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128 SUNSET AVE N
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=". BUSIASS LICENSE APPLICATION
DATE_ LICENSE NO.
CITY of EDMONDS
Civic Cuter • Edmonds, Washington 98020
�• City -"Clerk Phone 775-2525
ANNUAL FEES PENALTY AFTERFEB. 15
❑
HOME OCCUPATION
INSTRUCTIONS:
CLASS
YEAR LIC.
EFFEC. DATE IREASG.
LIC. NO.
SPEC.
0,00 (A) ADDIT L $5.00 ❑
• All items must be completed
❑
SMALL ESS
or application Will not be aC
RECEIPT N0.
DATE PAID
pRINT'x'
$15.00 ADDITIONAL $7.50 ❑
ce ted.
P
IN SPEC. Box
❑
Business w 0 or
��##
• Sign and return application
FEE PAID
PENALTY AID
FOR ISSUE OF
CORRECTED
more ppToyees AD NAL $25.00 ❑
with fee. Renewals received
1
LICENSE WITH
'LC' ACTION.
rF" (G.)
/Y00.0O
after February 15 must pay
D—NEW APPLICATION (LA)
penalty in addition to fee.
❑ RENEWAL (LB)
NEW BUSINESSES AFTER
❑ CHANGE (LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) ❑ DELETE (LD)
NAME OF FIR
BUSINESS PHONE
NO. OF EMPLOYEES
MAILING ADDRESS / NATURE OF BUSINESS
BUSINESS ADDRESS CL4400 INDIVIDUAL PARTNERSHIP CORPORATION
�112�i'l %�l>' ��C r-r'irc /r :x— (S) C—] (P) P
OWNERS NAME HOME ADDRESS
HOME PHONE DATE OF BIRTH P4ACE OF BI TH SOCIAL SECURITY NUMBER,
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATURES
DO NOT WRITE BELOW THIS LINE'
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE fly LAND USE CODE ZONING CODE
¢APPROVE ❑ DISAPPROVE
SIGNATURE
i
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPARTMENT DATE _� �� I i Building Ap
❑ DISAPPROVE g ❑ tMotel )
SIGNATURE '_ Permit ❑ Apt.. Bldg. (AA)
❑ Office Bldg. (0)
Occupancy ❑ Restaurant (R)
COMMENTS: Group ❑ Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS) ® ❑ School (S)
FIRE DEPARTMENT DATE U.F.I.R.
X APPROVE ❑ DISAPPROVE SIGNATURE
COMMENTS:
P09GE DEPARTMENT
APPROVE ❑ DISAPPROVE DATE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT ,p
❑ APPROVE ❑ DISAPPROVE DATE 9 SIGNATURE
COMMENTS:
440
INSPECI•[O11 RECORD
CITY OF El)'-;ONDS, PUBLIC [•'ORES DIE' PA RT i-lf: T
PRO.] FICT:
MEMO TO:
FROM:
SUBJECT:
DATE: 41 ZCQ ( 7 oo
Building Division
Community Development Department
Engineering Division
Public Works Department
128 'So
After review of the subject building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is t e
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -!day .or public easement.
4) Driveway slope not to exceed 14 0.
PW 5/77
PUBLIC WORKS DEPARM= CHECnIST
BUILDING PERMIT REVIEW c �� NS �� Z(
ad ess to
0
Street Right -of -Way Exist'
O REQD
z
Access Easements Existing
REQD
H
a
Utility Easement Exist
REQD
w
Lot Per Subdivision —" Plat
iK Assessor Map
w
Site Plan Checked for Accuracy
A Z
z
Underground Wiring Reqd.
H
0
Check Accuracy of Legal Description
A-
z
Review by
Date LQ- 2
w
Existing Water Main Size D V--
Water Main Required 0 A
Service Line Required 314, "
Hydrant Size Existing O lL-
c4
Hydrant Reqd Per Fire Code -*JO
Size
w
Detector Check Meter Reqd. 00
Cross Connection Inspection O
H
Fire Department Conrients
Water Meter Charge Reqd. 0 �a�-� c ►.�
Review by was
Date 1 21 '7�
A,K.ic.
Septic Tank Design Approved /�
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj .
Drawing No.
File No.
Side Sewer Availability ci 17A-J51
w
Sanitary Sewer Connection Fee Reqd.
lht�
3
Review by Vill
Date 4�2/ ?g
w
Open Ditch Existing ZVj�r—
Regd.
Culvert Regd./
Size
c4
Catch Basin Reqd. k19
Indicate on Site Plan
O
Shoulder dr inage maintain collection on
swale open runoff
Manhole re d. q ,fA
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by
Date
Date
Revised: lv10-1977
Page 2
040
09
Street Paving Reqd. i(/,f4-
H
Curb and Gutter Reqd.
W Sidewalk Reqd.
W Curb Cut for Driveway Reqd.
w Right -of -Way Construction Permit Reqd.
H Bond Reqd. for Public Improvements
Street Name Sign Reqd. &-A
Other Signing Reqd. /(/ff—
A, . Pre Permit Site Inspection made on
z
BY: SEWER
H
W W WATER
a
H z STREET
ENGINEERING r-j Vj
'4 Special Requirements listed in menu to Comrnmity Development Department,
Building Division
� BY Date
o All items filled in on Building Permit Application 2CP
76
P� BY _ Date
Drawings Stamped and Notations Made
w BY Date
Approved by Public Works Department
Kevised: 1v 10-1977
s
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT, ENGINEERIIG DIVISION
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to: J�,,/ l� o.%✓T�c�,/�f,� S
For Work at:(address or vicinity)
<-f
Type of Work to be done: SE Lek elm"g,7QL
(attach drawing when applicable)
Time Required -- Start: �9 Finish:ri J 6
Owner: J/9c./`- 'JpoaisoN
Name
Mailing Address
City State Zip
Contractor: IN W U i` -) '/—/ 6-E
Name
7 7 / 8 /G 91 f~
Mailing Address
'/ oo'V 0 o
City State Zip
U 'dam 44x�y�i I L E
Telephone Number
Al
State License Number
-2- --27D-7
Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: Date: -
Owner or Agen
C, TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Permit No.: Fee:/G
Security Bond:
Time Authorized: 28
APPROVED BY
1 . t e�i l�
t�i
USE
PERMIT
BUILDING DEPARTMENT Applicant Fill ZONEg
/ NUMBER
PERMIT APPLICATION Inside Heavy Lines (O
JOB
NAME (OR NAME OF BUSINESS) / ADDRESS
Ir NC± k B 1 c. c Y���`�� SUBDIVISION NO. PLAT NAME ASSESSOR MAP NO.
W MAILING ADDRESS /1 F/ PL_A-IT Z
0 CITY /N ELEPHONE NUMBER PUBLIC RIGHT OF WAY PER ORDINANCE NO.
F7 2 �� �O
'c ib ] �J A.; c (S v EXISTING RIGHT OF WAY
NAME PROPOSED RIGHT OF WAY
U� DEFICIENCY OF RIGHT OF WAY O
W N
ADDRESS + ,1
H STREET/UTILITY WORK REQUIRED ❑1
YES `NO E
PERMIT FOR WORK IN PUBLIC R/W El YES ONO °
u < CITY TELEPHONE NUMBER 3
a UNDERGROUND WIRING REQUIRED El YES ONO U_
CONNECTION TO SANITARY SEWER ®YES NO J
NAME m
SEPTIC TANK PERMIT REQUIRED ❑YES ENO y
SEPTIC TANK PERMIT NO.
0 ADDRESS
h SEE MEMO DATED 1? �
u A� l a
E CITY TELEPHONE NUMBER REMARKS
F
Z A•
U STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BV
Legal Description of Property (Show Below or Attachh Four Copies) METER SIZE YfUILDINJ SUPPLY SIZE
7L 3 ,5 H i t.� W
7 W
REMAR S f'
Z a
d SIGN AREA ENV, REVIEW ADB N
N/', ALLOWED PROPOSED COMPLETE EXEMPT
a REMARKS
U
W
J
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
❑ V (FRONT SIDE �. /REAR
ryEW L_J RESIDENTIAL GAS
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD E DEMOLISH RETAINING SPECIAL REQUIRED INSPECTOR JAREA OCC
( UPANCV OCCUPANT
❑GROUP LOAD
ALTER ❑ EXCAVATE FENCE ❑ YES ❑ NO
OR FILL ❑ X �
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
❑ REPAIR El NSP. El POOL SHOULDO EDCODEDA31 04�ES TAX
NUMBER OF STORIES NUMBER OF REMARKS (fin,' //�� ``
1 �1/I�-<��tl C,li UNITSLING NU 0cc PA1,3C VP �tW `
NATURE OF WORK TO BE DONE H ` , 1 W
f
a
IL
/ W
�% C�(i C' 'x 6)/ PLAN CHECK FEE a
Z
PROPOSED USE VALUATION FEE - --
_ — F
W
IL P T PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING IL
(A O
W PL I-.��-,� J
zwa E. W
0
--- -- >
ILL:0 W: MECHANICAL W
1
FENCE ---
-- t
SIGN Z
RETAINING
--- -- _ -_
WALL F
-_, 0
PUBLIC WORKS DEPART CHEMIST
BUILDING PERMIT REVIEW c �' ('' NS �`� 24 Fn
(address) to
0
Street Right -of -Way Existing C����
O REQD
2
Access Easements Existing (`�
REQD
Q
1 1
H
Utility Easement Existing
REQD
w
Lot Per Subdivision -- Plat
i( Assessor Map
w
Site Plan Checked for Accuracy
Z
z
H
Underground [,Tiring Reqd.
U
Check Accuracy of Legal Description
-4- (
�j
z
Review by ����, �
Date 4- 2
w
Existing Water Main Size Z�>
Water Main Required 0 A
Service Line Required
Hydrant Size Existing p IL
c�
Hydrant Reqd Per Fire Code "C
Size
w
Detector Check Meter Reqd. 00
Cross Connection Inspection I� O
Fire Department Conments
Water Mater Charge Reqd. V UA, C et;'� IJ
Review by • '�s
Date 2i �-7
K. K...
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj .
Drawing No.
Fi No.
Side Sewer Availability IL'i' ti
w
Sanitary Sewer Connection Fee Reqd.
:a:
Review by
Date
w
►; �-
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
04
Catch Basin Reqd.
Indicate on Site Plan
O
Shoulder drainage maintain collection on
swale open runoff
T,ianhole reqd. f�/1�1
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by c hi Z
Date
10It,
BUILDING DEPARTMENT Applicant Fill
USE PERM T
ZONE-(/ NUMBER
PERMIT APPLICATION Inside Heavy Lines
J/
JOB
ADDRESS
NAME IOR NAME OF BUSINESS)
k, g 1
J bse`�
SUBDIVISION NO.
PLAT NAME
n�!�^,'T
ASSESSOR MAP NO.
�1L..
, F1_ � G {{//
W
MAILING ADDRESS
z
1
G
JN
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
CITY
�
E LEPHONE NUMBER
G 4? U 0/s
•' / jj
EXISTING RIGHT OF WAY_
PROPOSED RIGHT OF WAY
NAME
U
<I
DEFICIENCY OF RIGHT OF WAY
O
W
f
ADDRESS
STREET/UTILITY WORK REQUIRED
h
❑YES WINO Y
u
PERMIT FOR WORK IN PUBLIC R/W
❑ YES ONO G
3
CITY
TELEPHONE NUMBER
Z
C
UNDERGROUND WIRING REQUIRED
❑YES NO U_
CONNECTION TO SANITARY SEWER
®YES El NO m
NAME
SEPTIC TANK PERMIT REQUIRED
❑YES ONO a
SEPTIC TANK PERMIT NO.
O
ADDRESS
U
SEE MEMO DATED
a12c,116
Q
IC
F
CITY
TELEPHONE NUMBER
REMARKS
Z
o
A
U
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
Legal Description Of Property (Show Below Or Attach Four Copies)
METER SIZE
BUILDIN9 SUPPLY SIZE
& D/
3
'3 +� � r3 �
W
W
REMAR S I
Q
Z
o
�
3
a
SIGN AREA
ENV. REVIEW
ADB N
NALLOWED
PROPOSED
COMPLETE
EXEMPT
W
/
`
O
REMARKS
W
J
VARIANCE OR Cu
PLANNING REVIEW BY
DATE
YARDS
rFRONT SIDE �. /REAR
LOT COVERAGE
I Li( ryEW
RESIDENTIAL
GAS
❑ LINE
FIRE
L=J
❑ NON-RESIDENTIAL
SIGN
ZONE
TYPE
OF CONSTRUCTION
CODE
HEIGHT
❑-
ADD
❑
DEMOLISH
❑ RETAINING
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
OCCUPANT
❑WALL
ALTER EXCAVATE
OR FILL
FENCE
❑ I FT )
❑ YES ❑ NO
GROUP
LOAD
--
PLAN CHECKED BY
THIS SITE IS LOCATED IN
OF EDMONDS.
THE CITY
REPAIR PRE -MOVE
INSP.
SWIM
POOL
LOCAL SALES TAX
SHOULD BE CODED 31.04.
NUMBER OF STORIES
NUMBER OF
REMARKS
�j/�.S
UNITSLING
/
(� //�� \ ,- l
NO O cc.v PAQ C. 0 F wk-
C��CI C,�i
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`lC5
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NATURE OF WORK TO BE DONE
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PROPOSED USE
PLAN CHECK FEE
VALUATION
FEE
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PLOT PLAN INDICATE BUILDING SETBACKS,
_
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ABUTTING STREETS)
BUILDING
6
UIn
0
W
PLUMBING
W
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— —_..._—�
Mom.
__—.
_�
MECHANICAL
__—_
_
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FENCE
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SIGN
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Z
RETAINING WALL
0
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
�..,� Fi PERMIT
/Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
`Inspection will be provided within 24 hours after requat. NO Sat., Sun., or holiday inspections)
ADDRESS LOCATION OF CONSTRUCTION...... ......:`' a+::r...::.:..P....................................................................1........................_..............
PROPERTYLEGAL DESCRIPTION...... ...........r ...........I..� !s :..; ...... ......................................................................................................
....................... .............................................................................................................................. ........................................................................................................
8..lt.S...l.................
................................................................OWNER AND/OR BUILDER.. ...... ..ee...... ,
CONTRACTOR'S NAME &ADDRESS::......: � • :�c2.1.� .:.�......... c?;...<.._�(:5.::.t9 :'"..._......: �'9 . y!- ,/.: !... ,�. ...j.... `�. !O � '
.. ..yp .. .. ..r. .. .............• :,,.•
l
Permission Is granted .........................:.. .. .., 19,,;,6for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A� JTION IS CALLED TO THE FOLLOWING:
NOTE No. I 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—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property Iine; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5—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,
NOTE No. 6—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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED Date ............. ........._.......... By ................ Date.......
APPROVED Date......... ��. By�
Remarks: ..................................................................................... .......
............. By ................ Date .................................... By ................
................._..............................._.......................................................
........... .......................................................... _............................... ......................................................................................................................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection --
I ................ ............................ ........................................... ... I hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Construction)
w,\__1istalled in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................day of ................................................................. 19.........
Check BEFORE you dig for: Water Cj, Gas p, Telephone Ej, Power Ej, Sewer [], Other ❑ V -�
•
APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No ...........................................
112-04400
OWNER.......... RQgn.d... Dean ........................................................................... CONTRACTOR.------------------.....------......------......-------- ------......------....------... PERMIT No. ......................
ADDRESS ....... IZS--Sunset.-A.ve•.............................................. .............. LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No. ............................................
NAMEOF ADDITION.........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
is
DATE................................................ BY......---------------.----.---..:---.---............------..........--
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION E] REPAIRS E LID NO . .................. . ASMT. NO- ------------------
OWNER ..... ..... - ------------------------- CONTRACTOR ... PERMIT NO.
JOB ADDRESS ---- A ---- �-V� ------------------------- LEGAL DESCRIPTION: LOT NO. -----------`sue > -------------- ----- BLOCK NO. ---------- V72 - ------------------
7TI,
am""w
M
APPLICATION
The City of Edmonds for EASEMENT NO- --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS ❑ LID NO-------------------.ASMT. NO. ----------------
OWNER -- �'(_s�f' /....... L) AA--- 5------------•------. CONTRACTOR �_ �/7 f�c� /, i � - E PERMIT NO.
JOB ADDRESS 1 .----•---•--------------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------- BLOCK NO. .-Z�-------------
NAMEOF ADDITION --------------------------------- ------------------------------------------------------------------------------------
Approved:
DATE--------------------------------- ---------- BY--------------------------------------------------iiiis