20010632.pdfI DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
ZIP I TELEPHONE
CITY e ' /,/ D5
NAME
ADDRESS
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PLAT NAMEISUBDIVISION NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL
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EXISTING — PROPOSED—
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UC�BNIEN.M.ER�
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OMPLETE EXEMPT
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REMARKS
PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REQ'Dj 6
PLAN CHECKFEE
1.07-W
BUILDING
PLAN CHECK NO:
PLUMBING
AV- _j.,EDOATT
MeG.�
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ON THE PUS
OPIERTY ONLY. ANY CONSTRUCTION
BEOONEONPRIV EPR UUC
ILL REG IRE
SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.1 WILL REG IRE
GRADINGIFILL
no MAIN JCURBS.
m SEPARATE PERMISSION.
E SURCHARGE ,A
PERMIT APPLICATION: 110 DAYS
FEES
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW
'A PLICANT ON BEHALF 0 - HI S ON HE A SPOUDSE HDE IR&AS S 1 SAND SO CES R5
F
j'F
ENG. INSPECTION FEE
NOEM . DE EN iN H LESS T E ITY
INPINTEREIT A.RIIS To % ANDHA ISIR ANYAN
LANDSCAPING
INSPECTION FEE
OFFICIALS. EMPLOYEES.
EDMONDS, ""'N'T'N ARISINGOI TLY R 'RE TLY
ALLCLAIMS FORGANM.Fj.FWHATElER NATURE. ARISING 01 11
FROM TIIE E OF THIS PERMIT. AILN TO
ISSUANCE OFITHTIS PFIMIT'fYoRDINANC
OFAN'C
PLAN CHECK DEPOSIT
D�EMEOTOSSUANC ORREDU A N' REOURE.
0 S ABICL:IETY TO E N FO RCE ANY ORIN NANO E P ROVI SION.*
N OR U MI T IN`A`N`Y'FYk'YWTAlT`E`C ITY
TOTAL AM
THERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORM ION
OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT. AND THAT I AM THE
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS CONSTRUC-
CALL
REONULNTINg
ION AND IN DOING THE WORK AUTHM., E EMP DYED
T 0 THEREBY. No RE R WL
IN VIOLATION OF THE LABOR C STATE OF WASHINGTON RELATI
r
_2
WORKMENIS COMPENSATION IN;W.C�1627
(425)
SL DATE SIGNED—
1-1,4,61
771-0220
XT 1333
AtrtNTION
-
IT IS UNLAWFULTO USE 0 - Y 'L-ING OR STR CT RE U
OR �A.l
71-0221
AND APPROVAL OR C
A FINAL INSPECTION AS KIEN A E.
.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1 OS
FAX
VALUATION
A
__3 1
APPLICATION APPROVAL
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FFICIALS SIGNATURE DATE
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EL Etary
ORIGINAL - FILE YEL INSPECT8n X
LOWPINK. OWNER GOLD -ASSESSOR
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luly 13, 2001
Attention: Building Department I w
City of Edmonds
121 5th Avenue MR�
-4 &
Edmond 0
s, WA 98020
Harbor Square Athletic Club
Z I
aFon, Architect will submit application for improvements that Y611 allow for the
Warren L
additio of net 16 parldng stalls. Located at the South West Side ofBuilding 8, being The 'j
n Exhibit "X' attached hereto.
Harbor Inn and as outlined on
ceed with the application and improvements. m
The tenant is authorized to pro
Please call me ifyou require anything further. C: I
Sincerely,
J 6nC nner
(A;
irect r of Operations
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120 West Dayton, Suite B-6. Edmonds. Washington 98020 (425)774-1511 Fax670-6736
W6AC
SCHEME TWO
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L. I IT UI- MUMUNUb 8/22/01 ..........
Bond Do To EApire—
Bond Number MU-�—
CITY OF EDMONDS
121 STH AVENUE NORTH. EDMONDS, WA98020 -(425)771-0220- FAX (425)771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Edmonds Buildini Permit No-orl
Project Address 60 W Dayt , Edmonds, Wa
Developer/0-11 etic Club
WHEREAS, Harbor Scluarp Athl e t iL_Uub hereinafter referred to as "the Principal", has
applied to the City of Edmonds, hereinafter referred to as "the City", to construct the project known
Construction of Parking Lot ofEdmonds, and on a site located
WHEREAS the City approved the requested action and,
WHEREAS, the approval granted by the City and the provisions of the Edmonds Development
Code require certain improvements to be made in connection with construction of the project, and
whereas the improvements arc shown on the approved site plan and other required plans and are further
defined by the conditions identified in the City file, Contractors Bonding and
NOW, THEREFORE, the undersigned Principal and bonding company_Lnj!j��ny a
corporation authorized to transact surety business in the State of Washington, hereinafter referred to as
"the Surety", agree and bind themselves, their heirs, executors, administrators and assigns, unto the
City in the sum of $14,400.00 ---- $_1L4_+,4+u002020 --------------- �-lawfiul money of
the United States, according to the following terms and conditions;
1) If the Principal does not complete all improvements required by the above -referenced
conditions, plans, and file within 24 months (not to exceed 24 months), then the
Surety shall, upon the demand of the City, remit to the City within ten (10) days of receipt of said
demand the amount ofthis bond or such lesser amount as may be specified in the demand.
2) In the event the Principal fails to complete all of the above referenced improvements within
the time period specified by the City, its employees and agents shall have the right at their sole election
to enter onto said property described above for the purpose of completing the improvements. This
provision shall not be construed as creating an obligation on the part of the City or its representatives to
complete such improvements.
3) In the event any lawsuit is instituted by the City of Edmonds, the Principal or the Surety to
enforce the terms of this bond or to determine the rights of any party hereunder, the prevailing party in
such litigation shall be entitled to recover from the losing party its costs, including reasonable
attorneys, fees, incurred as a result ofsuch lawsuit
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City ofEdmonds Performance Bond Bonding Company
Page Two
44>7 t1W221 P. 03/0?
4) This bond shall remain in HI force and effect until the obligations secured hereby have
been fully perfon-ned and a bond guaranteeing maintenance of all improvements for a period of two (2)
years from acceptance has been submitted to the City in an amount to be determined by the City, of the
cost of the improvements and in a form suitable to the City, and until released in writing by the City at
the request of the Surety or the Principal upon expiration of the period specified in the above
paragraph.
DATED this 22Ad —dayof August 2001
Contractors Bonding and
Insurance Company
ing Comp D,4cT9R_W1&wncr
Officer/Title Donna M LanqV, Attorney- i n- fact Title
1213 Valley St, Seattle, Wa 98109 _ 160 W Dayton St., Edmonds, Wa
Address Mailing Address
N" 425-778-3546
Bond Number Telephone Number
Bond Accepted by Development Services Technician Date
B!2NDING COMPANY SURETY ACKNOWLEDGMEN
Idaho
STATE OF-W*9HWeT0N
) ss.
COUNTY OFKootenai
On this 22nd —, day of Auqu�� , _1 2001 , before me, the
under -signed, a Notary Public in and for the State ofAGQgtoxi, duly commissioned and sworn,
Cg8g%rLg*pR8fflT4 Donna 11 Lange -tome known to be thcAttorney- in -fact —of
& 1 9 the corporation that executed the foregoing instrument, and acknowledged the
,!7 =�"Z betle free and voluntary act Nd deed of said corporation, for the uses and purposes
therein mentioned, and on oath stated that s e was authorized to execute
said instrument and that the seal affixed is the corporate seal of said corporation.
WITNESS my and official seal hereto affixed the day and yeffih& above written.
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NOTARY LIC in and for the
"OT�
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State of esiding at
da o
P LIG/n
r d'Alene, Idaho 83814
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City of Edmonds Performance Bond Bonding Company
Page Three
ACKNOWLEDGEMM
STATE OF WASBINGTON
ss.
COUNTY OF
On this day of before me, the under -signed, a
Notary Public.in and for the State of Z slii�n duly conunissioned and sworn, personally appeared
r%Qj- of
to me known to be the 0'�
t Me—C the general partnership that executed the foregoing instrument, and
acknowledged the said instrument to be the free and voluntary act and deed of said partnership, for the
uses and purposes therein mentioned, and on oath stated that _was
authorized to execute said instrument.
WITNESS my hand and official scal hereto affixed the day and year first above written.
. ..........
N"
NO LIC in and for The
P'
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COW LIMITED POWER OF ATTORNEY
Not Valid for Bonds Power of Attorney
Executed On or After: rEBRUARY 28TH, 2003 Number: 629487
A valid original of this document must be printed on security paper with black, blue, and red ink, and must
bear the seal of Contractors Bonding and Insurance Company (the "Company"). Only an unaltered original
of this power of attorney is valid. If a photocopy, the word "VOID" should appear clearly in one or more
places. This Power of Attorney is valid solely In connection with the execution and delivery of the bond
bearing the number indicated below, provided the bond is of the type indicated below, and is valid only if the
MOW ALL MN BY THESE PRESENTS, that the Company does hereby make, constitute
SPENCER B. DEAN, DONNA bl' LANGE, KARLA Y. ANDERSEN,
and appoint the following: and lawful Attorney(s)-in-Fact,
ELIZABETH A. MADRY and SCOTT HAGUE its true
with full p r and authority hereby conferred in its nans, place and stead, to
owe (1) any and all
execute, acknowledge and deliver on behalf Of the Company:
purPowe, provided, however,
bonds and undertakings of suretyship given for any
th t, no such Person shall be authorized to �ecute and deliver any bond or
a h penal sum
undertaking that shall obligate the Company for any portion of t e
thereof in sacceS9 Of $6,000,0001 and provided, further, that no AttOrD6Y-in-
Fact shall have the authority to issue a bid or proposal bond for any project
'here, if a contract is awarded, any bond or undertaking would be required with
penal sum in excess of $6,000,000; and (2) consents, releases and other similar
documents required by an obliges, under a contract bonded by 0 the company. This
appointment is made under the authority of the Board of Dix CtOrs Of the
company ------- w ----------
------------------------- ----------------------
CERTIFICATE
1, the undersigned secretary of Contractors Bonding and Insurance Company, a
Washington corporation, DO HEREBY CERTIFY that this Power of Attorney remains in full
force and effect and has not been revoked, and , furthermore, that the resolutions of the
Board of Directors set forth on the reverse are now in full force and effect.
BondNumber -TA 757,9
.2 �L day of 5
Npi . tVali I d Signed and sealed this_���
ufliess.Seal Robert M. Ogle, Secretary
.0271
CBIC 9 1213 Valley street - P.O. Box 9271 - Seattle, WA 98109
(206) 622-7053 a (800) 765-CBIC (Toll Free) a (206) 382-9623 FAX
P..I.POA.04-US101700
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HNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE -
ENGINEERING DIVISION DATE
PL IN
PLANNING DIVISION DATE
CTASPROJEC
SITE ADDRESS
PERMIT ADB#
INSPECTED -
DESCRIPTION OF WORK TO BE INSPE::]D A"
A field Inspection was conducted to deter e fmal compliance with approved plans. Final approval
ere are no objections from the above signed Department to the release of
denotes that th
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/cOntractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE_INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date. Sip-
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FINAL PROJECTAPPROVAIL FORM
TO:(YJA
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
M�M ENGINEERING DIVISION DATE—]!ijaLo
PLANNING DIVISION DATE—
PERMIT 4_6&V - JA_q,�o ADB#--------PATE INSPECTED
YA, 4�
DESCRIPTION OF wORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are, no objections from the above signed Department to the release of
PER RMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy ofCONDITIONS given to owner/contractor by inspector
1.
OUTSTANDING ISSUES
FAILED FINAL INSPECTION
c3 Copy ofCORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE - GRANT FINAL PROJECT APPROVAL
_INSPECTED OUTSTANDING ISSUES
Sign_
Date.
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Floor Insulation
Coiling Insulation
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FPERMIT �XPIRES
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CITY OF EDMONDS
E E
URMIT
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CONSTRUCTION PERMIT APPLICATION
08 SUITEJAPTA
ADDRESS
OW01177;ZOIIUIINESS
PI -AT NAME/SUBDIViSION NO,
LIONO.
LID FEE S
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REMARKS
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CHECKED By
SERA REVIEW
CO MPLETE I EXEMPT
EXP
SIGN AREA
ALL IW SED
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OEBCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
P4P_911J('l /_A7'
AAVq
VALUATION
FEE
PILANCHECKFEk
LOT)LFA�
VIES ED DATE PLUMBING
PLAN CHECK NO:
26E EE-1
A,
THIS PERMIT AUTHORIZES ONLY THEW RKNOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFILL
DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERdISSION.
STATE SURCHARGE
PERMIT APPLICATION: lea DAYS 19
PERMIT UMIT.' I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS ENG. REVIEW FEES &
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF 01 HIS On HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
To I G
IN INTEREST. AGREES NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDICARN
11 E ONDS.WA HINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND INSPECTION FEE
ALLCI.AIMSFOR DAMAGESOFWWEVER NATURE, ARISING DIRECTLYOR IND
I DM 5 IRECTLY REC7T_7,,r
FIR . THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMICTISH LL NOT BE PLAN CHECK DEPOSIT
9 DEOEMEDTO MODIFY. WAIVI2.R FE.UCEANY BEQUIREMENTOFANY, TYORDINAN E
S ABILITY TO ENFORCE ANY ORDINA CEFROVISION,'
NOR LIMIT IN ANY WAY THE CITY TOTAL AMOUNT DUE P Z971 50 1 1
I HEREBY ACKNOWLEDGE THAT I HWE READ THIS APPLICATION. THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF M.
REGULATING CONSTRUC
T.EOWNER. IAGREETOC MPLY WITH CITY AND STATE LAWS CALL
TION. AND IN DOING THE WORK AUTHORIZED THEREBY 110 PERSON WILL BE
0 "PLOY'O O,OR INSPECTION, IF
IN II.L-I.N 01 THE LABOR C T11DEgE OF WASHINGTON RELATING T oo,p a,I, ... WgId p-ldd.
WORKMENr COMPENSATION INS� �NC A to .27. ip FFICIALS SIGNATUR� DATE
11111n, (425)... 1 �/, I.
771-0220 RE E 'DATE
AfTENTION EXT 1333
PY
IT IS LIN LAWF U L TO USE 0 R 08 DING OR STRUCTURE UNTIL 771-0221
'L
UPY 'L
C`U ji.. AN PPROVAL OR A CERTIF.1-W
A FINAL INSPECTION HAS BEEN �A.. ND A ORIGINAL -FILE VELLO/ - INS/PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD - ASSESSOR
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