310 6TH AVE N (2).PDF11111111 lill
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310 6TH AVE N
, NBUILDING PERMIT PERMIT #: BLD19890083
PROP OWNER: CITY OF EDMONDS STATUS: FINAL
'�A ADDRESS: 310 6TI-I AV17 N. F.DMONDS BALANCE: $0.00
ISSUED: 2/6/1989 CREATED: 2/6/1989
SCREENS: ... I 7r-- FUNCTIONS: I.Select Permit Function... Ej
4 .. ALTERATION/RFMOD11- 1NTF;Ri0R,
DATA SCREEN: GENERAL INFORMATION
I LIN)ATE I SPELI, Ctit,:( I
Permit Title: 14 - Alteration/Remodel Interior Status: IfINjA
Permit Type: 14 -_,��tpra�tion/Rernodel Interior Issue Date: 2mclose Date:
Situs: 1310 6TH AV N
Occupant Load: Occupancy: JB2
Subdivision: Lot:
Units: 0: Archive Record: 12
I
Plans on File: IB26
Notes:
131-MAM.
Zone:
Code Edition:
Pro.ject Value:
Plan Review Fee:
Permit Fee:
BUILDING PERMIT PERMIT #: BLD19950435
PROP OWNER: CITY OF EDMONDS STATUS: FINAL
ADDRESS: 310 6 I'll AVE N. I-.D,\4(.)NI)S BALANCE: $0.00
ISSUED: 8/14/199i CREATED: 8/14/1995
SCREENS: I sel.ect screen... FUNCTIONS: Select Permit Function.... 1��
3o - 1:1R.L. SPRINKLER
DATA SCREEN: GENERAL INFORMATION
UPDATE, I Spliil,.11(111111cl� I (-I,( SI,:
Status: FINAL
Permit Title: 1130 -Fire. Sprinkler I
Permit Type: Issue Date: 18/1,4L1�q�
- Fire Sprinkler
130 _gClose Date:
Situs: 1310 6TH AV N
Occupant Load: 1289 Occupancy: 1132 Zone:
Subdivision: Lot: Code Edition:
Units: 0, Archive Record: 12 Project Value:
Plans on File: IB44 Plan Review Fee:
Notes:
IFire sprinkler
Permit Fee:
4
M
BUILDING PERMIT PERMIT #: BLD19960219
PROP OWNER: EDMONDS SCHOOL DISTRICT STATUS: FINAL
ADDRESS: 310 611-1 AVE N. I..'DM0NDS BALANCE: $0.00
I SS U E D: 4/12/ 1996 CREATED: 4/12/1996
SCREENS: 1.�_elect FUNCTIONS: �p�mit Function... A�J
AITFRATION/RFMIODFI, liVITRIOR
DATA SCREEN: GENERAL INFORMATION
SPEHIC111,X
r111
Permit Title: 15 - Alteration/Remodel Exterior Status: I FINAL
Permit Type: 15 - Alteration/Re model Exterior Issue Date-14/12/1996 RMCIose Date:
Situs: N
Occupant Load: Occupancy: B2 Zone:"
Subdivision: i Lot: Code Edition:
Units: 01 Archi ecord: 14 Project Value:
ans on File: IB46 Plan Review Fee:
Notes: z Permit Fee:
ISiding north and eastXnd of building, reroof, remove chimney. CA-95-84
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DEPARTMENT OF BUILDINGS
fill t?
P� iffil rnational Building C
TH fliding Permit BLD2010-0301
At: 3106 Ave N E imonds WA
No. Stories: 2
i1ificate: Dwelling Units: **N/A**
Occupancy established by this cert %
A T p Basement: No
Typ�7,construction: VB
AIE
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J
Zmf
od, WA 98036
0* d te W.,Lvgnwo
Building Owner: Edmonds School District _4q-�
#61 201,142,011
AW1 r 'PPR S COMPLY
ING WITH THE REQUIREMENTS
-HA V. 'D A
THE Edmonds BoVs and Girls Club�"-: - S B -0 ' OCCUPANCY
CODE F THE GROUP AND DIVISION OF
-'J T-
ACBUjt:6jN6
OF THE 2006 -EDITION OF THE INTERNATION,
AND THE USE FOR WHICH THE PROPOSED OdCtjlp�kNCY ISCLASSIFI
ay of,-�, 2010
Issued this -10th d
F IL IFFICIAL STREET FILE
BY:
rrnit and a new
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building pe
Certificate of occupancy issued by the City of Edmonds Building Official.
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CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: -3ltD— &AM0 '5 -
2. Property Tax Account Number: 4542- 1,00 0-00 0' C>
3. Approximate Site Size (acres or square feet): MO j 00
4. Is this site currently developed? Y yes; no.
P� -Rec 0 H
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
XFlat: 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 over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: MC
_; Approx. Depth:
7. Site contains areas of seasonal stdnding water: -;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway k)n floodplain On. of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? _ (What time of year?
10. Site is primarily: forested meadow _; shrubs mixed
urban landscaped Qawn,shrubs etc) X
11. Obvious wetland is present on site: NO -
Rev 01/04t94
& 9 0 . 19 9 -
City of Ednon&
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 Edmondsprior
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 availableTrom
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
mustfill out the checklist, sign and date it,
and submit it to the City. The City will
review the checklist, make a precursory site
i
visit, and makea 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
or plot plan for individual lots of the parcel
withenough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent infonnation (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing theik 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: Applicant Representative:
Bill —rsouqk�I-a!5
Name Name
1�>O - —P--)O)< 6224- 562Lo C2 (W rY% 01 C-- V I e— LJ
Street Address Street Address
EVCYCM. 1 -7 CX-30 �EAM06A
City, State, ZIP Phone City, State, Phone
Signature Date Signature Date
( �OLA Poilt). 6.115,19
FLAYM
7 Ave- 14
me'r
AVV
-44
.. PVMG4-1.�� �J K r"CiM H C14--
151TE- PLAt,,4 - 310 &11, 14VM,
4$�L� r:::,Tlow
LCIT-i5 I - Zo lE�lLcCi<- C�o; - Yll-ILL
Lorri�;) 2j -4�' E!)Lpc-r�lqi, PL.A-r c>r--r+4e-: c-rTY
OF - r-_�okj ��, I Wa-U r7l N161 VACATET�:,
A" L-\/IK16+ Ni-n4N !�,5CnOK Z4, -rbWN -
,!�-Ai VF- Z71 RAN 61 tv- --5 M�--W I �5�.�Ho M
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APPIJCANT- -REP:
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As!
BOYS & GIRLS CLUBS
OF SNOHOMISH COUNW
P.O. Box 5224
Evereft, WA 98206
Phone: 258-2436
Fax: 259-6177
Officers
James R. Pinkham.' MD
President
Brian Olson
Vice President
Chuck Nelson
SecretatylTreasurer
Board of D frectors
Dan Anderson
Glenn 'Jeep"Carpenter
Atana Chailman
Tom Collins
Bert Cronin Jr.
Bob Fankhauser
Jim Ga ffney
Tom Gaffney
Terry Goodrich
Ken Green
Rod Henry
Cal l(Inney
Rosemary Lane
Steve McCary
Rock Peterson
Jurgen Sauertand
Lane Savitch
Larry Stave
Katherine Wilson
Executive Director
BlIlTioukalas
Branches
Alderwood
Arington
Edmonds.
Everett
Mukilleo
Monroe
Suftan
JAN 1 3 1995
ENGINEERING
27 December, 1994
Mayor'Laura Hall
City of Edmonds
505 Bell Street
Edmonds, WA 98020
Dear Mayor Hall:
S"IrREET FILE RECEI"ED
JAN 0 iggs
COM.,.iU
,;Ty SERVICES
i IL TOR
4_0
03 1995
0,C;C1Ce 0,C r
lye 4M Yon
As you know, the Alderwood Rotary -Club is undertaking,the
remodeling of the Edmonds Boys & Girls Club as their 1995
community service project.
Currently, we have a year-to-year lease for one dollar with the City.
of Edmonds., renewable January 1, 1995. The Alderwood Rotary
Club has listed twelve criteria that need to be -satisfied before
proceeding. One of the criteria is for us to secure a ten year lease.
Please let me know how to. proceed to secure a minimum ten year
lease.
On a related -issue to the lease, our insurance agent has advised us
to add a mutual waiver and release to the fire/legal liability clause
of the lease. lam sure that. the Alderwood Rotary Club will ask for
this as welfonce they -are informed.
Sincerely,
Bill Tsoukalas
Executive Director
cc:' Ray Gould
The Positive Place For Kids. A Unfted Way Agency
'DEC-i3-1994 20:*23 P. 01
Dec.14,1994
To: Ile Major Pr4ect, Task Force for reftubishing The Edmonds B, & G Club:
Ruth Cassidy
Carol Bag - Christiansen - Fax 640-1532
Tan Bierne - Fax 776-0607
Luis DeArias - Fax 771-5416
Jurgen Swerland - Fax 672-7998
Howard Chern3ak - Fax 774-4993
Ray Gould - Fax 776-0924
Subject: ftnutes of our M13-94 task f
pree ineeting
Copy to - Brian Senzel Fax 670-7182
Laura Hall - Fax 771-0252
Bud Kopp - Fax 771-3891
Bill Tsoulakas
1. We reykwedand_agpU9gd the "Ofteria for an Acceptable and Succeasfid Edzaonds
Boys.and Gids Club Major Projece. Mfis document is mached and will be used at
presentations to both the Edmonds and the Aidawood Rotary Club Boards.
2. Ilm amk—d Rm lbrww reykwed and mukdared Additional possible finNfin
sources were added- An updated copy is attached. Ehving had ffie structure inspected by
proftsional painters,- it. was agreed that a sift n9lacetnent was the beat way to proceed
for that portion of the job.
3. A WII&rft of Oc.-WOrm WM Mmmgnd by Unda. and was dxwougWy rrviewedL This
.do
,*cd work via Chermak Construction is grcady appreciated and does indeed gin us a.
fe,pi for what the facffity will look like before and after I
Bill Tsoulakas has agreed to pemnally pwvue the gyMgwnt a kaw -o a-
eL_ 10 fi mth
city.
S. Two ideas were discussed for the "ham* -on" pgff o
Ithe gMject. At this point it way
work out beat to assist: in the new fiont, oftanoe work
6. Ile task force is in general agreement that a small VMk& maMMgEyAM should be
empowered to *make the bid awards and oversee the project. This migft include a co -
of payments to contractor& We am xWestiag that Ruth Cassidy, Carol Berg -
and Ray Gould be the project management tem although were open to other
ideas on this.
7—Fund was discumd at.109th and now ideas were added to the list (see'the
scope shed) along W* the contact persons nam Carol will ask *e Edmonds RDtary fbr
$15,000-20,000 ovef the ncxI two years.
S. TU new is wboduled for ZkLes
ifti
mlo.1995@ 11:00AIW@Pwnimd'y,
Well review how the two Board meetings wad, any info on fimding, and start in" a
sche"c as to what happens and when. We must be aw= oftho Taste ofEdmonds
Schedule too..
Submitted by,
Ray Gould
12-0�1994 09:09PM P.101
DEC-13-1994 20:23 P.02
B&GESTIM-XLS
'Edmonds Boys and Mrls Club Refunfting.
Reptioritized 12-13-94
item
Gym floor mpair
Replace e)dt gans in wn
Replace IiM floor e)dt signs
Priority
1
1
1'
Labor
400'
400
Mdu
1000
300
300
TOW
7500
700
700
Contractor
nVactor
Contractor
Canxd mp! and tHe Instauation
1
4000
2000
Wd
—
Front eMmnce mhab
Roof seal coat
Newsignage
$1ding replacement and painfing
1
1
1
1
12000
1000
25M
190M
6WO
SM
SIX
13000
iWW
1500
3000
32000
Contractor
Contractor
Window replaoement and north wall revision
1
1500
Soo
200C)
Contractor
ingall protedive Orfil oul;sIde sag lights
Upgrade gym fighft
Furniture re*oemcnt
1
1
2
300
10001.
0
300
aw
3000
600
IBM
3000
Contractor
ReKir, rqmlnt,h!Me , reinstall window grills
1300
100
1400
InMll rag. backboamb & hoops
Install boys msftom adnal
Install secuft s
y-4wn
21
-1
2
1350
- 5w
l5w
11650
. rm:
low
2000
joad
25M
Vender
Contractor
Misc. elecb1call wodr
Obdure M2!�Oements
2
2GOO
1000
.3000
Additional wat for acUuslable bacUmards
2
SW
ow
1400
Vender
Interior painting
3
—1 SM
Sw
2000
Relocate 2 backbowds
i
1300
100
1400
Fix up study room
3-
500
—5w
1000
Replace window In dimetom offioe
Owtowil ftnt pomh M
3
31
100
100
2w
100
SIX
200
Contractor
SubbAW for pdordy I jobs
738W
Subtabd fbr pd2ft 2 jobs
ism
Subtftl fbr erfodly 3 jobs
49W
Tow pajea i-xd-
59M
49450
Tax -
77W
Con*qwcy 10%
10200
Gmnd taW
PossiMe funding (hat W commiffed)
Allderwood Rotary Club
35OW
B&O Clubs of Sno. CouiiFy*
10000
City of Edmonds
28M
Edmonds Rotafy & local
Crime bill bricks & moftr mon
10000
Hubbad Foundation
10000
Jurgen Vu
Edmonds Chamber
Howafd ft
Edmonds famnis
Carol Vu
Edmonds LJons
Jim flu
Reliable Room
IJIM
flu
Edmonds Nurawy
I
Page I
12-13-1994 09:09PM P.02
DEC-13-19§4 20:24
'P.03
CMEIUA FOR AN ACCEPTABLE AND SUCCESSFUL
EDMONDS BOYS AM GIRLS'CLUI3 MAJOR
PROJECT
Approval for the project shall be secured from the Sch001 Districti the City and
the Rotary Club.
I* The building subamcture shall be deemed Adequate to last for ten yeam
* 17he Boys and Girls Club shall hold 8 ten Ytar minimum lease on the building.
I%e PrOject smpe shall be developed with input from the MW District, the Cityl
the Boys and Girb Club N[anagemeat and the Rotary Club.
*.The initial PrOJect cost estimating shall be done in such a mmmerthat a high
degree ofConfidence resides in the numbem
The actual job shall be done Utilizing a flat Sam bidding prftess. for nWor sections
of the work Cost plus bidding is not an Alternative -
The job swpe parts shall be prioritized to that the rinal job can be fit to the
Revenue for the project shall be Awed in a restricted Boys and Girts Club
account
A portion of the project shall be developed as a "hands on" job for the Rotarlans.
A rewguition system shall be developed for those supporting the prjed,.ith
funding, labor or In Idnd oontrffiutiou&
-A A community celebration shall be planned for the reopening event
Ile schedule for.the project wW can for completion by the end of August 1M.
TOTAL P.03
12-13-1994 09:09PM P.03
FINLEY/ARCHITECTSm AlAl PS.
I B1 2 Hewitt Avenue
P.O. Box 100B
Everett, Washington 9B201BS7��--�EL,=-'T FILE
25B-6471
��l
�W—APV W401 MWA
JUR
1987
ELEUTUB VF
-�11`9 4� '/-�
.ATI ��
.77
r. ...
ATTENTiOR
n;,(=) E2--> rl f LL S
RE:
p W "RKSENDING YOU 9 Attached 0 Under separate cover via
_UBL _
• Shop drawings 0 Prints 0 Plans 0 Samples
• Copy of letter 0 Change order 0
the following items:
El Specifications
COPIES
DATE
NO.
DESCRIPTION
eaf!)t f'Lo&lj!5
s:f .. 0RC-4jjbjAL-.
C?L�
-R�AQA:TF-00 ELAQ
THESE ARE TRANSMITTED as checked below:
• For approval
• For your use
;6 As requested
0 For review and comment
FOR BIDS DUE
REMARKS
• Approved as submitted
• Approved as noted
13 Returned for corrections
0
• Resubmit-cooies for approval
• Submit -copies for distribution
El Return -corrected prints
19 0 PRINTS RETURNED AFTER LOAN TO US
COPY TO
SIGNED:
It enclosures are not as noted, kindly notify us at once.
.1 0�
'City. of Edmonds
8 9 0 - �1- 9 C, -
RIOMT-'OF-WAY CONSTRUCTION
mtwr
Permit Nu
9-
Usue Date:
\ �A. Address or Vicinity of Construction:
�B. Type of Work (be specific): /ov SZ-
C. Contractor:
Mailing Address: 5,1 J'Q j /3
State License #: (�6
D. Building Permit # (if applicable):
E. C-] Commercial E) Subdivision
Ej Multi -Family [-] Single Family
INSPECTOR:
F. Pavement or Concrete Cut:
Contact: Djq Aft C,�")
Phone: :?(o6-5(�Z—'3702,
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
t'' Pro
EJ Ci Y ject
El Othek
116EC7"IOR:
0 Yes ONo G. Size of Cut:
E] Utility (PUD, GTE, WNG, CABLE, WATER)
H. Chargo�,$
APPLICANT TO READ AN N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmond8 harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or. any of its departments or,
employees, includingornot limitedto the defense of any legalproceeding8 including defqn8e costs, andattorneyfee8 by reason of�r�inting 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 COMPLETEO BY CITY FORCE9, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLir-ANT. Ali*
Construction drawing of proposed work required with permit application.
N'�-`-A .24,hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work a`n`d`m' A-terial is to be inspected during progress and at completion.-�
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTION$. 11� Ir I
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on �ea�alltimes r inspection pMposes.
Signature: Date: Ag hr,
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: "j�� RIGHT OF WAY DEPOSIT
goo
"0
TIME AUTHORIZED: VOID AFTER DAYS -PISRUPTION FEE/FUND. Ill:
SPECIAL CONDITIONS: RESTOR , ATION FEE:
PERMIT FEE:
TOTAL FEE: 74 e--
COMMENTS: RECEIPT FEE:
DATE*: ISSUE D BY: ?Z-�nl
- NO WORK SHALL,. BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
--------------
'he table are
he depth Of
fee.
gG LOAD
-ER 50 FOOT
1.oeo
2,000
3000
W/Clay 4:000
10.00c)
thrust$ shall be
rods tO $0110
?.. k or
9'.. MOVOI 0
rr- SrA LLAT
TW
ALL
ith ballast Of
thrusts
F 1P t, .1 75 4-
resist
1,0;cessor jq shall first bt
P?per or
THL)R5r
buildin
prior to I
fricteric?
ta permit joking up i
—. FIF
ton tM installed prior to
)Q7, V,-TT I
f
F.M. APPROVED
,D AND TESTED IN
THE OWNERs
W&
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SAWTUARY
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. ICITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION,
OWNER NAME/NAME OF. BUSINESS
t I 19:)1
_;aZ4 ___
MAILING ADDRESSIt -lu AV&
.2
'04200;�"&o
CITY Zi P TELEPHONENUMBER
L_11�lju LUCM COO
NAME
ADDRESS
-7521.a P
CITY z TELEPHONE NUMBER
20(v- 77(P-A�"7
IP
NAM��e
'r ; r L4 C+ cm
ro YL
CITY ZIP I TELEPHON
STATE LICENSE NUMBER LXPIKA I IUN UA I L
ejf&jZM - C -r 110 AJ UL (a- 110 —7
Legal Description o.f Property - include all easements .
20, EXX q 4, A LJ— BL� 1001 LV75 21-1k
-bL4 lc>l pwr,�>p
r I
me-l'ad(VII vz_-Caf;�
9!ct rrwrtoe, zsr,_
Property
TaxAccount 4:31�a /00 oco 00.
Parcel No.
1:1 NEW El RESIDENTIAL D PLUMBING
'PLA au C_
El ADDITION sem� D MECHANICAL
APT. BLDG.
El REMODEL El SIGN
GRADING FENCE
REPAIR CIDS. x _FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT D HOT TUB/SPA
EGARAGE RETAINING WALL/
l C ROCKERY El RENEWAL
(TYPE OF USE, BUSINE$S OFIJAPTNITY)AX5 _810- ___ '_ , 'N
vac PERMIT
ZONE NUM13ER 966-219
JOB U1
ADDRESS F-b400T)G, N
PUBLIC'RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
vnnPnQF:n
METER SIZE LINE SIZE I NO. OF FIXTUi
REMARKS
TESCP Approved
RW Permit Required
Street Use Permit Req'd
E3
Inspection Required
. 0
Sidewalk Required
0
PRV REQUIRED
YES 13 NO 13
ENGINEERING MEMO DATED
REVIEWED BY
FIREMEMO ATED--..
R IEWEDBY
C-11V
SIGN AREA
SEPA RE IEW
ADS NO.
PROPOSED
COMPLETE
F5— 7-7
.
SHORELINE#
E XP' :_[7
VARIANCE OR CU
fjll! IEW BY
PLAt4PIN,( v
E
SETBACKS — FEET
HEIGHT
"I
LOT COVERAGE
FRONT /0 SIDE I
REAR
I <'I
NUMBER
NUMBER OF
CRITICAL4?,
I OF
DWELLING
NA
AREAS
3, STORIES
UNITS
NUMBER
DESC918E WORK TO BE DONE CATTACH
PLOT PLAN) 'ReP49ce-
-slairiq on N,9k"rif
iL&7;G;r
5141Z_`iP/Arj4:lr1_
.6?*
rip c.,,--rrr'r I �r
7.
ove-ClimillwC4
Rvlh �
1 --4111-11PI 4 -
CHECKED BY
OF CONSTRUCTION
CODE
OCCUPANT
ITYPE
GRO6
SPECIAL INSPECTOR
AREA
OCCUPANT
REQUIRED
0 YES
LOADc2oq
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
FEE
tZemove- 1r1laCj6U is, can SrrL_j1C__r
'U,k
PLAN CHECK FEE
;-/ 0-21 �
dbay' 6ozd-av Akside
BUILDING
26,
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No. 1?6 _3 9
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will (equlre-sep2rate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
(n
successors in interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington. Its qfficials,
employees, and agents from any and.,oll-,clalms for darfiftes of
whatever nature, arising directly or 1pd�feqtly from Me Isguince
x
of this permit. Issuance of this peftit ifiall not be deemed to
PL��, C , HECK DEPOSIT,,.,. -
0
modify, waive or reduce any requirement of any city ordinqnce
limit In the City's riv
t
x
nor any way abiliw"nforcel
-oln6rice
T04L. AMOUNT DUE
provision."
e/
he/
I hereby acknowledge that I have read this application; that th
't halt
r 1 "0 d u
Information given is correct; and that I am the owner, or th.e dUIV
APPLICATION APPROVAL
and
authorized agent of the owner. I agree to comply with city and
c ty
au I horlz_
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
he Labor
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/htir
Code of t�.%Sto of Washington Sting to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
Ire
tion lnsL6Aw6 and RCW 18.27. . .
I NSPECTION
acknowledged In space provided.
SIGNAT WNER OR 1�4T�)z ATESIGNEJD
,
DEPARTMENT
OF A 'S SI NATURE DATE
4
76
Lai "'o
CITY OF
EDMONbs
NTION
CALL FOR
INSPECTION I(=
WELEASEOMB DATE
4311'&, -- 9
7-4 6�
IT' U TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
- -, f
ORIGINAL — File YELLOW — Inspector
771-02 0
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
1%
CHAPTER 3.
PINK — Owner GOLD — Assessor
102-87