133 4TH AVE N.PDFIIIIIIIIIIII
5019
133 4TH AVE N
1�
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:-- 76191242 DETERMINATION: ❑Conditional Waiver ❑Study RequiredWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED: / C/ / f2 /l////
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA'
OTHER:
LOT: BLOCK:
LATEMP\DSTs\Forms\.Street File Checklist.doc
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FEB - 8 2007 �{
BUILDING DEPARTMENT
CITY of Ebmons i; t
STREET EfLE
J CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 10/26/2006 R
Perin:t # BLD2006 jo
BUILDING PERMIT
r4 Expirallon"Datet0/26/200T
Project Address W44 11 AVIE N, EpM01!1DS
Parcel No: 00434400600600
•••• ERTYONNIN ER APPLICANT CONTRACTOR
SPIN & YARN SPIN & YARN N/A
PO BOX 1298 133 4TH AVE N
EDMONDS, WA 98020 EDMONDS, WA 98020
425-775-0909
LICENSE tl: EXP:
JOB DESCRIPTION
Change use of eAsting lower floor from office to retail and 2 rooms of upper floor from office to storage. IBC 302.3.1 Nonseparated
Uses was used.
VALUATION: $0
PERMIT TYPE: Commercial
PERMIT GROUP: I 1 - Change of Use
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION: VB
RETAINING WALL ROCKERY: N
OCCUPANT GROUP: MB
OCCUPANT LOAD: 27
FENCE: N ( 0 X 0 FT.)
CODE: 2003
OTHER: N------- OTHER DESC:
ZONE: BC
NUMBER OF STORIES: 2
VESTED DATE:
NUMBER OF DWELLING UNITS: 0
BASEMENT :O 1ST FLOOR: 994 2ND FLOOR: 994
BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK- 433 OTHER: 0 13RD
FLOOR: 0 GARAGE: 0 DECK: 0 OTHER- 0
FRONTSETBACK SIDESETBACK'E-rBACK
REQUIRED: 0 PROPOSED: N/C I REQUIRED: 0 PROPOSED: N/C REQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED:
SETBACK NOTES: NO CHANGE TO HEIGHT/SETBACKS/FAR/PARKING.
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINGCONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATINGTO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THIS APPLICATION (SNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR RISKIER D_PUTY AND ALL FEES ARE PAID.
Print Name
Released
ATTENTION
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPEC'ION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF.
OCCUPANCY 1IAS BEEN GRANTED. UBC109/ IBC110/ IRCI 10.
FIARCHWE. APPLICANT ASSESSOR OTHER
0 0
PLANNING DATA
New Commercial / Multi -Family Projects
STREET FILE
Name: �Pvw _ A- y0.vV1 C Grig Wr(5/3V) �
Date: IO. 05. 51- 00to
Site Address: (?>?) '--OA iW2 N
Plan Check #: BLD-2006- (O 9 �--
Project Description: GV1 AM JV Of U *'C,- tv Y C i"A.11 4 I,n +t W e, _ f- S A
Use(s) Proposed: ref-aA' I
Allowed Use: ( ES NO)
CUP File Number: ICJ I A-.
To Allow What Uses:
Legal Nonconforming Land Use Determination Issued: (YES / NO
Reduced Site Plan Provided: ( ES))NO)
Zoning: g(�
Map Page: ko�y
Comp Plan Designation: () T ky s cw+w cor.
Corner Lot:, CEJS NO) 4-GY1 �jQ.��
Flag Lot: (YES / O)
ADB File Number (date aived
Lot Area: Zp X (p O �Op `C
Plans Match ADB Approved: (YES / NO)
Shoreline Required: (YES / O)
Critical Areas Determination #:
❑ Study Required (✓ R'A l a�-
® Waiver
SEPA Determination: 42,44 ✓YL+.
❑■ Exempt
❑ Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: 1 Fee, 2 Environmental Checklist, and 3 APO List with notarized form).
Re u/red Setbacks
S reet: �� O i
Side: O i
Side: O/
W
Rear: �j..1 O �
E
Actual Setbacks
Street: N I
Side: NI G--
Side: N' Ci
Rear: I
Lot Coverag FAR equired: I to
Lot Coverage/ AR rovided: q $g 41
Lot Coverage/ AR alculations: N l f!/ 4 M ay = a -I 1 (p 00
---------------
Buildin Hei ht
Datum Point:
Datum•Elevation:•
Maximum Height: 2 G
Actual Height:
Subdivision: ---
Lot Aggregation Required: N V
Landscaping
Landscaping Matches ADB Approved: A --
Landscaping Bid Provided: (YES / NO)
Bond Amount (100% Bid): ----
Plan Review By: gt;w aaP,G6Q
0 PLANNING DATA 0
New Commercial / Multi -Family Projects
STREET FILE
Commercial Parkin_d
Ana/ sis
Business Name
Type/Use
Parking,"
Ratio
Tenant
Area ,
Required
Parking
GjPVVV,-,4-yAvh
YVVw.''
'�.✓dU
(..
I 1UZi
/
Total Parking Required.,
N L
Total Parking Provided."
Multi-Famil Parkin Ana/ is
# Bedrooms per Dwelling Unit
Parking Ratio
nits
Required
Parkin
Studio
1 Bedroom
.5/D.U.
2 Bedrooms
1.8/D.U.
3 + Bedroo
2.0ID;U.
Total Parking Required:
Total Parking Provided.•
Other,
I }. D • i71D. B . 2 IzE : C In am at, of p a Kk4'n , aLc-7 -ZUft?
P►W'OU5 r4rkA'Vl j r•afi'o =office. = l GPa(,C,/ 400 �
J1?-W PA ✓t J'nj rAfi'.0. = rt f-�'1 = I
Plan Review By
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Dc r-
I -,
ST EET FILE
z O'N' F
S LE T B.A C KS
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AUG 3 1
PERMIT C(
STREET FILE
7 14�
PC, c. p I, ll� D, L
Critical Areas Checklist
Site Information /
Project Name: WJi—sol Permit Number:
Site Location: 13U `�' Alf-C. Property Tax Account Number. �017
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? N 0 Date of most recent action:
Soils / Topography
t
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? fu er e ff ��rutl G� Sv,Yd -
3. Des cri a the general site topography. Check all that apply. _
Flat: less than 5 feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30%-present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water. 0
5. Site contains areas of seasonal standing water. Approx. Depth:
6. Site is in the floodway floodplain 6 of a water course.
7. Site contains a creek r an area where water flows, peross the grounds surface? flows
are year-round? Flows are seasonal?
4
8. Site is primarily: forested : meadow ; shrubs ; mixed �� r
9. Obvious wetland is present on site: —
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:
For City Use Only
STUDY REQUIRED: Critical areas study is required.
CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.
WAIVER: Critical areas study is not required.
Determination Number. ��`� 7 Reviewer0*�,
Planner
Rev 3127192
•
STREET FILE'
"9o-199-
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development permit
to the City.
The purpose of the Checklist is to enable
City staff to determine whether any potential
Critical Areas are or may be present on the
subject property. The information needed to
complete the Checklist should be easily
available from observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
• L11 yam- '/ 417
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City. The City will review
the checklist, make a precursory site visit,
and make a determination of the subsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
kaw
Name
Title
Street Address f
e� Z2.
City, State, ZIP } Phone
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
A {j
J a.
�. 4J .< 7
Sigiatur,e V to Signature
Date
Building Permit OMEE
. T FILE
Application. Information
Application V. 920778BLDG Date.... -8/31/92
Site Address:...133 4th.Ave N
Job Name... Wilson
Owner Information
Name Greg Wilson
Permit... # P-920778BLDG
unit #.....
ATA# 4344.006 006 00
'Address . .:. 133 4th Ave, N`�
City/St/Zip... Edmonds TWA' :.. 9802'U
Home Phone.... Work Phone.. .
hone .. F
<,--X6ntractorx Information — `
Name.......... �3' •� eont #. OWNER
Address....
City/St/Zip
Contact.... �1 . �t Phone
"^ � ,: ••Architects Znfo'rmation. "'
Name.. ...~: Arch #. . .
Address A .. f
City/St/Zip.
a -
Contact. ': Phone... 776=3444
` Engineer Information
Name.. <r- a Engr_ # . i
Address . •:..�.
City/St/zip...
Contact.... k c <t ': Phone
'�
New.:. .. Addit'ion�� X `Arlteration j ° -- Repair Heat ... O
Nature of Work..a28,0li iare'..foot garage.�addI lon y Y °• j
Building Type .code=-yxMIS VN;�` a�Co¢st/SgFt �:' $",16:37'
Building Area
Basement....... r = s Furst ' -Story
Second Stor ...
;; Third St
Y •ory'
Over 3-Stories... Garage.. .... 280
Decks—, ...... ;- Siiell Only: N
Total Square, Footage'::_::':.:...: 280
Building.Va,luation......... $ \4,480.00
Building Permit Fee. $ 56.70.'
Plan Review Fee........ $ 36.86
Total Fees............ $ 93.56
Property owner: Gregwilson APPROVED BY PLANNING
Tax Account #: 00434400600600
133 0 Ave N. Edmonds WA. 98020
'Lone (�-O - S Corner�F)A
NORTH: - « Setbacks Recuired Actual
Scale 1" = 2(' Front e_..Q_._._-
Sides CD
Rear
Other
Height
A Ib
Pro c-r+%l tin 60
Orivf-Wey Par ki
Proposed:
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Replace deck railling on
second story deck
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RECEIVED
MAY 0 7 2015
DEVELOPMENT SERVICES
COUNTER
Property owner: Greg Wilson
Tax Account #: 00434400600600
133 a Ave N. Edmonds WA. 98020
NORTH:
Scale 1" = 20'
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Height 0 ha
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ENGINEERINP, DIVISION
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APP VED PLANNING
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CIV0
AUG - 8 2013
DEVELOPIVIENT SERVICES CT -A.
CITY OF EDMONDS
S
TREET FILE
Property owner: Greg Wilson
Tax Account 00434400600600
133 0 Ave N. Edmonds WA. 98020
NORTH: «.
Scale 1" = 20'
Aiy
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perive,wad Po.r%29
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APPROVED BY PLANNING.
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RECEIVE®
AUG 2 9 2013
DEVELOPMENT SERVICES
COUNTER
City of Edmonds "- e e ■�®
Traffic Impact Analysis Worksheet
Name of Proposed Project: RED I qY QA1V J WG 2 9 2013
DEVELOPMENT SERVICES
Owner/Applicant" (f111NTFR
LSO/
Name
.O. 5oX 12a�
Stre t/Mailing Address
tdM0 �,)5 , WIC 1i8020
City State
�Zip
Telephone ir� ^ a51l g q 8' ✓�I 1
Applicant Contact Person:
Name
Street/Mailing Address
City . State ip
Telephone: (T"''�/ /�T —Cm)
Traffic Engineer who prepared the Traffic Impact Analysis (if applicable):
Firm Name
Telephone:
THRESHOLD LEVELS OF ANALYSIS
Contact Name
E-mail:
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: 33 ' - L 1A Par- N oyi . f-DMoN%,WA g9DW
(Attach a vicinity map and site plan.)
b. Specify existing land use: IN" WAIL.
c. Specify proposed type and size of development: F)(1511 STMO GTylef- ID BE 1/RFD Yok S
SNCLOIv
(# of residential units and/or square footage of building)
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page I of 5
d. Date construction will begin aadbli complet&d.'.
e. Define proposed access locations:
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: ,
Land Use;
Daily (ADT)
PM Peak -Hour
Trips
IN"
OUT .. .
b. Proposed Project Trip Generation Table:
Land Use
PM Peak -Hour
Daily (ADT) IN
Trips
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 lVorksheet 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 detennined through use of the City traffic model.'
4. SITE ACCESS ROADWAY/DRIVEWAYS AND SAFETY
a. Have sight distance requirements at egress location been rmet per AASHTO requirements?
b. Intersection Level of Service (LOS) Analysis:
Intersections to be evaluated shall be detennined 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):
r
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 history2 (only required for access to principal and minor arterials):
' Available upon request at City of Edmonds Development Services Department
2 Available upon request at City of Edmonds Police Department
Revised on 6/24/10 E82 - Traffic Impact Analysis Work -sheet Page 3 of 5
t
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:
1 A list of planned developments are available at the City upon request for public records
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 4 of 5
r1
1
DMITIGATION 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 permitted 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 I Per Unit
Fee Rate
Units in
square feet,
# of dwelling,
of , etc.
New Use S c. RF?K)!. $ , 36 X . 2O D D
Prior Use `620' $ q3,14 x 2 DOD
New Use Fee: $ - Prior Use Fee: $ _ $
❑ NEW DEVELOPMENT
Units in
❑ OTHER
J
ITE Land Use Category Per Unit square feet,
Fee Rate # of dwelling,
vfn. 'etc.
M
$ Ix
Fee
MITIGATION FEE RECOMMENDATION:
INDEPENDENT FEE CALCULATION: $200.00 + consultant fee
$
TOTAL TRAFFIC IMPACT FEE
$
City of EdmonA E
Approval
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
133 eh Avenue North, Edmonds, WA 98020
Benefits: on main walk for art walk & 1 block off of main st.
4th Avenue Cultural Corridor
The original idea for the 4th Avenue Cultural Corridor emerged in 2003-4 when Parks, the Arts Commission, and Planning Board
were all looking at ways that the proposed Edmonds Center for the Arts facility could be better linked to downtown retail
shops, restaurants and services.The Planning Board subsequently integrated that initial concept into their downtown /
waterfront activity center planning — part of the land use element of the city's comprehensive plan --
In 2005-6 the Parks, Recreation and Cultural Service Department undertook an update of the Urban Design Plan and renamed it
the Streetscape Plan. Managed by the Cultural Services Manager, the 2006 Streetscape Plan update included new appendices,
one of which was the 4th Avenue Arts Corridor concept plan developed by CREA.
In 2007 the City received a matching grant for $50,000 from the National Park Service's Preserve America program, and
contracted with SvR Design to further develop the ideas for the 4th Avenue corridor. Renamed the "4th Avenue Cultural
Corridor," the new plan elaborated on the earlier design concepts and resulted in the 4th Avenue Cultural Corridor
Implementation and Funding Plan which was adopted in 2009.
Building Owner ®;
Greg Wilson
Monthly Lease: 3k
Damage Deposit: lk '
4 parking spots+
I
1 ADA
ADA accessible
Bathrooms:3 baths
7 'a
Bldg: 2,032 sq. ft
_ _. .1
--••••�
T
Lot: 7,405 sq. ft.
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Year Built: c 1901
Heating Type: Forced air
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Minimum Building Needs
In order to salon open
p
t G48
o'"" .. Set 8wyv Jj4
-Electrical
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1-«7*M1eL
wncM1ee -1 �� L-Mainsc— nJt
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-Painting Interior
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$Iia.eS
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-Exterior Signage
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-Landscaping
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-Owner open to removing shrubs
to add 2 parking spots
BUSINE* LICENSE APPLI
CITY OF EDMONDS
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020
STREET FILtPHONE (206) 775-2525
INSTRUCTIONS
1. PRINT APPLICABLE LICENSE CLASS. FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15.
2. NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY).
4. LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
- TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION, PRINT CHANGES AT RIGHT.
SOCIAL SECURITY
IRATE OF BIRTH I PLACE OF BIRTH
!HOME ADDRESS
3. BUSINESS IDENTIFICATION
.,USINESS NAME
o0<ps�
RPM
STAFF ACTION
t� RESIDESE APPL. NO.: 3
DATE:
JUN 14 1978 APPLICATION FOR:
NEW ❑ LIC. LICENSEn;-�
Public Works 0*"BUS. RENEW YEAR
. ANNUAL FEES
TYPE BUS. CLASS
FEE
PENALTY
HOME A
S10.00.
S 5.00
SMALL B
15.00
7.50
'GENERAL C
50.00
25.00
ATURE OF BUSINESS I BUSINESS PHONE
WASH. STATE TAX NR. I EMPLOYEES I ORGAN. (OCCUPANCY
'OVER 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLASS 1. FEE PAID •� PENALTY PAID
O
E
TYPE ORGANIZATION
IF BUSINESS IS- TYPE
HOTEL/MOTEL L
APT. BLDG. A
OFFICE BLDG. 0
RESTAURANT R
HOME H
SCHOOL S
CAPACITY
NR OF ROOMS/ UNITS
NR OR APTS
NR OF OFFICES
NR OF SEATS
NR OF BEDS
NR OF STUDENTS
C - CORPORATION
L - LTD. PART
P-PARTNERSHIP
S -SOLE OWNERHOSP./NURS.
d. BUSINESS ADDRESSES
BUSINESS ADDRESS
.iCENSE MAILING ADDRESS
�. EMERGENCY NOTIFICATION
j
(2)
NAME
AREA
TELEPHONE-
OFFICIAL
USE ONLY
U.F.I.R. CODE
BLDG.
PERMIT
OCCUP.
C U. PERMIT
LAND USE
ZONING
OFFICIAL. E ONLY.
LICENSE NUM I ACTION ( LA - NEW BUS.
J Jl LB - RENEWAL
LC • CHANGE
LD - DELETE
�1 ICL�A�SSI`EAR f LIC. EFFEC. DATE I REASG. LIC. NO.I SPEC
:CEIPT NO. DATE PAID
• PRINT 'X'
S IN SPEC. BOi
C
FEE PAID PENALTY PAID FOR ISSUE OI
' CORRECTED
i LICENSE WITH
'LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
2. APPLICANT
LAST NAME, FIRST INITIAL SOCIAL SECURITY NUMBER
DATE OF BIRTH PLACE OF BIRTH
MO. I DAY YEAR CITY STATE
Q
61,6 / v- ^� / II /,i 171 r �'I /l l Z I �I 51 I I I 1 1.1 1 c '
HOME ADDRESS
B(LDG. NUMBER
0,U
STREET
f T hl -
APT. NO.
1
CITY
STATE
ZIP CODE
F U M o )I I I I
'7F
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL) _
—h
ECG/ s c-
NATURE OF BUSINESS (DRUG STORE, CPA, ETC)
BUSINESS PHONE
AP t -Ti> A -7—, I I I I I I
Is—, z
TYPE OF OCCUPANCY
. STATE TAX NR. AMEMPLOYEES
LI(REGISTRATION)NR ORGAN. TYPE CA_ PACITIY
` �I I I 4L-
t- ENTER APPLICABLE TYPES AND CAPACITY - T T
__BUS+NfSS-ADDRESS_
'BLDG'. NUMBER STRE�
LICENSE MAILING ADDRESS T
BLDG. NUMBER I STREET APT. N0.
GI r n
CITY STATE ZIP CODE
FD i 0. XI) PI i Ccl
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME,
ME. FIRST INITIAL. AREA CODE TELEPHONE
(1'GPI<17 0 , '/ 3 x
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(2) n 11 (; S 9 3 S
5S OFFICIAL USE ONLY T
U.F.I.R. PRIM. 1, UNITS BUS,
CODE
COND. USEPERLAND USE
_I 11 1 1
BLDG. PERMIT
OCCUP./GRP.
n
ZONING
CITY CLERK'S
SIGNATURE
APPROVED L ! DISAPPROVED DATE
ki'PLICANT'S
IGNATURE b e'L .<L- / �.� L /l L.
FUS. TITLE c OAT t.� r
�/t/OTES
FIELD L.-OCATF-
Al ¢ IV
C..7,
4f
C.
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT permit Number: 9to - 7
Issue Date: / q f ,
r
A. Address or Vicinity of Construction: 133 4th Av N
GTE to place, operate, and maintain a buried service
8 9 9 y B. Type of Work (be specific): at 4th
0 1 Avenue N then west to a residence at 133 4th Av N. GTE to plow 37 feet, push
one sidewalk and push noroads-R.O w 49 fppt
Mary A Bower,. Permit Coord.
Contractor: l:T Northwest 1 nnnrT nrated Contact: Dennis Al exanAer 771 -9D36 or mohi 1 e 388-135A
2312C W Casino Rd
Mailing Address: Everett, IA-98204-1400 Phone: -Hart' 29GA88-4628 or 710-4130
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision,
❑ Multi -Family ❑ Single Family
INSPECTOR:
Side Sewer Permit # (if applicable):
❑ City Project )0 Utility (PUD, GTE)WNG, CABLE, WATER)
❑ Other 2100-9P001DB 242310
INSPECTOR: , ,L .4t,✓1� �1
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: ,4 H.
Please see attached sketch-
APPLICANT TO READ AND STGZT { �1
INDEMNITY: Applicant understands and by his signature to this applicatioir; agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be madewgaihst the City of Edmonds, or any of iti..departments or
employees, including or not limited to the defense of any legal proceedings including defense coats, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET 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. "'A 1. 1
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 statementsaadwnderstand the permit requirements and the pink copy of the permit will be
available on site at alb i es ' n urposes.
Signature: John H Stewart Date: .tune 28, 1996
(Contractor or Agent) oprns Supv-OSP Engrg.
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER �►_�— DAYS
SPECIAL CONDITIONS: WA r
COMMENTS:
RIGHT OF WAY DEPOSIT —
DISRUPTION FEE/FUND 111:
RESTORATION 'FEE:
PERMIT FEE: _50.yo
TOTAL FEE:
RECEIPT FEE:
DATE:
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
i
PERMIT SUBMITTED BY
GTE
Gu�-� o r
s
p6wer 1 n ee i
----- --------------------
K
----- - - - - -- �s'----- - - - - --
77
swe
C4S��MLr �sjr5
PL)c 3 BS
� l
)33
LEGEND
PEDS 0
POLES O
ROAD BORES
OVERHEAD LINES-
I.D. UTILITY POTHOLE CO
UG TRENCHING --)GT
8 e� 4 S-i'
------------------------------
i
R.0.Wo
`THE FOLLOWING INFO TO BE PROVIDED
.RIGHT OF WAY LINES.EOP OR FACE OF CURB, EXISTING SIDEWALK, POLES, ROAD CUTS AND THE UTILITY UNDER ROAD CUTS,
ABOVE GROUND FACILITIES.(Ie:) PEDS,BOXES.CABINETS, ETC..UNDERGROUND TRENCHING AND OVERHEAD LINES.
rnnTwrr nC 11uI1Dlt Im 0 A w
m
m
cn
Ln
z
0
Rl
�.-:- -_ �r-..1, P�•`{�•-mCa.mp•:a�+•x�c'�e,'�tiY^--s ,b�� z'S'�Jfr"oe,.i�'; rlY�".�"o`.r:: _+:r` ^m'vec�-et� m•, T-S,",•,3'�T� .r ° � ''✓,-� .,-�''j 'i'�`
r
# City of Edmon0
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 9 158
Y
F,e, k.w a • •� •
Issue Date:
A. Address or Vicinity of Construction: / 3 3 -' y t� e, 6A
18 9 1 9 B. Type of Work (be spec
ific)• A�i) e�
y
r~
C. Contractor: Su b Lt �� K �Gl V 1 Contact: L9 r'±q (�(� t /SOV/
Mailing Address: Phone: 775%ail/- % rS(3 -�
State License #: S U b'4 K ,oe ;k (ok L- E Liability Insurance: Bond: $
D. Building Permit li (if applicable): Yt� 03.S i� Side Sewer Permit tl (if applicable):.
E. P Commercial ❑Subdivision. _❑ .,City Project=❑--Utility,(PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
F Pavement or Concrete Cut : n Yes" -r1No ------G--Size of Cut: x U H. Chame S
` APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands dnd by his signature to this application, agrees to hold the City of Edmond0armless from injuries, damages, or
claims of any kind or deseription•whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costa, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF O YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE.OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UN THE FI L STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED F IS E TO APPLICANT.
Construction drawing of pioposedw.ork.required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Di s , 771-02
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 C• ulatioil s required by the City Engineer.
All street cut ditches shall be patched with asphalt or City�ppr materi prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit require ents and the pink copy of the permit will be
available on site gt all times_ ' insp7cY purposes.
Signature: Date: la 4Q7�_�
.i, (Contractor or ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
3-_ aa,
APPROVED BY:� RIGHT OF WAY DEPOSIT- "'"'" `
TIME AUTHORIZED: VOID AFTER DAYS -DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT, FEE:
1 f�. TOTAL FEE:.
COMMENTS: RECEIPTYEE:
DATE: ISSUED BY: M 1
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
0
9
FIELD INSPECTION NOTES
Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES. ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
CITY OF EDMONDS,
PUBL-it Wf ;S DEPARTMENT, ENGINE'L14 INC. JVISION
dPPI TrATTnJ FnR PTUT-nP-inv rnr,ICTRIirT .nm PPPMTT 783192
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: WASHINGTON NATURAL GAS . COMPANY
For Work at:(address or v i c i n i t E-NQRTH°
Type of Work to be done: Install 1�4'.' Plastic Main
(attach drawing when applicable)
Time Required -- Start:
Owner: WASHINGTON NATURAL GAS COMPANY
Name
P.O. BOX 1869
Mailing Address
SEATTLE WASH. 98111
City State Zip
Contractor:
Name
Mailing Address
Finish: Approx 90 days from date
Below
MA 2-6767 EXT. 256
Telephone Number
State License Number
City State Zip 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
`Y24�Yhourr notice is required sfor ins:pectio by Engineering. Call 775-2525, ext. 220.
�,�P'u`rp.oses at a "� mesr ,, :��• f fn i/%: y .�:�� ,;��...�?'
EDMONDS PERMIT Signature `� e= . % _ 4 Date: jim a ?1 1978
Owner o,r" gen't ,
C, TO BE COMPLETED B ISSUING AGENCY:
Date Issued% Permit No.: 16, Fee: - —
Security Bond 7/
Time Authorized:
TREETFILE APPROVED BY Date:
'7LS7—
\ LV «evisea11
� - -
n
WASHINGTON NATURAL GAS
815 Alercer Street (P.O. Box 1869) Seattle, Washington 98711
MR. LEIF LARSON
CITY ENGINEER
505 BELL STREET
EDMONDS, WASHINGTON 98020
Gentlemen:
JUN - U. 11jid
COMPANY
Telephone (206) 622-6767
Washington Natural Gas Company hereby applies Jor ,permission to:
Permission is requested to Install 1�4" Plastic Main in the alley west of 4
Avenue North between Main Street and Bell Street
Per Attached Drawing: 783192
Construction is scheduled to begin July 1978 and will require
approximately 90 days to complete. If this work meets .with your approval, please sign
and return the original of this form.
Application Date June 21. 1978
EDMONDS PERMIT
WASHINGTON NATURAL GAS COMPANY
Q4 V 4,.��
Douglas V. Damm
Operations Supervisor
WASHINGTON NATURAL GAS COMPANY is hereby.authorized to perform the work listed above in ac-
cordahce with their franchise and subject to all applicable te, county, and/or municipal ordinances and
specifications. l
i
Approval Date ,%/0 V12
WNG 568.1 (7/76)
iBCATION
EET FILE APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No- ..........................................
NEW CONSTRUCTION El REPAIRS
114-o0850
Arthup L. Johnson CONTRACTOR ..............
PERMIT No. ..............
ADDRESS ....... � 3 3 4 t h A V e. N.
•-----------------------------------•--------------••-------•-• .........................
LEGAL DESCRIPTION: LOT No. .............................................. BLACK No. ----------• ...............................
NAMEOF ADDITION ................................. .......................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE............................................•... BY--•-----•--•--.......................................................
CITY OF EDMONDS
r PUB C W*S DEPARTMENT, ENGINE INIVISION
APPI TrATTntj Pnp RT(;uT_ni:_wAv f n!vZTDh TT.nK1 DGDMTT 783192
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: WASHINGTON NATURAL GAS . COMPANY
For Work at:(address or vicinity) 133 4 AVENUE NORTH
Type of Work to be done: Install 114'.' Plastic Main
(attach drawing when applicable)
Time Required -- Start:
Owner: WASHINGTON NATURAL GAS COMPANY
Name
P.O. BOX 1869
Mailing Address
SEATTLE WASH. 98111
City State Zip
Contractor:
Name
Mailing Address
City State
Finish: Approx 90 days from date
Below
MA 2-6767 EXT. 256
Telephone Number
State License Number
Zip 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. Ca11,775-2525, ext. 220.
2 rstand that this permi - ust be avail b1 1 t__the job,site for,.inspection
1 purposes at all times.
EDMONDS PERMIT Signature. �'„ _ Date: ,Tune 21 1978
Owner o, gent '
C. TO BE COMPLETED B ISSUING AGENCY:
Date IssuedPermit No.: 7S'- /6 Fee: --�--'
Security Bond
Time Authorized: 30 ,r
STREETFILE APPROVED BY Date.01
10-771v (Revised)
i ,
• •
/ � , ,
���
��� �/��
� S.
...
.w
N
•
i
WASHINGTON NATURAL GAS
815 A1ercer Street (P.0. Box 1869) Seattle, Washington 98111
MR. LEIF LARSON
CITY ENGINEER
505 BELL STREET
EDMONDS, WASHINGTON 98020
Gentlemen:
COMPANY t.
Dir. Vi
Telephone (206) 622.6767
Washington Natural Gas Company hereby applies .for permission to:
Permission is.requested to Install 1k" Plastic Main in the alley.west of 4
Avenue North between Main Street and.Bell.Street
Per Attached Drawing: 783192
Construction is scheduled to begin __ _ July 1978 and will require
approximately 90 days to complete. If this work meets with your approval, please sign
and return the original of this form.
Application Date June 21, 1978
EDMONDS PERMIT
WASHINGTON NATURAL GAS COMPANY
Cl�a►
V.
Douglas V. Damm
Operations Supervisor
WASHINGTON NATURAL GAS COMPANY is hereby.authorized to perform the work listed above in ac-
cordalice with their franchise and subject to all applicable state, county; and/or municipal ordinances and
specifications.
i
Approval Date
WNG 886.1 (7/76)
Dy
CITY OF EDMONDS ZONENUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APTp
/l
OWNER NAME/NAME OF BUSINESS ADDRESS 13.E 4 A- At , I
/i/
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
e
Cc
w
MAILING ADDRESS
Z
�/>,•� %'`1� TESCP
O
�.). ri�p.Ir% r' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
APPROVED BY
CITY ZIP TELEPHONE NUMBER
✓ ` �' I REQUIRED DEDICATION
L"; i Iti,ol�r•I r �r.J�' ��'G'�l/"i 77!`- `�l �
®T
NAME Ar Z
RIGHT OF WAY CTION PERMIT REQUIRED ❑ w
ow
ADDRESSSTREET USE PERMIT RE IRED ❑ Z
r
SEE ENGINEERING MEMO DATED 7 R VIEW/BY w
Ly
1
CITY ZIP TELEPHONE NUMBER
REMARKS ,
NAME
¢
1 ♦ /
ADDRESS J� /U�
/
/ �� ^ Y• a I N lr �� METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
CITY r ZIP TELEPHONE NUMBER ¢'
w
Z
fI r REMARKS a
3
O
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB' 0.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT J�
Z
(show below or attach two copies) SHORELINE #
(L
a
2 U
,- �� U� VARIANCE OR PLANNING REVIEW BY DATE
Cif / • `
/`� /
'
O
a
�% SETBACKS — F ET
/w C-0`(V1C` HEIGHT LOT COVERAGE Z
w
/ /7 FRONT 'ZO SIDE REAR / 2 S�G Q
7;1�
Tax Account Parcel No. REMARKS a
NEW RESIDENTIAL PLUMBING
oi,•
ADDIALTER COMMERCIAL MECHANICAL
APT. BLDG.
REPAIR SIGN ! .�
EXCAVATE, FILL FENCE CHECKED BY TYPE OF CONSTRUCTION' CODE HEIGHT
DEMOLISH OR GRADE El ( XFT)
dal//
CARPORT SWIM SPECIAL INSPECTOR AREA OCCUPANCY
REMODEL GARAGE OCCUPANT
POOL
REQUIRED GROUP LOAD
NO )23
❑ W00 INSERT
❑ G WALL/ RENEWAL REMARKS
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 o
ul��j��•�
w
NUMBER OF STORIES NUMBER OF ��IS�� •J
o
m
�
DWELLING
UNITS
r
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
K or r�� hko,i FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
f
e. c. (�
BUILDING
PLUMBING
Plan Check No. MECHANICAL .— —
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
o
successors in interest, agrees to indemnify, defend and hold
w
harmless the City of Edmonds, tWashington, its officials, I r
5
employees, and agents from any and all claims for damages of-
<
whatever nature arisiri direct) or ihdirectl from the issuance
9 Y Y u
=
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
,
°
modify, waive or reduce any requirement of any city ordinance
°
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE®
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 ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application IS not a permit until
`'
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
SIGNATURE, (OWNER OR AGENT) DATE SIGNED DEPARTMENT
OFFI S SIGNAT E DATE
_ _ r CITY OF
EDMONDS/'�®
CALL FOR FLEA 6 DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE %%9-�202
UNTIL A FINAL INSPECTION HP'"' EN MADE AND APPROVAL OR ORIGINAL — File YELLO —Inspector
A CERTIFICATE OF OCCUPr .,_t HAS BEEN GRANTED, UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
162.87
USE
CITY OF EDMONDS ZONE �..
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS. -
Alaska rrontler Co.
MAILING ADDRESS
360 Adnttal Way, Suit;e 206
CITY ZIP TELEPHONE NUMBER
r:dmonds 775-3424 13
E NUMBER
NAME
ADDRESS
CITY
STATE LICENSE NUMBER EXPIRATION
- include all easements
JOB
ADDRESS 13
PERMIT NUMBER 9 G0 3 /1 `'TJ C°
?H ` f�%�n�/ SUITE/APT q
/, vL / /'!0/e rh
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION.Street
PROPOSED
TESCP Approved
RW Permit Required
Use Permit Req'd
Inspection Required
Sidewalk Required
D
❑
❑
❑
O
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REOUIRED
YES ❑ NO ❑
REMARKS
ENGINEERING MEMO DATED
REVIEWED BY
SIGN AREA SEPA REVIEW ADS NO.
ALLOWED I PROPOSED I COMPLETE IEXEMPT
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
FRONT SIDE REAR
HEIGHT
LOT COVERAGE
Property
Tax Account ? � ; .�- .,, ;�
Parcel No. �_).:�.7 . —� ,4
REMARKS
NEW RESIDENTIAL PLUMBING
ADDITION ® COMMERCIAL MECHANICAL
REMODEL APT .BLDG.
� El SIGN
REPAIR a GRADING CYDS. 1 FENCE x—�
SWIMPOOL HO TUB SPA
DEMOLISH INSERT HOT
ARAGE GRETAINING WALL/ je /j 1e,,
CARPORT ROCKERY ® N u
(TYPE OF USE. BUSINESSORACTIVITY) ,EXPLAIN:
DA5
CHECKED BY
TYPE OF CONSTRUCTION
CODE
C
Y
OCCUPANT
GROUP
<
1
SPECIAL INSPECTOR
REQUIRED � YES
AREA
OCCUPANT
LOAD
MARKS
PROGRESS INSPE/C�TIONS PER UB/C__305
J
N ,� O�IYII�/ 19/lAlc iQrN A/{/[�
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
DES I E WORK TO BE OONE TT CH PLOT PLO/�/�►
/1 C D off/IXW
FINAL INSPECTION REQUIRED
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PLAN CHECK FEE
VALUATION
FEE
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BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
GRADING/FILL
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.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit:1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors 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 City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
Zy
I hereby acknowledge that I have read this application, that the
ATTENTION
APPLICATION APPROVAL
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
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged In space provided.
tion Insurance and RCW 18.27.
INSPECTION
SIGNATURE -(OWNER•OR,AGEl*T).,_.... -.. DATE SIGNED .,,
......_......_...........-....:..... .. ..
DEPARTMENT
OFFICI�L'SSIGNAWRE DATE
I
j
CITY OF
CALL FOR
RELEASED BY: DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
HAS BEEN MADE AND APPROVAL OR
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11
ORIGINAL — File YELLOW — Inspector
I
UNTIL A FINAL INSPECTION
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor j
10247
i
CITY OF EDMONDS
USE PERMIT 9Gb35-
ZONE � NUMBER
CONSTRUCTION PERMIT APPLICATION
dOB 33 v� ��UITE/APT#
ADDRESSXV
OWNER NAME/NAME OF BUSINESS
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO. LID
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MAI NO ADD ES
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TESCP Approved ❑
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
RW Permit Required ❑
CITY ` ZIP
TELEPHONE NUMBER
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EXISTING REQUIRED DEDICATION
PROPOSED
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
NAME S —4 1
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES ❑ NO ❑
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ADDRESS
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REMARKS
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CITY ZIP
TELEPHONE NUMBER
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ENGINEERING MEMO DATED REVIEWED BY
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CITY ZIP
TELEPHONE NUMBER
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FIRE MEMO DATED REVIEWED BY
Lu
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STATE LICENSE NUMBER EXPIRATION DATE
U.
SIGN AREA
SEPA REVIEW
ADB
IIIIIIII
ALLOWED PROPOSED
COMPLETE EXEMPT
Legal Description of Property - include all easements
SH ELINE #
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EXP
10
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¢
VARIANCE OR CU
P.LAAR EW BY
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SETBACKS — FEET
EIGHT
LOT COVER GE
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FRONT SIDE REAR
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Property OVV 0(� o i1�
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Tax Account .. ...-/Vy,/�/ /V
REMARKS
Q.
Parcel No. (y/}
NEW RESIDENTIAL PLUMBING
E.ADDITION CIaL COMMERCIAL MECHANICAL
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APT. BLDG.
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REMODEL SIGN
CHECKED BY
OCCUPANT
GRADING FENCE
REPAIR CYOS. L_ x _FT)
ITYPECONSTRUCTION
ICODE
POOL
DEMOLISH INSERTWOODSOVE HOT TUB SPA
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INSPECTORSWIM
SPECIAL
OCCUPANTINSERT
JAREA
REQUIRED RED
CI YES
GARAGE r7 RETAINING WALL/
CARPORT It RENEWAL
REMARKS
ROCKERY
PROGRESS INSPECTIONS PER UBC 305
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(TYP OF E. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL�/j/�/
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STORIES f.� UNITS NUM ERr'
DES RIB WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REWIRED
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N/�d
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VALUATION
FEE
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,/� �� ��'r /
PLAN CHECK FEE
%
s••
BUILDING
(�//pPy'���
HEAT
SOURCE:
GLAZING
PLUMBING
[Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work i8 Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
w
successors 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
Q
i
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
c
0
modify, waive or reduce any requirement of any city ordinance
i
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
slow Z/360
provision."
I hereby acknowledge that 1 have read this application; that the ATTENTION APPLICATION APPROVAL
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 THIS PERMIT •
state laws regulating con ruction; and in doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, person w I be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the, a Of ington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insura a 118.27. INSPECTION acknowledged in space provided.
SIGNATUR O 1 ' "� DATE SIGNED DEPARTMENT
CITY OF WGNATURE DATE
EDMONDS 1�0/
CALL FOR RELEAS BY: DATE
ATTE TION INSPECTION �--�-- 1-7 7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� Owwo
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL File YELLOW Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 11 — —
CHAPTER' 3. PINK — Owner GOLD — Assessor
102-87