-4400
215 West Dakota Ave., Clovis, CA 93612
1559) 348-2200
2205 Coy Ave., Bakersheld, CA 93307
(661) 837-9200
1501 - 1Y St. NW Suite 106, Auburn, WA 98002
(253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, CA 95351
(209) 572-2200
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370
(360) 598-2126
545 Parrott St., San Jose, CA 95112
(408) 271-2200
19501-140 Ave. NE #F-300, Woodinville, WA 98072
(425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652
(916) 564-2200
'M 2 IELD REPORT NO: 57.7
,am 0
0
'":'�KraZan Associates, Inc.
GEOTECHNicAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: 7-7y-4-5- CONTRACTOR: la,14/
PROJECT #: 011,76 -CZ-16 JURISDICTION:
PROJECT- COW&W,"IXne C42rnAl cAfi&ll PERMIT#:
LOCATION: 61-5- Qu7il Jr INSPECTOR: ave
KRAZAN PROJECT MANAGER: WEATHER: -r-Z. Y TEMP:
P-10 Ww"r"Er';
MMaF-,?0�,1M
WMWAII,!WA�N
Fo%�
M0
53
pi -W,7mfflj M-1 F OW
E14' F0 I
Agr
To the best of my knoWedge, the above e/ WAS NOT performed in accordance with the approved plans, specifl)Vons, and regulatory requirements.
Superintendent/Representafive:
215 West Dakota Ave., Clovis, CA 93612 (559) 348-2200
2205 Coy Ave.' Bakersfield, CA 93307 (661) 837-9200
1025 Lone Palm Ave. #2E, Modesto, CA 95351 (209) 572-2200
545 Parrott St., San Jose, CA 95112 (408) 271-2200
5808 Price Ave. Bld- 10 16 Mrl-11— C4 95652 19161564-2200
Technician:
ce z
4221 Brickell St., (6iritaria, cA 9 176 11 (909) 974-4"
1501 - 1 Y St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 0 (360) 598-2126
19501-140 Ave. NE 0-300, Woodinville, WA 98072 (425) 485-5519
Revision 0
Effective Date: 8/16/02
The infortnation provided on this report is prepared for the exclusive use of the client. This report my not be reproduced in any formt without the written perTnission ofthe client and Krazan & Associates.
--`;--mKrazan8, Associates, Inc.
GEOTECHNICAL ENGINEERING 9 ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: -�L t(-.) CONTRACT(
PROJECTt. C )Wr (1t) 164- PERMIT NO:
ni A ^ f4k ST I INSPECTOR
PROJECT. 34 11 '1�
LOCATION: ?!� 1, � (pLaXA� 3T" JURISDICTIC
KRAZAN PROJECT MANAOER: kA WEATHER:
WELOOG
REPORTNO 2882
�� FIELD 13. SHOP WELDING 0 M.T 0 P.T 0 V.T
item(s) inspected:
Position:
FLAT
Process:
SMAW
E) Weld Type:
FILLET
0 Weld Size
3/16"
C1 Codes:
AWS
Wm�%O
—k( 11 .
VERITCAL
HORIZONTAL
OVERHEAD
FillerMetal:
FCAW
GMAW
SAW
Other:
C.P.
P.P.
PLUG
El
other:
1/4"
5/16"
3/8'
0
Other:
AISC
TITLE 21
TITLE 24
UBC ASME
To the best of m.y knowledge, the abZ e =WAS WAS NOT performed in accordance with the approved pl ificatio regulato�pj requirements
Superintendent/Representative: Technician:
215 West Dakota Ave., Clovis, CA 93612 (559) 348-2200 4221 Brickell St., Ontario, CA 91761 (909) 974-,"00
2205 Coy Ave., Bakersfteld, CA 93307 (661) 837-9200 1501-1Y St. NW Suite 106, Auburn, VVA 980027�Z (253) 939-2500
1025 Lone Palm Ave. #2E. Modesto, CA 95351 (209) 572-2200 20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 (360) 598-2126
545 Porratt St., San Jose, CA 95112 (408) 271-2200 19501-144' Ave. NE #F-300, Woodinville, WA 98072 (425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652 (916) 5"-2200
1""-zWKr;azm As S o c iates. Inc.
401ELD REPORT NO: 55927
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE:
PROJECT #:
PROJECT: CAA&w.117-Y OYA'2�,l C4i4&II
LOCATION: 61-5- 6-ed-j
KRAZAN PROJECT MANAGER:
CONTRACTOR: CeJj�wzxemtoJ
JURISDICTION: * &-Z,^042gS
PERMIT#:
INSPECTOR:
WEATHER: celepeeA;e7— TEMP:
. ZA'�J 'Le-0 OJ 01-9— .71--J
-094)5*221C 2:)Zl-
z.
&xw Z;k',Y4jWee- -r4ekjr A? �)'C' 14T Ife O;e ��CZ:,-r- 1-27V
44e(, J710Z-
ej 1, r r,7.
,0*A0 el
A4X,44J 77
To the best of my knowledge, the above4!9� WAS NOT performed in accordance with the approved plans, specifications,
Superintendent/Representafive:
215 West Dakota Ave., Clovis, CA 93612 (559) 348-2200
2205 Coy Ave., Bakersheld, CA 93307 (661) 837-9200
1025 Lone Palm Ave. #2E, Modesto, CA 95351 (209) 572-2200
545 Parrott St., San Jose, CA 95112 (408) 271-2200
5808 Price Ave 81,4- 10 1 A McClellan CA 95652 191 A) 5"-2200
uIre is
and regulatory req 7 .
TechjQIclan:
,d227 Brickell StAtarici, CA 91761 (909) 974-,"00
1501- 1Y St. NW Suite 106, Auburn, WA 98002 0 (253) 939-2500
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 0 (360) 598-2126
19501-140 Ave. NE #F-300, Woodinville, WA 98072 0 (425) 485-5519
Revision 0
Effective Date: 8/16/02
The infortirmition provided on this report is prepared for the exclusive use ofthe client. This report may not be reproduced in any fornnat without the written perintission ofthe client and Krazan & Associates.
Krazan & Associates, Inc.
19501 - 144th Avenue NE #F-3(
WA 98072, (425) 485-5519
Project No. 096-05167 C_yT. Code 19436 Pour Date 6/14705 Report No. 06627
Weather Clear Jurisdiction City of Edmonds Permit No. BUILDING
Project Community Christian Church Fellowship Engineer JUL 2�P005
Location 615 Glen Architect BPH Architects
Client Community Christian Church Fellowsh contractor Ryan General Contracting
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No. Everett
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F) (Pcf)
9:50
5334 21771214 -- 4
67
57
Placement Area
Location New interior column box footings and running footings in
existing builidng.
Remarks Please refer to Field Report No. 51103.
Reinforcing steel conforms to approved plans.
Concrete placed by buggy and mechanically consolidated.
Reported Batch Data
Design
Actual
Weights
Weights
Mix No.
1336916
Cern. lbs.
513
F. Ash lbs.
C. agg. lbs. 1 (3/4)
1682
C. agg. lbs. 2 (3/8)
204
C. agg. lbs. 3
Sand lbs.
1585
Water lbs.
Air Ent. (oz)
WRA (oz)
20.8
Glen (oz)
1/2 gal
HRWRA (oz)
31.4
Other (oz)
Water Added on Job (gals.)
15
Field Test Methods
ASTM C143 ASTM C138
ASTM C1 064 ASTM C173
ASTM C31 Other
Inspector C. Monaceiii
Laboratory Data Design Strength 3,000 @ 28 days Date Specimens Rec'd. 6/15/05
Cyl. Test Field Max. Comp. Tested Break Laboratory
Code Date Cure Age Dim. Area C.F. Load Str. (psi) Set# By Type Test Methods
19436-1 6/21/05 7 3.990 12.50 1.0 - 66000 5,280 1 cm 3 X ASTM C39
19436-2 7/12/05 28 3.992 12.52 1.0 84330 6,740 1 Cm I ASTM C109
19436-3 7/12/05 28 3.992 12.52 1.0 84640 6,760 1 Cm I ASTM C617
19436-4 H 1 X ASTM C1231
19436-5 ASTM C780
19436-6 Other
19436-7 L
19436-8 Test Results
Remarks X Conforming
Results Reviewed By Date Reviewed Non -Conforming
Codes for Break Types: Con 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
Form03101
Revision 2
Effective Date 12002/02
The information provided an this report is prepared for the axdusive use of the client. This report may not be reproduced In any faffnat without the written peffnission of the client and Kraz2n & Associates.
4 ffi- Krazan &Associates, Inc.
WELMG
REPMT NO.: 2 2 3 0
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE:
PROJECT #:
PROJECT
LOCATION:
KRAZAN PROJECT MANAGER:
CONTRACTOR: . --R�* —C.4�2
PERMIT NO:
INSPECTOR: M:'virk D. L-2)Lvr�t2-
JURISDICTION: 01-Ac tA 04
WEATHER: C—Llu(� TEMP: —+661V
-�eFIIELD 11. SHOP WELDING 11 M.T 11 RT V. T.
item(s) inspected:
Ll ) NIA V-LD
( ti &
'Zzl
L- C-0
C-U t-," ti
�� 0 � F-(caT�o t� Yg- k
C3 Position:
1:29
1�
��
OVERHEAD
)KFiller Metal:
F-1 Process:
SMA
FCAW
GMAW
SAW
Other:
C1 Weld Type:
C.P.
P.P.
PLUG
Other:
El Weld Size
a
5/16"
3/8"
C3 Other:
0 Codes:
4N -" F
AISC
I
TITLE 21
TITLE 24
UBC ASME
�)c� A
4W
b11:5
UZC I
��Z 'Y I C-,-ZK-'
To the best of my knowledge, the abov2FA�S
WAS NOT performed in accordance with t;he approve lans, specificat' ns, and regulatory requirements.
Superintendent/Representative:
Technician:
2 15 West Dakota Ave., Clovis, CA 93612
1559) 348-2200
4221 Brickell St., Ontario, CA 91761 11,
(909) 974-4400
2205 Coy Ave., Bakersfield, CA 93307
(661) 837-9200
1501 - I Y St. NW Suite 106, Auburn, WA 98002
1253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, cA 9535 1
(209) 572-2200
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370
(360) 598-2126
545 Parrott St., Son Jose, CA 95112
(408) 271-2200
19501-144' Ave. NE #F-300, Woodinville, WA 98072
(425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652
1916) 564-2200
Krazan & Associates, Inc.
Project No. 096-05167 'Tyl. Code 20095 Pour Date 8/776/05 Report No. 08975
Weather Sunny Jurisdiction City of Edmonds Permit No.
Project Community Christian Church Fellowship Engineer
Location 615 Glen Architect BPH Architects
client Community Christian Church Fellowsh Contractor Ryan General Contracting
I Field Data CYLINDER REPORT
Concrete X Other
Supplier Rinker Plant No. Site Mix
Mix Air Unit
Slump Temp. Temp. wt.
Time Truck# Ticket # % Air (in.) (F) (F) (pcf)
2:15 11 8001396 4.5 6.5 80 79
Placement Area
Location Handicap ramp walls.
Remarks Please refer to Field Report No. 52127.
Concrete placed by pump and mechanically consolidated
inspector Chris Allbee
Laboratory Data
Cyl.
Test
Code
Date
20095-1
9/1/05
20095-2
9/22/05
20095-3
9/22/05
20095-4
20095-5
20095-6
20095-7
20095-8
Remarks
Results Reviewed By
19501 - 144th Avenue -2M- Woodinville, WA 98072, (425) 485-5519
I Reported Batch Data
Design
Actual
Weights
Weights
Mix No. 134901 B
134901 B
Cem. lbs.
562
F. Ash lbs.
C. agg. lbs. 1
1244
C. agg. lbs. 2
C. agg. lbs. 3
Sand lbs.
1727
Water lbs.
34 gal
Air Ent. (oz)
3.4
WRA (oz)
33.9
Glen (oz)
HRWRA (oz)
Other(oz)
Water Added on Job (gals.)
34
Field Test Methods
ASTM C143 ASTM C1 38
ASTM C1 064 ASTM C1 73
ASTM C31 Other
Design Strength 3,000 @ 28 days Date Specimens Rec'd. 8/26/05
Field
Max. Comp.
Tested Break Laboratory
Cure Age
Dim. Area C.F. Load Str. (psi) Set#
By Type Test Methods
7
3.995 12.54 1.0 44450 3,540 1
Cm 2 X ASTM C39
28
1
ASTM C 109
28
1
ASTM C617
H
1
X ASTM C1231
BU110ING
ASTM C780
SEP 15 2005
Other
Test Results
Conforming
Date Reviewed Non -Conforming
Codes for Break Types: 1: Cone 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
191-111"Itt'-_1
Form 03 1 01
Revision 2
EffedWe Date 12102102
The Information proWded on this report is prepared for the exclutiNe use of the client. This report may riot be reproduced In any fornvat wftut the written permission of the client and Krazan & Asvwcfates.
"d =Krazan Associates, I n c
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
.01ELD REPORT NO
DATE: S./26-/615- CONTRACTOR: -42VAQ
PROJECT#: 00 f, - n-ir 14:i7 JURISDICTION: C—I�i O'V46
PROJECT- C- OAJ, -re C-HP-15'—,zAAJ
LOCATION: r= Q.,i--\,oAjj0f2
KRAZAN PROJECT MANAGER:
PERMIT #: Zoo
INSPECTOR: C
WEATHER: TEMP: -7ef -
f i "I M r. M-
B U 110 1 N 0
SEP
To the best of my knoWedge, the abovQ�� WAS NOT performed in accordance with the approved plans, specifications, and regulatory requirements.
Superintendent/Representafive:
215 Welt Dakota Ave., Clovis, CA 93612
(559) 348-2200
2205 Coy Ave., Bakerfield, CA 93307
0 (661) 837-9200
1025 Lope Palm Ave. #2E, Modesto, CA 95351
(209) 572-2200
545 Parrott St., Son Jose, CA 95112
(408) 271-2200
AO 0— A D in? r�� cictc')
01A
Technicign:
422Wrickell St., O*rio--CA 91761 (909) 974-4400
1501 - I Y St. NW Suite 106, Aubum, WA 98002 0 (253) 939-2500
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 (3601598-2126
19501-144* Ave. NE 0-300, Woodinville, WA 98072 (425) 485-5519
Va. IOU. -1 n, Revision 0
Effective Date: 8116/02
The inforniation provided on this report is prepared for the exclusive use ofthe client. This report may not be reproduced in any forniat �ithout the ntten per�rntssion ofthc client and Krazan & Associates.
Krazan & Associates, Inc.
19501 - 144th Avenue NE #F-3g& Woodinville, WA 98072, (425) 485-5519
Project No. 096-05167 V. Code 20021 Pour Date 8/W5 Report No. 13628
Weather Sunny Jurisdiction City of Edmonds Permit No. V/
Project Community Christian Church Fellowship Engineer
Location 615 Glen Architect BPH Architects
client Community Christian Church Fellowsh Contractor Ryan General Contracting
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No. 1800
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F) (Pcf)
1:10
5341 21840795 4
69
65
Placement Area
Location Handicap ramp footings at line 1.
Remarks Please refer to Field Report No. 57799.
Concrete placed by chute and mechanically consolidated.
Inspector Tuyen Tran
I Reported Batch Data
Design
Weights
Mix No.
1337673
Cem. lbs.
376
F. Ash lbs.
94
C. agg. lbs. 1
(#57) 1620
C. agg. lbs. 2
(#8) 204
C. agg. lbs. 3
Sand lbs.
1598
Water lbs.
244
Air Ent. (oz)
WRA (oz)
22.5
Glen (oz)
HRWRA (oz)
Other(oz)
Water Added on Job (gals
Actual
Weights
1337673
374
94
1589
194
1480
223
22.5
8
Field Test Methods
ASTM C143 ASTM C1 38
ASTM C1064 ASTM C1 73
ASTM C31 Other
Laboratory Data Design Strength 3,000 @ 28 days Date Specimens Rec'd. 8/19/05
Cyl. Test Field Max. Comp. Tested Break Laboratory
Code Date Cure Age Dim. Area C.F. Load S tr. (psi) Set# By Type Test Methods
20021-1 8/25105 7 3.994 12.53 1.0 36990 2,950 1 Cm 3 X ASTM C39
20021-2 9/15/05 28 1 ASTM C109
20021-3 9/15/05 28 1 ASTM C617
20021-4 H 8 U 111) 1 N 6 X ASTM C1231
20021-5 SEP — 9 2005 ASTM C780
20021-6 Other
20021-7
20021.-8 Test Results
Remarks Conforming
Results Reviewe d By A 6-�4 Date Reviewed .1 Non -Conforming
Codes for Break Types: 1. C he 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
Form 03101
Revision 2
Effective Date 12102/02
The Information provided on this report is prepared for the exclusive use of the client. This report may not be reproduced in any formal wthout the wntten permission of the client and Krazan & Associates.
Krazan & Associates, Inc.
19501 - 144th Avenue NE #F-:
Woodinville, WA 98072,(425) 485-5519
Project No. 096-05167 Code 19835 Pour Date 71M05 Report No. 06570
Weather Sunny Jurisdiction City of Edmonds Permit No. IV/
Project Community Christian Church Fellowship Engineer
Location 615 Glen Archi tect BPH Architects
Client Community Christian Church Fellowsh Contractor Ryan General Contracting
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No. 1800
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F) (Pcf)
12:37
.5337 21820233 3.5
78
73
Placement Area
Location HVAC slab on roof at grids 7.5-8.9/B-C.
Remarks Please refer to Field RePlort No. 57702.
6 cy load.
Inspector Doug Kostal
Reported Batch Data
Design
Actual
Weights
Weights
Mix No.
1188244
1188244
Cem. lbs.
3102
3080
F. Ash lbs.
C. agg. lbs. 1
(#8) 9551
9380
C. agg. lbs. 2
C. agg. lbs. 3
Sand lbs.
10073
10080
Water lbs.
968
985
Air Ent. (oz)
WRA (oz)
186
188
Glen (oz)
H RWRA (oz)
Other(oz)
Water Added
on Job (gals.)
13
Field Test Methods
ASTM C143 ASTM C138
ASTM C1064 ASTM C173
ASTM C31 Other
Laboratory Data Cesi�in Strength 3,000 @ 2.3 days Cate Specimens Rec'd. 7/30/05
Cyl. Test Field N-11 a x. Comp. Tested Break Laboratory
Code Date Cure Age Dim. Area C.F. Load Str. (psi) Set# By Type Tdst Methods
19835-1 8/5/05 7
-, -1 12.52 1.0 52970 4,230 1 Cm 3 X ASTM C39
19835-2 8/26/05 28 3,999 11 2.56 1.0 66000 5,250 1 BM 3 ASTM C109
19835-3 8/26/05 28 3.999 12.56 1.0 64810 5,160 1 BM 3 ASTM C617
19835-4 H BUftDING X ASTM C1 231
19835-5 ASTM C780
19835-6 SEP 2g05 Other
19835-7.
19835-8 Test Results
Remarks X Conforming
Results Reviewed By Date Reviewed Non -Conforming
Codes for Break Types: 1: Cone 2: Cone & Split 3: Cone & Shear 4: Shear 5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
Fonn 03101
Revision 2
Effective Date 12/02102
The information provided on this report is prepared for the exclusive use of the client. This repon may not be reproduceo in any format witnoot the written permission of the client and Krazan &Associates.
"ki-.4. KraZan Associates, Inc.
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
WIELD REPORT NO: 57799
V-11'
DATE: k- -/j- CONTRACTOR:
PROJECT#: Cni!603262 JURISDICTION:
PROJECT-r-�,�,- PERMIT#:
LOCATION: 61-5- ZF- INSPECTOR: -7—e,�e �-'
KRAZAN PROJECT MANAGER: WEATHER: S;.," TEMP:
a2e'6&"� ez '4'�
V
To the best of my knowledge, the above OAS WAS NOT performed in accordance with the approved plans,
Superintendent/Representafive:
Technician:
and regulatory requirements.
2 15 West Dakota Ave., Clovis, CA 93612
(559) 348-2200
42Vicke1(St., Ontoirio,'CA 9,61
0 (909) 974-4400
2205 Coy Ave., Bakerskeld, C4 93307
(661) 837-9200
1501-15h St. NW Suite 106, Auburn, WA 98002
0 (253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, CA 95351
(209) 572-2200
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370
(360) 598-2126
545 Parrott St., Son Jose, CA 95112
N08) 271-2200
19501-140 Ave. NE 0-300, Woodinville, WA 98072
(425),485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652
(916) 564-2200
Revision 0
The infornnation provided on this report is prepared for the exclusive
Effective Date: 8/16102
me of the client. This report my not be reproduced in my forniat without the written permission ofthe client and Krazan & Associates.
/-,K'razan & Associates, Inc. ANk 19501 -144th Avenue NE #F:a Woodinville, WA 98072, (425)
Project No. 096-05167 T91. Code 19835 Pour Date 7/ff/05 Report No. C
Weather Sunny Jurisdiction City of Edmonds Permit No.
Project Community Christian Church Fellowship Engineer
Location 615 Glen Architect BPH Architects
client Community Christian Church Fellowsh Contractor Ryan General Contracting
Field Data
CYLINDER REPORT
Concrete
X Other
Supplier
Rinker Plant No. 1800
Site Mix
Mix
Air Unit
Slump
Temp.
Temp. wt.
Time
Truck# Ticket # % Air (in.)
(F)
(F) (Pcf)
12:37
5337 21820233 3.5
78
73
Placement Area
Location HVAC slab on roof at grids 7.5-8.9/13-C.
Remarks Please refer to Field Report No. 57702.
6 cy load.
Inspector Doug Kostal
Design
Actua'
Weights
Weights
Mix No.
1188244
1188244
Cem. lbs.
3102
3080
F. Ash lbs.
C. agg. lbs. 1
(#8) 9551
9380
C. agg. lbs. 2
C. agg. lbs. 3
Sand lbs.
10073
10080
Water lbs.
968
985
Air Ent. (oz)
WRA (oz)
186
188
Glen (oz)
HRWRA (oz)
Other(oz)
Water Added
on Job (gals.)
13
Field Test Methods
ASTM C143 ASTM C1 38
ASTM C1064 ASTM C1 73
ASTM C31 Other
Laboratory Data Design Strength 3,000 @ 28 days Date Specimens Rec'd. 7/30/05
Cyl. Test Field Max. Comp. Tested Break Laboratory
Code Date Cure Age Dim. Area C.F. Load Str. (psi) Set# By Type Test Methods
19835-1 8/5/05 7 3.993 12.52 1.0 52970 4,230 1 Cm 3 X ASTM C39
19835-2 8/26/05 28 1 ASTM C109
19835-3 8/26/05 28 1 ASTM C617
19835-4 H 1 X ASTM C1231
19835-5 ASTM C780
19835-6 Other
19835-7
19835-8 Test Results
Remarks Conforming
Results Reviewed By Date Reviewed S-1 0 Non -Conforming
Codes for Break Types: 1: Cone 2: Cone & Split 3: Cone & Shear 4: Shear -5: Columnar (Split)
Measurement Uncertainties: ASTM C-39 +/- 8%
Form 031 01
RevLslon 2
Effective Date 121=02
The InforrnaWn provided on this report is prepared for the eclusive use of the client. This report may not be reproduced in any forntat without the wrttten pemission of the c1lent and Krazan & Associates.
Jul 18 05 08:15a
sent By: UULAINU;
Tb: PSCAA
-A
2 OY) t;
David Draszt 425 778 5954 p.2
2067632879; 12:5tPM; Page III
At: 2060073
'Date Rei:tived
e No. X"AM-AGENCY
I I-Q 500
295 Seudc, WA 98101-2038
2005
Www.pscicanainorg JA �N A
NOnCE OF 24TENT
.4geno We Only
.4ency Me Only
W17 MR Ifin, Ton,
Property Owner: Commuriity ChTistian.Fe3l'awship Phone-. 425-744-0160
Mailing Addmss: 4 10 fourth Ave. Nor6 Cit), Edrri=d. state WA Tip: _ 58020
C. Asbeftos PZZASEPWrCLMLY7X NUMM)AAAMAMMAWAGLA&M
Contractor- CDCS, Inc. Owner/CEO: W. Kirk Baker
Contractor
Mailirm Ad drtm: 12213 51' Place South Phone: (206) 763-5822 lob No.:
City: 'Tukwila Szatm WA I Zip: 98178 Fax.� (M) 763 -2379 105-301
D. Site
Addr=: 615 Men Streer City: F monds Zip: 98020
Nlanhg"- Crai g Hal ternian Local Pho'ne: L425) 486-6668
R. LIL Asbestos Survey or No. of Date of Mbestas
U M2V1 Prmurned Structures: I Surycy. 96102
AHERA Buitding CerfiEcation M
fiwc��tor. Kendra Rob=U @ EKS In( . erns"nal. Exp, Date:
An AHERA. Sarmy Ii.-eqw1rad Wore tdl dgmtilrfion FMIEM
Wai Friable Asbestos Identified? bQYes UNo
Was NcafiriableAsb"tos1d=tMed? RlYes C3No
Attach a copy of the survey whenfnable arbestox
has norbeRn identified.
F. DeM611dibfi Start No. of I.: U. Training Fire CList Fire Dept)
Date: Structures. 2.* U. Ordered-D lition (attach coey of Order
Diernblition Inaffi demalTdam contmetor 'i mailing addmm c)h back Will nonfiiabic asbestos bc-loft-in place during dc=? U Yes U No
Contractior. If yes, list type and qty. Note di-Vosal requirements In Step 6 (on back).
G. Friable Asbestos
P:�djiiet Imformation:
SUM MtC.- IJ26/05
Completion Date: 2/28/05
Work Dnys-. W40 q
Hours: 7:30 AM- 3:30PM'
Will aU fdable.-mbestos
IrA!tLials- be removed?
Usa S,
1Z Yes
No
To W Qty. to be- Rc=ycd: 1850 '. Linear Ft.
12600 Squn=
U aoiletTurnace rnsalstion LJ Duct h=kti.6n bd'Pipe Insulation -
U Fireproofing
U. Paints L , 1, PLaster
LJ Te=red Coafings
Ed CeMtbcBo&rd - U Gw=[ Pipe C3 yriabie madring U F ria—bi r
*"60
JiMad ..
6thrr
_7 &.0
IL AabeslooMftwiltion P-toitctCategarles:
L. SingIL-Fainity Residence (vwuar-aceup(ed): CK. NO
A. U Asbestag Rerwyal Project Only RCp1
l3.U-.Dcmo1ifm E'Toject(with..cwwithmnapbegtcsramvaipm b 7
, I 1p
'(Asbestos r=wval can beizin. uvonmodfiEnfiirnz dernoUtion nmurt wait 10 days
c
LZ
Natifityfii�un?erjtid
*A. PriCT Notice
B. 10 Day3*
Project
Fee
A� S25
B. 350
Dernolld an
SurchLae
Note.- -If-1he jinglefamdy residence Is owned by anefamily -who has been or will be aring the. residence as Asir domicile, the above boxes
1A or Iffmay be checked. 'Tf.tft a not an-ownei-occupW residence, one of Me caregodirs iWedfielow musl be used Instead. A single
fd'�m0vyo.,t1dPnrr dryox tint ime-fuAp
Jul 18 05 08:13a a id Draszt
0
425 778 5954
0
P.1
General Coniractors
FAX TRANSMITTAL
To: MIKE SNOOK
Company: CITY OF EDMONDS
From: D DRASZT
Subject: E.C.C.F
Ryan General Contractors, Inc.
20205 140 Ave. N.E., Suite 201
Woodinville, WA 98072
(425) 488-4489
Fax: (425) 486-2344
web: www.ryangc.com
Date: - July 18,2005
Fax No: (425) 778-5954
Phone No: (206) 356-7920
City: EDMONDS
Number of Pages Transmitted (including cover page): 4
Remarks: El Urgent Z Foryourreview EJ ReplyASAP f-1 PleaseComment
HERE ARE THE FORMS YOU REQUESTED
Signed:
Copies To:
Please caft (425) 488-4489 if all items are not as indicated
Jul 18 05 08:13a
tienc by: LIULAINU;
TO: PSCkA
... A64yVis
2 010t
David Draszt 425 778 5954 p.2
12:bt)VM; Page iii
At: 2060073
AIR AGENCY 'Date Rei:tived
e No. GEr.SOUND-_�
I to Tjri�dn U
0 1295 ScuticWA 981-Ot-ZO38
J A. '%q I "! 2005
www.p3clzanair.org
NOTICE F nq=.
Agency Use only
AS�Mcy U.1c onty
IN.T.M.MM TM 1�901=1 #I MT-11M CTP1117-117=7 M.-UMT17TW-19 CT= PIR I-P-MM �10N' 1=1 - IR MW �'
Property Owner-, Con=miity C*hfisfian'.*Fe1lbw%hip
Phone: 425-74:4-0160
Mailing Address: 4 10 fourth Ave. Nortfi
City: Ednimids
State WA
I Zip: 98020
C. Asbestos PL"SXPX&7C1WLY, DO WU
ContrRetor: CDCS, Inc.
M P01M UTEOWM"WC
OwnerJCEO: W. KirK- Baker
MaffingAddrtw; 12218 51'Maice South
Phoite: (206) 763-5822
Coaftaclor
Job No..
05-301
City. Tt�kwila
Smtc� WA
Zip: 99179
Pax:, (206) 763-2879
D. Site
Address: 615 Glen smeet
—Tcity.-
Edmonds
Zip:
R8020
site
Mamg": Craig Halterman
Local Phone: C425) 486-6668
E. Ed AsiYestas Survey or
C1 Mat'l Prmamed Structu=. I
Date of Asbestos
surycr. 96/02
Was Friable Asbe3tos Identified? EYes UNo
Was NoAfriable Asbestos Identified? ZYes 13N'o
Aftach a copy of the survey whenfrwble asbestos
has not -been identifled.
AHOLA.Building
Impe.ctor. Kendra Roberts @ EHIS Tot&mdonal ,
certificadon M
Exp, Date:
AnAHERA.ILUrmylirreqj4tpvdWotv(dldcwuCtionproje�ii
X D", �blfdlbil Start No. of U. Training Fire (List Firg Dept.)
n(ohnadon: Date: Stra=es: 0. Ordemd -Demolition (attach copy of Ordci
D6xblition Will nonfriable agbe stos be -left-in place during dam? U Yes U No
Cant Mctor: If ycs� list type and qty. Note. disposal Tequiternmts iin Step 6 (on back).
G. FrIabla Asbestm
Pr�j�-et Information: _FZ
Date- IJ26/05
completion Date- 2128/05
Work Days! Q (MV
Hourx 7:30 AM 3:360M
Will all friable wbesics
Tnat!%'Jal �- be rmwvcd7
Sa SU
YCS
U No
Tatil Qty, to be Rc= vcd: 1850 Line2rFt,
12600 Square
U Sailetlpumace rnsula6on LJ Duct Inmdatidn. 12FP—ipe Insulafion
U Fimproofing
U. Faints LJ* Plziter 1-1 Te%rured Co3rings
bd cep���Boi.wd.. .. U cw=r Pipe U 7riz6i&no6riDj LJ FriaNe
84
*-Gims,
.. 6tcr
ANOIJIVII
— _7 d.0
IL Asbtsto*nD�ttmlltfonftoilaetCategarJes:
L. Single-Fandly.Resideirme (orwnar-ocmpled): CX NO C
A Asbtsta§ Rmoyal PToject Only RCP At
3. U- Dc=lidm Project (with.or withmit asbestos rarioval, pralo 7
w(AsUestos rc=vaI can beziialmon.notificifiim. de==w6tion mmwtwot lodays
x6firl0dian-period
LZ'A. Prior Notice
B. 10 Day3*
Project
Fee
A. S25
B. 35D
Dernolitlan
Surchari2e
Now .1fibe 5inglefamily reyiddnce is owned by onefamdy -who hai been or iv(11 be adng the.residence as their domicile- theaboveboxes
]A or Iff-may hie checked. lf.M4 is. not an owAej%;-occqpied residence, one of Me caregorfes,&red fielow must be used insiread. A single
fa�&�-r&idencr does not include rental-Drovermt.-multi-fami1v uni&- are2xv mirorl-ttro, hrsild;nm
0
0
General Contractors
FAX TRANSMITTAL
To: MIKE SNOOK
Company- CITY OF EDMONDS
From: D DRASZT
Subject E.C.C.F
Ryan General Contractors, Inc.
202D5 144 th Ave. N.E., Suite 201
Woodinville, WA 98072
Number of Pages Transmitted (including cover page): 4
(425) 488-4489
Fax: (425) 486-2344
web: wwwryangc-corn
Date: July 18, 2005
Fax No: (425) 778-5954
Phone No: (206) 356-7920
City: EDMONDS
Remarks: [J Urgent Z For your review E Reply ASAP E3 Please Comment
HERE ARE THE FORMS YOU REQUESTED
Signed:
Copies To:
P/ease call (425) 488-4489 if all items are not as indicated
L-d V969 9LL 9ZV 7SLIJ(] P!AIBC] egL:90 go 9L Inr
0 .0
Labor and Industries NOTICE OF
Industrial Hygiene Compliance ASBESTOS ABATEMENT
(Regional addresses and phone PROJECT
numbers on page 2)
THIS NOTICE MUST BE RECEIVED NO LATERTHAN 10 CALENDAR DAYS PlUORTO"I"HE START DATL
COMPLETE ALL APPLICABLE BOXES — INCOMPLETE OR ILLEGIBLE NOTICES WILL NOT BE ACCEPTED
MAIL OR FAX TO THE PLEGIONAL OFFICE — CIRCLE CHANGES ON AMENDED NOTICES
Notice date: 01 117/05 Initial Amended Site Work Hours Su Mo Tu We Th Fr Sa
Start date: 01 127 105 On Hold Off HoldE] -,-,30 am am —F—T
to . I I
Completion: 02 i 28 / 05 1-mcrgcncy 1:1 3:30 Pm 1)[11 Project Ditc.sand Work Hours must be F-x.ict
CONTRACTOR
PROPERTY OWNER
CompanyName
Name
Inc.
Community Christian
Fellowship
-CDCS,
Contractor Certification Number
Owner's Agent
1322
Cr2ig UnItcrman
S' ture
5a
Company
�4,1
�
Printed Name
Address
W. Kirk Baker
410 Fourth Ave. North
Phone Number
City
S tatc ZIP-14
(206) 763-5822
Edmonds
WA 98020
Job Site C.A.S.
Phone ntiniber
Pnol 11-aillion
(425) 7444 161)
JOB SITE
FACILITY
Address
Type
615 Glen Street
Old Library
Building Name
Room
Age Size
Old Library Building
50 + years 10,000 sqlft
City
Remodel [I Demolition
Edmonds
WA
[I Rcpair 0 Maintenance
ZIP+4 County
98020 Snabornish
QUANTITY OF ASBESTOS TO BE: R1 REMOVED ENCAPSULATED
Quantity 12600 square feet
Z Indoors 0 Outdoors
Fireproofing
Boiler insulation
CONTROL MEASURES
Popcorn ceiling
Duct paper
El Neg. pres. enclosure
Wrap &cut
CAB
VAT
Glove bag
Wet methods
Sheet vinyl
Roofing
Mini enclosure
HEPA vicuum
Asbestos paper
Othcr
Critical barriers
Manual methods
Quantity 1850 1 i near feet
Other
Othcr
Mag. pipe insulation
Cement asbestos pipe
RESPIRATORY PROTECTION
Air cell pipe insulation
Mudded pipe ins.
I/, mask APR
Type C continuous flow
Ducting/duct insulation
Duct tape
Full fice APR
Type C pressure demand
Other
T 7Dt 11 - r
PAPR
Other
F413-025-000 notice of asbestos abatement project 9-02
For clean copies go to http:,I/www.Ini.wa.gov/formsi
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Jul 18 05 08:18a David Draszt 425 778 5954 p.3
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'dU KraZan A s s o c i a t e s, I n c.
01ELD REPORT NO: 50941
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: L- 14 � ,, �
PROJECT #: %-05'1107
PROJECT. LL,,L
LOCATION: f��9 %A
KRAZAN PROJECT MANAGER:
il -L
L
C 0
CONTRACTOR:
RLf r, '%-1
JURISDICTION:
PERMIT #:
INSPECTOR:
WEATHER: __. Cjj, TEMP.,
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To the best of my knowledge, the above WAS / WAS NOT performed in accordance with the approved plans, specifications, and regulcol KIDWIRS.
Superintendent/Representative:
2 15 West Dakota Ave., Clovis, CA 93612
(559) 348-2200
2205 Coy Ave., Bakersfield, CA 93307
1661) 837-9200
1025 Lone Palm Ave. #2E, Modesto, C4 95351
(209) 572-2200
545 Parrott St., Son Jose, CA 95112
1408) 271-2200
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652
1916) 564-2200
TecKintplan: /I JUN 2 1 2005
4221 Brickell St., Ontario, CA 91761 (909) 974-4400
150 1 - 151 St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
207 14 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 (360) 598-2126
19501-144' Ave. NE 0-300, Woodinville, WA 98072 (425) 485-5519
Revision 0
"' ivc Date: 8/16/02
The infirimuttion provided on this report is prcpaed for the exclusive use of the client. This report =y not be reproduced in �y forouit without the written nerrnk6)n nfth, 12.TA V-- z A
,----,=KraZan Associates, Inc.
WELD REPORT NO
50790
GEOTECHNICAL ENGINEERING s ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
DATE: 6 - / 0 - �-7 '4�-
PROJECT #: 2! cle — 0 s— 1 6 72
PROJECT- F,76� Q*vd5 1!6 A AA Ok r, I �4"A-Al
LOCATION: CrIew
KRAZAN PROJECT MANAGER:
CONTRACTOR:
JURISDICTION:
PERMIT#: 000
INSPECTOR
WEATHER:
TEMP:
To the best of my knowledge, the above WAS / WAS NOT performed in accordance with the approved plans, specifications, and regulat"WOMIN's,
Superintendent/Representative:
Technician
J U N 18 2005
215 West Dakota Ave., Clovis, CA 93612
(559) 348-2200
4221 Brickell St., Ontario, CA 9 1761
0 (909) 974-,"00
2205 Coy Ave., Bakersfield, CA 93307 0
(661) 837-9200
1501-IY St. NW Suite 106, Auburn, WA 98002
o 1253) 939-2500
1025 Lone Palm Ave. #2E, Modesto, CA 95351
(209) 572-2200
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370
0 (360) 598-2126
545 Parrott St., San Jose, CA 95112
(408) 271-2200
19501-144' Ave. NE 0-300, woodinville, wA 98o72
(425) 485-5519
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652 0
1916) 564-2200
Revision 0
The information provided on this report is prepared for the exclusive use of
the client, This i wort rrav
not he re—d—M i, — fi,—, "';'k
Effe . ct ive Date: 8/16102
49-
DATE
V%raZan Associates, Inc.
GEOTECHNICAL ENGINEERING - ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
el -
PROJECT#:
PROJECT- K
LOCATION:
KRAZAN PROJECT MANAGER:
OVIELD REPORT NO: 51103
L'�
CONTRACTOR: "V /o
JURISDICTION:
PERMIT #: '-w 0-7
INSPECTOR: C--i�
WEATHER: TEMP: -'5
A-) -F /,A-) e.6 67
�2 e 7 "A
To the best of my knowledge, the abov<W7A.�,j WAS NOT performed in accordance with the approved plans, specifications, and regulatory requirements,
Superintendent/Representatilve:
215 West Dakota Ave., Clovis, CA 93612
0 (559) 348-2200
2205 Coy Ave., Bakersfield, CA 93307
(661) 837-9200
1025 Lone PoInt Ave. #2E, Modesto, CA 95351
(209) 572-2200
545 Parrott St., Son Jose, C4 95112
(408) 271-2200
5808 Price Ave. Bldg. 10 16, McClellan, CA 95652
(916) 564-2200
Technician- B U110 ING
r " J Q N Z--8 2005
4221 Brickell St., Ontario, CA 91761 (909) 974-,d4OO
1501-IY St. NW Suite 106, Auburn, WA 98002 (253) 939-2500
20714 State Hwy 305 NE Suite 3C, Poulsbo, WA 98370 (360) 598-2126
19501-144' Ave. NE #F-300, Woodinville, WA 98072 (425) 485-5519
Revision 0
The infornation provided on this report is prepat ed for the exclusive use of the client, This report nray not be reproduced in anv forrinat without the wriurn —icci— �F,h� i. Effective Date: 8/16JO2
...' —,1 v---. . .— _4
When recorded aild (4):
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
SpACE ABOVE THE LWE FOR RECORDERS USE
Assessor's F2rcel No.: 'Z!0�)MOOI od—
Applic2nt:112M"
ENCROACHMENT AGREEMENT
This ENCROACHMENT AGREENENT CAgreement') is entered into between the
CrrY OF EDMONDS C'Cit3e) and COmn414144
(110wnerfs]"), in accordance with Chapter 18.70 of the E . dinonds Community Development
Code.
1. The Pro owner is the owner of that certain
4 1!�- 61CL�, S -, within the
Washington, Assessor's Parcel Number 27 0 3 2 +oo -Z7,4!;OD
and more particularly describ�d as follows
real property located at
City of Edmonds,
Z,
as described in Exhibit "N' attached hereto and incorporated herein by reference.
2. The Easement. The City right-of-way adjacent to owner's property or an
existing easement used for (strike those that don't apply) (street, 4ea*-at�,
PedeG saftitalygew a,%& 5i4f-CJ41k.
3. The Encroachment. The City hereby covenants agre and gmts its
permission to Ownerto allow lkc -'Aed kelus .. 114f �:Ix "I'll" nfa5-0 -- I - AArXi,,,64A-Wr
to remain in a portion of the City right-of-way/easement. A partW site plan, scaled 1'�=20',
showing the -location of the encroachment is attached as Exhibit "B" and incorporated by
reference- This Agreement is sub ect to the'following terms and conditions:
- t of 3 -
0 0
2. The encroachment shall be installed and maintained in a safe and
sanitary condition at the sole cost, risk, and responsibility of the owner and its successors in
interest.
b. The Owner shall Agree at all times to indemnify and hold the City free
and harmless from any and all claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair or removal of the structure installed hereunder,
including any loss, damage or expense arising out of (1) loss or damages to property and (2)
injury to or death of persons.
C. The Owner must remove or relocate any part of ' the encroachment
within ten (10) days or such other time as specified in the notice ' after receipt of it from the
City Engineer, or the City Engineer may cause such work to be done and the reasonable cost
thereof shall constitute a lien upon the property.
d. Whatever rights and obligations were acquired by the City with respect
to the casement, shall remain and continue in full force and effect and shall in no way be
affected by City"s grant of permission to construct and inaintain. the encroachment structure
e. The property owner is required to provide and continually maintain
during the term of the permit a certificate of insurance naming the'City as an additional
insured, with respect to liability, and providing that it shall be primary as to any other policy
of insurance. A copy of the insurance certificate shall be provided to the. City at the beginning
of each calendar year, no later than the 2 1 " day of January.
4. Entire Agreement This Agreement constitutes the entire agreement between
the parties with respect'to the'subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
5. - Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in writing by United States mail, first class, postage pre -paid,
registered or certified with return receipt requested, or by other comparable commercial
means and addressed as follows:
ff to the Cifw
City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
&to the Owner.-
bm -I F'IIOCJS�"
—r. 0. e0y, .5b
OA 807'0
which addresses may be changed fi-om time to time by providing notice to the other party in
the manner described above.
-2 of 3 -
. I n by Owner shall
6. Waiver. City's consent to or approval of any act or onuss'O
not constitute a waiver of any other default by Owner and shall not be deemed a waiver or
render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver
by City of any default must be in writing and shall not be a waiver of any other default
concerning the same or any other provision of the Agreement.
7. Successors and Assigns. This Agreement shall be binding and inure to the
benefit of the parties hereto and their respective legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference in - any subsequent deeds to the
I property, but any failure to do so does not invalidate this provision.
8. Capaci this Agreement
ly. Each party represents that the person(s) executing
on behialf of such party has the authority to execute this Agreement and by such signature(s)
thereby bind such party.
IN VnTNESS WHEREOF, the parties hereto have executed this Agreement on this
L 2qday of /
)2d22,Z--ff
, 20 e5'
0 MR SL �
0� By-
B
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
This day, personally appeared before, me,
J� Z C' -,, IV- - ?-,.-^7 " �O bU W.IfCIZI
to me known to be the person(O who executed the within andfioregoig docurnent and that
(halshelfhey) —Aa-� signed the same as (hislherltheir) free and voluntary act
and deed for the uses and es therein mentioned-
0 -yV
4;�z's% No ublic
00
LLji-
0
Typed or Printed Name
v OK/ My Commission expires::n,-1,�-1,/--3-,—)-�X
tATE
CITY OF EDMOND
By.
ENGINEERING DIVISION\
-3 of 3 -
COMMUNITY CHRISTIAN FELLOWSHIP
6 15 GLEN STREET
EDMONDS, WASHINGTON 98020
REFERENCE NUMBER:
GRANTOR:
CITY OF EDMONDS
GRANTEE:
COMMUNITY CHRISTIAN FELLOWSHIP
TAX PARCEL NUMBER:
27032400224500
LEGAL DESCRIPTION:
SECTION 24 TOWNSHIP
27 RANGE 03 QUARTER NW
THAT PORTION OF GOVERNMENT LOT 2
DEFINED AS FOLLOWS: BEGINNING AT
THE INTERSECTION OF THE EAST LINE OF
6TH STREET WITH THE NORTH LINE OF
GLEN STREET AS SHOWN ON PLAT OF
BRACKETT'S FIRST ADDITION TO
EDMONDS, THENCE RUNNING NORTH
ALONG EAST LINE OF 6TH STREET 90 FEET,
THENCE EAST PARALLEL TO GLEN STREET
195 FEET, THENCE SOUTH PARALLEL TO
6TH STREET 90 FEET TO NORTH LINE OF
GLEN STREET, THENCE WEST ALONG
NORTH LINE OF GLEN STREET 195 FEET TO
THE POINT OF BEGINNING.
ENCROACHMENT INCLUDES:
• STEEL TRELLIS
• SIX WALL -MOUNTED LIGHT FIXTURES
• TWO PIPE HANDRAILS
__4 -
SIDE ELEVATION OF TRELLIS
BOTTOM EDGE VARIES FROM
9'-6" TO 10'-3" ABOVE SIDEWALK
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