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TAX ACCOUNT/PARCEL#:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver El Study Required 0 Waiver
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver Study Required El Waiver
DISCRETIONARY PERMIT #S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
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121 5T H AVENUE NORTH - EDMONDSMA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
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STATUS: ISSUED ENG20080494
Permit Number: ENG20080494
Address of Public Use/Encroachment: 614 DAYTON ST, EDMONDS
PROPERTYOWNER BUSINESS OWNER
SCOTT M & AMY ZOLOT H
614 DAYTON ST
EDMONDS, WA 98020-3432
i STREEY US EIENCROACHMENT
PARKINGPOD IN RIGIiTOF WAYFROM FRIDAY 1/2/09TOMONDAY 1/5/09.
STREET USE: Placement of any temporary or movable objects in any portion of public space or City right-of-way
sha'll 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 THISPUBLIC USEIENCROACHMENTISINEFFECT, THE OWNER SHALL COMPLYWITH
THE PERMIT CONDITIONS SET FORTHB 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 harmlessfirom 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 shallprovide 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.
THIS A PPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE P A I D, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
LECOPY
INS PECTOR COPY
Printed: Wednesday. December 31, 2008
DATE
0 APPLICANT COPY
Z� ;�i
STATUS: ISSUED
ENG20080494
• The proposal will not adversely impact public space open to vehicular or pedestrian travel.
• The proposal will not unreasonably interfere with the rights of the public.
• 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.)
• Illumination from the city light fiKtures shall not be blocked.
• Three feet of clearance around fire hydrants, standp�es, P.I.Ws, manholes, water meters, blowoff-s, 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 pen-nitted project.
INSPECTIONS
M 2 MOM,
City of Edmonds Pern-dt No:
RIGHT-O&WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction:
C. Contractor:
Mailing Address:
State License #:
City Business License #:
D. Building Permit # (if applicable):
E. r_1 Commercial El Subdivision
F� Multi -Family �KSingle Family
INSPECTOR:
Contact:
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable
City Project El EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
Other
F. PAVEMENT CUT: [I YES MNO G. SIZE OF CUT x
CONCRETE CUT: El YES ;27NO
G. El Mail Approved Permit F� Call for Pickup
INDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds 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, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting 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 TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
# Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
IRAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TI MUST�MAKE THE PaK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPE TIONS
/2,/3 / d' 9-
Signature: Date:
/16ntractor or Agent)
FOR CITY USE ONLY
Approved by: Right-of-way Fee:
Time Authorized: Void After DisrUption.Fee/Fufid III:
Special Conditions: Inspection. Fee:
Total Fee:
Receipt No:
Issued by:
REQUIRED INSPECTIONS:
Call 4.25-771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK:
Inspector's Signature
DATE:
I NO WORK SHAH, BEGIN PRIOR TO PERMIT ISSUANCE
SAENGR\JaTnes Bronder(007)\ROW Pcffnit.doc Revised 10/01/03