20030215.pdf, Q':
I
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
sone-s W WA*% uj� S5
MAILING ADDRESS
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CITY ZIP
�j\� Crtt\(- StOS2-
NAME
ADDRESS
CITY
NAME
?)'j6aeA-
ADDRESS
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e—b 0
C
STATE LICENSE NUMBER
— —1 1 1 —
ZIP ITELEPHONE
155 '2,
ZIP I TELEPHONE
WAR
1,
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
n-t Y-A-4�
JOB
ADDRESS 8 C)'Z,5 2_\qi%-
SUITE/APT#
SW
�j
PLAT NAME/SUBDIVISION N077LOT
NO.
7D NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
iEsE;P Approved
AW Perrrit Required
Street Use Permit R0q'd
EXISTING — PROPOSED
Inspecdon Required
SldewaA Required
REQUIRED DEDICATION- Fr
Underground
WWg required 13
METER SIZE
LINE SIZE
I
NO. OF FIXTURES
PRV REQUIRED
I
YES NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
RSHAL
f
f
FIRE REVIEWED BY DATE LU
cc
I M
VARIANCE OR CLI SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
13YES C]NO
SEPA REVIEW SIGN AREA I HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
.XP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) rFROPOSED SETBACKS (Fr.)
[3 NEW )!(_RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR RD T LIR SIDE REAR
COMPLIANCE OR
[:I ADDITION E3 COMMERCIAL CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY
-90b I -
r c"ecKEo By
0 REMODEL
0 APARTMENT
0 SIGN
REOD
I PROVIDED
0 REPAIR 0 GRADING
CYDS
0 FENCE X
( —
FT) REMARKS
0 DEMOLISH TANK
0 OTHER
o GARAGE RETAINING WALL
0
0 RENEWAL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY)I EXPLAIN:
'Re-moval
CHECKED By
TYPE Ot_99hSTRUCTjbN
US-T
\,�
1pn4f—�--
NUMBER
OF
z-
NUMBER OF
DWELLING
I
I
CRITICAL
AREAS
i
SPECIAL INSPECTOR
""
AffEA
STORIES
UNITS
NUM BER
REQUIRED 0 YES
DESCRIBE WORK TO BE DONE e--) _
— I—,
REMARKS
PROGRESS INSP
VAWATION $
OCCUPANT
GROUP
OCCUPANT
LOAD
PER ILIBC 1108/FINAL INSPECTION RE01101 I I
I I Descriotion I FEE I Description I FEE—J
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building
PLAN CHECK —NO- VESTED DATE
&
Plumbing
2
Mechanical
THIS PERMIT AUTHOREZIES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEffff ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: ISODAYS
PERMIT UMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
Engr. Inspection
GEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CrIya ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I
Landscapelnsp.
I 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 COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMENS C
,04PENSATION INSURANCE AND RCW 18.27.
SIGNATURPEER O�&ENTf DATE JIGNED (425)
. -11, 11" s )0/0-� . 771-0220
= I 'Am. I
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
10101
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt # '74
APPLICATION APPROVAL
This application is not a permit Until signed by the
tbqg otticialp-Roftr Deputy-.,4md Foos are paid. and
?I
ORIGINAL -FILE - YELLOW -INSPECTOR
PINK -OWNER - GOLD -ASSESSOR
FINAL PROJECT APPROVAL FORM
TO:
DATE:
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date . S*
ocaprvi.doc.l:temp.bldg:formslO/,OI
05/13/2003 11:12 FAX 425 771 6916
FIDELITY -ESCROW DEPT, Z001/015
Ld 1 03
tA 14
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77 V
NTAL SERVIC.IES c1c (2J3
BUDGET E
(A, DIVIOM Or 11AX _1"K M' = "'
P.O. Box 77552
Sesittle, Wasbington 93177
206-789-5500; 800-545-9228 - Fax: 2W306,9111191
M&A, 2003
219P StrCd SM
I ds, Wadftlon 98026
RE: C�ONTAMNATED SOIL REMMIAflON REPORT AN]D
SITE ASSESSNWNT FOR:
ONDS, Wk
PROMCT SITE. $025 —219Mgntm sm., EDm
Mr. Wood1whs..
LEmAmuntnt8l Samicm (Budgd) is a Ucensed, bonded and kouxed ti-mbounod8l
,Wn mmi comdtb* fiM specMemS in caviromoental issum mmu 'ding sOil and
grou�W water rgonuldwtioa coised by leal&ll undeWound stonge tanks (L IsTs) =&or their
=Ftsitm Budge contracted directly with Jim WOO&MM tO Pulbrm:::r0f"sl0n&l
outbe above rgkTcncedPtCdm Site. Budgcessavkes tegardfttl-ic She inchiM a
McontardmaWd soil *e m.-.nant, excawft tbomaof COUtwimftd $00, taking
son �M06 in saverd diffiment locatlow Of the movation, baviq ft soil ambrad for
covtk�uA backdl%g the excavation w1th clun tacIdW nvnrW and to, npacft the
bmis materiaL
ExAvu&n ac&ffim WCm directed at ramvbDg soil whkh contained cone" Irations of TOW
pet�lem Hyftcae MCA) Metlmd
0=3 (TpH) C=eeft the Moftl TO)ecs Conuol Aces t
A SdU CWMMP kvel Of 2,000 mWigram P" kWPM (m9'kV) or parts per It. iiHo"pm.
Rmakmiround
On 26,2003, guapt runmd a 300 gallonUST whkh proviouslY mnlm� hmfing
oll I oil), At the thm ofthe UST removal, it was &tmvinW &A Om 1 '.O'T ha k"
ail ko the soil underm'G* tbm UST-
- - - - — — ...... ^^ ^^ "me I
gli
M.
a
A
A
05/13/2003 11:13 FAX 425 771 6916 FIDELITY -ESCROW DEPT.
T
in
8,2003
2
Z002/015
ST bad 10*ed war, vimily obvious due to the ilhjis�vv
n that the U
soil in vafious areas ofthe excavation. in addition. SMIM] un&U holes
[oration or ft the b A M&A
visft in ft tank. Moreover, a hand grab of the SOU mdcrucath
of dieW A Tbmu& fidd obwmdons ad experienM the bavY VMOD of diesel oil
ft KrCA!s 2,0N ppm CIMW level fe (Iul&g a'
son WW pmumd to a=W
15'
OMUM%al. Clem x1p. L'
TO ernime the Cormmio-n Of TPH that ww in ft soil undec the UST, 11 $OD sauVic was
I � 0
iw AS Schedule A. I
� :_7
S=pie site bbp stwhed hereto
ed and idertiftd, as 13-1. 90 Soil I lac., a waswqoon
to ft Seattle based &m ofFrWmwl & Bruya.
SID =Mple B-1 was taken -T
S CAi&d Tesft Luwrejory qwffied to V%*Ma NOT&West Tow Petroleum
mm* was pmerved U4
carbon - Diesel Extended (NWrPH-DX) arAblis- The 0 w exuactiou and
Of CUStOdy procedUMS 101ding to
m&ported accordirD9 to =zlard dhab, of 43,000 PPM
pla B-1 mvealed a TpH concentr4on
njaportation of SOD u3MIC& $00 swq soil sawle
UU&r ft MTm See Schedule I
w" requked an ewftmmcnW cleanup
an April 21, 2003 and ending on April 24,2003, Budget nowed 109.14 tons
nr.b* fWMftrrojev Site. ThtFCS
OR
="M containinaw soil (PCs) contabw diad
of
Unsported to Robanco RWYCIP9 COMPUY in S=jtje� Vabington-
ftjWjW md dispoged offt FCS at dick RoowYclt R*08d Laft= C llnter loWed'n
glou SU.I:e Ikensed and
Corepany is a Washin
"seva, wa"ston. RabaAco RCOYC&* th I., C=vatiw
facuity. T1VOU*Ut ffie C=vmdon. ft Sol in
itiWered waste &VOsd aediation at the
'Mou&Uj 60 PCs rel
was
coh&ed of &9 to =d1= V& =6 and Clay-
untered ta ft exavation v&jr-b m c bed a UWIMM
shei rp Wund %ster WaS
of 12 lbet.
Ain
ft pxgjca Site, it wu de%Tmin4 fto%h field obscM TIOU CM UOUS
wd dmugh laboraD,,V "Ybis, tW ILU
TPH detection bdruw=t
tuft with a kmdhWd broL the Project
In he conlamkow soil above ft MTCA7 2
,poo ppMHrnjt vim removed
.th C. "I Site man
Pt for the SOD remwAing jgftjocation eatmeda3irtoDune
exce
hardowscbeduleA. Son Sam& B4 contained TPH C43UCC&at11=% intxCM of
V�,
ppa
FIDELITY -ESCROW DEPT.
___g5a3/200� 11:13 FAX 425 771 6916
Mr.
2003
IM003/015
State DWItmout Of 1111coiDgy (WA-
i�k�-rdingtoRPOlirYPMWWgatedbyftWashbWon cS,;o9abftTPBcorXmtmionsin
D04), �e Vepmtmm does not squim the remval Of'P ftea to humm hcd* or ft
,Ofgw MTCA Vmdu& wben the PCS does not PO
mlOval of ft PCs would compromim the s1ml 19*1 imtqAtY Of 11
en onmeird and whm Ibc re s opinion that the UMW almum Of PCS
we's bowe foumwim it is BudgeV b=am boo It or ft
ivithe ==MeVtj&d= W does RM pose adlrwto q; from
InadMiomkisSudget's opinion tha tm zemoval of the PC,
=10r�W3 Wkcaifiad as B4 woWd comPrOMe the. strucWral iltcgrity Of tht Vsjdm=,s house.
fAO
mow;
maditims, the cjmW pmedum ar-4 slandmls,,1!11� and ft
or 1h. 13-1 S- - issm h9min, it is Biudse'Vs pro 10WODd OPWOn
j 10, tolist tdel. the WA -ME
mpm spuble WVels Of Q1DDtan]b)ati0U Ur
58 1710 pqject Site and dw no fiff1het
C
4C,:2t11V1,VA?j WTI on
ns
K;-'aod to th'o
,a of ft excavafion ud the soil 3MV10 tcst amlyBis W= Y
TTho " 'a mm those ob jtve(L A
r
ex*valad arm Ce dmous oulside dw excavation M very 111
. . r the pte9mce Ofunknown. QW&mtifiad, um"Mia4 or
potentw always rMMS TO 0XdmdrA6ou. or advem Ubsurfice c08,1itXm& Furt1wr
"MM suf= or sub=rbm
evWelme apalst WCb potentel ofte couumgmecm or advcm conditiODS WEI-11H tequ're
. The conr I
ap*orrh" su�s� oVioration and testing IwioM expecW) is and
A-1.1 Oln our
==do0onsgesented ill 0S mpod am OW prormiond opWou bw
�;=. Son of bzo)mobn avm1mbit to m. No wronlY, OVM or impt ,�d, r&ting to our
Op. onbaekkismoe.
r
Very t* YOM31
GZT j&prr=NNWffjA1L SERVICSS
ington Stow C=tBed Site Assessor
M ttt b *rw PVIV69me6d e r - hQtOn StOU
4 V MCM
lkosurm
11005/015
FIDELITY,o,,ESCROW DEPT*
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