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PERMIT EXPIRES
CITY OF EDMONDS ZONE
us PERMIT
NUMBER 2-00768
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APPLICATION 'A00DRESS
CONSTRUCTION PERMIT
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PLAT NAMEISUBDIVISION NO.
LOT NO,
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0 FEE $
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MAILINGADDRE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
PROPOSED—
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ITY
REOUIREDOEDICATION— FT —
METER SIZE
NAME
PRV REQUIRED
YES 0 NO
ADDRESS
REMARKS
RAINAGE
CITY ZIP
]TELEPHONE
NAME
ENGINEERING REVIEWEDIDATE
ADDRESS
FIRE REVIEWED By DATE
CITY ZIP TELEPHONE
0
0
VARIANCE OR CU
SHORELINE 09 ADBI
RNSPECTION
C3YREO 'D
ES ONO
BOND
POSTED
_TTATE LICENSE NUMBER EXPIRATION DATE
CREUKED BY
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
P'Opo
ALLOWED BE"
PROPERTY TAX ACCOUNT PARCEL NO.
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RESIDENTIAL 0 p
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LOT COVERA '
'OSED
ALLOWED PROP
REQUIRE SET ACKS (PT.)
FRONTO SIDE REA R
PROPOS D S BACKS (FT,)
E IJAIT
FRONT SIDE REAR
0 ADDITION COMMERCIAL o COMPLIA CE R
0 CHANGE OF USE
PA
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pLANNjNG REVIEWED By DATE
0 REMODEL C] APARTMENT SIGN
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0 REPAIR cl GRADING CYGS (ENCE X FT)
MARKS
0 DEMOLISH C3 TANK ci OTHER
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OCCUPA
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DESCRIBE WORK TO BE DONE
REMARKS SPECTION REO'D
PROGRESS INSPECTIONS PER UBC 1081FINAL IN
C
VALUATION
FEE
PLAN CHECK FEE
LOT SLOPE % BUILDING
PLAN CHECK NO: E PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PI IT COVERS WORK TO
BE DONE ON PR YATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Lk SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUtRE GRADINGfPILL
DOMAIN (CURBS, SEPARATE PERMISSION.
SURCHARGE
PERMIT APPLICATI N: 180 DAYS
T PERMIT LIMIT: I YEAR - ROVIDED ORK IS STA TED WITHIN 100 DAYS ENG. REVIEW FEES
A W R
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
IPPLICANT, ON BEHALF F HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCC5SOAS j0wf
I N IN E BE A R NDSMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LA-BICA� E
R T G .. To I CIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
TNDS A R'NGTON ' IT, O'Ft ICTLY
DMO -W S 'VYHATE�E. NATURE, ARISING DIRECTLYOR INDIA
'ALL CLAIMS FOR DAMAGES. ..IT ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS P NY REOUIREMENT OF A14Y CITY ORDINANCE PLAN CHECK DEPOSIT
G ME. T . Iy , WA'�E 0. HE ... A 0
N E IM - TY'S UUTY T ENFORCE ANY ORDINANCE PROVISION RECE PT
OR LIMIT IN ANY WAY THE C' A
TOTAL AMOUNT DUE
IREFE6Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN CORRECT, AND THAT I AM THECOWNENR6 OR THE DULY AUTHORIZED AGENT OF A P.—I -1.1 IAI
IS ETOCOMPLYWITH ITYA STATE LAWS REGULATING CONSTRUC-
THE OWNER. I AGRE E'P CALL Bl,ldllg Olfic.., �, I,—, �I, -d F111 ,a pald, 1�d
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE L LOYED d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE ATtNG TO FOR INSPECTION 'A-P- . g'd �� sp"o p—dod
WORKM EN'S COMPENSATION INSURANCE AND ROW 18.27, 0 1 S SIGNATURE DATE
EATE SIGNED (425) q-;-? :7
q12-7 771-0220 EILEASEDW
ATTENTION EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW . INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
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QUAUTY OF THE DOCUMENT.
IT is DUE TO THE
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When recorded mail to:
Clerk
20232
2001012 - SnobomIsh
cl �y
City of Edmunds
0112212001 11:415 AM county
RECORDED
121 Fifth Avenue North
P.0003
Edmonds, WA 98020
T
SPACE ABOVE THIS LINE FOR RECORDER'S USE
Assessor's PhrceM.
'Project No. & Name*
Right.of-Way Permit No.
'EMENT
ENCROACHNENT AGRL
ACIUvMNT AGREEMENT ("Agree ent'l is entered into between the
This ENCRO C'Owner"), in
CITY OF EDMONDS C'CitY") and — Edmond I a I Community Development Code.
accordance with Chapter 1&70 of the
is the owner of that certain real property located at,
3:h 0 the City of Edmonds, Washington,
Z ��,4 within
=- -t�v&-a 'described in Exhibit
Assessor , a P arc el Numb er 5j, M -X0 9 ._, and more particularly
,A!, attached hereto and incorporated herein by reference.
which
2. pA. City currently owns an existing easement over, under, and across
Owner's property for
easement is described in Exhibit'T" attached hereto and incorporated by reference.
ants ityermisgon
3. 31gyjLqLQRJcIMSAt. City hereby venants and agrees and gr A
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to Owner to allow 0-4 eA o 4194 �0?t k&�Le _e�
-95w- easement. A plat showing
to remain in a portion of the t
"C" attached hereto and incorporated by
A the location of the encroachment is attached as Exhibit
reference. This Agreement is subject to the following terms and conditions:
alled and maintained in a safe and sanitary
The encroachment shall be inst
e, owner and its successors in interest.
condition at the sole cost, risk, and responsibility of th
e and
b. The Owner shall agree at all times to indemnify and hold the City fre
ages or expenses resulting from the
installed hereunder, including
harmless from any and all claims, demands, losses, dam
tructure
construction, maintenance, use, repair or removal of the s
any loss, damage or expense arising out of (1) loss or damages to property and (2) injury to or
death ofpersons.
C. The Owner must remove or relocate any part of the encroachment within
ten (10) days or such other time as specified in the notice after receipt of it from the City
Engineer, or the City Engineer may cause such work to be done and the reasonable cost thereof
shall constitute a lien upon the property.
I Whatever rights and obligations were acquired by the City with respect to
the easement shall remain and continue in fall force and effect and shall in no way be affected by
city's grant of permission to construct and maintain the encroachment structure.
4. Entire Agreemen . This Agreement constitutes the entire agreement between the
parties with respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
5. Notice . Any notice which is required or may be given pursuant to this
Agreement shall be sent in writing by United States mail, first class, postage pre -paid, registered
or certified with return receipt requested, or by other comparable commercial means and
addressed as follows:
City Engineer
City ofEdmonds
which addresses may be changed from time to time by providing notice to the other party in the
marine, described above,
_ E 6. Waive City's consent to or approval of any act or omission by Owner shall not
constitute a waiver of any other default by Owner and shall not be deemed a waiver or render
unnecessary City's consent for approval to any subsequent act by Owner. Any waiver by City of
any default must be in writing and shall not be a waiver of any other default concerning the same
�I or any other provision of the Agreement.
7. Successors and Assigns. This Agreement shall be binding and inure to the
benefit of the parties hereto and their respective legal representatives, successors, and assigns.
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Owner agrees to incorporate this agreement by reference in any subsequent deeds to the
property, but any failure to do so does not invalidate this provision.
8. Capacity. Each party represents that the person(s) executing this Agreement on
behalf of such party has the authority to execute this Agreement and by such signature(s) thereby
bind such party.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this
day of 20j20-
4,
6i
OWNER: CITY OF EDMONDS
By: By:
Don Fiene, PE
M 01
Acting City Engineer
mzi�
OF WASHINGTON
zi
STATE
COUNTY OF SNOHOMISI-I
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This day, personally appeared before me, to me
'�M mi,
known to be the person who executed the within and foregoing document and that 12e signed
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the same as 1*5 free and voluntary act and deed for the uses and purposes therein
mentioned.
0 No c
Publi
Ro
5
00TARle Typed or Printed Name
My Commission expires: 9- 10 -3
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�l 00AT.RECEIVED
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USE PERMI f
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CITY OF EDMONDS ZONE NUMBER ZW768
ILICATION 'AODRS.B
CONSTRUCTION PERMIT APPLICATION 'AOSRESS
?-07/0
LOT NO,
V'EO' LID NO.
PI NAME/SUBDIVISION NO,
OWNIIINAMIMAMEOF SINESSf4�tj�
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EXISTING — PROPOSED—-_ R a 0
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ITELEPH011
7 4 - 1 -1 76 REQUIRED DEDICaTlON_ FT
PRV REQUIRES
METER SIZE I LINE YES
NAME 0 NO 0
REMARKS
ADDRESS OWINERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
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NAME
ENGINEERING
ADDRESS
FIRE REVIEWED BY DATE
CITY
z
VARIANCE OR CU SHORELINE OR ADS' R
STATE LICENSE NUMBER
C3
SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
—000 o EXP I
4 91
Lol COVERAG REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS
8 E NTIAL PLUMBING I MEC OSED FRONT SIDE REAR A
n NEW H ALLOWED PROPE FRONT UNDE HE
SIDE
Is
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0 POSIT ION JAL o COMPLIANCE OR
0 COMMESC CHANGE OF USE
REVIEWED BY DATE
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0
PARKING L TAREA PLANNING
RED, D ROVIDED
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DEL—n SIGN
C] REMO 0 A ARTMEJN
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0 REPAIR 0 GRADING DYSS (PENCE
X REMARK.
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0 DEMOLISH TANK OTHER
AGE RITAININGWALI
0 AR C, 0 RENEWAL
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0 EX—ft CCUR`A3/
ORO
CHECKEDBY ITYPIO STRUCTION G
lv�r UP 141
O"n
OF CAL
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UMBER OCCUPANT
N CTOR
IN
U-SLUN. AREAS SPEC] SPE LOAD
oplf I
0 OF DUAL JAREA
o STORIES NUMBER RE [RED 0 YES
UNIT.
m
DESCRIBE WORK TO BE DONE
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REMARKS ION REQ'
PROGRESS INSPECTIONS PER t@C 1081FINAL INSPECT D
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0
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VALUATION FEE
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PLAN CHECK FEE
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HEATSOUPICE LOT SLOPE I BUILDING
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PLAN CHECK NO: LEST�D "I ILUM51NG
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MECHANICAL
TH S PERMIT COVERS WORK To
OTED if
THIS PERMIT AUTHORIZES ONLY THE WORK NN HE PUBLIC
I_ BE DONE ON PRIVATE PROPERTY ONLY. A YC�NSTFUUJON ON T U GRADINGIFILL
RED IRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, FTC.) WILL
PERMISSION.
SEPARATE
SURCHARGE
PERMIT APPLICATIOW. 140 DAYS
PERMIT UMIT�. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT, ON BEHALF OF HIS OR HER SPOUSE. HISRS, ASSIGNS AND SUCCESORS
p
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LAesmmmti
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY RECEIPT
NOT BE
I FRO THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL PLAN CHECK DEPOSIT
OFANY CITYORDINANCE
DEEMEDTO MODIFY, WMVE OR REDUCE ANY REQUIREMENT
0 RECEIPT
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFO CEANYORDINANCEPROVISION��
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS COSRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This lipplillfi., is 10 1 Peimit lhttl ligh"s sy she
VAGREE TEO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL asi F ... ... s.ih
d
THE CWNER� Builafia, Olki.1 h, O.puly:
TION; AND IN DOING T H WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED FOR INSPECTION sehpt is llkl.wlodgad se space p—dod.
RELATING TO
IN VIOLATION OF TH LABOR CODE OF THE STATE OF WASHINGTON
WORKMEWS C . OMpENSATION INSURANCE AND FICW 18 27. OFFIC ALS SIGNATURE DATE
SIGNAT R IT ENT DATE SIGNED (425)
1
. 6, 1 1 q12- 771-0220 ELEASEWS1 ullt
ATTENTION EXT1333
IT IS UNLAWFULTOUSE OR OCCUPYABUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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