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CITY OF EDMONDS
BUILDING DEPARTMENT
WORK —
ADDRESS
OWN ER —
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PERMIT NUMBER
APPROVED BY PLANNING
qN -(Q 10 "2-
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MAR 2 6 2992
D�VE109vi'.EK SERVICES CTR.
,;ITY OF
ID
R!, E.(
S 14 2001
BUILDING DEPT.
STREET FILE
'VE M-1
Plan Check No. Q
City of Edmonds
Commercial Kitchen Hood WorksheelF E C E IV ED
Project Address: 2,23 1 %o �t CM Wfj
Business Name: C X�ffi kp 0 -)
DEC - i 2003
PERMIT COUNTER
Two copies of this worksheet/checklist must accompany plan sets submitted for permit applications involving the
installation of a commercial kitchen range hood. Applicant shall provide plan and elevation views showing ductwork,
duct enclosure, hood, cooking surface air supply, exhaust systern, and equipment support system including structural
framing detail (see attached typical construction views) and type of cooking appliances below the hood. This worksheet
is based on the 1997 LJMC Chapter 5, Part H, Commercial Kitchens.
Is this an existing restaurant, food processing area, or food service area? 0 Yes 0 No
If no, a separate tenant improvement permit and/or change of use pern-dt is required.
1. Type of Material/Gage
Type I Hood
Installed for grease and smoke removal (i.e.: deep fat fryer,
charbroilers, grill and roasting ovens)
Type H Hood
For steam, vapor, heat or odor removal (i.e.: steamer,
pastry and pizza ovens) All Type II hoods shall have
a permanent, visible label identifying it as a Type Il
Hood
Type of Material
Gage
Min roposed
Gage
Min Proposed
Ductand
Plenum
Stainless Steel
.18
24 (Up to -12" diameter)
22 (Up to 30" diameter)
Galvanized Steel
16
24 (Up to 12" diameter)
22 (Up to 30" diameter)
Hood
Stainless Steel
22
22
Galvanized Steel
22
24
Flashing
Siainles Steel
22'-
NOT REQUIRED
Galvanized Steel
22
2. Quantity of air exhausted through the hood
Hoods shall extend beyond the cooking surface a minimum of 6" on all open sides and the distance between the lip of the
hood and the edge of the cooking surface shall not exceed 4'. In the formulas below the following values apply:
N = number of hood sides exposed
Q = quantity ofair
A =area of hood in ft2
L = linealfeet of thefront cooking equipment surface
Cooking surface area = . % " x .77% ft2
Hooded area (A) = 7_�a" x 7-6 4, Wt%� ft2
Canopy Hood
Non -Canopy Hood
Type I Hood
N=4
I Q= 150 x tk�
�Off (A�)= '7
It cfin
Q= 300 x
_(L) = cfin
N=3 or less
I Q= 100 x (A) cfm
Type H Hood
N=4
75 x
(A) =
cfm
Q= 150 x
_(L) = cfm
N=3 or less
I Q=50x (A) = cftn
L:\TEMP\BUILDING\FORMS\ConimerciaI Hood Worksheet.doc
10/ 10/02 STREL
3. Exhaust duct systems
a. Provide size of duct in square feet
Type of Hood
Air Velocity (FPM) Required
CFM/Duct Area (ft2)
PLoposed Air Velocity (FPM)
1
1500 to 2500 (minimum)
11
500 to 2500 (recommended)
b. Static �ressure Loss '3 5-'
Duct 1, in. + grease filters/extractor ;I in. + other — in = Total —!�—in. of H20.
c. Fan and motor shall be of sufficient capacity to provide the required air movement. Fan motor shall not be installed
within ducts or under hood.
Fan make and model 0 1 N !� I
. - t
Static pressure in. at —cfm.
4. Exhaust outlet location
Exhaust outlets shall terminate above the roof If exhaust outlet terminates at exterior wall, provide cleaning equipment.
Table of Clearances
LocationlSituation
Minimum Required
Proposed
Extend above roof
24 inches
tv -
Distance from same or adjacent building
10 feet
st I
Distance above adjoining grade
10 feet
V1 I V,
Distance from property line
10 feet
1(31
Distance from windows and doors
10 feet
Distance from mechanical air intake
10 feet
Distance of duct above adjoining grade at alley
16 feet
5. Make Up Air
a. Applicant shall provide makeup air not less than 90% of the exhaust: cfm.
b. Makeup air system shall be electrically interlocked with the exhaust system, such that the makeup air system will
operate when the exhaust system is in operation.
c. Makeup air shall be provided by a fan or motorized damper of sufficient capacity. Windows and door openings shall
not be used for the purpose of providing makeup air.
d. If more than 2500 cfm supplied to the space other than the hood, provide heater capable of heating makeup air
supplied to the space to 65 degrees F.
Heater model# Input BTU Output BTU
Heater CFM AFUE
Fan
Makeandmodel IEC�LV
Static Pressure 11—L in. at cfm.
Duct Dimension, k'1" area .'1%5 ft2
Air velocity = cfin/area 100 / .7%13
Recommended air velocity, 500 fpm
Duct area req. = cfni/500 fmp 1500
Duct dimension req. =
Eff. Damper opening x — ft2
L:\TENV\BUILDING\FORMS\ConnnerciaI Hood Worksheet.doc
10/10/02
ft2
6. Slope of Duct and Cleanout access
Horizontal ducts less than 75' feet in length are required to be sloped a minimum 1/4" inch per foot. Horizontal ducts
that exceed 75' feet in length are required to be sloped I" inch per foot. Note: tight -fitting cleanout doors shall be
provided at every change in ductwork direction.
7. Duct Enclosure
a. Ducts penetrating a ceiling, wall, or floor shall be enclosed in a duct enclosure from the point of penetration to
the outside air. A duct may only penetrate exterior walls at locations where unprotected openings are'permitted
by table 5A of the 1997 Uniform Building Code (or current adopted edition).
b. On the plans, detail how the duct enclosure will be constructed to meet the minimum fire protection rating.
c. Duct enclosures shall be separated from the duct by at least 3 and not more than 12 inches.
d. Duct enclosures shall be sealed around the duct at the point of penetration and vented to the exterior through a
weather -protected opening.
e. Duct enclosures shall serve only one kitchen exhaust duct.
f Tight -fitting access openings shall be provided at each cleanout door. Access enclosure doors shall have a fire
resistance rating equal to the enclosure.
8. Multiple Hood Venting
a. A single duct system may serve more than one hood located in the same story of the building, provided that the
interconnecting ducts do not penetrate any fire resistive construction.
b. A hood outlet shall serve not more than a 12-foot section of hood.
9. Additional Information for Type I Hoods only
a. Grease filters shall be installed at minimum 45-degree angle and equipped with drip tray and gutter beneath
lower edge of filters.
b. Distance between the lowest edge of grease filters and cooking surface shall be:
Grill, fryer, exposed flame: not less than 2 feet
Exposed charcoal, charbroil shall not be less than 3 1/2feet
c. Type I Hood and ducts shall have clearances from combustible construction per table below:
Unprotected
Protected
1-HR Fire resistive Material
Hood
Min Required 18"
Proposed
Minimum Required 3 "
osed
Duct
Min Required 18"
Proposed 19
Minimum Required 3"
PPro
Prop sed
d. Hoods less than 12 inches from the ceilings or walls shall be flashed solidly.
e. All joints and seams shall be made with continuous liquid -tight weld or braze made on the external surface of the
duct system. Vibration insulation connector may be used provided it consists of noncombustible packing in a
metal sleeve joint.
f. Centrifugal fans used for discharging grease exhaust shall be positioned in a bottom horizontal discharge position
only. A duct that diverts the fan discharge shall not exceed 3 times the diameter of the fan outlets connected to
the fan outlet. The duct shall be provided with an adequate drain opening at the lowest point to permit drainage
of grease to a suitable collection device.
L:\TEMP\BUILDING\FORMS\ConunerciaI Hood Worksheet.doc
10/10/02
;DATE RECEIVED 1�
11 I t*
6;WA qljylL - PERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE PERMIT
6� NUMBER 40w e5q5o
CONSTRUCTION PERMIT APPLICATION
�08
)IlllTEIAPT,
APDRESS C�(
OWNER NAMEINAM I OF BUSINESS
,_�, X,� " , I C b
PLAT NAMEISUBDIVISION NO.
LOT Noi,
LIO NO.
LID FEE S
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE.1 A—. 0
0
EXISTING 2ROP
P.— Rau.rd 8
a.. Us. P— Frio d
Inap— As. 0
3biranser Requ." �O
CITY P 7TiLEP.131112
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1 ��2
REOUIREDD I N
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NAME
METER SIZE I
LI
NOj OF FIXTURES
PRY REQUIRED
YES 0 NO C3
0
ADDRESS
REMARKS
OWNEFVCONTf!CTOR ESPON9,11�Le*Z-AEROSIO�CONTROLIORAINAGE
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c TTY ZIP
TELEPHONE
NAME
6-- x
0 0/062�,
ENGINEERING REVIEWEDID�TE
-
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0
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FIRE REVIEWED BY DATE
X CITY ZIP
HONE
0
U
ITELEP
STATE LICENSE NUMBER EXPIRATION DATE
CHE KED BY
VAAI,�N�CE OR CU
SHOREUNE OR ADBN
INSPECTION
80
REO'D
POSND
TED
I
_�YES .0
jC0 13
I
4 PROPERTY TAX ACCO NT PARCEL NO.
C
SEPA REVIEW
COMPLETE EXEMPT
P
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
_i
o I L4 i�,
Q I q
NEW RESIDENTIAL PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
COMPLIANCE OR
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ALLOWV7�14�ROPOSEO
OPO
FRqMTCE REAR
FR= REAR
0 ADDITION COMMERCIAL
CHANGE OF USE
PARKING
R PROVIDED
LOTAREA
12��NG REVIEWED BY GAT
REMODEL C] APARTMENT SIGN
FENCE
:::;K
0 REPAIR 0 GRADING CYOS 0
1
0 DEMOLISH 0 TANK 0 OTHER
0 CARAG 0
GARPOIEIT FR',ETAINING WALL RENEWA�
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'KEF Y
(TYPE 0 A ACTIVITY) EXPLAIN:
BUSINESS 0
CHECKEDBY JTY;��TION
_
177
OCCUPAN%
GROUP
�ZE,
jv-r
NUMBER
UMBER OF
'UNITS
—
I CRITICAL
SPECIALEINSPECTOR
JAREA
OCCUPANT
ad OF . -
DWELLING ---
EAS
0 STORI'E'S
(!!5"1
NA
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REQUI R 0 YES
I
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 101YFINAL INSPECTION REO'D
to
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE % BUILDING "2—
PLAN CHECK NO: IVESTIO DATE PLUMBING
F
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T IS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE GRAGINC31FILL
SEPARATE PERMISSION.
S&WrSURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIM M I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS ENG. REVIEW FEES
E
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
E
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM MY AND
-ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
0 PLAN CHECK DEPOSIT
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE IRECE17e
0
DEEMEOT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABI�ITY TO ENFORCE ANY ORDINANCE PROVISION.'
IRICE11T
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THATI HAVE READTHIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL This application is not a pennit until signed by the
IIIAGREE
TION:ANDiN DING 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 ce pl . ric n Wedged n Pa. p—idird.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
_TE SIGNED OFt�IALS SIGNATURE DATE
rIGNATURE (425)
01A
0 9)'dial -5 M_
771-0220
lt�,IEI BY DATE I
ATTENTION EXT 1333
lo�IT
IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - IWSPE&OR
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
5198
No
SITE PLAN
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EXHIBIT
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PLANNING DATA
New Commercial Proiects
SITE ADDRESS: ZZ�t� 4A0a4 R9 —ZONING: C.6
USE(S) PROPOSED: . - i6A Aft-Af — ALLOWED?: Vef�
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED —1 (Y/N)
CUP File: - e__1- — To Allow What Uses?:
ADB FILE #: -h 1A _AVA�ou
PARKING:
Use: AXA-Wfm 03424 No. Spaces Required:
&-van-
X
Use: Dor area, # employees, etc.)
X No. Spaces Required:
(floor area, # employees, etc.)
Use: No. Spaces Required:
X (floor area, # employees, etc.)
Use: No. Spaces Requir .
X (floor area, # employee etc.
Total Required: Actual Provided:
SETBACKS:
Required Setbacks:
Front: ::�Left Side:—R* S ide: Rear:
Actual SetbackEs:
Front: Left Right Side: Rear:
=_2 r uir
Street map checke r additional setback required? (Yes/No)
MAXIMUM FLOOR AREA:
Maximum Allowed: Actual:
BUILDING HEIGHT_�'�
Maximum Allowed: Actual Height:
Modulation Allow Modulation Height:
Datum Pol Datum Elevation:
Elev Penthouse > 3 feet over height limit? — If so,VAR#
LANDSCAPING:
Matches ADB app
Bid Provided? _-
DATE:
NAME OF 8UILDING PERMIT
Continued ...
ond Amount (100% bid):
PLAN CHK#:
APPLICANT: (Offl
1AfibmrWP1andatNewComm.doc
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96
0
AD13 FILE #: OR DATE WAIVED:
PLANS MATCH APPROVED PLAN: -
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION:
SHORELINE REQUIRED?:
LOT AGGREGATION REQUIRE D?:
REDUCED SITE PLAN (8.5X11) PROVIDED FOR STREET FILE?
�9�2 ;;
1:\Iibrary\,*,PlandatNewConun.doc
64�,fM. /7- 4)601�0ES �O
CITY OVEDMONDS _9M PERMIT
18 9 0 9 1z PERMIT N 2 3840
Address of Construction:
Property Legal Description (Include all easements):
a
Ot ',
4.�ri JTAT�uiq
6-2w, lii�ie, - TA4, +/0- - /Soo C)Allow5 llllsAlled —7
0A1 We-51 �S Ide 0 ( h/// ddWil
Owner and/or Contractorq-�-T
MIN 1.1-* 9 ly'3JCI-T Building Permit No.
I i r- in n -zn N r) RECEIVEL
FEB U 5 W1
)BLIC WORKS DEP-
El Single Family Invasion into City Right-of-Way:WNo El Yes
C3 Multi -Family (No. of Units.-) RW Constructi.on Permit No.
R"Comme Cross other Private Property: RNo El Yes
El Public Attach legal description And copy of record ed easement
I certify that I have read and shall coarply with all city requirements
as indicated on the back of the Permit Card.
Date
_!n—
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION."'
OFFICE USE ONLY
FOR INSPECTION CALL 7M-SM, PUBLIC WORKS DEPT.
7 7/ - OA,�
Permit Fee$60- oo, Issued By
Trunk Charge: MIA Date Issued:
Assessment Fee: /V/9 Receipt No
Lid No.: Ald
Partial Inspection:
Comments
Reason Rejected:
Final Inspection. Approved
Date - I nitial
Date
DateP_:A-�Initial.�Pc,te4-3 bi 7. b4xf -1.5 "
Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant Revised 3190
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................
NEW CONSTRUCTION zr REPAIRS F� LID NO . .................. ASMT. NO . ..................
OWNER................................................................................................
JOB ADDRESS .. ..... 4wlj . ..... ..............
LV, F. V. c- 0-
PWW-0001-1 V75 (REVA 1178)
10
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1 i,00 341. seqeIrWrok
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CONTRACTOR .................................................................................... PERMIT NO. (".. ,
LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
A
..................................................................................... ......................................... )LTA..�U!
NAME OF ADDITION ...............................................................................
.........................
4
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dos-lz 91-45,t-ic-
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Approved:
c�eDATE ........... 7 ............. By '--t? t
-----------------
APPLICATION CARD No . ..................
for
The City of Edmonds SIODE SEWER PERMT
EASEMENT No. ...........................
OUTSIDE INSIDE REPAIRS 0
2j 3 —
OWNER.h�kff --- --------- Aj-1.k..e .... ........... A!-`.C-.��-.4CONTRAbTOR Z'Ald. 24�;7 ............ I.Y.
- -------- PERMIT No.
STREET
HOUSENo..( ... Z-4-1 .......... -------- fl) .................................. AVENUE LOT No . ...................................................................... BLOCK No . .......................... -------------------
k ... ...............................
4IC-14WAY NAME ADD. _ ...................... S�,.A, ------- - ------- ............. .............
c
c
JL�
CIO
Date
BACKFILL WORK ORDER ISSUED ...................................
SEWER WORK ORDER ISSUED ..........................................
,I g it, g'; t"Ll
Approved:
DEPOSIT, $ ..............................................
DATE .........
By..................
That portion of the S 1/2 of the SE 1/4 of
SE 1/4 of SE 1/4 of Section 30, Township 27
North, Range 4 EWM lying West of State Highway
No. 1; LESS the North 75 feet thereof and lets
the West 60 feet thereof, Snohomish County,
Washington, less County Road.
'd
.4
CITY'01F _tumb`146
S
call YR�spec�; flii� M—whed -Work
E
CENTER ��'MATER-SEWER DEPA11fA4 NT
Is, ready- for-linspection.* (No inspec� 'i
OF
U
ii06 i
nq
SIDE -SEWER PERMIT--.-
........................ ........................................ I .............................
.......... * .....................
...................
,OW, K CONTRACTOR ....... In i.rxia1.iP.riq.j'1EiC.-Es .............. ........
-14 .............. -19..'65, f."
io�' granted, _.April...
...................... days, to REPA..jU,_or CONNECT -'-a gidb
�wers in-adcordance With' application. on M6 and koverning'.ordinanbes,
q
A -
THE. FOLLOWING:
TtNTION- 18:Ck
�,LED� TO
..—The. owneis..of the_�roperty may obtain- a perMItL to cons ru6t -Sewer %inside property line. A- licensed Stde--.'B5TeF.;Contractdr.-mti at-,..
bo 'employed - to construct slde_s�weroln street area. Do 'riot -'cover -any 'Poit Ion -of- -saws i'vef6re --it has"beep. inspected.
No. liw btain. full 'information regarding Ordinance 11A6.030 and Regulations goverfilng:,slde saw ri when -.ybu -jet -permit.
a
NOTM�_ No. 3—Top of side a . ewer,must'have -EU:least 30 Inch6s.icoverage.at.property line_and 12 inches--insids,'pr6pert : y, . lin . e;' minimum , *grade.of 2,%
V_
No benas'in-grade sharper than.,%:will be permitted,..
-0
NOTE,�NO.-4—Trenches'An .6freet -must be -water, iAtied � and- durface of,street restored Ao, original condition. Contractors - shall, IY6 - risponsible- for
failure due to Improper wark, w!�o may develop, within- one year Of completion.
:No E -No.. 5--It is, unlawful' to � alteror. to ain�.,;other_ work ban Is provided.if r7int or to do.any' work-,Oii' the. main sewer pri A
a t be,. permit, L 'P_
T - - - a
p -tenances exce
ui 5f to insert- the jiipe� Into the. Wye.
p
PUBLIC WORKS DEPARMA4 CHECKLIST
BUILDING^'PM%14IT REVIEW
Ito Y+*(44wme
(address) *.t 60
Street Right -of -Way Existing
RE
Z
I
Access Easements Existing'
-----jEQD
P�
Utility Easement Existing
D
Lot Per Subdivision 0-0� Plat
Assessor
Site Plan Checked for Accuracy
-7
Z
Underground Wiring Reqd.
_
0
Check Accuracy o al Description
FIS
Z
Review by
Date
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
1:4
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection
jInspectim�
re jjt�
Fire Departumt Comnents
E& Ott
"'Pt
Water 14--t� ge Reqd.
WIS
; ��by
Date 26�-729
Septic Tank Design Approved. AIA
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drx,,ing No. q S. -X71Ce
File No.
Side Sewer Availability,
Sanitary Sewer Connection Fee Reqd.
Review by W/S
Date 3/7-_0/76
Open Ditch Existing 4
Reqd.
Culvert Reqd.
Size
P4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection on
swale open runoff
44�r4;ZL 44(::�
-, Zi
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked 41Z
Review by_44W&Z;,,.��.._Date
g
Revised: 1v10-1977
Page 2
0
Street Paving Reqd.
Curb and Gutter.Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Re
em
g Right-of-Wa'y Cxmstruct*,,Y�t ZIR4 d
Bond Reqd. for Public Irrp aveTmts
Street Nam Sign Reqd.
Other Signing Reqd.
P3Pre Permit Site Inspection made on,
z
0
BY: S94ER
WATER
P4
STREET
ENGINEERING K
Special', Requiren-ents listed in mem to Com=ity Development Department,
Building Division
> BY Date
o All items filled in on Building Permit Application ��1261
P4 BY Date
Drawings Stamped and Notations Made,
P4 BY Date
-4
Approved by Public Works Department
Revised: lv 10-1977
Iolp, BU81NLSS LICENSE APPLICATION
f
CITY OF EDMONDS--
11 103�,0_3S66
250 5TH AVENUE NORT
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.
2. NEW BUSINESS. COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT
3. SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY).
4 LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
I., TO APPEAR FOR APPLICATION REVIEW.
11 ANNUAL FEES
-1
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,
CLASS I FEE PAID I PENALTY PAI�
LICENSE RENEWAL
REVIEW BELOW INFORMATION, PRINT CHANGES AT RIGHT.___2
PLACE OF BIRTH
HOME ADDRESS
IAL SECURITY NO.
3 BUSINESS IDENTIFICATION
BUSINESS NAME
NATURE OF BUSINESS
WASH. STATE TAX NR. EMPLOYEES I ORGAN. JOCCUPANCY
L
TYPE ORGANIZATION
IF BUSINESS IS-
TYPE
CAPACITY
c
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
C CORPORATION
APT.BLDG.
A
NR OR APTS
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
S
S SOLE OWNER
HOSP./NURS. HOM�H
NR OF BEDS
SCHOOL
S
NR OF STUDENTS
BUSINESS ADDRESSES
I I
BUSINESS ADDRESS
ILA
5. EMERGENCY NOTIFICATION
NAME
AREA
TELEPHONE
(2)
OFFICIAL USE ONLY
I.I.F.I.R. CODE
I BLDG.
PERMIT
OCCUP1
C.U. PERMIT
LAND USE
I ZONING
STAFF ACTION
EVERSE� APPL. NO.:
SIDE DATE: 1,2(� y
(,,�APPLICATION FOR:
NEW LIC. LICENSE
BUS. 1:1 RENEW YEAR
LICENSE NUMB�� [, UCTIO LA - NEW BUS. i
LB RENEWAL
I I LC CHANCE
LID DELEIE I
CLASS YEAR LIC. EFFEC. DATE REASG. LIC. NO.ISPEC.
1.1 _ I _ I I
RECEIPT NO. DATE PAID Ak
Q01— INT X
E, IN SPEC. BO)
1 91 If FOR ISSUE OF
FfEPAID PENALTY PAID C 0 R R E C T E 0
LICENSE WITH
0_1 I I I I LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
2. APPLICAN
NAME FIRST I - INITIAL SOCIAL SECURITY NUMBER
R- �A c�
I III -S 5, - 11 c 1.� 1- 7
I I L L_j
DATE OF BIRTH PLACE OF BIRTH
TAT
Y AR CITY F-sT F�
-MO. I �DAY I
HOME ADD RESS
BLDG. NUMBE71
STREI�T
APT. NO.
CITY
STA
ZIP CODE
, .:) Cj
Cl.":. 7
3. BUSINESS lDnT.LFICATION
CkQ le
c — I
N
I
OF BUSINESS (DRUG STOXE. CIrIT) I
BUSINESS PHONE
rA�T �,C: v N k, Q '7 1
I WASH. STATE TA NR. ANTICIPAT TYPE OF oc AN
X CU"
GISTRAT) 0 N) NR. EMPLO ES ORGAN. TYPE C�A P ACCYI T Y
L
0 ENTER APPLICABLE TYPES AND CAPACITY
41NE' S ADDRE
BLDG, NUMBER STREET
J_k'>�-7 % �j 0
I I I I
I E` E P , E M-A4�
BLDG. NUMBER
'ZL,17
STI�EfT C�,C-\
APT. NO
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I el A 4
CITY t
C.
ATE I
T,
Zip CuLl"
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/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE. BURGLARY, ETC.)
LAST NAME. FIRST INITI
AREA CODE'
TELEPHONE
(2)
LAST NAME, FIRST INIT"L
AREA CODE
E
-7
3
Llf I R PRIM.
CODE' Z/ I/
COND. USE PERMIT
- I I I I L
C�Ty CLERK'S APPLICANT'S
S GNATURE SIGNATURE
[:] APPROVED F1 DISAP . PROVED DArE rBUS. TITLE
— 5S OFFICIAL USE ONLY
UNITS BUS. BLDG.PER
� -IZ-) I / I MI) I/
I I LAND USE ZONING
P. GRP.
DATE 5;l
FORM CC-1 (10�'76) -,-- --- T - I- - - I --- ) (-
In= OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
N
OWNER NAME/NAME OF BUSINESS All,
N
PP
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S
'C A �ON
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W MAILING ADDRESS
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ELEPHONE
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NAME
ADDRESS
CITY _,--21P ITELEPHONE
NAME
)-V7"A147(Wj,+L wo) cu.
ADDRESS
CITY ZIP
tvow-rr I,
TELEPHONE
.42T-,7*fWI1j
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKEDBY"
ZA1 Tt-R-S C 0
2.�O�
031 0 �,
�0\1
PROPERTY TAX ACCOUNT PARCEL NO.. opol .
3 0Z 0300.
0 RESIDENTIAL
PLUMBtNG / MECH
'E�rNEW
AUDIT16N aIC-0 MME . RCIAL
COMPLIANCE 0 R,
CHANGE OF USE
REMODEL 0 APARTMENT
5KS'IGN
0 REPAIR GRADING CYDS 0 FENCE X FT)
C] D EMOLISH TANK
o OTHER
r 0 GARAGE 0 R . ETAINING WALL C:] RENEWAL
CARPORT,; ROCKERY
(TYPE OF USE. BLAINESS OR ACTIVITY) EXPLAIN:
4 1 JVL� �_
Co CRITICAL
40 NUMBER NYMBER OF
0 AREAS
111 OF DWELLING
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
A I V f\ A'0A In ir -1 11 IA I I+ L 'bh "-x I"
PERMIT EXPIRES _q4LArw-2
USE PERMIT 39&2.31.
ZONE NUMBER
JOB SUITE/APT.#
ADDRESS 0 Q
CPkC1K I
I \0 'Tj
V V
PLAT NAMEISUBDIVIS�IDN NO.
LOT NO.
LID NO.
LID FEE $
TESCP Approved
0
PUBLIC RIGHT
WAY PER OFFICIAL STREET MAP
RW Permit Required
0
I . f
Street Use Pernift Req'd
0
EXISTING PROPOSED-
Inspection Required
Sidewalk Required
0
0
REQUIRED DEE) CATION_ FT
Underground
wiring required
0
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 :NO 0 .3
W
W
REMARKS
z
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OWNER/CONT CTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
0
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ENGINEERING REVIEWED/DATE
FIRE REV . IEV�D BY DATE
UE,
VARIANCP OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
gYES 0 NO
I PIONE
DST D
SERA IfIEVIEW
SIGN AREA
HEIGHT
COMPLETE i EXEMPT
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ALLOWED PROPOSED
)4.
ryp
LOT COVERAGE
REQUIREU1. SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALL!:ED PROPOSED
FRONT SIDE REAR
FRONT UPSIDE REAR
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PARKIN4
LOT AREA
PLANNING REVIEWED BY DATE
RE IDED
—
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CHECKED BY TYPEPW.g.NSTRUCTION 121DA I OCCUPAN . T
I A GROUP
SPECIAL INSPECTOR 1AF11AI I W�
REQUIRED C] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER LIBC 1081FINAL INSPECTION REQ'D 0
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
LOT SLOPE %
BUILDING
10. LO
PLUMBING
PLAN CHECK NO:
VESTED DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
aw=RCHARGE
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PRO41DED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSP ECTION FEE
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
NOT BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
PLAN CHECK DEPOSIT
q,13
oz,
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
? NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
IVEN 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-
CALL
This application is not a permit until signed by the
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
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
V4pRKMEN'S'COMPENSATION INSURANCE AND RCW 18.27.
OFF]PIALS SIGNATURE DATE
S1614ATU WNER NT) N
DATE SI7GD
(425)
771-10220
ELEASED K DATE
EXT 333
R
—V,4 ', 7, 7/1 V
ION
IT IS'UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN. MADE AND APPROVAL OR A CERTIFI-
CAfE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5198,�.;
771-0221
ORIGINAL -FILE YELLOW- INSPECTOR
FAX PINK - OWNER GOLD - ASSESSOR
ATE RECEIVED
S PERMIT EXPIRES jg�_
CITY OF EDMONDS
us PERMIT
20023Z
ZO E C4
I
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
..
ADDRESS a3l'�H�o kAk-tj ----
k-A 9
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
NO.
7
LID NO.
LID FEE $
*-i- #0!2 IAaeLvolw?
IX
MAILING ADDRESS
z
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appmed 0
RN Permit Required 0
0
EXISTING — PROPOSED
Street Use Penns Req'd 0
Inspection Required 0
CITY ZIP
TELEPHONE
LREQUIRED
qjj,o
DEDICATION— FT
Sidewalk Required 0
Underground
'/h
Wiring required 0
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO C1
Lu
ADDRESS
REMARKS
z
z
')'74
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
a
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W
CITY ZIP
TELEPHONE
NAME
n
ENGINEERING REVIEWED/DATE
ADDRESS
o:
I DAT?
00
Lu
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LL
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0
'-00_�
12S3
TELEPHONE
RIANCE 0 PU
SHORELINE OR ADB#
INSPECTION
REO'
kO
BOqD
- DAI
STATE LICENSE NUMBEpo�, EXPIR96N E
CHECKED BY
4C 03 3�T57
1
[3YES
4F!�Z--W
SERA REVIEW
COMPLETE EXpe
.04 SIGN AREA
ALLOWED PROPOSED
I
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL Nn-
uj
2 7 Oq _
I
-1
.>OZ/
EXP
RESIDENTIAL
NEW PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
ADDITION COMMERCIAL ci COMPLIANCE OR
I - -
I
z
2
CHANGE OF USE
z
-C
PARKING
IDED
LOT AREA
—
NNtj REVIEWED B Y DATE
REMODEL APARTMENT SIGN
i
IL
REPAIR C] GRADING FENCE
. CYDS ( _ X FT)
REMARKS
DEMOLISH 0 TANK OTHER
z
r-1 GARAGE C] RETAINING WALL 0 RENEWAL
L-J CARPORT ROCKERY
(�
P
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
9HECKED BY
YPE OF COUSTRUCTION
gQDE
OCCUPANT
GROUP
4
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
Lu
SPECIAL INSPECTOR JAREA
'9
OCCUPANT
0
STORIES
UNITS q'i
NUMBER
REQUIREDOYES I
Z
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 101VFINAL INSPECTION REO'D
Two :i�ovwj lteAOW�7
gLk
I
CIA nclvoclLe
A6
VALUATION
FEE
PLAN CHECK FEE
491
HEAT SOURCE LAZING % LOT SLOPE %
G-P_� 1
BUILDING 00 ;7-
PLAN CHECk-NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPILICATION: 180 DAYS
PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BE+qALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
;N
/I _11144 lr_I�Alt A14W 157040
Lu INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
.j
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc
INSPECTION FEE
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF
RECEIPT
PLAN CHECK DEPOSIT
DEEMED ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I .
RECEIFPr
TOTAL AMOUNT DUE
1. 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
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application is not a permit until signed by the
CALL
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.
WqRKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
-
SIGNATURE (OWNER OR AGENT) DATE SIGNED
OFFICIALS SIGNATURE DATE
(4215)
/00
3
771 4�220 - J21
"RELMED
IV TE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
EXT 333
3A LZ6
UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW- INSPECTOR
FAX PINK - OWNER GOLD - ASSESSOR
5/98
41.1
Project Ninf&
Project Address: 22716 EDMONDS, WA 98020
Date: 2/8/00
Design #:NOODLE1
Scale: NTS
Signature: Date:
13214 4th Ave. West
Everett� WA 98204
Phone: (425) 741-8877
Fax: 25) 741-9656
REcF.WED
1h
Si
This is a WdEnng Ofall cnguW UrP'bhdwd design created by International Sign Co.. AM as axb is proteaW under federal copyd& laws. It is submitted fcr your personal use in
mection with a Kojeet being planned ft youby International SignCo, It is not to be shown to arwcm outside yourarganizatim4 nor is it to be used, rqro&04 copied cr embbitetl in
mWfluibion. 7be chm*M ofodors� sizes or applications ofmaterials orilluraination shall not alter the basic oopynghted desWi Client Agra= tDPW 2M Ofthe seuingpnce offl,
dgiay&pctedhemntohtem&onea&pCo.Wmd=aM&wwrifftsdmpjswedmrqgo&=WmwMecrputbymWportyo&aambgwmtLmW&gnoompmny
FEB 0 8 2000
DEVELOPMENT SERVICES CTFL
CITY OF EDMONDS
L 111il
i Lmm;
,�agdficqdons
Sheet metal, internally illuminated, single face cabinet sign
wfth a confinuous Lexan face
Size: 3--o*"X 15'�-O*
Graphics: 3M series Scotchcal premium vinyl
Black
3M series Scotchcal translucent vinyl
Red
Yelk)w
Green
Blue
Mounfing: As W chy specs APPROVE . D BY PLANNING
2.
z-/'
SETBACKS:
FRONT ............
SIDE
PEAR
JL.jL�
/J� 1� r-
Ml KE-
7K MOVK
9 ERR--
UBC
PACI ci.o
F I
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LOT PL4&) :2.1716 Niv� 9?
alicl =/O E12 m oAl 0
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FEB 2000
DEVELOPME NT SERV'CES CTR-
CITY OF EDMONDS