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115 5TH AVE S.PDF - LEGACY1111111111115143 115 5TH AVE S I City of Edmonds STREF FIL Traffic Impact Analysis Worksheet Name of Proposed Project: Owner/Applicant Name /,/-S Street/Mailing Address r/) ray, 0 ) L-" L o L City State Zip Telephone: "'. 10' Applicant Contact Person: Name Z, s s Street/Mailing Address City State Zip Telephone: 3r-2— Traffic Engineer who prepared the Traffic Impact Analysis (if applicable): Firm Name Contact Name Telephone: E-mail: THRESHOLD LEVELS OF ANALYSIS Project Traffic Levels Sections to Complete I. Less than 25 peak -hour trips generated 1 and 7 only (Worksheet/Checklist) II. More than 25 peak -hour trips generated All sections 1. PROJECT DESCRIPTION a. Location - Street address: l S �� L (Attach a vicinity map and site plan.) b. Specify existing land use: )"Ze&rF.-6e d 7"t-�.�p e_-e- /lil Doi c. Specify proposed type and size of development: -S (# of residential units an or square footage of building) RESUB Revised on 6124110 E82 - Traffic Impact Analysis Worksheet MAY 0 9 2013Page 1 of S BUILDING DEPAREIMENT CITY OF EDMONDS d. Date construction will begin and be completed: �Zt' a ` 6 4 � e. Define proposed access locations: �' �� % S ��> �h�.� l✓ f. Define proposed sight distance at site egress locations: 2. TRIP GENERATION Source shall be the Eighth Edition of the Institute of Transportation Engineers (ITE) Trip Generation manual. For independent fee calculations, the current edition of the ITE manual may be used. ADT = Average Daily Traffic PM Peak -hour trips (AM, noon or school peak may also apply as directed by the City Engineer) a. Existing Site Trip Generation Table: PM Peak -Hour Trips Land Use Daily (ADT) IN OUT b. Proposed Project Trip Generation Table: PM Peak -Hour Trips Land Use Daily (ADT) IN OUT c. Net New Project Trip Generation Table: PM Peak -Hour Trips Land Use Daily (ADT) IN OUT d. State assumptions and methodology for internal, link -diverted or passby trips: Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 2 of 5 7. MITIGATION RECOMMENDATIONS State recommended measures and fees required to mitigate project specific traffic impacts. Traffic impact fee shall be calculated from the Edmonds Road Impact Fee Rate Study Table 4 (attached) and as identified in ECDC 18.82.120, except as otherwise provided for independent fee calculations in ECDC 18.82.130. 0 CHANGE IN USE Fee for prior use shall be based on fee established at the time the prior use was permitted. If the previous use was permitted prior to the adoption of Ordinance 3516 (effective date: 09/12/04), the 2004 ECDC 18.82.120 impact fee shall be used. Units in ITE Land Use Category Per Unit square feet, Fee Rate # of dwelling, nn v , etc. New Use 10 Q 1(� $ OC X 2;0 Prior Use 1`6b Z $ lx� 2J -3n New Use Fee: $ - FpTor Use Fee: $ ❑ NEW DEVELOPMENT Units in ITE Land Use Category Per Unit square feet, Fee Rate # of dwelling, vfp, etc. New Use $ X ❑ OTHER RECOMMENDATION:MITIGATION FEE INDEPENDENT FEE CALCULATION: $200.00 + consultant fee $ TOTAL TRAFFIC IMPACT FEE $ City of Division Approval U Date ` No impact fees will be due, nor will a credit be given, for an impact fee calculation resulting in a net negative. Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 5 of 5 The City of Edmonds OWNER - HOUSE No..---... -------- 10 APPLICATION CARD No . ..................... for SIDE SEWER PERMIT EASEMENT No. - ---------------------- ------ OUTSIDE ❑ INSIDE C] REPAIRS F1 ............................................................................ CONTRACTOR ........ ..................... -------------- PERMIT No. ----- ----- --------- STREET f ---------- - - ................... AVENUE LOT No . .......................... 1-2 9 — ------------------- ------------- ------------ -------- . ............. If --- d .......... BLOCK No. ------------------------- NAME ADD. 67:i ---------- cl ----------------------- * ------------------------------------------------------------------------------------------------- Date Approved: -L WORK ORDER ISSUED ----------------------------------- DEPOSIT, $ ..................... - ---------------------- 'S `T)ER ISSUED ---------------------- - ------------------ DATE .............................................. By -------- N✓--------------------- - - - APPLICATION for The City of Edmonds till)), Sl,wiut r)+:Irmrr EASEMENT No .................................. ..... NEW CONSTHUCTION ("( HPIPAII2S 0 OWNER ...l�LJL.(G+QISXL�J.. �QQ�J',...................................... CONTRACTOR................................................................. PERMIT No. . ADDRESS ....Ll ...... ,/_CiL.... Lt[/zJ....�1.................................................. LROAL DESCRIPTION: LOT No............................................... BLOCK No............................................. NAME, OF ADDITION ............... ..... i CITY OF EDMONDS . CIVIC CENTER — WATER -SEWER DEPARTMENT aaR PRospect 6-1107 when work is ready for inspection. (No inspeo- �T 1343 tions Saturday, Sunday or holidays.) jr O SIDE SEWER PERMIT ADDRESS.............................. 13---Ffth..Avenue.-- .-------------------------._............--------------------------------.......-------------•----------------- OWNER .......... Engles__.Tavern------------------------ CONTRACTOR ....L.ee ...W.00ley.. . .......................... .................... jv Permission is granted ..._Decettlber---_2------------- 19.65., for ...................... days, to REPAIR or CONNECT a side sewer with City Sewers in accordance with application on file and governing ordinances. ATTENTION IS CALLED TO THE FOLLOWING: i NOTE No. 1—The owners of the property. may .obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected. \ NOTE No. 2—Obtain full information regarding Ordinance 11.10.030 and Regulations governing side sewers when you get permit. -- - t r NOTE No. 3—Top of side sewer must have at least N inches coverage at property line and 12 inches inside property line; minimum grade of 2%. • No bends in grade sharper than % will be permitted. NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for ' failure due to improper work which may develop within one year of completion. s NOTE No. 5—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its ap- purtenances except to insert the pipe into the wye. - pprov d: DATE................................................ By ........................................ "I r When recorded mail to: City Clerk City of Edmonds M il""""""nl11111111111111111111gill 1111 200110020365 121 Fifth Avenue North 10/02/2001 11:25 AM Snohomish Edmonds, WA 98020 P. 0006 RECORDED County RECORDER'S NOTE: PORTIONS OF THIS DOCUMENT ARE POOR QUALITY FOR SCANNING. SPACE ABOVE THIS LINE FOR RECORDER'S USE Assessor's Parcel No. 4110 %�_ o ege Project No. & Name: A/LtC4161ye 116LE ENCROACHMENT AGREEMENT This ENCROACHMENT AGREEMENT ("Agreement") is entered into between the CITY OF EDMONDS ("City") and tVill/94i WAI ok~ ve ,6 p. _V 19jMei (ul�,rf14ie ("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development Code. 1. The Property. Owner is the owner of that certain real property located at 4yf 5; , within the City of Edmonds, Washington, Assessor's Parcel Number'�,/a/��'�f'QQ , and more particularly described in Exhibit "A" attached hereto and incorporated herein by reference. Business owner, lf�,04 is the business owner of that certain real property noted above. 2. The Easement. The City currently owns an existing easement over, under, and across Owner's property for street, alley, sidewalk, other ( ) which is described in Exhibit `B" attached hereto and incorporated by reference. 3. The Encroachment. The City hereby covenants and agrees and grants its permission to Owner or Business Owner to allow 1r1, . i•9Es� �f cl�cgs to remain in a portion of the City right-of-way/easement. A plat map showing the location of the encroachment is attached as Exhibit "C" and incorporated by reference. This Agreement is subject to the following terms and conditions; lwel'u/7 '70• 040 A&57kO 41-11-141 a. 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 -1- 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 easement 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 maintain the encroachment structure. 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: If to the City: City Engineer City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 If to the Owner: &AKC I&MMiEf 91,4ke Louis Aolva sye, which addresses may be changed from time to time by providing notice to the other party in the manner described above. 6. Waiver. City's consent to or approval of any act or omission by Owner shall 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. i 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 property, but any failure to do so does not invalidate this provision. 8. ' Capacity Each party represents that the person(s) executing this Agreement on behalf of such party has the authority to execute this Agreement and by such signature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this I day of VJAJ , 20_CL. OWNER(S): B V By: STATE OF WASHINGTON ) COUNTY OF SNOHOMISH ) This day, personally appeared before me, to me known to be the person(s) who executed the within and foregoing document and that (he/she/they) signed the same as (his/her/their) free and voluntary act and deed for the uses and purposes therein mentioned. Notary Public Typed or Printed Name My Commission expires: CITY OF EDMONDS By: c'v EN G ERING DIVISION G:ISHARE\TEMP\BUILDING\HANDOUT\EncroachAgree.doc - 3 - STATE OF WASHINGTON, ACKNOWLEDGMENT - Representative Capacity County of 61)vI ()h I certify that I know or have satisfactory evidence that 8 b a-1 - L C u I.5E�- is the person who appeared before me, and said person acknowledged that he/she signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the wopFk� I 7 Din I ES of to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. GIVEN under my hand and official seal the day and year last above written. SUSAN J. EARLING NOTARY PUBLIC STATE OF WASHINGTON COMMISSION EXPIRES APRIL 29.2005 Nota y Public in and f r the State ofWashingto , l residing at My appointment expires 4 -q61-'y� A v A C' "q-M E �,/T -ro i�-1l0,i$oA(!H l-1E%/7— AL`�4!E:7 LI EAl r This jurat is page of and is attached to dated fBE Mi Easement Census Neighborhood Code Zoning Zoning Rest Actual Use Building Name Land Use Subdivision/Plat Legal Vol:2 Page PROPERTY DESCRIPTION :Tract:505.00 Block:4 :500 MapGrid:454 F5 :Bc :Retail Store :5Th Avenue Hair Design :582 Com,Retail,Drinking (Alcohol) :City Of Edmonds :CITY OF EDMONDS BLK 120 D-00 - N :40FT OF W 15FT OF LOT 38 & N 40FT :OF LOTS 39 & 40 :39 ��x /W6 / 7 m 'top LC30t<JtVrr OOWA) C-A)r-c 6 s Pus 4 1 ?A (Oar. TREE P/O-- 2"a 13 / LAY .:5 APPROVED AS NOTED BYERING ------------ Date: --4144411 -C) F 8, u I I. DIAI � SNOHOMISH HEALTH DISTRICT May 30, 2001 ENVIRONMENTAL HEALTH DIVISION 3020 Rucker Avenue, Suite 104 Everett, WA 98201-3900 425.339.5250 FAX:425.339.5254 Healthy Lifestyles, Healthy Communities RECEIVED William Day J U N - 4 2001 822 W. Fulton Seattle, WA 98119 BUILDING DEPT. Subject: Proposed, Remodel, Billy's Cubby Hole, 115 5t' Avenue South, Edmonds Dear Mr. Day: Your plans have been received; however the plans cannot be approved as submitted. The following information is needed prior to further plan review. 1. Customer seating is shown on the floor plan. When customer seating is provided, customer restrooms must also be provided. Customers are not permitted to access customer restrooms through the food service, preparation, or storage areas. Customer restrooms must be included on the floor plan. 2. Manufacturer name and model number was submitted for only one refrigerator. The manufacturer name and model number for the second refrigerator, the espresso machine and all other food service equipment including counter top equipment must be submitted. 3. No mop sink is shown on the floor plan. A mop sink is required. 4. An additional handwash sink is required in the three -compartment sink and food preparation sink room. 5. No drainboards are indicated for the three -compartment sink. Three -compartment sinks must have integral drainboards at both ends. 6. No drainboard is indicated for the food preparation sink. The food preparation sink must be listed by the National Sanitation Foundation (NSF), and have at least one integral drainboard. 7. Finish schedule for floors, walls, ceilings, counters and cabinets. 8. Plumbing details or schedule. 9. Submit a revised floor plan, drawn to scale, showing location of all equipment, plumbing fixtures and the like, which includes the required additional sinks and information. The scale of the drawing should be 1/4 inch equals 1 foot. 10. Please refer to the enclosed copy of Food Establishment Construction Plan Guidelines for additional information and sample floor plan drawing. Please note that prior to opening of the facility after the remodel, after the Health District plan review process is completed and remodel construction is finished, the balance of the Subject: Proposed, Remodel, Billy's Cubby Hole, 115 5`h Avenue South, Edmonds May 30, 2001 Page 2 operating permit fee, for change from concession stand to restaurant, must be submitted and a preoperational inspection must be conducted Please contact me if you have any questions. My office number is 425.339.5250. Sinc , ?Ro ert A. Hoppa,S. nvironmental Health Specialist RH/ek Enclosure: Construction Plan Guidelines cc: City of Edmonds Building Department David Compton, R.S. Environmental Health Specialist FEB. 8. 2002 12: 10PM SWANBERG REALTY aat!lMWDDnn ACOgD,P ' CENTIFICATE OF LIABILITY INSURANCE T 02/08/20.02 PRool►caw CE FIr. 18 18U AE A MAT R OF INFORMATION ONLY TAND CQNt�R8 NO RIGHTS L)PON THE CBR71FtCATE Roy A Ovenell inSuranae Agency, I • I• , HOLDER, THIS CEKTIPICATC DOSE NOT AMEND, EXTEND OR AFRORt7ED e1f THE pOW01E8 BELOW, 13310 Lake City Way NE `' ALTER THE COVE OE "INSURER8APWROMOCQNLi�GE ► Seattle, WA, 96125 (206) 362-9062 1-80Q 862-9Q62 E INGURERA FA RB TNSURANCF,. EX �IAN(3E INiUNiO WILLI M DAY, DBA: THE CUSS HO INDUREA B: 115 5TH AVE S ► 14jumv. EDMONDS,WA 59020 INsuAER0; I RP CON8RAGES THE POLICIPA pF OMM11M UBT40 BELOW -HAVE BEEN 10SUF0 TO ThIE1NSUREp NAM6D A6OVE FOR THE POLICY PERIOD INDICATED. NO1WRHeTAN01140 , DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 13GUED OR hNY REQUIREMENT, TERM OR•CONDIT(ON OF ANY CONTRACT OR OTHFR THE INSURANCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, MLUBIONE AND CONDITIONS OF SUCH MAY PERTAIN, POLICIES. AOOREOATE LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAID CLAIMS. T`/PC eNNaONANtd POLICY NU1ArEN iwrr EACH OCCURRENCE . 01.000,000 OagaNAL W1aUTT PIKE DAMAGE and Ara) i 100 0 0 0 jC OONMMCNLaC-NERAL 1u61LITv CLVW MADE �X OCCUR M D EXP Whom 65 000 00 000 000,00 602467074 92-05-02 02-05�-03 PMWNAL+ADVINJURY $1, A QENERALA QPAPATE 62 00, 0 PRODUCT6•COMPIOPAQO r 000 000 OEWL AWRF-XE LIMIT APPLIEL PER' X1 PoLoY M ° D LDS CaMPINEOpA INQtPUMrt s AUT0100FLNUA011AY (Ea aopld,hq ANYAUTO ALLOWNWAUT09 (P�+TOPQ1°lU r BCHECUIEDAUTOO MIIAUT06 OODIIYItJURY (Pay A[dd�lll) s NON4"L'D AUTOS PPOPERIY DAMAGE IPNaoaao y AUTQONW-!A DENT i QWMA3aluiurtY ANYAUTO THAN EAAcC i A�UTNiERIA A00 >p FAGH OCCURRENCE r Oman YAv1UTy OCCUR IDCIA109WADE AOgREOAT9 i i i DEDUCTIBLE i RaTEJdTION a i WORKIPA OOWaarAT10N AND NPLOyrila'UANUTY 8 EL,W&HAOCIDENT r EL.DI86ABE•EAVMFLCYEC i EL.OIswe-POLICY LIMIT Is CTNaN COFFEE SHOP/DELI E HOLDER IX I ADNTIONAL INiv11iD: INBU"W LCTTER: �+�•��-^, •—•• ONOULO ANY 0► TNi Aaoua DrrONUue vo4w as oANCpµwO WORM TOM EXPONA7► M THE CITY OF EVIN IONDS aATA YNulror, THR OWNS Errullra VaL 11imy" To NMM1 30 0AT■ aNmaa 121 STH AVE N NOTICaTOTNtarafllldlTwRolDgnNANDToTllsLriY,101►AIWRrToDoaodNUL EDMONDS, WA 98020 N►Ord No aoW SAWN Ow UAWUTY OF ANT MO UPON THr INrIINNA,"AWN" OR waPwndRTAYP+aa. � AUTweNgwo RIPNar1►fJA ACORD 2" (7/67) m AOORD GREET FILE DUTIES OF AN EXECUTOR 1. Obtain the original of the Last Will. If in safety deposit box, it is sometimes necessary to obtain an order of the court to gain admittance. 2. Offer the Will, through an attorney, for probate in probate court. 3. Prove execution of the Will in court through the subscribing witness or otherwise. 4. Secure letters testamentary from the court. These are the executor's legal authority to administer and settle the estate. 5. Secure appointment from the court and furnish the required bond. 6. Notify all persons interested in the estate of the decedent — creditors, banks, safe deposit companies, insurance companies and the post office. 7. Take possession of all the property of the deceased; investigate his books of account, records and private papers; collect all valuable not in safe deposit. 8. Prepare a complete detailed inventory of all assets; keep an accurate record of stocks, bonds, mortgages, notes, etc., and watch investments for bond calls, interest defaults, stock rights, etc. 9. Ascertain bank balances, check insurance policies and verify debts. 10. Attend meeting of appraisers to assist in accurate valuations; protect property by insurance. 11. Collect insurance proceeds payable to the estate; collect interest and dividends due the decedent. 12. List specific bequests to be delivered. 13. Obtain all property in custody of others; pay all debts and severe release of property held as collateral for bank loans or brokerage accounts. 14. Arrange for supervision and preservation of business interests of the decedent. Obtain order to advertise for claims against the estate. Arrange for such advertising. 15. Examine claims filed against the estate; Determine correctness of same and secure adjustments; defend estate against exorbitant or fraudulent claims; pay all approved claims and require claimants to submit others to the court. 16. Obtain all papers relating to real estate; inspect real estate and checks its condition; review mortgages, leases and status of taxes; arrange for collection of rents; general supervision and management. 17. If circumstances require sale of property, have property listed. Receive offers and negotiate sale. Securities offered through KMS Financial Services, Inc. (174QSNOHOMISH HEALTH DISTRICT August 29, 2001 William Day 822 West Fulton Seattle, WA 98119 ENVIRONMENTAL HEALTH DIVISION 3020 Rucker Avenue, Suite 104 Everett, WA 98201-3900 425.339.5250 FAX:425.339.5254 Healthy Lifestyles, Healthy Communities Subject: Proposed, Remodel, Billy's Cubby Hole, 115 5`h Avenue South, Edmonds Dear Mr. Day: RECEIVED 'US 3 0 2001 6 Gn,NG DEPARiAtE�; OF EDMO(yoc Your plans have been reviewed with the Rules and Regulations of the State Board of Health, and with the policies of the Snohomish Health District. With the addition of the following, the plans are approved. 1. Water heaters must be of sufficient size to provide hot water to dishwasher and/or scullery sinks and at the same time provide hot water to all handwash sinks. 2. The ceiling above the food preparation areas must be nonabsorbent, smooth, and easily cleanable. 3. All light fixtures in food preparation and storage areas must be provided with covers or shatter proof bulbs. 4. Plumbing must meet state and local codes. 5. The ventilation system shall be installed and operated to meet applicable building, mechanical, and fire codes. 6. Note: prior to approval of any customer seating, customer restrooms must be provided. Customers are not permitted to access to customer restrooms through the food preparation, service, or storage areas. A pre -operational inspection is required prior to opening for business. At the time of inspection the construction of the food service establishment must be complete and all equipment must be in place. Incomplete construction may result in a $130.00 reinspection fee. Please contact the Food Program office a minimum of one week in advance to schedule an appointment. This will ensure compliance with the Rules and Regulations of the State Board of Health for Food Service Sanitation. If there are any significant changes or additions to your layout or equipment, the Snohomish Health District must be notified. Please contact me if you have any questions. My office number is 425.339.5250. :ialist RH/ek cc: City of Edmonds Building Department David Compton, R.S. Environmental Health Specialist When recorded mail to: City Clerk City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 CONFORMED COPY 200110020365 10/02/2001 11:25 AM Snohomish p.0006 RECORDED County SPACE ABOVE THIS LINE FOR RECORDER'S USE Assessor's Parcel No. l.3a J-VA994Q Project No. & Name: Alztlef 6udblc' hloiz ENCROACHMENT AGREEMENT This ENCROACHMENT AGREEMENT ("Agreement") is entered into between the CITY OF EDMONDS ("City") and _ Gal; /h v41 0A oWoe,1 vcr liurMc t.r /gt llre� Kbd eflV ("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development Code. 1. The Property. Owner is the owner of that certain real property located at /l-5� -� A <W s S , within the City of Edmonds, Washington, Assessor's Parcel Number 4lW &M6 59'OD , and more particularly described in Exhibit "A" attached hereto and incorporated herein by reference. is the property noted above. Business owner, business owner of that certain real 2. The Easement. The City currently owns an existing easement over, under, and across Owner's property for street, alley, sidewalk, other ( ) which is described in Exhibit "B" attached hereto and incorporated by reference. 3. The Encroachment. - The City hereby covenants and agrees and grants its permission to Owner or Business Owner to allow �U�,e ,g rJ�s.�,,U�,� �{ 3 ig&-eS J,—Iwa to remain in a portion of the City right-of-way/easement. A plat map showing the location of the encroachment is attached as Exhibit "C" and incorporated by reference. This Agreement is subject to the following terms and conditions; 1wela d -4'410G /? ,74. C14D Kati 6>sllzo ,Qi,✓j.✓y� . a. The encroachment shall be installed and maintained in a safe and sanitary condition at the sole cgst, 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 -1- 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 easement 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 maintain the encroachment structure. 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: If to the City: City Engineer City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 If to the Owner: which addresses may be changed from time to time by providing notice to the other party in the manner described above. 6. Waiver. City's consent to or approval of any act or omission by Owner shall 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. -2- 7. Successors and Assi ns. 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 property, but any failure to do so does not invalidate this provision. 8. Ca aci . Each party represents that the person(s) executing this Agreement on behalf of such party has the authority to execute this Agreement and by such signature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this day of , 20_CL. OWNER(S): B � V By: STATE OF WASHINGTON ) COUNTY OF SNOHOMISH ) This day, personally appeared before me, to me known to be the person(s) who executed the within and foregoing document and that (he/she/they) signed the same as (his/her/their) free and voluntary act and deed for the uses and purposes therein mentioned. Notary Public Typed or Printed Name My Commission expires: CITY OF EDMONDS By: EN G ER1NG DIVISION G:ISHARE\TEMP\BUILDING\HANDOUTEncroachAgree.doc — 3 — STATE OF WASHINGTON, I SS ACKNOWLEDGMENT - Representative Capacity County of 61)bhokiz 15 I certify that I know or have satisfactory evidence that a- Ln U is the person who appeared before me, and said person acknowledged that he/she signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the i'C�� w�T 7 t �I r l-yE-P— QF- of to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. GIVEN under my hand and official seal the day and year last above written. SUSAN J. EARLING NOTARY PUBLIC STATE OF WASHINGTON COMMISSION EXPIRES APRIL 29.2005 Nota y Public in and f r the State of Washingto , residing at My appointment expires �/'v5" A 7fi A L`'.4 M �i7c5�j�}Q� This jurat is page of and is attached to _ dated ZWY16/j /,4 PROPERTY DESCRIPTION Easement Census :Tract:505.00 Block:4 Neighborhood Code :500 MapGrid:454 F5 Zoning :BC Zoning Rest Actual Use :Retail Store Building Name :5Th Avenue Hair Design Land Use :582 Com,Retail,Drinking (Alcohol) Subdivision/Plat :City Of Edmonds Legal :CITY OF EDMONDS BLK 120 D-00 - N :40FT OF W 15FT OF LOT 38 & N 40FT :OF LOTS 39 & 40 Vol:2 Page :39 VW617 "Mp vlcw LC)O/<JA/C,-, m PV18 EDCc-. or - 0 SET w 4 (far. u 11. 01416: it. - APPROVED AS NOTED BY ER,ING pf, Date: --4f'Z'ZI-1 IV City of Edmonds 8g0_199- RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number. Issue Date: 7 E A. Address or Vicinity of Construction: B. Type of Work (be specific): C. Contractor: ( [a -fy L. Mailing Address: State License #: r j,15 7-0 r'T�2 �! L r, Contact: Phone: �� , , 77 `7 ti -7 2 4 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑_ Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family 0 Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut : 6? Yes ❑No G. Size of Cut: - -1 " x _7 1 , H. Charge $ -~"-"' - --- - - - APPLICANT TO READ AN GN ®�! INDEMNITY: Applicant understands and by his signature to this application, agrees to ht�' City ojEdmonde harm as om i dun"ea, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ainst the City of Edmonds, or any of its departments or employees, including or not limited to the defense ofany legalproceedings including defens, and attorney fees by reason of gran ng this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR RIOD OF ONE YEAR �r'� W%FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION F LL BE HELD UNTIL THE FiN L S ET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all times forlispection purposes. Signature: Date: (C ntra r or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR. CITY USE ONLY t p APPROVED BY: RIGHT OF WAY DEPOSIT f TIME AUTHORIZED: VOID AFTE DAYS DISRUPTION FEE/FUND Ill: SPECIAL CONDITIONS: RESTORATION FEE: COMMENTS: DATE: PERMIT FEE: TOTAL FEE: 14J �a RECEIPT FEE: ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 FIELD INSPECTION NOTES Comments Diagram (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION ❑ YES Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: ❑ NO ,p. of EQA.1 City of Edmonds Traffic Impact Analysis Worksheet n. 1890 Name of Proposed Project: Owner/Applicant Applicant Contact Person: Tlh4 c/ D rat k e 5 Name Name '14 R `j 2:12 (Sk , `z�� Street/MailiIUML'44 Address City State Zip Street/Mailing Address City Telephone: / Z __ " �(� Telephone: Traffic Engineer who prepared the Traffic Impact Analysis (if applicable): Firm Name Telephone: THRESHOLD LEVELS OF ANALYSIS . Contact Name E-mail: State Zip Project Traffic Levels Sections to Complete I. Less than 25 peak -hour trips generated 1 and 7 only (Worksheet/Checklist) 11. More than 25 peak -hour trips generated All sections 1. PROJECT DESCRIPTION a. Location - Street address: ttach a vicinity map and site plan.) b. Specify existing land use: C)!� c. Specify proposed type and size of development: / (# of residentia units and/or square footage of building) Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page I of 5 d. Date construction will begin and be completed: rs- P e. Define proposed access locations: 511U (AIM k. f. Define proposed sight distance at site egress locations: 11 41- G cbQ'v,,e-- 2. TRIP GENERATION Source shall be the Eighth Edition of the Institute of Transportation Engineers (ITE) Trip Generation manual. For independent fee calculations, the current edition of the ITE manual may be used. ADT = Average Daily Traffic PM Peak -hour trips (AM, noon or school peak may also apply as directed by the City Engineer) a. Existing Site Trip Generation Table: Land Use Daily (ADT) PM Peak -Hour Trips IN OUT b. Proposed Project Trip Generation Table: Land Use Daily (ADT) PM Peak -Hour Trips IN OUT c. Net New Project Trip Generation Table: Land Use Daily (ADT) PM Peak -Hour Trips IN OUT d. State assumptions and methodology for internal, link -diverted or passby trips: Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 2 of 5 3. TRIP DISTRIBUTION Prepare and attach a graphic showing project trip distribution percentages and assignments. For developments that generate over 75 peak -hour trips, the City Engineer reserves the right to require trip distribution to be determined through use of the City traffic model. 1 4. SITE ACCESS ROADWAY/DRIVEWAYS AND SAFETY a. Have sight distance requirements at egress location been met per AASHTO requirements? b. Intersection Level of Service (LOS) Analysis: Intersections to be evaluated shall be determined by the City of Edmonds Traffic Engineer Existing Conditions LOS Delays Year of Opening LOS Delays Five Years Beyond Change of LOS Delays Land Use c. Describe channelization warrants: (Attach striping plan.) d. Vehicle Storage/Queuing Analysis (calculate 50% and 95 % queuing lengths): 50 % 95 % Existing Conditions Year of Opening Five Years Beyond Change of Land Use e. If appropriate, state traffic control warrants (e.g. stop sign warrants, signal warrants): f. Summarize local accident history' (only required for access to principal and minor arterials): Available upon request at City of Edmonds Development Services Department z Available upon request at City of Edmonds Police Department Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 3 of 5 5. TRAFFIC VOLUMES Provide the following and other planned development traffic within the city.' a. Describe existing ADT and peak -hour counts (less than two years old), including turning movements, on street adjacent to and directly impacted by the project. b. Describe the estimated ADT and peak -hour counts, including turning movements, the year the project is fully open (with and without project traffic). c. Describe the estimated ADT and peak -hour counts, including turning movements, five years after the project has been fully open (with and without project traffic). d. State annual background traffic growth factor and source: 6. LEVEL OF SERVICE (LOS) ANALYSIS a. Summarize Level of Service Analysis below and attach supporting LOS analysis documentation. Provide the following documentation for each arterial street or arterial intersection impacted by ten or more peak -hour trips. Other City -planned developments' must also be factored into the LOS calculations. LOS LOS Existing Conditions Existing Delays Year of Opening With Project Without Project Five Years Beyond Change of Land Use With Project Without Project b. Note any assumptions/variations to standard analysis default values and justifications: ' A list of planned developments are available at the City upon request for public records Revised on 6124110 E82 - Traffic Impact Analysis lvorksheet Page 4 of 5 7. MITIGATION RECOMMENDATIONS State recommended measures and fees required to mitigate project specific traffic impacts. Traffic impact fee shall be calculated from the Edmonds Road Impact Fee Rate Study Table 4 (attached) and as identified in ECDC 18.82.120, except as otherwise provided for independent fee calculations in ECDC 18.82.130. CHANGE IN USE Fee for prior use shall be based on fee established at the time the prior use was permitted. If the previous use was pennitted prior to the adoption of Ordinance 3516 (effective date: 09/12/04), the 2004 ECDC 18.82.120 impact fee shall be used. ITE Land Use Category Per Unit Fee Rate New Use G le l $ X Prior Use i $ X Units in square feet, # of dwelling, vfp, etc. 4Y. New Use Fee: $ - Prior Use Fee: $ :1 _ $ ' ❑ NEW DEVELOPMENT Units in ITE Land Use Category Per Unit square feet, Fee Rate # of dwelling, of , etc. New Use $ X = ❑ OTHER MITIGATION FEE RECOMMENDATION: INDEPENDENT FEE CALCULATION: $200.00 + consultant fee $ TOTAL TRAFFIC IMPACT FEE $ City of Division Approval zli3 ' No impact fees will be due, nor will a credit be given, for an impact fee calculation resulting in a net negative. Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 5 of 5 DATE RECEIVED PERMIT EXPIRES CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION USE PERMIT ZONE C NUMBS --,&�Ia JOB ADDRESS A SUITE/APT# OWNER NAME/NAME OF BUSINESS IPLAT NAME/SUBDIVISION NO. LOT NO. LID NO. ir 111 MAILING A DRESS 3 O il£ 50 CITY ZIP TELEPHONE 976 Adv4l0.UalS q?OiO `fir 9 4'7F, NAME ADDRESS CITY NAME &Z1 L ADDRESS CITY STATE LICENSE NUMBER ZIP ITELEPHONE ZIP I TELEPHONE a PROPERTY TAX ACCOUNT PARCEL NO. �� 41�9 /v'2 D G3S 00 NEW E RESIDENTIAL ADDITION COMMERCIAL REMODEL ❑ APARTMENT REPAIR GRADING CYDS DEMOLISH TANK ❑GARAGE Q RETAINING WALL z CARPORT O ROCKERY F (TYPE OF USE, BUSINESS ACTT ITY EXPLAIN: a U W NUMBER NUMBE . OF DWELLI G O STORIES UNITS DESCRIBE WORK TO BE DONE i CHECKED BY PLUMBING / MECH EDCOMPLIANCE OR CHANGE OF USE ► SIGN ❑ FENCE ( X FT) OTHER RENEWAL AREAS NUMBER LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP CP RW Pe Approved O rmit Required Street Use Permit Req'd EXISTING PROPOSED Inspection Requlred p Sidewalk Required O REQUIRED DEDICATION FT Underground Wiring required O METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED t, YES ❑ NO ❑ z W REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE � Z W . ' . 7W&3rrP &E P&,feci I_U_ e ��c�q / ii� kCen ¢ Imn 64or1 'ENGINEERING - REVIEWED/DATE O FIRE REVIEWED BY DATE W LL VARIANCE OR CU SHORELINE O DB# INSPECTION BOND D .r 0. REQ'D POSTED Y❑ ES NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT EXP I ALLOWED PROPOSED !zT !,U $ ALLOWED PROPOSED 1 +1 1 ,S1 LOT COVERAGE ALLOWED PROP SED REQUIRED SETBACKS (FT.) FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT UR SIDE REAR Z z z PAR ING REQ'D I PROVIDED LOT AREA I P N G REVIE ;ED ATE 73 0l g CHECKED BY ITYP C TR CTION OCCUPANT ((( GROUP SPECIAL INSPECTOR AREA OCCUPANT REQUIRED YES LOAD REMARKS t7 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D o VALUATION FEE PLAN CHECK FEE HEAT SOURCE GLAZING % LOT SLOPE % BUILDING J V E PLAN CHECK NO. 1 li O EST D DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL J SEPARATE PERMISSION. 2 cc `tSTAi SURCHARGE W PERMIT APPLICATION: 180 DAYS a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION y "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS U) ENG. INSPECTION FEE W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING ¢EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEI DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE = NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.- RECEIP .� TOTAL AMOUNT DUE ' ` I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPROVAL 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. on OF IALS SIGNATURE DATE SIGNATURE (O NER AGENT) DATE SIGNED (425) k- ` —O/ 771 -0220 , &Y Own RELE SED BY DAT ATTENTI N EXT 1333 r IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 I D A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE • YELLOW - IN PELT R FAX PINK -OWNER • GOLD - ASSESSOR 5198 G DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSIN SS ��-- M►KE 14ARRI.S•�EDMONLJ �FS/enp Co} MAILING ADDRESS 111 S 5A AVE. So . CITY ZIP ITELEPHONE NAME ADDRESS CITY NAME ADDRESS CITY STATE LICENSE NUMBER PROPERTY TAX ACCOUN yzs `f 78 i6a3 ZIP ITELEPHONE ZIP I TELEPHONE PARCEL NO. CBL# EXPIRATION DATE I CHECKED BY &3/NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH ❑ ADDITION COMMERCIAL COMPLIANCE OR ❑ CHANGE OF USE ❑ REMODEL ❑ MULTIFAMILY IGN ❑ REPAIR ❑ GRADING CYDS //❑ FENCE X FT) ❑ DEMOLISH ❑ TANK ❑ OTHER ❑ CCAAFlPORT ❑ ROCKERY G WALL ❑ FIRE ALARMF RE SPRINKLER (TYPE OF USE. BUSINESS OR ACTNITY) EXPLAIN: 00*140C 640 .514AI Wit% ^I � W NUMBER OF NUMBER OF DWELLING I CRITICAL AREAS STORIES UNITS I NUMBER DESCRIBE WORK TO BE DONE REMOVE E*sT11�< S14 !J AAJD I?F_F1 ArE It w1 Tip Mew dlNe HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHEPKINO: VESTED DATE 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 APPLICATION: 180 DAYS PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, 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 OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. - 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 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- 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 WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNATURE (O R GE DATE SI ED J �3 PERMIT EXPIRES USE PERMIT ZONE NUMBER 0�19�3 7�S JOB // AA • SUITE/APT# ADDRESS i ,— �`T'lli , /1 _ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit Req'd EXISTING PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION FT Underground wlAng rquired eo METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 13NO 13 Z ac W REMARKS 2 Z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE UfjG � <[A 0 I S to Pc.�cc ENGINEERING REVIEWED BY DA E FIRE REVIEWED BY DATE rL VARIANCE OR CU SHORELINE OR APB# INSPECTION BOND R 'D POSTED �-- tj+" DYES D $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALL PROPOSED WED ALLOWED PROPOSED X 1-7,08� I EXP LOT COVERAGE REQUIRED SETBACKS (FT.) ROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT QR SIDE REAR O 2 -•► l z PARKING LOT AREA PLANNING REVIEWED BY DATE d REO'D I PROVIDED �� /1 A QI� CHECKED BY TYPE rQJJST U 1 N CAE OCCUPANT GROUP `/� SPECIAL INSPECTION AREA OCCUPANT REQUIRED YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 'm VALUATION $ Description FEE Description FEE Plan Check a J State Surcharge Building Permit City Surcharge Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # E-1 GALL FOR INSPECTION (425) 771-0220 7— APPLICATION APPROVAL This application is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and receipt is acknowledged in space provided. O CULLS SI NATURE DATE /DIE RE ED BY ATTENTION L� M 1333 USO�ABa %,IT IS UNLAWFUL TO R UNTIL . A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL. FILE • YELLOW - INSPE oR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING EM m Win,. IMEM",( IMMURNT, 111111", m 1 0 v am Co(oajierb 0 C�e� ct ei2A;6 G, CUP m /ice �ape, �