315 5TH AVE S.PDFIIIIIIIIIIII
5147
315 5TH AVE S
0 0
ADDRESS: 315-- 5`4 RW6
TAX ACCOUNT/PARCEL NLTM13ER: 12o 0 --37 -o/ o 7
13UILDING PERMIT (NEW STRUCTURE):_ � j b
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: �1 3 - "�l DETERMINATION: [:] Conditional Waiver Ej Study Required 43waiver
DISCRETIONARY PERMIT #'S: ODC243-Z&
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
�11
PLANNING DATA CHECKLIST DATED: -'2( )5—a
SCALED PLOT PLAN DATED: -7/Z
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: 37— 4 0 BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: 5-76
SOILS REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED: qJ71f-1 6217-q
-N-Cab r4hlp-Y &-W-q3-5S--7 (PbfD) Pd)W-13-
LATEMP\DSrs\Forms\Sftwt File Checklist.doc
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PLANNING DATA
SIGN PROPOSAL
StMtF=,veJ
Name: W Ok !�P f-OL Y-9
D
Review Dat : 0 1 - 'k5. 1_0 I D
Site Address: 15'T" Avt b'W U 0
Permit Numher: BLD.20 10. 0 0 1
Project Description:
rltur vkf A n
Zoning: D17 se
Comp Plan: 01 M i At4 60 M M OVU4
Corner Lot: (0/ NO)
Flag Lot: (YES
Variance:
Shoreline:
ADB: NJA—
CUP_
Pre -App:
LLA:
Plans Match ADB Approved: (YES NO) WIA
Lot Aggregation Required: (YES / NO)
Legal Nonconforming Land Use Determination Issued: (YES / NO)
Total Area Per Sign
Type of Sign
Allowed in
zone?
Matrix
conditions
met?
Allowed
area per
unit
Unit
TOTAL sign
area
allowed f or
this sign
Proposed
sign area
EXampie
Wa// wlinternal
illumination
Yes, With
conditions
Yes
154ft.11lneolft.
attached wall
41ft. OttoCt7ed
wall
41SqUarefeet
20 square feet
Sign -1
V40,%%
IrOL Cc"
Y
fau,uf-
Ito
y 31
S3. 1
Sign #2
WOM
0 n "Po
d
.,0
ytoi-
1poxcd
Wo . V,
TOTAL SignAreofor Tenont/Site
Max Permitted:
___FPreviouS
Total: -�p flo�
Proposed Total:
Sign Height
Sign Type: W ml
Max Permitted: Iq I
Actual Height: lap
Sign Type:
Max Permitted:
Actual Height:
Sign Lignting
Sign Type:
Proposed:
WIAIIIA I r,+4?w'7
Allowed in Zone:
ye
Sign Type:
Proposed:
Allowed in Zone:
Other
K of
:- J,
6ns
;47
F-Z
PLANNING DATA SUWt=Fnej
SIGN PROPOSAL
Sign Colors
Proposed: &OLp
MOD)
Acceptable?
Requires AD13 Approval?
Sign Location
If freestanding and 3-f eet or over (unless a f ence) meets setbacks?
Required Setbacks
Street:
T---de:
Side:
Rear:
ACtUalSetbaCkS
Street:
de:
Side:
Rear:
Landscaping for Frees tanding Signs
Size:
Location:
Critical Areas Determination
El Study Required
waiver
Other
Plan Review By: Gina Coccia, Associate Planner
10.4, lot.*-W to-w-r."Nl -- -- —!n
50c Ave ue--5cuth--60-".a.W.
STREET FILE
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AM
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JFXn Legal Descridtic
;Ppe OT WO(K-Gonoral TeffifiiCUMDrovemin
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Critical Areas Checklist' Li FILE
Site Information
Project Name. ty,210ff Permit Number.
Site Location: '�2 Property Tax Account Number -
Approximate Site Size (acres or square feet): 5F
Have you filled out a Critical Areas Checklist for a project on this site before? Lno
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action:
Soils / Topography
2- In the Snohomish County Soil Survey, what is the mapped soil tyje(s)? 67���
3. Describe the general site topography. Chccic all that apply.
Flat less than 5 feei elevation change over entire site. WW toorem
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
)ffilly.- slopes present on site of more than 15% and less than 30%9 ( a vertical rise
of 10 feet of horizontal distance.)
Steep: gradesof greater than 30% present on site. f<
Comments
Hydrology/Vegetation, '
4. Site contains areas of year-round standing water. N)d)
5. Site contains areas of seasonal standing water. KLO Approx. Depth:
6. Site is in the floodway floodplain KDO of a water course.
7. Site contains a creek or an area where water flows across the grounds surface?130 flows -
are year-round? Flows are seasonal?
8. Site is primarily: forested L)L:� meadow Q0 ;shrubs mixed �)o
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: K)p
0 0
9
CRY of ]Edmonds
Critical Areas Checklist
The Critical Arms Checklist contained on
this form is to be filled out by any person
Prq)adng a Development Permit
Application for the CitY 'Of Edmonds prior
to his&cr submittal of a development permit
to the city.
T11C PurPose of the Checklist is to enable
City staff to determine 'whether any potential
Critical Areas am or may be present on the
subject FOPWY. ne information needed to
complete the Chcddist should be casily
'lablc fi'0111 Observations of the site or
aval
data available at City Hall (Critical Areas
inventories, maps, or soil surveys) -
An applicant� 'or his/her representative, must
f '11 out the chocld'st, sign and date it, and
submit it to the City- Tke City will revie
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
aPP"cant should also submit a vicinity map
of the parcelvilh enough detail that City
staff can find and identify die subject
Parcel(s). In addition, the applicant is
encouraged to include any other pertinent,
information or sttidics 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:
14 �Mq WAMIZ- VIP
Title -
F-0-�>N
Street Address
hone
City. State, ZIP P
1z
Applicant Representative:
-b -
M$ame
&-amw
Title
"z'10( �A-
Street Address
—fL2�-
Phone
Signature Date gna e
Date
0 0
PLANNING DATA
NEA,J Lom r-i�-2,(- (A,
NAME:
SITE ADDRESS:-�/'��'� AV. 4-�- —DATE: 101111V
ZONING:'?,o- PLAN CHK#: qq-
PROJECT DESCRIPTION:
USE(S) PROPOSED: �fto o
M-aff ALLOWED
LEGALNON FORMING LAND USE DETERMINATION ISSUEi�k)�. (-YIN)
CUP File: !q
ADB FILE #: N 1A OR DATE WAIVED:
PLANS MATCH APPROVED PLAN:
PARKING : �AIN 6110 VJ1 R -4
Use: 1 No. spaces Required: I ORf
X (floor area, # employees, etc.) :J
Use No. Spaces Required:
X (floor area, # employeerT,
Total Required: Actual Provided:
SETBACKS:
Required Setbacks:
Front: Left Side: A14Right Side., Rear:
Actual Setbacks: P
Front: Left Side: — Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
MAXIMUM FLOOR AREA:
Maximum Allowed:- Actual:
BUILDING HEIGHT:
Maximum Allowed: ____.Actual Height:
Modulation Allowed?:- Modulation Height:
Datum Point: Datum Elevation:
LANDSCAPING:
Matches ADB approved:
Bond: -A
SUBDIVISION:
CRITICAL AREAS
aAf11es\permN^PLANDAcD0C t ave-r )
SEPA DETERMINATION:
SHORELINE REQUIRED?:
LOT AGGREGATION REQUIRED?:
OTHER:
Plan Review By:
c:\fl1es\porrrsRr1PLANDAC.D0C
Site Development Services
310 - 208th ST SE Bothell 90D12 481-9687
DRAINAGE CALCULATIONS
FOR
PROJECT:
SITE ADDRESS: e- .5 1
DATE: 7-tj 11
ftcz/VZO
Jul 2 9
1993
cotivr
7/1
0�-
15182
NAL
EXPIAES
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RECI-ZIVED
ElDt"110"NDS
CITY 0 RE
SAPR I SIDE SEWER PERMIT
18 'XIC WORK6 C.-Eq, -1
cl PERMIT �.�O 4
Address of Construction: Z) 1,5-- 4ue- -,s I
Property Legal Description (Include all easements):
4,74---2
Owner and/or Contractor: S, ---T7/u c-
State License No. I LSZA)�Y� 4—C-) CLO Building Permit No. �?n 60 6,
Single Family Invasion into City Right -of -Way: /CK No El Yes
Multi -Family (No. of Units—) RW Construction PeL.Tit,Ng.
�k,commercial Cross other Private Property: �Kl\lo 0 Yes
El Public Attach legal description and copy of recorded easement
I dertifly that I haVe read and shall comply with all city requirements
as indicated on the back of the Perwit Card.
Y- 7- 9'
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL PUBLIC WORKS DEPT.
771-01220 /7
a,
Permit Fee: 7-n Issued By
Trunk Charge- Date Issued- 4 7
Assessment Fee: Receipt No.: /2270�?
Lid No.:
Partial Inspection: Date -Initial
Comments
Reason Rejected: Date —initial
Final Inspection Approved: Date
I n i t i a 1
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3 90
,rL el: f r-A A Side Sewer Drawing *?
e lly V EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ ASMT. NO . ..............
OWNER------------ ----------------------------------------------------------------------------------- CONTRACTOR -------------- -------------------------------------------- ------------------------ PERMIT NO.A',-s:-T�
S(D
JOB ADDRESS - - - -------------------------------------------- ------------------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ---------------------------- -------
C, -3
7,
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PWW-0001-1 1/75 (REV.1 1/78)
NAMEOF ADDITION ---------------------------- ------------------------------------------------------------------------------------------
E)
Approved:
DATE...... ...... By -------- - ------ ----------
PLANT
0,
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS E] LID NO -- ------------------ ASMT. NO. -----------------
OWNER- ---------------------------------------------------------------------------------------------- CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO.
JOB ADDRESS )- 0�t -------- - ---------------- LEGAL DESCRIPTION: LOT NO. — -------------------
................ BLOCK NO - ------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION
311 ths
Approved:
DATE........................................... � By -----------------------
STR.EET RLE
Certificate of OC'CUDancv
Building Division
�rj7c. 1 S9V
Thi's certificate is issued in accordance with the requirements of Section 111 of the 2012 International Building Code
certifying that at the time of issuance this structure was in compliance with the applicable provisions of the codes and
ordinances of the city regulating construction and use of buildings.
Description: 11 -Change of Use
Occupant: PAKTLA HEALTH MART Permit No: BLD20140819
Site Address: 315 5TH AVE S #C, EDMONDS Parcel No: 00434212203701
Construction Type: VB Occupant Load: 30
Owner: STRICKLAND TRUST Occupancy Group:, M
PO BOX 1004 -
EVERETT,WA 98206
12/29/2014
FVding Official Date Issued
POST IN A CONSPICUOUS PLACE
PLANNING DATA
-- Sign5 --
Name: OG, eA� f��
Date:
Site Address: 315 S "— Ay, 'S
Plan Check 9. BLD-Zoi S -0 1q-7
Project Description: Nejj L",j c, LA
Reduced Site Plan Provided: OTD NO)
Zoning: 7�
Comprehensive Plan Designation: -b T
Map Page:
Corner Lot: NO)
Flag Lot: (YES /<!LOD
ADS File 9 (or date I waived): ^J 1,4
TO TA L Area. per Type of
Type of Sign
Allowed in
zone?
Matrix
conditions
met?
Allowed
area per
unit
Unit
TOTAL sign
area
allowed for
this siqn
Proposed
sign area
Exa-ple
Wall. wlinternal
illuminobon
Yes, Wth
conditlons
yes
I sq- It 111neal
/t. attached
wall
41 tt. attached
Waff
41 square feet
20 square feet
Sign
L-LA
'Jq
Sign #2
Sign #3
TOTAL Sign Area for Tei7antl5tte
Max Permitted:
�Previou:s Total: �16,
Proposed Total: 51,
-5ign Heiglit
Sign Type: (-.,,)c-
Max Permitted: L4
Actual Height:
Sign Type: t
Max Permitted:
Actual Height:
Sign Type:
Max Permitted:
Actual Height:
Li
qh�Ui7g
Sign Type:
Proposed
Allowed in Zone:
Sign Type:
Proposed:
Allowed in Zone:
PLANNING DATA STREET
5i
gnS7--
�n . �ars
Proposed: -9k
Acceptable? Y. a-
Requires ADB Approval? r11A
5�gn Lccaticf7
If freestanding and 3-feet or over (unless a fence) meets setbacks?
Reqt�#'- -ad Setbasks r-J1,4
Street:
Side:
Rear.-.
Actual--Sietbacks ' tj/,4
Street:
Side:
Side:
Rear:
Ldndscaping for
Size:
Location:
Critical Areas Determination
0 Study Required
El Waiver
Other
C)
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Plan Review By:
CITY OF EDMONDS - 1215' AVENUE NORTH - EDMONDS, WA 98020
PHONE: 425.771.0220 - FAx: 425.771.0221 - WEB: www.edmondswa.gov
DEVELOPMENT SERVICES DEPARTMENT: PLANNING - ENGINEERING - BUILDING
February 20, 2015
Mr. Roy Myung, White Signs
Email: whitesign007@gmail.com
RE: PLAN REVIEW COMMENTS FOR PLAN CHECK #BLD20150147
PAKTIA PHARMACY WALL SIGN, LOCATED AT 315 5 TH AVE. S
Dear Mr. Myung:
I have reviewed the above building permit application for the Planning Division, and it was
found that the following information, corrections, or clarifications will need to be addressed
before review can continue:
Sign Area: Please provide a length for the "Paktia" lettering. You have provided the
height and length of the logo and the other lettering for the sign but didn't include this
length.
2. Sign Cross Section: Please provide the distance the face of the sign will be from the wall.
On the cross section provided in the submitted plans, the raceway dimension is provided;
however, there is not a dimension for the mounting boxes located between the wall and
raceway. In our phone conversation yesterday, you stated that the raceway would be
mounted flush with the wall. If this is correct, please amend the cross section accordingly
to portray this.
3. Sij4n Illumination: Pursuant to ECDC 20.60.020.M.2, internally illuminated signs in the
downtown area may only light the letters. As such, the logo and raceway cannot be
internally illuminated nor can the white box around the word "pharmacy". It appears that
the raceway is proposed to be illuminated based on the cross section shown in the
submitted plans. Please submit a revised lighting plan for the sign that shows how the
illumination will be in compliance with the city code. I have included an interpretation
from 2011 regarding illumination for Halo signs. This may help as you put together the
illumination proposal for the sign.
Please submit three copies of your revised plan sheets to a Development Services Permit
Coordinator. Our office hours are Mondays, Tuesdays, Thursdays, and Fridays, between 8:00
am and 4:30 pm, and Wednesdays between 8:00 am and noon. If you have any questions, feel
free to contact me at (425) 771-0220.
Sincerely,
Development Services Department - Planning Division
Sean Conrad
Associate Planner
APPROVED AS NOTED
BY EERING
Date: --IJ 1-7 f IL4
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313 5TH AVE SOUTH, 2ND FLOOR Front — ---------
EDMONDS, WA 98020 bv" Sides
NOTE: NO CHANGE TO EXTERIOR COMPONENTS 01 Rear
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BY NGINEERING
Date: 1, 11 -7 14
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313 5TH AVE SOUTH, 2ND FLOOR ��ckq _P,1(,1y i _re d Actual
EDMONDS, WA 98020 Front
NOTE: NO CHANGE TO EXTERIOR COMPONENTS Sides
Rear
shal �v t
"Nothing in this pertaZ�, aPTOTICY"FA Pn� 1 be Other
interpreted as allowmg or permitting the jLe�ight
SITE PLAN aintenanl,,;-: -!fany cu--,ently existing illegal,
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permit application, rp;gardleaa 01 whether such
building, strudwre. or condition is shown on the
Sits plan or diim--.17 Such building, structure Or M A IR 13' 2 0 144
b"& subject of a ealoamte
madition mw 2 DEVELOPPf-ENTSERVICES CTR
ILE '!'RoNwexit at-icn- CITY OF EDMONDS
Side Sewer Drawin
The City of Edmonds EASEMENT NO - ----------- ------------------
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ - ASMT. NO - ------------------
OWNER --------------------------------------------- -------------------------------------------------- CONTRACTOR ---------------------------------------- ------- PERMIT NO.(�'�s
----------------------- ------------
--- BLOCK NO - ----------- -------------------
JOB ADDRESS ------------------------------- ------------------ LEGAL DESCRIPTION: LOT, NO - -----------------------------------
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PWW-0001 -11/75 (REV. 11178)
NAMEOF ADDITION --------------------------- --------------------------------------------------------------------------------------------
1;
If 3
;L
Approved:
DATE ------ By -'�" --------
Rl: revise E01 and E02 to have behind the wag raceways par LL - 1(1121/09 -pdc
F12: revise E03 . E06, and 102 per custorners; request - 11/2109 -A
R3: revised E01 and E02 be facelit channel teleter; on exaosed raceways per LL -
S, if
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C' of Edmonds 011111i!ding
ity
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Ar?Pt0-"VTrbD PLAN
#614513
315 5th Avenue S,
Suite 200
Edmonds, WA 98020
Together we'll go far
6igntech
4444 Federal Blvd. San Diego CA 92iC2
Phone: (610) 527-6100 1 Fax: (619) 527.4111
www.signtechUSA.com
=j L11 .
Wells Fargo
#614513
PCG - Edmonds, WA
315 5th Ave S, Suite 200
Edmonds, WA 98020
Date: 10/13109
Salesperson: Art Navarro
Coordinator: jenriffer Brimm
Designer- 01109Y chiras
Scale: As Noted
CUSTOMER APPROVAL
Custonfor signature Wto
COPY COLORS & SIZES
Signtach cloes NOT prWiclo orimwv
electrical to sign location -
RESPONSIBILRY OF OTHERSI
Cmtomr Sitimture Data
This desian is the o-hisive omoom of stomach
Dravving Number: 09-
Work Order Number: 47500
Sign Number: Title Page
R31
Al: revise E01 and E02 to have behind the wall racmys per LL - 10/21/09 -pdC
Rz: wise E03, E06. and ID2 per customers m4wst - 11/20 -pdC
R3: revised E01 and E02 to farelit Channel letters on exposed raceways par LL - 11/109 -Pdc
b 11:1:19.11111
Existing Sign Recommended Sign
E01
Wall Cabinet
Wall Cabin t
E03
Wall Plaque
E04
Regulatory
E05
Vinyl
Wall Plaque
E01
k
13.�
181
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1.5'
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GO-1 5-HACW/ ra-c-eway
�312'
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33.2'
Al-20-48 (wall mounted)
2-!F�
3
Al-2048
2.8'-
3
Exterior Door Graphics
1
WP-2-ST-Nl
E02
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lit
92
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6igntech-
4444 Federal 81vd. San Diego CA 92142
Phone: (619) 527-6100 1 Fax: (519) 5274ill
www.signtechUSA.com
LxgAk
Wells Fargo
#614513
PCG - Edmonds, WA
315 5th Ave S, Suite 200
Edmonds, WA 98020
Date: 10/13/09
Salesperson: Art Navarro
Coordinator: Jennifer Brimin
Designer, 0009Y Chlras
scale: As Noted
tgwg��
�LIQ(21/09-pdc A
!L 11/02/09 -pdc A
1,11/1(VD9-pdc Z�,
CUSTOMER APPROVAL
cu.w— sjgn�ftre Dow
COPY COLORS & SIZES
Signtech does NOT provide orimary
eleiCldcal 1. sign locafioh -
RESPONSIBILITY OF OTHERSI
cust— slonature D.t.
T, , g. W the C 1.
.M cannot b r "a wh a of i
wl ut th Pdor Wdoen app'.— P
DrawIngNumber: 09-01447
a r a, urn an 47500
Sign Number: Bdedor Sh Plan
& Index R3.
0
6
Fa - of Edmonds Building Department
Rl : revis: E01 and E02 to have behind the wall rAceways per LL - 10/21/09 -pdc
112: revis E03, ED6, and 102 per customers request- 111A109 -pdc
113: revised 1131 and E02 to facelit channel letters an axposed raceways per LL - 11/10/09 -pdC
mL
C56 V8.
3'-
0. .................
im EXISTING ELEVATION SCALE: 3/32"= 1'
PROPOSED ELEVATION SCALE: 3/32"= 1'-0"
INSTALL SIGN CENTERED OVER ENTRANCE HORIZONTALLY;
CENTER VERTICALLY BETWEEN BOTTOM OF LIGHT FIXTURE AND FASCIA
PATCH AND PAINT WALL COLOR: SW 7063 NEBULOUS WHITE
(26'-5 7/8") 317 7/8"
T-8-
±9'-O'
A. F. F.
IM EXISTING ELEVATION SCALE: 1/8"= 1'-0"
Im EXISTING ELEVATION SCALE: 1/8"= 1'-0"
INSTALL SIGN CENTERED OVER ENTRANCE HORIZONTALLY;
CENTER VERTICALLY BETWEEN BOTTOM OF LIGHT FIXTURE AND FASCIA BOTT
PATCH AND PAINT WALL COLOR: SW 7063 NEBULOUS WHITE
6igntech
4444 Federal Blvd. SanDlego CA 92102
Phone: (6ill) 5274100 1 Fax: (619) 5274111
www.signtechUSA.com
��j Is C; ;�gAk
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Wells Fargo
#614513
PCG - Edmonds, WA
315 5th Ave S, Suite 200
Edmonds, WA 98020
Date: 10/13/09
Salesperson: Art Navarro
Coordinator: jerinder Blimm
Designer, P1109Y chiras
Scale: As Noted
10/21/09
1'�%11/10109-pdc / \ I
CUSTOMER APPROVAL
Cust— Sitim1ure D�t.
COPY, COLORS A SUES
Signtech does NOT provide primary
oleclrical to sign location -
RESPONSIBUTY OF OTHERSI
cusw— Sigroture c.t.
Drawing Number: 09-01447
Work Order Number: 47500
Sign Number: IM
R3
JA I Q, 6
City ef zdmiuc;' d5 OUP'ftmg bepanmefa
Rl : revis E01 and E02 to have behind the wag naceways per LL - 10/21/09 -Pdc
R2: revis: ED3 , E06. and 1112 par customers request - 1 1/Z/09 -PdC
R3: revised E0i and E02 to facefit channel letters on exposed raceways per LL - 111/1 O(OD -pdc A
317 7/8*
7,
33.2 SO. Ff.
FRONTVIEW
FACE -LIT ILLUMINATED CHANNEL LETTERS WITH EXPOSED RACEWAY SCALE: 3/8" = V-0"
MANUFACTURE TWO (2) SETS OF INTERNALLY ILLUMINATED FACE -LIT FACE CHANNEL LETTERS WITH EKPOSED RACEWAY
WELLS FARGO & ADVISORS COPY,
BACKS: ALUMINUM (THICKNESS AS REQUIRED)
RETURNS: MAXX BRUE ALUMINUM SHEETING AS MANUFACTURED BY AMERIMAX 1(800) 4484033 WWWAMERIMAXBRCOM
3' x.040' AWM SHEETING, ALLOY 3015.
FACES : 1h" THICK CLEAR ACRYLIC ROUTED WITH '/,' UP, 1/4" OF FACE TO STAND OUT WITH 3M OPAQUE GOLD ##77254199 FIRST SURFACE OVERLAY.
PAINT: EXTERIOR OF RETURNS PAINTED AKZO NOBEL GRIP GAURD PLUS SIGN91003C GOLD, SEMI -GLOSS.
INTERIOR SURFACES TO BE PAINTED WITH SPRAYLAT STAR-BRITE WHITE AS MANUFACTURED BY SPRAYLAT CORPORA71ON
(914) 738-1600 - WWW.SPRAYLAT.COM.
ILLUMINATION: GE MINIMAX, WARM WHITE LEDS.
RACEWAY: TO BE 5"X 5' OF ALL AWMINUM CONSTRUCTION TO HOLIES ALL ELECTRICAL AND POWER SUPLUES
PAINTED TO MATCH WALL COLOR SW 7063 NEBULOUS WHITE I
ELECTRICAL REOUIREMENTS FOR NEON LLLIMINATION
As required by standard #2161 . Signtarh Electrical Advertising, Inc.,
exclusively uses secondary around fauft4nterrupted (GFI) transformers.
Each Sign MUST have: - A dedicated branch circuit
Three wires: Una, Ground, and Neutral.
Wire Size: Min 12 GA THMN Copper Wine.
NOTE: The gauge of the wire is dictated by the length of the run & amperage as per NEC k0cle 600.
The ground wine must be continuous & go from the sign to the pandward ground bus.
Voltage between groLind and neutral shind measure no more Otan 3 Yoh.
Power to me sign must be done by a Ocensed electrical contractor or licensed electriclam
EObWn Electrical Permit frOm
' I
IM
S te � gboir & Industries
tba�lfl
Lf
SPLICE CONNECTOR
.5' ROUTED FLEX FACE
NTH VINYL OVERLAY
.050" ALUM BACK
INTERIOR PAINTED WHITE
11/4"0 WEEP HOLES REQUIRED
WITH LIGHT BAFFLE
TOGGLE DISCONNECT
SWITCH (TYR)
3' 5"
5'
END VIEW
MINUM RETURN
#lDX3'SCREWS
INTO BLUE PLASTIC
ANCHORS
(MIN 4 PER LTR)
- PRIMARY ELECTRICAL
BY OTHERS
POWER SUPPLY
E)(POSED
ALUMINUM
RACEWAY
TU.I., APPROVEO LEO CHANNEL LETTER WITH EXPOSED RACEWAY
SCALE: 1 1/2" = 1'-0"
6ignetech
4444 Federal Blvd. Sari Diep CA 92102
Phone: (619) 5274100 1 Fax: (619) 527-6111
www.signtechUSA.com
:��j 11
. — L
WeUs Fargo
#614513
PCG - Edmonds, WA
315 5th Ave S, Suite 200
Edmonds, WA 98020
Date: 10/13/09
Salesperson: Art Navarro
Coordinator: Jennifer Brimm
DesignerL.�hlras
Scale: As Noted
10/2l/D9
I&II/10/09-plic 'L I
I CUSTOMER APPROVAL I
C-10me, signal— D.I.
COPY, COLORS & SCES
Signtech does NOT provide primary
electrical to sign ocation -
RESPONSIBUTY OF OTHERSI
C�to signature
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APPROVED BY PLANNING
O'k-04-10
JAL""
(F�
QTROEE'Ti HIL=E
OV EDv
LE
CITY OVR b%04ft
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED ENG20080219
Permk Number: ENG20080219
Address of Pubfic Use/Encroachment: 315 5TH AVE S, EDMONDS
PROPFATI ONN NER - ----- -- ---------Bt'S INLSS ONN'NtR
TRUST # 323 STRICKLAND WACHOVIA SECURITIES
PO BOX 1004 315 5T H AVE S #A
EVERETT, WA 98206
EDMONDS, WA 98020
SIGN ON SOUTH SIDE OF BUILDING EXTENDS INTO THE RIGHT OF WAY.
STREET USE: Placement of any temporary or movable objects in any portion ofpublic space or City right-of-way
shall meet all code requirements as setforth in thefollowing chapters of the Edmonds Community Development
Code.
ENCROACHMENT. Permanent structures encroaching upon any portion ofpublic space, City right-of-way or
easement area shall meet all Code Requirements as setforth in thefollowing chapter of the Edmonds Community
Development Code.
CODE APPLICATION. Chapter 18.70, 17.65, and 17.70.040 of the Edmonds Community Development Code. All
terms of the adopted ordinance are incorporated herein as if setforth in full and this permit therefore is subject to
the terms of those chapters.
FOR THE TERM IN WHICH THIS PUBLIC USEIENCROACHMENTISINEFFECT, THE OWAER SHALL COMPLY WITH
THE PERMIT COADITIONS SET FOR TH B Y THIS PERMIT.
NOTE: The issuance of this permit is understood by the owner to be of a temporary nature, shall vest no
permanent right and shall be issued and may in any case be revoked at the sole discretion of the City per ECDC
18.70.040. Applicant is responsible to provide a copy of the insurance certificate to the City at the beginning of
each calendar year, no later than the 2 Ist day of January.
INDEMNITY: The Applicant understands and agrees to hold the City of Edmonds harmlessfrom 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 but not limited to the defense
of any legal proceedings including defense costs, court cost, and attorneyfees by reason of granting this permit.
In addition, the applicant understands that helshe shall provide and continually maintain during the term of the
permit a ceritificate of insurance naming the city as an additional insured, with respect to liability, and providing
that it shall be primary as to any other policy of insurance.
THIS APPLICATION IS NOT A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Pfinled: Diday, June 06,2008
DA
FILECOPY F� INSPECTORCOPY E] APPLICANT COPY
STATUS: ISSUED
ENG20080219
• The proposal will not adversely impact public space open to vehicular or pedestrian travel.
• Architectural Design Board Approval has been granted or the process has been administratively approved.
• The proposal will not unreasonably interfere with the rights of the public.
• Items shall be placed adjacent to the building and may encroach onto a maximum of two feet of the public
sidewalk; or in accordance with Bistro and outdoor dining code; or per an approved building permit.
• Safe Pedestrian travel area, or clear zone, of 44 inches minimum width, providing a level safe walking surface
along the public sidewalk, shall be maintained. (e.g. measuring 44 inches from edge of street tree grates or
newspaper stands toward place of business.)
• Exterior fight Fixtures, banners, signs and flags must provide for a minimum clear zone of 7 feet above City
right-of-way.
• Clear Landings of 44 inches or no less than the width of the door (whichever is greater), measured toward the
street, shall be maintained on the exterior side of all required exit doors.
• Illumination from the city fight fixtures shall not be blocked.
• No objects shall be hung from the City fight standards.
• Three feet of clearance around fire hydrants, standpipes, P.I.Ws, manholes, water meters, blowofFs, cleanouts
and valves shall be maintained.
Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City
standards that is caused by or occurs during the permitted project.
0 None
PROPERTY OWNER NAME:
BUSINESS NAME:
BUSINESS OWNER NAME:
RECEIvATREi FILE
MAY 0 5 2004 PERMIT #:
PERMIT COUNTER
STREET USE PERMIT
1>1'u-'
PLJ-Cl
I A 1;17�1
VAUT RL,
4:zc)h -7b - 1
If lu
ADDRESS OF PUBLIC USE: '�2 �Y 4t'C'- & C->tWO, Sta�t C,' -i�el Mo, e& :Y&'eo
APPLICANT MAILING ADDRESS: e? awv-,/
VI�IM-11-'M710=1=M �Z71��M
Placement of any temporary or movable objects in any portion of public space or City right-of-way shall
meet all Code Requirements as set forth in the following chapters of the Edmonds Community
Development Code.
18.70 STREET USE AND ENCROACHMENT PERMITS
17.65 LIN41TED OUTDOOR DISPLAY OF MERCHANDISE
17.70.040 TEMPORARY USES; Bistro and outdoor dining
PERMIT ISSUANCE
A Street Use Permit may be issued, at the discretion of the Development Services Director, City Engineer
or their respective designee, for temporary objects located within any public space, right-of-way, roadway,
parking strip and/or sidewalk, including the air space above them, if they are placed in compliance with the
above referenced Code Sections and the following criteria are met:
> It has been concluded that the proposal will not adversely impact public space open to vehicular or
pedestrian travel;
> Architectural Design Board approval has been granted or the process has been administratively
approved;
> The proposal will not unreasonably interfere with the rights of the public;
> Items shall be placed adjacent to the building and may encroach onto a maximum of two feet of the
public sidewalk; or in accordance with Bistro and outdoor dining code; or per an approved building
permit;
> Safe pedestrian travel area, or clear zone, of 44 inches. minimum width shall be maintained on City
sidewalks; (see definition of clear zone below)
> Exterior light fixtures, banners, signs and flags must be a minimum of 7 feet above City right-of-way;
> Clear landings of 44 inches or no less than the width of the door (whichever is greater), measured
toward the street, shall be maintained on the exterior side of all required exit doors;
> Illumination from City light fixtures shall not be blocked; R, INE
> No objects shall be hung from City light standards; and
SAEngr\Fonns\Street Use Pem-dt.doc Revised 2/6/04
0
0
> Three feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts
and valves shall be maintained. —.." '' )", I
Clear Zone Definition: Clear Zone refers to an area 7 feet in height and 44 inches in width providing a
level, safe walking surface along the public sidewalk (e.g. measuring 44 inches from edge of street tree
grates or newspgRer stands toward Rlace of business and from the ground MR to a height of 7 feet).
DESCRIPTION OF PROPOSED STREET USE: '5 IS(M4e k� b&CSL-y)-f-A;S
L.f I
APPLICANT TO READ AND SIGN
NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature, shall vest no
permanent right and shall be issued and may in any case be revoked at the sole discretion of the City per
ECDC 18.70.040. By signing this application, the applicant accepts responsibilityfor all existing andlor
future street uses. Applicant is responsible to pay an annual renewalfeefor this permit. Failure to do so
will terminate this permit application and require removal of any temporary structures granted by this
permit.
INDEMNITY: The applicant understands and by hislher signature to this application, agrees to hold the
City ofEdmonds harmlessfrom any injuries, damages or claims of any kind or description whatsoever,
foreseen or unforeseen, that may be made against the applicant or the City ofEdmonds, or any of its
departments or employees, including but not limited to the defense of any legal proceedings including
defense costs, court costs, and attorneyfees by reason ofgranting this permit. In addition, the applicant
understands that helshe shall provide and continually maintain during the term of the permit a certificate
of insurance naming the city as an additional insured, with respect to liability, and providing that it shal be
primary as to any other policy of insurance.
CODE APPLICATION: By signing the application below the applicant warrants that s1he has read or had
the opportunity to read Chapter 18.70, 17.65, and 17.70.040 of the Edmonds Community Development
Code and s1he understands that all terms of the adopted ordinance are incorporated herein as ifsetforth in
full and this application andpermits therefore are subject to the terms of those Chapters.
SIGNATURE dtl/v DATE 5
L
Property Owner/Busine'ss Owner
FOR CITY USE ONLY
Approved by:eorm�'M Street Use Fee:
Receipt No:
Issued by: Issue Date:
SAEngr\Forms\Str=t Use Pemftdoc Revised 2/6/04
0 0 Page I of I
htti):Hweb5.co.snohomish.wa.us/sasnhotos/0043/0043421220370]COI Linc, 7/16/90M
State Farm Fire and Casualty ompany
PO Box 5000
Dupon4 WA 98327-5000
K-15- 940E-F476 F U 3
CITY OF EDMONDS
BUILDING DIVISION
121 5TH AVE N
EDMONDS WA 98020-3145
Insured: SPARWASSER, RACHEL
DBA DETHLEFS SPARWASSER PLLC
Location: 315 5TH AVE
EDMONDS WA
98020-3600
Add Ins-11: CITY OF EDMONDS
BUILDING DIVISION
Forms, Options, and Endorsements
Special Form 3
WA Amendatory Endorsement
Tree Debris Removal
Business Policy Endorsement
Special Form 3 Endorsement
Policy Endorsement
Glass Deductible Deletion
Amendatory Collapse
Subcontractor Pd Exclusion
Domestic Abuse Endorsement
Policy Endorsement- Business
Inc Cost and Demolition Cov
Continued on next page
FP-6103
FE-6247. 1
FE-6451
FE-6464
FE-6500. 1
FE-6503
FE-6538. 1
FE-6573
FE-6598
FE-6562
FE-6610
FE-6587
0
RENEWAL CEWrIFICATE
07 2007 to APR 07 2008
TO BE PAID BY INSURED I
Coverages and Limits
Section I
A Buildings Excluded
B Business Personal Property 11 000
C Loss of Income Actual Loss
Deductibles - Section I
Basic 500
Other deductibles may
apply - refer to policy
Section 11
L Business Liability $300,000
M Medical Payments 5,000
Gen Aggregate (Other than PCO) 600,000
Products -Completed Operations 600,000
(PCO Aggregate)
Annual Premium
Total Amount
Premium Reductions
Renewal Year Discount
Sprinkler Discount
Claim Record Discount
Cov. A - Inflation Index: N/A
Cov. B - Consumer Price: 203.9
$325.00
$325.00
a
7
63N 401 M Agent NEIL KNISKERN
Telephone (503) 252-7095
If you have moved, please contact your agent.
See reverse side for important information.
REB Prepared FEB 21 2007
CONTINUED FROM FRONT
NOTICE TO POLICYHOLDER:
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this
policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached
to this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to
your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any
questions about your insurance coverage, contact your State Farm agent.
Please keep this with your policy.
imonna--% n- #%= n^^C
Ant. ADOREsS Fp F
CITY OF EDMONDS BARBARA FAHEY
I MAYOR
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
-(�'s t . 18 9 \�)
January 17, 1997
Attn: Richard P. Megenity
Rainier Property Management
P.O. Box 1004
Everett, WA 98206-1004
Subject: Leak Credit at 315 Fifth Ave. S. in Edmonds (#116230)
Dear: Mr Megenity
I have reviewed this account and will allow a credit adjustment for the time between
September 25, 1996 and November 25, 1996. This adjustment will be from the previous
year consumption of 18 units in accordance with our City policy. The policy states that the
customer will be billed at the retail rate based upon the average water consumption for the
same period during the previous year. In addition, the excess water lost from the leak will
be billed to customer at the City's wholesale rate with a 15% surcharge added for
administrative cost. Only one leak credit will be granted in any three year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerel
ju y
Scott Highland
Acting Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit96\# 116230 9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0
toll free (800) 572-8004
December 30, 1996
Scott Ifighland
Acting Water/Sewer Supervisor
City of Edmonds
71110 210th St. SW
Edmonds, WA 98026
Receiver)
JAN 0 2 1997
OUBLIC W0I?K8 DE
P7
Re: Water leak at 315 Fifth Ave So, Edmonds
Dear Mr. Highland:
We manage the property at 315 Fifth Ave So, Edmonds, for Frontier Bank as Trustee. Pursuant
to your November 26 letter to Frontier, on November 29 we inspected all plumbing fixtures in the
building and questioned all tenants about present or past leaking or malfunctioning fixtures. We
observed the city water meter for 60 seconds on three ocations, and visually inspected all
sprinkler heads of the landscape irrigation system.
Our conclusions are as follows:
None of the tenants were aware of any leaking or malfunctioning fixtures, and none were
leaking during our inspection;
During our three viewings of the city meter, no movement was observed-,
During the inspection I discovered a broken sprinkler head on the east side of the parking
lot, and that the irrigation system was still functioning on the summer schedule. I called our
landscape contractor who had reported winterizing the system in October, and after quizzing his
crew, he discovered that they had winterized only the neighboring Windermere Building irrigation
system, thinking it to be common to both buildings. As of December 5, our landscape contractor
had repaired the broken sprinkler head and winterized the 315 building irrigation system.
We are requesting that you acknowledge the source of the leak as the irrigation system, and make
an adjust to the account on that basis. Please don't hesitate to call me if you have any questions.
cc: Rose Marie Branson, Frontier Trust
RMNIERPROPERTY
MWGEMENT
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER 94671k
CONSTRUCTION PERMIT APPLICATION
joe SUITE/APT
#
ADDRESS'
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OWNER NAMEINAME OF BUSINESS
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
TESCP Approved 0
AW Permit Required 0
Street Use Permit Req'd 13
CITY — Zip
TLLt:PHUNt NUMBER
2-
inspection Required 0
PROPOSED
Sidewalk Required 0
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NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
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REMARKS
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TELEPHONE NUMBER
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0 STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
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Ape NO.
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ALLOWED PROPOSED
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Ce—gail Description of Property - include ail easements .
SHORELINE I
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ADDITION MECHANICAL
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REPAIR El — CYDS. El I— x _FT)
CHECKED By
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TYPE OF CONSTRUCTION
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SPECIAL INSPECTOR
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REQUIRED C3 YES
GARAGE RETAINING WALL/
CARPORT L_j ROCKERY El RENEWAL
01
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REMARKS
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P S� INSPECTIONS PER USC 305
PROGRESS
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9
9 ITYPF OF USE- BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLI AREAS
STORIES UNITS INUMBER
DESCRIBE WOPK TO BE DONE (AT7ACH PLOT PLAN)
: 7
�Q
:�AFINAL INSPECTION REOUIRED
.10 LUATION
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
/ 7
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewolks,
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
20 harmless the City of Edmonds, Washington, its officials,
m 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
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision." 11
I hereby acknowledge that I have read this application; that the
ATTENTION
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 construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion uranc d W 18.27.^
I NSPECTION
N DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
CALL FOR
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
4,FINAL INSPECTION HAS BEEN MADE AND APPROVAL OF; 771-0220
UNTIL
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
f�WAOTCO I
, SC)
RE
L-) , If
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
IFICIAL'S,SIGNATURE DATE
/0—
ELEASE9113 ()ATE
16 -12 5- 5 C)
1_w_ -
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
City of Edmon* S" FILE
RGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Usue Date:
A. Address or Vicinity of Construction: 3,f -5- STH AV E S
-.110000— C� B. Type of Work (be specific): IMSTALL- UG VIST CA 7-son NF-W
9 0
0 ht-S7�
C. Contractor: -C1+AR13EP-5/50PF-RJ6a CA Contact: 7-0M.&MDER-50AJ
Mailing Address: 'T-3 7, MAd tJ ST Phone: 774-S[4&
StateLicense#: 1(31&A Liability Insurance: _ Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial [J Subdivision 0 City Project VUtility (PUD, GTE, WNGeCAUETE) WATER)
E] Multi -Family E] Single Family F] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes 0 G. Size of Cut: — x H. Chargq_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold khe�City ofEdmonds harmlesffftom hiipri� �i' ages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made�agJ("t the City of Edmonds,"oF an- e 6, %t
p rtments or
emp loyees, including or not limited to the defense of any legal proceedings including defense cos ts, 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.
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. t I
Ihave read the above statements and understand thepermit requirgments and thepink copy of thepermit willbe
available on s all ti rzes fo spection purposes.
7
Date:
Sig,nature: -50 ;1�
' - -'(C(TntrdYt5r%TVent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: IVA RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER �4f-A DAYS
I - '
SPECIAL CONDITIONS: AA
COMMENTS:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: e
RECEIPT FEE:
11741% 0:9
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991