220 MAIN ST.PDFiiiiiiiiiiiiii
14148
220 MAIN ST
ADDRESS: 1�6--)-D
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TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: — DETERMINATION: El Conditional Waiver [] Study Required F� Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
-19,
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE /ENCROACHMENT PERMIT#: --Is—/
WATER METER TAP CARD DATED: -
OTHER:
LID #:
LOT: BLOCK:
LATEMP\DSrs\Fomis\Strcet File Checklist.doc
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RECEIVED
APR 14 204
PERMIT COUNTE"
STREET FILE
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RECEIVED
APR 14 2004
PERMIT COUNTER
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.220 Main St.. �t^j
Edmonds, WA 98020
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DEPARTMENT
505 HELL STRLET
1A)MOND';9 V1A';11111(;TO11 98020
APPLICATION FOR STREET USE PERMIT
(S bmit in Triplicate)
A I H
Name of Applicant � 0 —
Description of Public Place or Portion Thereof Desired to be used:
(Exhibit may be attached)
Type of Use desired to be Made of 11ii!,lic Place:
If ApplicableY Attach Plans and 'Jpecificaticns For Any Utility or Structure to be
Erected and/Jr Mair;tained on the Public Place:
Exhibit or Drawing Nos;
-/�' e-�'r—-,
Te mp - orory Permit:
Urljr!r'�71 rlesif,,nated herein, this permit is understood by applicant to be
vv,, Hy ()! J tilat it vests no permanent right whatsoever. If the
perMittUd L):,(' 1JUC:0f11'-':; (1111W ' ': I '(JLI.'; or' '; 11C11 L; t T'Ll(: Lure sh, , 11 1)(: Colfl(! 1,�;(-(nj Y-,� or urviaft.-
or shali not be constructed, maintained or used in accordance W.JL11 the provisioris
of thi..,� title, the Tr,JY b0 revoked and the ntructure and obstructions ordered
rewovi.�d ]q ordc-r 01 Lh- C�ty Engineer. if this application is for a specific
period of Lime, the term of said application is: / i
-3,
I n de 111ri i t V :
Applicant understands and by hL; signature to this application, agrees to hold the
city of Edmonds harmless from any in ' juries, damages or claims of any kind or des-
cription whatsoever, foreseen or unforeseen, that may be made against the applicant
or the City of Edmonds, or any of its departments or employees, including but not
limited to the defense of any legal proceedings including defense costs, court
costs, and attorney fees.
A22lication of Chapter 6.40_of the Edmonds CitX Code:
Applicant warrants that he has read, or had the opportunity to read, Chapter 6.40
of the Edmonds City Code, and understands that all terms, of that Ordinance are
incorporated herein as is set forth in full arid thi.� ; 'lication and permit there-
, �p
fore are subject to the terms of that Chapter of thq/ dmonds City Code.
��ignature of Appfic&nt)
City of L irionds Ap,
?1icati(-)ri for, �;tr-et IJ,;k- Vermil-
Name of Applicant: L
Street Address:
City:
Date: AF 1;7131
Approval (and Apreement, if Applicable) of Ahuttin�, PropertZ Owner(--,):
Signature(s) Address
DO NOT WRITE BLLOW THIS 1,114L (To be completed by 1�:,,.-,uinp Agency)
Date of City Council. Approval:
due January 1, 19
Permit Fee: Annual Fee
Provi.,;iori f2r 1nd-n1"iL:/:
Terms ond llrov��;it,n (if
(Note: Ruikjren(.o t),IiU-U�)L) ul L;lc aPPiiL;,'bie Urdillance)
Additional Condition-, Upon and Agreed to hy_ Applicant:
C i
Approved ijv.
ty Lngineer Date
Approved by:
(If applicable) Buiidin ff icial Date
Permit Issued: '1114? Permit Number:
—7 1 —at e
Applicant has read the forogoing application and conditions of approval of this
permit, fully understands and to all conditions of the foregoing �-Ipplica-
tion and permit approval, and by the execution of.. his signatur(, hereto aprees to
the same:
N
,�21 3— 03-706
vry op,
BUSINE10 LICENSE APPLICATION
CITY OF EDMONDS
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020
TELEPHONE (206) 775-2525
INSTRUCTIONS
i, 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.
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) '
LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION. PRINT CHANGES AT RIGHT.
--2. APPLICANT
NAME SOCIAL SECURITY NO.
DATE OF BIRTH PLACE OF BIRTH
HOME ADDRESS
3. BUSINESS IDENTIFICATION
BU
N
ES I ORGAN. I OCCUPANCY
STAFF ACTI
REVERSE APPL. NO.: 4
0 � SIDE DATE:
ARNUAL FEES
TYPE BUS. CLASS
FEE
PENALTY
HOME A
$10.00
$ 5.00
SMALL B
15.00
7.50
'GENERAL C
50.00
25.00
'OVER 10 EMPLOYEES. OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLAS FEE PAID PENALTY PAID
I--
TYPE ORGANIZATION
IF BUSINESS IS:
TYPE
CAPACITY
c
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
.0
C CORPORATION
APT.BLDG.
A
NR OR APTS
I D
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
�E
P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
jS
S SOLE OWNER
HOSP./NURS. HOME
H
NR OF BEDS
11-1
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
(5. EMERGENCY NOTIFICATION
NAME
AREA
TELEPHONE
(I�E
(2
OFFICIAL SE ONLY
U.F.I.R. CODE
BLDG.
PERMIT
OCCUP1
C.U. PERMIT—
I LAND USE
I ZONING
CAP-PLICATION FOR:
NEW [:] LIC. LICENSE
BUS. RENEW YEAR
-�z
LICENSE NUMn
LA NEW BUS.
LB RENEWAL
LC CHANGE
LID DELETE
CLASSI
YEAR
I L:C. EFFEC, DATE
R A G. LIC. NO.
SPEC
RECEIPT NO.
DATE PAID
,
11,
PRINT X'
IN SPEC. 13OX
FOR ISSUE OF
FEE PAID
PENALTY PAID
CORREC'TEO
LICENSE WITH
'LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
SOCIAL SECURITY NUMBER
ij'o , Iz 112 M6
DATE OF BIRTH PLACE OF BIRTH
MO. DAY YEAR C11 Y ISTA77
�f1lillIT719 -21
HOME ADDRES6
3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
NATURE OF BUSINESS (DRUG STORE,
F—WASH. STATE TAX NR.
(REGISTL�AT40N-)
ANTICIPATED
NR. EMPLOYEES
1,.2�-7
tn'
.0 ENTEKAPPLICABLETYPES AND' CAPACI'
4. BUSINESS AD
BLDG NUMBER STREET
1 1.212,011 Ah
BUSINESS PHONE
YPE 0 F CC UPAN Cy
ORG N C �PACITY
/P_
APT. NO.
STATE ZIP CODE
41 - At *,fo an
,"5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL- AREA CODE TELEPHONE
(1) D - / -7,7,4/1 j,&,i;t
10101pi 1,5vgA 1 ;b,4 1 1 _�2 66
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
.. 2) 111111.11 11 111 1 1 1 . -L-J-1 L-J-� I
5S OFFICIAL USE ONLY
PRIM.
Ul ITS BUS.
BLDG.PER
U.F.I.R.
CODE
I I
I I I
ND. USE PERMIT
ZONINa
I
2r
MIT
I
CITY CLERK'S j rAPPLICANT'S
SIGNATURE SIGNATURE
APPROVED [3 DISAPPROVED DATE BUS. TITLE
DATE V —
CITY CLERK'S j rAPPLICANT'S
SIGNATURE SIGNATURE
APPROVED [3 DISAPPROVED DATE BUS. TITLE
DATE V —
APPLICATION
for
The City of Edmonds SWE SEWWR PERN" EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS 0
'1113
owNER.......... W....P....Krasselt -------------------------------------------------------------- CONTRACTOR .............................................................. -- ......... ...................... PERIM No . ......................
ADDREM ...... 22.0 ... Main ---- St.1 .................................................................... LEGAL DESCRIPTION: LOT No . ..... ........................................ BLOCK No . ............................................
0
CIO:
I—
U)
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE.............................................. - W ......................................................................
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
t6AR4ANNE bA1A_Z0CC--,ArJ NA41
MAILING ADDRESS I
CITY ZIP
2!�,- -7 -1 T- 3 616
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
ADDRESS
USE
ZONE
JOB
ADDRESS
I PERMIT EXPIRES
;ERMIT o, . - ..
— C/1.:;;1?
SUITE/APT#
PLAT NAME/SUBDIVISION N
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ap;=
Rw parmIt
Street Use Parraft RoqW
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— Fr
Underground
jong raq 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NO 13
M
5
REMARKS
z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
DATE
L
CITY ZIP. TTELEPWONE
FIRE REVIEWED BYj�:t/,X( J�(44/� V'k DATE
0.
ILI
rL
STATE LICENSE NUMBER EXPIRATION DAT E
'CH KE
0
IA 9
..........
�.,�SHORELINE OR A
IN PPECTION
REQ'D
L.JNU
BOND
POSTED
$
z
z
z
SEPA REVIEW
COMPLETE -,,-EXEMPT
EXP..
j'SIGN AREAi'f
�-,�-,,,ALLOWED PROPOSFE.�
01H ial
HEIGHT
� I
.10OWEP PROPOSED
V, C to.0
Olt.
:Gq
NEW RESIDE NTIAL PLUM BING/ MECH
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
1:1 REMODEL 0 MuLnFAMILY'
GRADING FENCE
REPAIR CYDS
DEMOLISH 0 TANK 0 OTHER
o GARAGE RE TAJNING WALL'
CARPORT 0 FIRE SPRINKLER
ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
'REQUIRED SETBACKS
FRONT *SIDE REAR
-PROPOSED SETBACKS (Fr.)
FRONT L/R SIDE REAR
:,.PARKING,-
REOD PROVIDED
"LOT AREA, big DATE
51510 q
jTj 0-A
J0 It: co,
f Simi, v (0 ji�� yeRi.
MPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
hZA1 S 5A tAki
CHiCKE6 fly
TYPE 9�F
OCCUPA NT
GROUP
Is
NUMBER
OF
STORIES
NUMBIER,OF
DWELLING
UNITS
TcRrriCAL
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED
rREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS, PER Q13C 1 08/11FINAL INSPECTION REG-0
o It VIL n 2-1 �K
I 4P_
Err%&
r'-',IIAAJ" fA. ttAr �f# 4v
VALUAnON-
$
EE
Description
FEE
HEAT SOURCE
GLA23NG %
PLOT111LOPE %
I V"
J�
v,Buildi rintit
I
City Surcharge
PLAN CHECK NO:
W_/ 70
VESTED DAtE c,
Plurnbing-�
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK
I=
X
NOTEb. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN SIDEWALKS,
Grading
3
(CURBS, DRIVEWAYS, MARQUEES, E LL REQUIRE
TC.) vn
t
SEPARATE PERMISSION.
Engr. Review
IU
PERMITAPPLICATION: ISO DAYS
Engr. Inspection
CL
PERMIT LIMM I 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
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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
Landscapeinsp.
REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CrrlrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Total Arnt. Due
FRecelpt
Recording Fee
# 123013Z
I HERESY'ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN S CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
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
CALL
This application Is not a permit until signed by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt [a acknowledged In space provided.
WORIfMEN'S COMPENSATION INSURANCE AND RCW 18.27.
AGENT)
SIGNJ.TZURE* DATE GN
)R 1
(425)
C RE E
4;05
lKS-1 -4
4
X
o4-
771-0220
ATTENTION
EXT 1333
SED BY , DATE
0,( LA -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
Gkj&�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
� f
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - Fit E - YEI I ON - INSPE&R
09/03 PRESS HARD -YOU ARE
MAKING 4 COPIES PINK - OWNER - GOLD - ASSESSOR