614 5TH AVE S.PDF111111111111
5196
614 5TH AVE S
ADDRESS:
TAX ACCOUNT/P.AkCEL NUMBER: c�174<�v "—dIZZW
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: 'hQ
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
OTHER:
DETERMINATION: Ej Conditional Waiver F1 Study Required E] Waiver
LID #:
LOT: BLOCK:
LATEMP\DST's\Forms\Street File Checklist.doc
6�
C3�
Grease Trap Sizing Worksheet
Facility Name:
Address: - C(q �' Au, _S, Suite No.:
• A Grease Trap plumbing permit is required ($165.00 fee). Contact the Pretreatment
Technician (425-672-5755) if you have any questions and also to get signature approval on
this fonn.
• Dishwashers are not allowed to be connected to a Grease Trap.
• Food disposers are not allowed in a facility served by a Grease Trap and must be disabled or
removed. Solids must be screened out and placed in the solid waste container.
—
Fixture Capacity in Cubic
Inches
(L x W x D x no. of sinks)
Fixture Capacity
in Gallons
(Cu. In. — 231)
Drainage Load
(75% of Total
Capacity)
Flow Rate for
a 2-Minute
Drain Period
#1
1 _q_xtp�x (C) 4a= U00 c.i.
231 = _tR gal.
x.75 = L to gal.
2 = gpm
#2
x x X
231 = gal.
x .75 = gal.
2 = gpm
#3
X X X c.i.
231 = gal.
x .75 = gal.
2 = gpm
#4
X X X c.i.
231 = gal.
x .75 = gal.
_
�2= gpm
Grease Trap #1 — Total drainage flows from maximum of 4 fixtures
gpM
#1
X X q )&
--. 231 = 5j, gal.
x .75 = gal.
� 2 gpm
#2
X X X c.i.
—.* 231 = gal.
x .75 = gal.
— 2 gpm
#3
x x x c.i.
�231 = gal-
x .75 = gal.
� 2 gpm
#4
x x x 6.
+ 231 = gal.
x.75= gal.
-- 2 gpm
-Grease Trap #2 — Total drainage flows from maximum of 4 fixtures
gpm
MINIMUM SIZE OF GREASE TRAP(S) REQUIRED
gpm
Number of Fixtures Connected to a Grease Trap
2
1 3
4
-Grease Trap Size (in gpm)
25
35
50
Upsize for factors such as high volume dishwashing, high oil/grease content on menu, etc.
Remarks: I �:
City use only below this line) —
ct-, t- t- S
1�t :S i & t-
f-& _� FJ
� _% A V < u, �
Size Approved: gpm Approved by: Q6__� 40__� Date:
retreatment Technician
rt - t-�
[Rev.Feb.2004]
APPLICATION
for
The City of Edmonds SIDE SEW-Elig pERMrr
NEW CONSTRUCTION aj-� REPAIRS 0 EASEMENT No...-..-. ......... .................
OWNER 0. ------- CONTRACTOR -----
....... ...... .
...... ...... I ............................. ------ ......... PERMIT
------- ------------------------------------------------ *"* - _( - �$7
ADDRESS ..... LEGAL DESCRIPTION: LOT No. ------- 4714 .. P117-0 BLOCK NO . ...... .......... ..........
NAME OF ADDITION ...................................................................
14
Left 2- zt%
uj
U. aw.
uj Zi
Lil
WED
ho 12
I It
I Approved:
DATE ------ - BY
5y �14
aP T*.-fr.
N;
F; OF -rH
E.'c' i N -'RANd4G.-'-24
-N'E zbVT. A Z) 1-5 rA lasx�
OF
ro' r p,
A Pls'TAN�-k!
c K s .'S V. 1 44:1
-T E;
L.; L A VO 215-- t7l"
IT
V E-M 60 V.,
PA
c;�.lf 'r - SU IT F.- 1101Y' P- E ?-.E"r 'T-7 YJ 4,<,
�xh Nurfl�vr
ISTERED F.MNTTO BE Pk'r-'TU.RNED TO:
:111TECT
Du AND ASI�,M
FER E D
ITECT]
�E S C14, Avriv'd f3y
i i C & �:UIA?Y BLDG., UVEAL" I Ti. WAtl�l.'�E;Llo I
Go Pl-bNIE ALpine,2-1404
U!"VI.ENSIONS AND CONDMONS TO BE CHECKED AND�VERIFiED ON'jOG BEFORL
''TARTED, �AND AN'Y DISCREPA1,4--JES TO 9E REPORTED TO ARC'HITECT
Jot—
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER —SEWER DEPARTMENT is ready for Inspection. (No Inspee,
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 3870
ADDRESS....................................... 6-1-4 ... ..... 5-TH ... AVENUE --- S-OUT.H ....................... . .............................................................................
OWNER ..... B. & T. DEVELOPMENT COMPANY
.......................................................................... ------------- CONTRACTOR_BILL O'BRIEN CONSTRUCTION
...............................................................................
Permission is granted NOVEMBER 12 ................ 19.70.., N
........................... ..... for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
1, No. 2--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
N� No. 3—Top of side sewer must have at least 30 inches coverage at property -line and 12 inches inside property line; minimum grade of 2
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NO�E No. 5�—It is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe Into the wye.
0
Civic CENTE
R
250 FIFTH AVE. N
STREET FILE
CITY OF EDMONDS, Snohomish County, Washington
614 le Ave December 3, 1970
BASKIN - ROBBINS Building permit #700450
31 Flavors - BC Zone Sign permit #700553
Lot Size = 132' frontage on 5th Avenue North
SIGN AREA COMPUTATIONS
In order to provide the maximum possible area of signs for the above
structure, the calculations are based on total property frontage.
Future buildings added to the site will generate additional sign area.
I East Side (5th Ave N.)
Permitted area = 132 x 1/2 = 66 square feet
(Section 12-13-190 (0))
II South Side (Parking Lot)
Permitted area = 55 X 1-5 = 83 square feet
Less pole sign area square feet
Net area for signs 32 square feet
RESUIREMENTS 0)
1. No projection of pole sign into right-of-way.
2. Pole sign must be minimum of 50' to nearest pole sign.
Maximum area 50 square feet.
3. Submit detail of fascia sign layout.
Maximum area permitted
East side 66-51 = 15 square feet
South side 83-51 = 32 Square feet
PRo"mvr 6-1107
CIVIC CZNTI KR
250-ilPT14 Ave. N.
PRospreT 64107
Office of the City Attorney CITY %0)* EDMONDS
Snohomish County, Washington
Ho"Ab*r 3s 1970
Mr. Wm. P. Brust
a. T. Development Co.
3030 Hoyt - suits 103
Everett, Washington 98201
R&I Alloy between 4th Avenue and Sth Avenus
South of Ho4ell
Dear rix, Brustz
This acknowle4i aceipt of y letter of bar
1
22s, 1 0. You rofo�l to your 160 of inqui
Septs 26,, 1970. some re" I never race ad
a
tila t r. "#I
Pleast be advised that it is the belief of the city of
Zdmmde after checking past records that the subject
property Is in fact a dedicated street. Xt is our
understanding t-hat most of the deeds in the chain of
title to the abutting property owners have had a reser-
vation for streets and/or roads.
T
WhOrSfor* to &138viato any question regarding the status
of the chain of title from the original plat T sugg'est
that your company make a quitclaim deed to the City of
Z-dmonds for the subject property. I would make it for
you myself on a standard form quitclaim deed, but do not
know the legal structure of B. T. Development Co.
Therefore I suggest that you prepare a standard form
quitclaim deed,, which includes the usual "after acquired
title" clause for Wl* Subject Street. The consideration
should be Ofor mutual benefits to be derived* or for
"street dedication* or *municipal purposes" as you see
fit. I am advised that the legal description is as
follows:
'RECEIVED
'NOV 4 1970,
CITY'OF EDMONDS
40k, loom,
WIM, P. Brust
November 3* 1970
Page 2
aeginning at a point 30 foot West and 264 foot South
of the Northeast oaxner of the South half of the
Northeast quarter of Northeast qA%&Vtor of North-
east quarter of Section 26* Tow" ip 27 Northr Range
3 Easto, W.M.: thence South 20 foot# mora or les4s to
the North line of Lot 12j, Uook 2,p City Park Addi-
tion to x4mondso, according to plat thereof record4d
in volume 9 of plat&,, Vage, 10,, records of Snohomish
county, Washingtow thoneo-Wast along the North Una
of Lots 12 and 1p said Block 2 and said line
extended for 300 foeti thence north 20 feet,, move
or less,, to the South line of the North 264 foot of
said South half of the Northeast quarter of Nortbe-as&' '
quarter of Northeast quarter; thence East Along 86iu
south line for 300 feet to the point of beginning,
all situate In the City of Edmonds* County Of
snohomishe State of Washington.
The engineering and building departments of the City of
Edmonds have reviewed this matter and 3: am forwarding them
a copy of this letter for their files. if you will for-
ward the quitclaim deed to my attention I will adviSO
that the *ower connection can b* properly made.
Yours very truly#
James A. Murphy
JAM/lh
CCS Leif Larson
Dick Allen
Wally Salbaugh
17oo
.'. — — - 7'4A"P""f . ' '
6
�" it
BOTESCH * NASH AND ASSOCIATES
A R C. H I I T. E C. T S
PACIFIC AND COLBY BUILDING a EVERETT, WASHINGTON 98201 a 259-0868
m m C) I_J Im rr rr Im Fto
Mr. John Crawford DATE October 16, 1970
Crawford & Baerg
8910 Whitechuck Drive SUBJECT 31 FIAVORS BUILDING,
Everett, Washington 98201 EDMONDS, WASHINGTON
Rogarding retaining wall detail at the above project, in lieu of
that indicated we advise, instead of 12" gravel, 3/4" - 1-1/2"
wall fill, use pit run, set-in drain tile at the toe of the
vertical and horizontal concrete draining to the rear of the
property. Drain tile is to be set in 120 washed gravel.
BOTESCH, NASH AND ASSOCIATES
0"
4Ka y E. Botesch, A.Z.A.
HEBing
1�
t�-N77 lh� M ,, Bd, � B.. 5C5. D.H... T
0
Harrison, Marie
From: Graf, Jeannine
Sent: Thursday, November 03, 2005 2:58 PM
To: DST
Subject: FW: Baskin Robbins follow-up
Let me know if a Baskin Robbins person comes in...
----- Original Message -----
From: Lein, Jon
Sent: Thursday, November 03, 2005 12:11 PM
To: Graf, Jeannine
Subject: Baskin Robbins follow-up
Hi Jeannine,
This is a follow up to our earlier discussion. The Baskin Robbins on 614 Fifth Avenue South is going through a
remodel. I observed electrical, drywall, and cabinet work. I explained to the contractor that he needed to discuss his
remodel with Edmonds Building Department. My interest in the remodel was ensuring that the two installed grease traps
were properly permitted. The previous owner had them installed and had tried but never did got them permitted. I
explained to the General Contractor that either the building owner or a licensed plumber could apply for a permit for the
two in-service grease traps.
The General Contractor assured me he would take care of the permitting today. Please let me know if the
required permit applications have not been received. Jon
'OSTREET FILE
WASHINGTON NATURAL GAS COMPANY
815 Mercer Street (P. 0. Box 1869) Seattle, Wasbington, 98111 Telepbone MAin 2-6767
August 16, 1965
Mr. Leif Larson
City Engineer
114 5th Avenue North
Edmonds, Washington
Dear Mr. Larson:
Please consider this letter as our application for permission to make
a service connection to our 2-inch gas main on 5th Avenue South north of
Howell Way and to install a 3/4-inch gas service to 614 5th Avenue South.
With your approval we will tunnel und6r the vest edge of the new
pavement and make the connection without -cutting the pavement., The
enclosed drawing shows the location of the gas main in relation to the
pavement.
Sincerely yours,.
M. C. Natter
Project Engineering Supervisor
MCN/bm
0
47�
PA
\Sit
'I, le -�,
Q-A
r
SIMES fwE
LP
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: APPROVED
Permit Number: ENG20130233
Address of Public Use/Encroachment: 614 5TH AVE S, EDMONDS
PROPERTY OWNER BUSINESS OWNER
BASKIN ROBBINS
4012 COLBY AVE STE 103 614 5TH AVE S
EVERETT, WA 98201
SIGN
EDMONDS, WA 98026
ENG20130233
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 USEIENCROACHMENTIS IN EFFECT, THE OWNER SHALL COMPL Y WITH
THE PERMIT CONDITIONS SET FORTH 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 1& 70.040. Applicant is
responsible to provide a copy of the insurance certificate to the City at lite beginning of each calendar year, no later
than the 21st day of January.
INDEAffITY. The Applicant understands and agrees to hold the City of Edmonds harmlessftom 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 hut not limited to the defense of any legal
procee�ings including defense costs, court cost, 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 ceritificate of
insurance naming the city as an additional insured, with respect to liability, andproviding that it shall be primary as to
any other policy of insurance. I
A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HISIHER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
RELEASED
Printed: Wednesdav, Avril 17, 2013
81"L110
F-1 FILE COPY F-1 INSPECTOR COPY F-1 APPLICANT COPY
STATUS: APPROVED ENG20130233
CONDITIONS
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.
The proposal either benefits the public interest, safety or convenience (e.g., supports or protects the city
street) or is an accessory structure such'as fence normally associated with- residential use of the property
as fully complies with the requirements of criteria above.
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.
Sound/Noise originating from temporary construction sites as a result of construction activity are ' exempt
from the noise limits of 1ECC Chapter 5.30 only during the hours of 7:00am to 6:00prn on weekdays and
I 0:00am and 6:00pni on Saturdays, excluding Sundays and Federal Holidays. At all other times the
noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30,
unless a variance has been granted pursuant to ECC 5.30.120.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify
defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from
any and all claims for damages of whatever nature, arising directly or indirectly from the issuance fo this
permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any
City ordinance not limit in any way the City's ability to enforce any ordinance provision.
I INSPECTIONS
0 None
OV E1341 S FILE
CITY OF EDMOITq
("�Nmr
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: APPROVED ENG20130232
Permit Number: ENG20130232
Address of Public Use/Encroachment: 614 5TH AVE S, EDMONDS
PROPERTYOWNER BUSINESS OWNER
BASKIN ROBBINS
4012 COLBY AVE STE 103 614 5TH AVE S
EVERETT, WA 98201 EDMONDS, WA 98026
ARCHITECTURAL AWNING
STREET USE: Placement of any temporary or movable objects in any portion ofpuNic 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 1hefollowing chapter of the Edmonds Community
Development Code.
CODE APPLICA TION: 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 ifsetforth in full and this permit therefore is subject to the terms of
those chapters.
FOR THE TERM IN WHICH THIS,PUBLIC VSEIENCROA CHMENT IS IN EFFECT, THE 0 WNER SHA LL COMPL Y WITH
THE PERMIT CONDITIONS SET FORTH BY 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 18.76.040. 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 21st day of January.
INDEMNITY. The Applicant understands and agrees to hold the City ofEdmonds harmlessftom 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 cost, and attorneyfees by reason ofgranting this permiL 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, andproviding that it shall be primary as to
any otherpolicy of insurance.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HISIHER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Wednesday. Anril 17. 2013
BY
F-1 FILE COPY F__1 INSPECTOR COPY F-1 APPLICANT COPY
STATUS: A�PRQVED ENG20130232
CONDITIONS
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.
The proposal either benefits the public interest, safety or convenience (e.g., supports or protects the city
street) or is an accessory structure such as fence normally associated with residential use of the property
as fully complies with the requirements of criteria above.
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.
Sound/Noise originating from temporary construction sites as a result of construction activity are exempt
from the noise limits of ECC Chapter 5.30 only during the hours of 7:00arn to 6:00prn on weekdays and
10:00arn and 6:00prn on Saturdays, excluding Sundays and Federal Holidays. At all other times the
noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30,
unless a variance has been granted pursuant to ECC 5.30.120.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in. interests, agrees to indemnify
defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from
any and all claims for damages of whatever nature, arising directly or indirectly from the issuance fo this
permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any
City ordinance not limit in any way the City's ability to enforce any ordinance provision.
a None
W",
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME/NAME OF BUSINLSS ll�e, r] ADDRESS
LEGAL DE
PERIM
MdT
NU ER(�
S_ r*
/Z-.O Pr/f-7
jI
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESP.P Ap 'oved
I RW "" RPR. i,.d
11
13
CITY ZIP
ELEPHONE N6&R -
EXISTING - REQUIRED DEDICATION
Street Use Permit Req'd
13
PROPOSED
Inspection Required
0
NAWE
Sidewalk Required
0
cr
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 0
W
Lu ADDRESS
x
REMARKS
Z
U
Cr
W
w
Cr CITY ZIP
TELkWNE NUMBER
Z
w
INAME
ADDRESS
ENGINEERING MEMO DATED REVIEWED BY
13W1
CITY ZIP TELEPHONE NUMBER
: FIRE MEMO DATED REVIEWED BY
'OC611 9,V3 1,2 -19 1
STATE LICENSE NUMBER
EXPIRATION DATE
,6L7-PZ_v�?Z_
VARIANCE OR CU
ADB, #
SHORELINE #
Legal Description of Property - iricludeell:eAsemdrIts
SEPA� EVIEW
SIGN AREA
HEIGHT
Z
COMPLETE
'EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
I
I
EXP
�o EIRAGIE
'.REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (F1
Lu
ALL
PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
wi Property
7 1 ax Account
LOT AREA'
PLANNING�REVIEW BY
DATE
Parcel No. C7'11
74_� lid "o
_44
-REMARKS
NEW
RESIDENTIAL
P LUMBINGIMECH
..[],.COMPLIANCE OR
ADDITION
DSeOMMERCIAL-
.�CHANGEOFUSE
1:1
jAPT.BL G
El
REMODEL
SIGN,�,..
GRADING
PENCE":
E]
HECKED BY
TYPE'OF CONSTRUCTION
CODE
OCCUPANT
GROUP
REPAIR
CYDS_
x —FT)
DEMOLISH
WOODSTOVE':
INSERT:
SWIM POOL
El HOT.TUB/SPA
PECIAL INSPECTOR,
AREA
OCCUPANT
LOAD
I
13 YES.
F GARAGE
R ETAINING WALL/-,
C ARPORT
ET ROCKERY
11 RENEWAL
REMARKS
Z
0 (TYPE OF USE, BUSINESS OWACTIVITY�EXPLAIN:,�
PROGRESS, INSPECTIONS'PEWIUBC 1108
27ci
14."Vveg
6j%jA1
uj NUMBER
NUMBER OF
CRITICAL
0 OF
DWELLING_
AREAS
.3
LINITS,'
INUMBER
0 -LTORIES
DESCRIBE WORK TO BE DONE jATTACH PLOT PLAN)
FINAL-, INSPECTION REOUIRED
VA.LUATION'
FEE
PLAN CHECK FEE
HEAT SOURCE:
GLAZING
LUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate 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
w successors in interest, agrees to indemnify, defend and hold
'Wn harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
_;k
a: whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN C67ECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
x nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
f h-reb acknowledne that I have read this application* that'the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Wt.Angton relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RZY17V.27.
INSPECTION
ap nowledged in space provided.
SIGNATURE (OWNERfR AGENTI� DATE SIGNED
DEPARTMENT
1 05
ZW&�47 '71
CITY OF
EDMONDS
V,
0 rF%f,) �S aSAT' FIE D�AE
ATTENTION
CALL FOR
1`19LEA�13 BY: 4TI
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK — Owner GOLD — Assessor
102-87
0
K
Z
Z
5
(L