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BLD20120858.pdf111111111, OF E1)M CITY OF EDMONDS :t 121 5TH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 STATUS: ISSUED 09/26/2013 Permit #: BLD20120858 BUILDING' Expiration Date: 09/26/2015 Project Address: 15500 75TH PL,W, EDMONDS Parcel No: 00500900000103 GEORGE & GINGER OLSON JAMES THOMAS, ARCHITECT ROGER OLIN CONSTRUCTION 3528 102ND PL SE 2221 EVERETT AVE # 106 Po Box 3216 EVERETT, WA 98208 EVERETT, WA 98201 Everett, WA 98203 (425)337-5046 (425)259-0661 (425)337-7622 LICENSE #: ROGER00088CN EXP:02/28/2014 JOB DESCRIPTION NEW TWO STORY RESIDENCE WITH TWO CAR GARAGE - MECHANICAL AND PLUMBING INCLUDED - ESLHA VALUATION: $344,493.20 COMPLETED PERMIT TYPE: Residential PERMIT GROUP: 64 - Single Family Residence New GRADING: Y CYDS: 364 TYPE OF CONSTRUCTION: VB RETAINING WALL ROCKERY: N OCCUPANT GROUP: R-3/U OCCUPANT LOAD: FENCE: N ( 0 X 0 FT.) CODE: 09 OTHER: N------- OTHER DESC ZONE: RS-20 NUMBER OF STORIES: 2 VESTED DATE: NUMBER OF DWELLING UNITS: 1 EXISTING AREA LOT #: PROPOSEDAREA BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0 1BASEME7T70 I ST FLOOR: 1599 2ND FLOOR: 1339 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 13RD FLOOR: 0 GARAGE: 707 DECK: 496 OTHER: 345 FRONT SIDE SETBACK REAR SETBACK REQUIRED: E 25 PROPOSED: 25; 0* REQUIRED: N 10/35 PROPOSED: 17 RE UIRED: W 25 PROPOSED: 113/120+ HEIGHT ALLOWED:25 PROPOSED:25 REQUIRED: S 10/35 PROPOSED: 18 SETBACK NOTES: RS-20 setbacks - 10' minimum on sides, 35' min total, *0' setback for driveway/bridge and steps only, house is 25' per PLN20120047, rear - deck 113', house 120+' I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. /"' t� ft�''.�A.��.7 Si ature Print game Date Released By Date f ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109/ IBC110/IRCI10. t� ' � ONLINE APPLICANT ASSESSOR ` � OTHER I,9 STATUS: ISSUED BLD20120858 CONDITIONS • REQUIRED SPECIAL INSPECTIONS FOR THIS PROJECT: • 1) Grading/Soils • 2) Auger cast piles • 1. Development shall proceed in accordance with Nelson & Associates geotechnical reports of 7/15/11, 4/3/13 and 7/1/13." • 2. Tree #320, as shown on the landscaping plan from Harmsen & Associates approved July 22, 2013, shall be retained and protected until such time that an independent certified arborist selected by the City determines whether or not the tree is hazardous. This indepenent review shall be paid for by the applicant. Tree #320 shall be protected in accordance with the tree conservation notes on the approved landscaping plan. If the tree is found to be hazardous by the independent arborist, it may be removed in accordance with the approved landscaping plan. If the tree is to be retained, the landscaping plan shall be updated to note the retention of Tree #320 and, as applicable, the elimination of Vine Maple and Excelsa Cedar from the replanting plan. • Lot line stakes must be in place at the time of foundation/setback inspection. • Installation, use and maintenance of equipment and components shall be per manufacturer's specifications, installation instructions, and applicable state codes. Provide manufacture's installation instructions on site for Building Inspector. • Approval of this foundation design is conditional subject to inspection of existing site soil conditions. • Retaining Walls must be designed and constructed to resist the lateral pressure of the retained material. • Provisions must be made for the control and drainage of surface water around buildings. • Installer shall provide the manufacturer's installation, operating instructions, and a whole house ventilation system operation description. A label shall be affixed to the whole house timer control that reads "Whole House Ventilation" (see operating instructions). • Maximum Height 25 feet. The agent/contractor shall set up the equipment; establish the datum point and the point of average grade. Call for inspection to verify. These items must be consistent with the approved plan. If the proposed height of a building (as shown on the plans) is within 12 inches of the maximum height permitted for the zone an elevation survey is required. • Special inspections have been called for on this project and are noted on the approved construction plans and building permit. It is the owner and/or contractors responsibility to assure that reports are provided to the City on a weekly basis. Be advised -- if special inspection reports are not forthcoming, the Building Official may issue a "Stop Work" and no City inspections will be provided until such time as the reporting agency has complied and reports are reviewed and approved by the City. • Hose Bibbs (exterior faucets) are required to have a permanently affixed anti -siphon device installed. • In addition to the required pressure/relief valve, an approved listed expansion tank shall be installed on all hot water tanks. Per UPC 608. • Type B or L vent connectors required on fuel -burning appliances passing through unheated spaces. Per IMC 803.2 • Obtain Electrical Permit from State Department of Labor & Industries. 425-290-1309 • Pursuant to UPC 605.2 a water service shutoff shall be installed on the water line as it enters the building. • Gas pipe test must be observed by City Building Inspector, affidavits shall not be accepted. • As required by Ordinance #3632 the geotechnical engineer of record shall monitor this site during construction for compliance with the recommendations in the geotechnical report including: site excavation, shoring, soil support for foundation including piles, soil bearing capacity, subdrainage installation, soil compactions, and other geotechnical aspects of the construction. Specific recommendations contained in the approved geotechnical report must be implemented by the owner. The geotechnical engineer shall make written, dated reports on the progress of the construction and submit the report to the Building Official on a weekly basis until all site grading, drainage, foundation and associated ground work is complete. Omissions or deviations from the approved geotechinical report and/or approved plans or specifications shall be highlighted and immediately submitted in a seperate letter to the City for review. The City shall be advised in writing of work stoppages of more than one week. In addition to the geotechnical monitoring, special inspections based on the provisions of IBC Section 1704 are required when specified on the approved plans. Other special inspections may also be required by the geotechnical engineer, architect, or structural engineer of record (refer to approved plan set). At the completion of final site grading and all permitted structures, a final geotechnical report, prepared by the geotechnical engineer shall be submitted to the Building Official. This report shall contain a statement that, based upon his/her professional opinion, site observations, and testing during the monitoring of the construction, the completed development substantially complies with the recommendations in the geotechnical report and with all geotechnical related permit requirements. Any deviations or omissions in the report, plans, or specifications that occured during construction shall be addressed separately. Occupancy, final approval, or release of the bond for the project shall not be granted until the report has been reviewed and accepted by the Building Official. • Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of the building or structure. Check the job card for all required City inspections including final project approval and final occupancy inspections. • Provide combustion air per IMC Chapter 7 for commercial and multi -family residential installations, and IRC Chapter 17 for one and two-family dwellings. • Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing fees forisuch request shall be established by Council and shall be paid upon submittal and are non-refundable. • Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. • Pursuant to UPC 608 a pressure regulator valve (PRV) shall be installed near the water shutoff. • Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must. comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. • Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend.and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any ordinance provision. • New and existing buildings shall have approved address numbers, building numbers or approved building identification placed in a position that is plainly visible from the street or road fronting the property. Address numbers shall be Arabic numerals or alphabet letters. Numbers shall be legible from the public way, at least 4 inches high with a %: inch min. stroke width on a contrasting background. • Maintain 10"""" separation between the sanitary side sewer and the water service line. INSPECTIONS THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6) BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 PUBLIC WORKS (425) 771-0235 PRE-TREATMENT (425) 672-5755 RECYCLING (425) 275-4801 When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon. • B-Preconstruction meeting • B-Special Insp Auger Cast Piles • B-Setbacks • B-Footings • B-Foundation Wall • B-Foundation Drainage • B-Isolated Footings/Piers • B-Underfloor/First Floor Framing • B-Plumb Rough In • B-Gas Test/Pipe • B-Mechanical Rough In • B-Exterior Wall Sheathing • B-Roof Sheathing • B-Window Flashing • B-Height Verification • B-Interior Shear Walls • B-Framing • B-Shower Pan Test • B-Insulation/Energy • B-Sheetrock Nail • B-Building Final • P-Planning Final O� O V, i �Qr. 1 89Q City of Edmonds DEVELOPMENT SERVICES ESLHA BUILDING PERMIT APPLICATION FORM F 121 5t' Avenue N, Edmonds. WA 98020 Phone 425.771.0220 $ Fax 425.771.0221 PLEASE REFER TO THE RESIDENTIAL BUILDING CHECKLIST FOR SUBMITTAL REQUIREME.Nf'S PROJECT ADDRESS (Street, Suite #, City State, Zip): Parcel #: Subdivision/Lot #: Project VtaIuation: S APPLICANT- ✓t fi% �' jjyf� rh o Phone: ¢2f'•�Cq-�i6! Fax: �EAla f Address (Street, City, State, Zip): E-Mail Address: nr-i PROPERTY OWNER: C.6i- pp"5; Ely,9l� o&ZA1 Ph ne: f ar- OJT- 5VIL4 Fax: Address (� City,�0 f L 1p)E:6 L�l/P..�� • �� ' E-Mail Address: LENDING AGENCY: Phone: Fax: Address (Street, City, State, Zip): E-Mail Address: CONTRACTOR:* Ro6lt V"IV CetVJ7`V!>C.i%C7t1V Phone: - 3S'�' T/ •r2 "- ti1A ii�I�A�1G" Address (Street City, State, Zip): ( � try, P)� xPi �,;:�,-�,. _ License #/E Date: "Contractor must have a valid Ciry of Edmonds business license prior to doing wnr* in the City Business License #/Exp. Batt':§` City. Convect the City Clerk's ice at 425, 775.2525 DETAIL SCOPE OF WORK: N' 2- T Rn- / r t&C iL0L PROPOSED NEW SQUARE FOOTAGE FOR THIS PROJECT: Basement: AMA s . ft. Select Basement Type: 0 Finished:. 0 Unfinisbtgd ... I" Floor: MA4,VS'9 sq. ft. Garage/Carport: •T s F Floor: POP- 1,337 s . ft. Deck/Patio: Retaining Wall: Yes 2rNo er: VS'S.. O 6M aft ..' S +"tfi►j� tvMK-a Imo' 23 1 declare under penalty of perjury laws" the information I have provided on this fornr/appllcar�fotr►'aiu�, cotrt puui complete, and that I am the property owner or duly authorized agent of the property owner to subJr ft s pe ;;;j�. the City of Edmonds. PR'Gd 6�y'" Print Name: y4M ET A• %ff D S 0 Owner KAgent/other (specify): Signature: Date: a �A'��- LABuilding New Folder 201000NE & x-ferred to L-Building-Ntw drivelESLHAApplication.doe Updated: 912010 RECEIVED OCT 0 7 2014 DEVELOPMENT SERVICES COUNTER NELSON GEOTECHNICAL NGAGEOTECHNBCAL ENGINEERS & GEOLOGISTS Main 017ico \\ oodinrillc, \VA 9072 (425) 4k6-1669 I AX (4?5) 4�l-7i)(i September 19, 2014 Mr. George Olson c/o Roger Olin PO Box 3216 Everett, Washington. 98213 Construction Monitoring Summary Letter Olson Residence Edmonds, Washington NGA File No. 8342C 13 Dear Mr. Olson, I:ngincxrin,-Ucolon; Branch. 5526111dusury Lane.'72 Gas; \\ crtalchec, \\':\ 9; s02 (509) 665-7/696 FAX (509) 665-7692 We were requested by your builder Roger Olin to prepare this summary letter for your residence project located at 15500 — 75t' Place West in Edmonds, Washington. Introduction We were retained to provide part-time monitoring and consultation services during the earthwork phase of construction per the Special Inspections and Testing Agreement required by the City of Edmonds (Permit No. BLD20120858). Our earthwork monitoring activities at the project took place on a part-time basis from October 17, 2013 through June 24, 2014 and included observing pier installation, footing drain installation, and erosion control measures. Our observations and conclusions were documented in Field Reports 1 through 23, all of which have been submitted to you. We previously prepared a geotechnical engineering report for the property titled "Revised Geotechnical Engineering Report — Olson Residence — 15500-75t' Place West — Edmonds, Washington," dated July 15, 2011. We also prepared a plan review letter for the project dated April 3, 2013. Construction Monitoring Summary Letter NGA File No. 8342C13 Olson Residence September 19, 2014 Edmonds, Washington Page 2 Site Observations We monitored drilled pier installation activities on October 28, 2013 through October 30, 2013 as documented in Field Reports #3 through 6. We observed the drilling of 23, 22-inch diameter holes advanced to depths of approximately 26 feet below the ground surface throughout the entire residence foundation area. The holes were drilled with a large drilling auger and the soil exposed in the cuttings mostly consisted of light brown, fine to medium sand grading to dark gray clay. Minor caving was encountered in some of the holes and some of the holes required casing to remain open. After rebar cages were lowered into the drilled holes, the holes were backfilled with structural concrete to planned elevations. We also observed the installation of 18, 2-inch pin piles for the planned deck posts on the western side of the residence. The pin piles consisted of Schedule 80 galvanized steel piles and were driven between 13 to 19 feet below the ground surface. The pin piles were driven with a 140-1b hammer to a refusal criteria of less than one inch of movement during 60 seconds of continuous driving. We observed the stormwater overflow pipe that was installed down the steep slope on the northern side of the property. The pipe consisted of an 8-inch diameter HDPE pipe and was anchored to the slope using a clamp and cable system. The clamps were secured to the slope using 5-foot long, 3-inch diameter galvanized bars. We observed some of the backfill for the on -site utilities including storm and water lines and detention pipes and manholes. Some of the material consisted of on -site soil and other areas were backfilled with crushed rock. The areas where on -site material was used was generally over -optimum moisture when it was placed and was pumping. We tested the backfill with a nuclear densometer and the test results did not meet 95% compaction of ASTM D1557. We recommended to the contractor that the unsuitable soils be removed and replaced with drier soil, or re-evaluated at a later time. We returned to the site roughly two months later and retested the failed areas. Some of the areas met compaction, but an area on the northem side of the house was -still over optimum. We discussed the slight potential for future settlement of this material. We were informed by Roger Olin that no structures were planned for this area and that they were aware of the risks. NELSON GEOTECHNICAL ASSOCIATES, INC. Construction Monitoring Summary Letter NGA File No. 8342C13 Olson Residence September 19, 2014 Edmonds, Washington Page 3 We also observed that footing drains were installed along the western, uphill side of the residence. The drains consisted of 4-inch perforated pipes. We recommended that the drains be surrounded with washed rock and covered with filter fabric. The contractor agreed. The contractor informed us that the roof downspouts would not be connected to the footing drains, as we recommended in our geotechnical report. We visited the site on September 10, 2014 to observe the final landscaping preparation. We observed that the site had been graded and that some vegetation planted throughout the backyard and side yard. We did observe areas of exposed soils. We recommend that all remaining exposed areas be covered with landscaping plants and/or hydroseed to reduce the potential for soil erosion during the wet season. These areas should be closely monitored and repaired as needed. It is our opinion that the erosion control methods incorporated into the landscape design appear to be' adequate and should help prevent surface water from reaching the steep slope once these systems are fully established. We also observed the steep slope and did not observe significant signs of instability. We should note; however, that the slope below the residence did experience a small landslide two to three years ago. Although the area that was affected by the slide is relatively far away from the new residence and should not have an impact on the recent improvements, during extreme weather, this area may experience additional movement. We recommend that this area be monitored from time to time, especially during heavy rainfall. We should be contacted should signs of renewed earth movement be observed. Conclusion Based on our part-time observations, it is our opinion that the geotechnical earthwork activities at this site, including residential foundation subgrade, pier installation, subsurface drainage, and erosion control methods were completed in general accordance with our recommendations, contract plans, and specifications. The steep slope should be closely monitored for any signs of distress. If any distress is observed, we should be contacted immediately to evaluate the conditions and provide recommendations for slope repairs. Also, long-term maintenance of the drains and landscaped areas is important to prevent water from flowing over the slope and creating instability concerns. All other recommendations and precautions presented in our report and memo regarding maintaining slope stability should be strictly followed. We recommend that our report and memo along with this letter be passed on to future home owners if the house is sold. NELSON GEOTECHNICAL ASSOCIATES, INC. Construction Monitoring Summary Letter Olson Residence Edmonds, Washington NGA File No. 8342C13 September 19, 2014 Page 4 We appreciate the opportunity to be of service to you on this project. We consider our services for this project to be complete, unless you specifically contact us for additional work. If you have any questions regarding this letter or require further information, please call. Sincerely, NELSON GEOTECHNICAL ASSOCIATES, INC. Bala Dodoye-Alali, Project Geologist Exp. July 28, 2015 Khaled M. Shawish, PE Principal BD:KMS:cja NELSON GEOTECHNICAL ASSOCIATES, INC. CITY OF EDMONDS 121 5th AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • fax (425) 771-0221 www.edmondswa.gov DEVELOPMENT SERVICES DEPARTMENT .. N October 14, 2014 George & Virginia Olson 3528 102n, PL SE Everett, WA 98208 RE: Release of ESLHA Site Restoration Bond #359 5619 873 Owner: George and Virginia Olson Project Address: 15500 75t' PL W George and Virginia Olson: DAVE EARLING MAYOR The City of Edmonds hereby authorizes the full release of the ESLHA Site Restoration Bond #3595619 873. All interested City departments have approved the release of this bond. I have attached a copy of the Bond. Please take. this letter to BECU for release per conversation with Ayla Gillum on October 14, 2014. Sincerely, Zt&c,- Linda Thornquist Senior Permit Coordinator City of Edmonds 425-771=0220 Cc: File • Incorporated August 11, 1890 • Sister City - Hekinan, Japan Q. co ro• v D N! N C CD a 0 0 O A rr y � (D O r• f� (D C MAD c Q � D. .. a .•� CD 0 •'� o. eD r. � mw<j rA mmgoC-n o� O o k .a mom o rA N. m . z go r•h r• n D D omM 00 O vCD CD r r. . O O Z Z M' !•t r. r. D 04- Cl) i o e °--%� 46pill N C �C !• to r. m r O m m � ° 0w CD:: Z z z °y �• •G O O 0 c Dr � o• co w o r- D Co- CDo b o• -' N rr D r.. OC) Lrl �• C . O OD C• CC) C: O � C �Q p O• D p„ CD O s 11 OTTO ROSENAU & ASSOCIATES. INC.. RECEIVED Geotechnical Engineering, Construction Inspection & Materials Testing DES 10 2013 DEVELOPMENT SERVICES COUNTER GROUT REPORT Job Number: 13-0684 Report Number: Project: Olson Residence - Edmonds Client: Address: 15500 75`" Place West, Edmonds Address: Date: 10/29/13 Inspector. 125916 Permit Number: BLD 2012-0858 George & Ginger Olson 15500 75u' Place W, Edmonds Gordy Moe Description / Location: Augered and cast in -place pile numbers 9, 10, 11, 21, and 22. Reinforcing steel as per the approved plans and specifications for size, grade, and spacing. Resteel grade: 60 Manufacturer: Cascade Mills Placement Data Batch Weights Supplier: Cadman Cement (Ibs%type.): 846# 1/II Water (Ibs./gal): 450# Mix Number: 3GO0149 Fine Agg.,(Ibs.): 2357# Admixtures (specify) Total Yards Placed: 18 . Coarse Agg. (size/lbs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 @ 28 days Coarse Agg. (size/Ibs.): Sampling and Casting of Samples Additional Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Time Cubic Grout Ambient Truck Ticket Size: Set # Cast Yards Flow Temp Temp No. No. Cast Samples: 1-5 9 n/a 64° 47' 310 114479 Cast Samples: 6-10 15 n/a 62° 54° 285 114679 Weather: Fair, Mid 40°F-Mid 50°F Date Samples Picked Up: 10/30/13 Comments Contractor: McDowell N.W. Other Test Methods / Standards Used: REINFORCING / PLACEMENT: Conforms X Does Not Conform TEST RESULTS . Specimen Test Field Age Size Area Max Load Strength Type of Fracture Number Date Cure (Days) (in.) (Sq.In•) Weight Lbs. f P-Si (other than cone) 1 11 /1 /13 3 2x4 3.14 .95# 9330 2970 2 11/5/13 7 2x4 3.14 .90# 13,870 4460 3 11/26/13 28 2x4 .3.11 .93# 15,880 5110 4 11/26/13 28 2x4 3.11 .90# 13,860 4460 5 11/26/13 28 2x4 3.11 .92# 18,690 6010 6 11/1/13 3 2x4 3.14 .98# 11,100 3540 7 11/5/13 7 2x4 3.11 .90# 12,840 4130 8 11/26/13 28 2x4 3.11 .91# 17,800 5720 9 11/26/13 28 2x4 3.11 .91# 17,520. 5630 10 11/26/13 28 2x4 r 3.11 .91# 18,810 6050 Tested in general accordance to: ASTM C39 x ASTM C78 ASTM C109 ASTM C617 _ ASTM C1231 Note: Type of fracture does not apply when testing in conformance to ASTM C1231 Copies to: X Client Contractor X Architect X Building Dept. Technical Responsibility: Engineer. Anthony Coy:VeDr( ssional En ' eer This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associates, Induction of this report, except in full, without written permission from our firm is strictly prohibited. Page 1 of 1 6747 M.L. King VVay S., Seattle, Washington 98118 - Phone (206) 725-4600 or 1-888-OTTO4-US - Fax (206) 723-2221 Form No.: ADMIN-71-04 (Rev 05113) RECEIVED OTTO ROSENQU & ASSOCIATES, INC. DEC .10 2013 Geotechnical Engineering, Construction Inspection & Materials Testing DIEVELOPMENT SERVICE: (;UUNILH GROUT REPORT Job Number. 13-0684 "Report Number: 125917 Permit Number: BLD 2012-0858 Project: Olson Residence — Edmonds Client: George & Ginger Olson Address: 15500 75'" Place West, Edmonds Address: 15500 75"' Place W, Edmonds Date: 10/30/13 Inspector. Gordy Moe Description / Location: Augered and cast in -place pile numbers 9, 10, 11, 21, and 22. Reinforcing steel as per the approved plans and specifications for size, grade, and spacing. Resteel grade: 60 Manufacturer. Cascade Mills Placement Data Batch Weights Supplier: Cadman Cement (Ibs/type.): 846# 1111 Water (Ibs./gal): 450# Mix Number: 3G00149 Fine Agg. (Ibs.): 2357# Admixtures (specify) Total Yards Placed: 18 Coarse Agg. (size/Ibs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 @ 28 days Coarse Agg. (size/Ibs.): Sampling and Casting of Samples Additional Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Time Cubic Grout Ambient Truck Ticket Size: Set # Cast Yards Flow Temp Temp No. No. Cast Samples: 1-5 9 n/a 64° 51 ° 272 114805 Cast Samples: 6-10 18 n/a 63' 54' 274 114913 Weather: Date Samples Picked Up: 10/31/13 Comments Contractor: McDowell N.W. Other Test Methods / Standards Used: REINFORCING / PLACEMENT: Conforms X Does Not Conform TEST RESULTS Specimen Test Field Age Size Area Max Load Strength Type of Fracture Number Date Cure (Days) (In.) (Sg•In•) Weight Lbs. fwa (other than cone) 1 11/1/13 2 2x4 3.14 .89# 7170 2280 2 11/6/13 7 2x4 3.11 87# 12,650 4070 3 11/27/13 28 2x4 .3.08 .88# 20,110 6530 4 11/27/13 28 2x4 3.08 .89# 19,49b 6330 5 11/27/13 28 2x4 3.08 .87# 19,980 6490 6 11/1/13 2 2x4 3.14 .93# 6980. 2220 7 11/6/13 7 2x4 3.11 .86# 12,580 4050 8 11/27/1'3 28 2x4 3.08 .87#. 18,340 5960 9 11/27/13 28 2x4 3.08 .91# 18,140 5890 10 11/27/13 28 2x4 r 3.08 .90# 17,740 5760 Tested in general accordance to: ASTM C39 x ASTM C78 ASTM C109 ASTM C617 ASTM C1231 Note: Type of fracture does not apply when testing in conformance to ASTM C1231 Copies to: X Client Contractor X Architect X Building Dept Technical Responsibility: Engineer Anthony Coyne, Pr fessional En eer This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associate I Reproduction of this report, . except in full, without written permission from bur firm is strictly prohibited. Page 1 of 1 6747 M.L. King Way S., Seattle, Washington 98118 - Phone (206) 7254600 or 1-888-OTT04-US - Fax (206) 723-2221 Form No.: ADMIN-71-04 (Rev 05113) r RECEIVED OTTO ROSENAU & ASSOCIATES, INC. opC 10 2013 Geotechnical Engineering, Construction Inspection & Materials Testing Q Q-0AAChIT eGQInrrES COUNTER GROUT REPORT. Job Number. 13-0684 Report Number. 125918 Permit Number: BLD 2012-0858 Project: Olson Residence - Edmonds Client: George & Ginger Olson Address: 15500 75"' Place West, Edmonds Address: 15500 75"' Place W, Edmonds Date: 10/31/13 Inspector. Gordy Moe Description / Location: Augered and cast in -place pile numbers 17, 18, 19, 22, and 23. Reinforcing steel as per the approved plans and specifications for size, grade, and spacing. Resteel grade: 60 Manufacturer: Cascade Mills Placement Data Batch Weights Supplier: Cadman Cement (lbs/type.): 846# 1/11 Water.(Ibs./gal): 450# Mix Number: 3GO0149 Fine Agg. (lbs.y 2357# Admixtures (specify) Total Yards Placed: 15 Coarse Agg. (sizeAbs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 @ 28 Coarse Agg. (sizeAbs.): days Sampling and Casting of Samples Additional Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Time Cubic Grout Ambient Truck Ticket Size: Set # Cast Yards Flow Temp Temp No. No. Cast Samples: 1-5 9 n/a 65° 52' 312 115061 Cast Samples: 6-10 14 n/a 620 54° 284 115239 Weather: Overcast, Low to Mid 50°F Date Samples Picked Up: 11/4/13 Comments Contractor: McDowell N.W. Other Test Methods / Standards Used: REINFORCING / PLACEMENT: Conforms X Does Not Conform TEST RESULTS Specimen Test Age Size Area Max Load Number Date (Days) u (So•In.) Weight Its.) 1 11/4/13 4 2.00x4.00 3.11 .90# 9630 2 11 /7/13 7 2.00x4.00 3.11 .91 # 11,580 4 11/28/13 28 1.98x3.91 3.07 .93# 20,680 5 11/28/13 28 2.02x3.92 3.20 .94# '20,620 6 11/28/13 28 1.99x4.21 3.11 1.01# 20,290 6 11/4/13 4 2.00x4.00 3.11 .91 # 9420 7 1IM13 7 2.00x4.00 3.11 .89# 8480 8 11/28/13 28 1.98x3.98 3.07 .93# 17,890 9 11/28/13 28 2.00x3.97 -3.14 .94# 16,730 10 11/28/13 28 2.00x3.93 3.14 .92# 17,490 Tested in general accordance to: ASTM C39 x ASTM C78 ASTM C109 Note: Type of fracture does not apply when testing in conformance. to ASTM C1231 Strength Type of Fracture si (other than cone) 3100 4610 6740 6440-Q 6520 3030 2730 5830 5330 5570 ASTM C617 ASTM C1231 _ Copies to: X Client Contractor X Architect X Building Dept. Technical Responsibility: Engineer Anthony?/,Innc. Professio I Engineer This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associa Reproduction of this report, except in full, without written permission from our firm is strictly prohibited. Page 1 of 1 6747 M.L. King Way S., Seattle, Washington 98118 - Phone (206) 725-4600 or 1-888-0TTO-4-US - Fax (206) 723-2221 Form No.: ADMIN-71-04 (Rev 05113) I ECEIVED OTTO ROSE AU ASSOCIATES, INC � NOV Geotechnical Engineering, Construction Inspection & Materials Testing 1 �D13 Vr-LU N7 SERli COUNTEt� ICES F` GROUT REPORT Job Number: 13-0684 Report Number: 125915 Permit Number: BLD2012-0858 Project: Olson Residence = Edmonds Client: George & Ginger Olson Address: 15500 75"' Place West, Edmonds Address: 15500 75`" Place W, Edmonds Date: October 28, 2013 Inspector. Gordon Moe Description / Location: Inspected augered and cast in place pile #'s: 1, 2, 3, 12, 13, 15 and 16. Reinforcing steel as per the approved plans and specifications for size, grade and spacing. Resteel grade: 60 Manufacturer: Cascade Mills Placement Data Batch Weights Supplier: Cadman Cement (Ibs/type.): 846# 1/11 Water (Ibs./gal): 450# Mix Number: 3GO0149 Fine Agg. (lbs.): 2357# Admixtures (specify) Total Yards Placed: 18 Coarse Agg. (size/Ibs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 Coarse Agg. (size/Ibs.): Sampling and Casting of Samples Additional-Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Time Cubic Grout Ambient Truck Ticket Size: Set#. Cast Yards Flow Temp Temp No. No. Cast Samples: 1-5 9 n/a 55° 45° 274 114233 Cast Samples: 6-10 18 n/a 61 ° 540 285 114334 Weather: Fair; mid 40's to mid 50's Date Samples Picked Up: 10/29/2013 Comments Other Test Methods / Standards Used: REINFORCING / PLACEMENT: Conforms Does Not Conform _ TEST RESULTS Specimen Test Field Age Size Area Max Load Strength Type of Fracture Number Date Cure (Days) (in.) S .In. Weight . L( bs-) si (other than cone) 1 10/31/13 3 2x4 3.14 .84# 12,070 3840 2 11/4/13 7 2x4 3.11 .87# 16,050 5160 6 10/31/13 3 2x4 3.14 .89# 10,830 3450 7 11/4/13 7 2x4 3.11 .87# 15,710 5050 Tested in general accordance to: ASTM C39 x ASTM C78 ASTM C109ASTM C617 ASTM C1231 Note: Type of fracture does not apply when testing. in conformance to ASTM C1231 Copies to: %) X Client Contractor X Architect X Building Dept. Technical Responsibility: i Engineer Anthony Coyne,,Profesiionalpfigineer This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associate , c. Reproduction of this report, except in full, without written permission from our firm is strictly prohibited. Page 1 of 1 6747 M.L. King Way S., Seattle, Washington 98118 — Phone (206) 725-4600 or 1-888-OTTO-4-US — Fax (206) 723-2221 Form No.: ADMIN-71-04 (Rev 05113) OTTO ROSENAU .7, ASSOCIATES, INC ; j Geotechnical Engineering, Construction Inspection & Materials Testing GROUT REPORT Rece,v t COUIVTSERVICE, Job Number: 13-0684 Report Number: 125916 Permit Number: BLD 2012-0858 Project: Olson Residence — Edmonds Client: George & Ginger Olson Address: 15500 75"' Place West, Edmonds Address: 1550075 Place W, Edmonds Date: 10/29/13 Inspector: Gordy Moe Description / Location: Augered and cast in -place pile numbers 9, 10, 11, 21, and 22. Reinforcing steel as per the approved plans and specifications for size, grade, and spacing. Resteel grade: 60 Manufacturer: Cascade Mills Placement, Data Batch Weights Supplier: Cadman Cement (Ibs/type.): 846# 1/11 . Water (Ibs./gal): 450# Mix Number: 3GO0149 Fine Agg. (Ibs.): 2357# Admixtures (specify) Total Yards Placed: 18 Coarse Agg. (size/Ibs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 @ 28 Coarse Agg. (size/Ibs.): days Sampling and Casting of Samples Additional Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Size: Set # Cast Samples: 1-5 Cast Samples: 6-10 Weather: Fair, Mid 40°F-Mid 50°F Date Samples Picked Up: 10/30/13 Contractor: McDowell N.W. Other Test Methods / Standards Used: Specimen Number 1 2 6 7 Test Field Age Date Cure (Days) 11/1/13 3 11/5/13 7 Time Cubic Grout Ambient Truck Ticket Cast Yards Flow Temp Temp No. No. 9 n/a 640 47° 310 114479 15 n/a 620 540 285 114679 Comments REINFORCING / PLACEMENT: Conforms X Does Not Conform TEST RESULTS Size Area Max Load Strength I(.) (Sg.In•) Weight L( bs•) i2§jI 2x4 3.14 .95# 9330 2970 2x4 3.14 .90# 13,870 4460 -s 11 /1 /13 3 2x4 3.14 .98# 11,100 3540 11/5/13 7 2x4 3.11 .90# 12,840 4130 Tested. in general accordance to: ASTM C39 x ASTM C78 ASTM C109 ASTM C617 Note: Type of fracture does not apply when testing in -conformance to ASTM C1231 Type of Fracture (other than cone) ASTM C 1231 Copies to: X Client Contractor X Architect X Building Dept: Technical Responsibility: Engineer Anthony Coyne, rofessional Engineer This report applies only to the items tested or reported and is the.exclusive property of Otto Rosenau & Associates, Inc. Reproduction of this report, except in full, without written permission from our firm is strictly. prohibited. Page 1 of 1 6747 M.L. King Way S., Seattle, Washington 98118 - Phone (206) 725-4600 or 1-888-OTTO-4-US - Fax (206) 723-2221 Form No.: ADMIN-71-04 ,(Rev 05113) OTT®. ROSENAU �'ASSOCIATES, INC.' Geotechnical Engineering, Construction Inspection & Materials Testing ��'�� NOV ? 1 2013 CONSTRUCTION INSPECTION REPORT DEVELOPMENT SERVICES COUNTER Report Number: 266335 Project: Anthony's Beach Cafe Permit Number: 2013-0313 Address: 456 Admiral Way, Edmonds Job Number. 13-0422 Client: Anthonv's Restaurants Client Address: PO Box 3805. Bellevue. WA 98009 Inspections Performed . Steel Decking Other (specify): Welds at kitchen / . hoods and duct X Other (specify): Structural Steel Fabrication Structural Steel Erection Inspector and Date Remarks Tom Maddock Performed visual inspection of welds at (2) kitchen exhaust hoods and ventilation ducts. These welds 10/30/13 had a continuous butt welded connection at duct to duct pieces and duct to hoods. Welder was Ryan Patton. Welding was done with a metal inert gas ( MIG) Welder. Conforms .o Copies to: X Client X Engineer Others kHeff X Owner Contractor Technical Responsibility:X Architect X Building Dept Rabe, Project Manager This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associates, Inc. Reproduction of this report, except in full, without written permission from our firm is strictly prohibited. Page 1 of 1 6747 M.L. King Way S., Seattle, Washington 98118 - Phone (206) 725-4600 or 1-888-OTTO-4-US - Fax (206) 723-2221 Form No.: ADMIN==63-05 (Rev 10/10) RECEIVED OTTO ROSENAU & ASSOCIATES, INC. rcr 10 2013 Geotechnical Engineering, Construction Inspection & Materials Testing nnAlFPr iz�nj COUNTER GROUT REPORT Job Number: 13-0684 Report Number: 125915 Permit Number. BLD2012-0858 Project: Olson Residence - Edmonds Client: George & Ginger Olson Address: 15500 75`' Place West, Edmonds Address: 15500 75"' Place W, Edmonds Date: October 28, 2013 Inspector Gordon Moe Description / Location: Inspected angered and cast in place pile #'s: 1, 2, 3, 12, 13, 15 and 16. Reinforcing steel as per the approved plans and specifications for size, grade and spacing. Resteel grade: 60 Manufacturer: Cascade Mills Placement Data Batch Weights Supplier: Cadman Cement (Ibs/type.): 846# 1/II Water (Ibs./gal): 450# Mix Number: 3GO0149 Fine Agg. (Ibs.): 2357# Admixtures (specify) Total Yards Placed: 18 Coarse Agg. (size/Ibs.): 42 oz. Delvo Stabilizer Specified Strength (psi): 3000 Coarse Agg. (sizeAbs.): Sampling and Casting of Samples Additional Tests/Data Obtained ASTM C 31, C 109 ASTM C939 Time Cubic Grout Ambient Truck Ticket Siie: Set # Cast Yards Flow Temp Temp No. No. Cast Samples: 1-5 9 n/a 550 45°. 274 114233 Cast Samples: 6-10 18 n/a 61 ° 54° 285 114334 Weather. Fair, mid 40's to mid 50's Date Samples Picked Up: 10/29/2013 Comments Other Test Methods / Standards Used: REINFORCING / PLACEMENT: Conforms X Does Not Conform TEST RESULTS Specimen Test Field Age Size Area Max Load Strength Type of Fracture Number Date Cure (Days) (In.) (So.In.) Weight L( bs.) inga bother than cone) 1 10/31/13 3 2x4 3.14 .84# 12,070 3840 2 11 /4/13 7 2x4 3.1.1 .87# 16,050 5160 3 11/25/13 28 2x4 3.14 .90# 17,670 5630 4 11/25/13 28 2x4 3.14 .87# 17,820 5680 5 11/25/13 28- 2x4 3.1.4 .88# 18,560 %910 6 10/31/13 3 2x4 3.14 .89# 10,830 3450 7 11/4/13 7 2x4 3.11 .87# 15,710 5050 8 11/25/13 28 2x4 3.14 .85# 15,150 4830 9 11/25/13 28 2x4 3.14 .85# 17,640 5620 10 11/25/13 28 2x47 3.14 .88# 17,710 5640 Tested in general accordance to: ASTM C39 x ASTM C78 ASTM C109 Note: Type of fracture does not apply .when testing in conformance to ASTM C1231 ASTM C617 — ASTM C1231 Copies to: X Client Contractor , Z, X Architect X Building Dept Technical Responsibility: Engineer Anthony CoyFReproduction rofessiona ngineer ciates IThis report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Assoof this report, except in full, without written permission from our firm is strictly prohibited. Page 1 of 1 6747. M.L. King Way S., Seattle, Washington 98118 -- Phone (206) 725-4600 or 1-883-0TTO-4-US - Fax (206) 723-2221 Form No.: ADMIN-71-04 (Rev 05113) I/ DATE: �-1-7-aola OWNER(S): GL,Dr2�� Vlf4�ajrJJA 01GOAf PROPERTY ADDRESS: 15.600 7S7_11 �� monl�si uiA TAX PARCEL ID # LEGAL DESRCIPTION SEC 05 TWN Z7 /V RNG 4' E OTR or NW �//C/- LOT BLK PLAT THE UNDERSIGNED OWNERS OF THE ABOVE DESIGNATED PROPERTY DO HEREBY ACKNOWLEDGE THE FOLLOWING: That the accuracy of all permit submittal information is warranted , by the applicant/owner in a form which relieves the City and its staff from any liability associated with reliance on such permit application submittals. • While an application may reference the reports of prior public consultants to the City, all conclusions shall be those of the applicant/owner and her/his design professionals. s That the applicant/owner understands and accepts the risk of developing in an area with potential unstable soils and understands the required temporary and permanent erosion control and site maintenance issues associated with specific geologic hazards or conditions of the site that may affect slope stability over time. • That they will advise, in writing, any prospective purchasers of the site, or any prospective lessees of structures on the site, of the slide potential and on -going maintenance issues of the area and on the property. RECE FED AUG 2 3 2012 DEVELOTM CTR. OF EDMONDS CITY copy WASHINGTON SHORT -FORM INDIVIDUAL ACKNOWLEDGMENT (RCW 42.44.100) State of Washington 1 ss. County of :5 nn ' 1,� `o � � 1\ I certify that I know or have satisfactory evidence that 6�gG i I �� Name of Signer is the person who appeared before me, and said person acknowledged that he/she signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and_purposes mentioned in the instrument. Dated: I onth/DayNear Signature of Notarizing Officer Stm of Washingft Lucas A pi _� My Appointment Expireses Oct Oct 19. 2015 Title (Such as "Notary Public") My appointment expires Place Notary Seal and/or Stamp Above Month/DayNear of Appointme t Expiration OPTIONAL Although the information in this section is not required by law, it may prove valuable to Top of thumb.here persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: ?_GnPJ_V Document Date: g— ' — d� Number of Pages: Signer(s) Other Than Named Above: 0 2010 National Notary Association - NationalNotary.org • 1.800-US NOTARY (1.800-876-6827) Item s.19U0 VICINITY. MAP Not to Scale I-'WiJ at OW 0. 1100, fts ', V i r iJ�.A f J JI �tA Fish Project - � _ _ ' ii E. 1��. t [- - - Site � r[152 nd st SW a i1} S9O D L4 Clr11$ C 7" Ga!;r ty Para _ 156th St S�v- y rD tj I t �l .i�Z .._...!• -! L. —" ice--. ;,.�-; r',5 IaEe^�11. N--=- ___w. J i v 16dth,StSx � rT Ac �es o' • f M1 ''1 ��p i �eYe r Oth St S%v RES �172nd PI SW �t _ C120i1M1 TECH_-_ aL Lynnwood, WA RECEIVE® AUG 2 3 2012 DEVELO TM 0 EDMO'CE CTR. Project Number 83421311 Olson Residence Vicinity Map NELSON GEOTECHNICAL N^ A ASSOCIATES, INC. GEOTECMNICAL ENGINEERS & GEOLOGISTS No. I Date I Revision I By 1 i 3/25/11 i Original i DPN OV EDAf 04, Fat.. t 89� File -No": �ttp 4f mlonh Applicant: Affidavit of Earth Subsidence Landshde Hazard Axea Permit Posting RECEIVE® btate of a jingtott. :} AUG 23 2012 — DEVELOPMENT SERVICES CTR. county of .6nobont[5b } CITY OF EDMONDS being first duly sworn, on oath,; deposes_and says: That on the a� day of A(,(�'��CS ,20� a site located at DO cog DODOD 10 lfi was posted as prescribed by Ordinance No. 3632 on the subject property. 'Phis posting begins on j ion the day the City accepts the Permit Application for review and shall remain until building occupancy is granted. _ i5igtied Signed: ` Subscribed and swrn oto .befoie me this day of 20' i`PrintedName:-� Notary PuMeotary Public in and for the State of Washington, residing at State of washln$10 — LUCAS A M EVANS - My Appointment Expires Oct 19.2015 1Gfy ionn expires' j Wemp/Building/Meadow/Affidavit 4/07 i RETURN ADDRESS- City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 201310110420 CONFORMED 5OPY PGS SNOHOMISH3COUNTY, WEHINGTON COVENANT OF NO'IMCAATION AND INDEIVINII'ICAI'ION/HOLD HARIlMESS Reference #: 2�13? Grantor(s)• (1)4!'5 (2)// �� Additional on pg., Grantee(s): Citv of Edmonds .)) Legal Description (abbreviated): Sec &vr Twn v�-ZXI Rng OR Lot Block Plat Assessor's Tag Parcel 11DR(s): (1)41 ��%�%G � (2) Assessor's Tax Parcel 1D# not yet assigned .CITY OF EDMONDS • APPROVED FOR RECORDING BY: A DATE:& AFFAGE L OF� Under the review procedures established pursuant to the State Building Code, incorporating amendments promulgated. by the City of Edmonds, and as a prerequisite to the issuance of a building permit for the construction of a residential structure and attendant facilities, the undersigned OWNERS of property do hereby covenant, stipulate and promise as follows: 1. Description of Subject Property. APP 0 PIVIT FOR RECORDING: DATE: - PA_ OF This covenant of notification and indemnification/hold harmless relates to a tract of land at the street address of (insert street address), Edmonds Snohomish County, Washington and legally described as: Pr rJ Lc lI L-V A/ O )::� LV L-l\i LX / S i f� ALs o 10 r-7- 1--0l I L% W or V✓ 4W or (;--x i 3 or j5AM oRD .3a L?3 r2IE4, 4F22,2 L03 01g7 2. Notification and Covenant of Notification: The above referenced site (hereinafter "subject site") lies within an area which has been identified by the City of Edmonds as having a potential for earth subsidence or landslide hazard. The risks I associated with development of the site have been evaluated by technical consultants and engineers engaged by the applicant as a part of the process to obtain a building permit for the subject site. The results of the consultant's reports and evaluations of the risks associated with development are contained in building permit tile numbercxOD�!�Dg�i (insert number) on file with the City of Edmonds Building Department. Conditions, limitations, or prohibitions on development may have been imposed in accordance with the recommendations of APPROOVEDFOR RECORDING: DATE: PAGE _ OF I the consultants in the course of permit issuance. The conditions, limitations, or prohibitions may require ongoing maintenance on the part of any owner or lessee or, may require modifications to the structures and earth stabilization matters in order to address future or anticipated changes in soil or other site conditions. The statements and conditions proposed by the OWNERS' geotechnical engineer, geologist, architect and/or structural engineer are hereby incorporated by reference from the contents of the file as fully as if herein set forth. Any future purchaser, lessee, lender or any other person acquiring or seeking to acquire an interest in the property is put on notice of the existence of the content of the file and the City urges review of its contents. The file may be reviewed during normal business hours or copies obtained at the Building Department, City of Edmonds, 121 Sth Avenue North, Edmonds, Washington 98020. 3. Indemnification and Hold Harmless. The undersigned OWNERS hereby waive any and all liability associated with development, stating that they have fully informed themselves of all risks associated with development of the property and do therefore waive and relinquish any and all causes of action against the City of Edmonds, its officers, agents and employees arising from and out of such development. In addition, the.OWNERS on behalf of themselves, their successors in interest, heirs and assignees, do hereby promise to indemnify and hold harmless the City of Edmonds, its officers, agents and employees from any loss, claim, liability or damage of any kind or nature to persons or property either on or off the site resulting from or out of earth subsidence or landslide hazard, arising from or out of the issuance of any permit(s) authorizing development of the site, or occurring or APPR— (YED FOR RECORDING: BY: 6'ih�s av?— DATE: PAGE— XI^ OF _�j arising out of any false, misleading, or inaccurate information provided by the OWNERS, their employees, or professional consultants in the course of issuance of . the building permit. 4. Insurance Requirement. In addition to any bonding which may be ,required during the course of development, the Community Services Director has/has not (strike one) specifically required the maintenance of an insurance policy for public liability coverage in the amount and for the time set forth below in order to provide for the financial responsibilities established through the indemnification and hold harmless agreement above: 5. Covenant to Touch and Concern the Land. This cosenant of notification and indemnification/hold harmless touches and concerns the- subject tract and shall run with the land; binding, obligating and/or inuring to the benefit of future owners, heirs, successors and. interests or any other person or entity acquiring an interest in property, as -their interest may appear. This provision shall not be interpreted to require a mortgagor or lender to indemnify the City except to the extent of.their loss nor to obligate such persons to maintain the insurance above required. DONE this l day of ONVNER(S) By: By: _ Gia By STATE OF WASIIU GTON ) ) ss: COUNTY OF ��IS) I certify that I know or have satisfactory evidence that CSON signed this instrument and acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in this instrument. 7�J DATED this ��LL� day ofeo- Notm PUM NOTARY PUBLIC 7 l Sto Of W"NON My commission expires: o� / UMA USUANOVA r` MY Appointment ExOm Sep 27, 2014