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CITY OF EDMONDS 7
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIMS NLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t 0 DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
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Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES. Inc.) WILL REQUIRE
SEPARATEPEROSSION.
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City Surcharge
PE UITAPPLICATION: 1NDAYS
PERMIT LIMP. I YEAR - PROVIO D WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Slats Surcharge -IV _L�
'APPLIC W. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WAININOTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AN.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
_. .
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUA14CE OF THIS PERMIT SHALL NOT 8:
DEEMED TO MODIFY, WAIVE OR ORDINANC
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Fire inspection
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Total Amount Due
REDUCE ANY REQUIREMENT OF AM CITY
0. NOR LIMIT IN ANY WAY THE CITY. Afift.11 TO ENFORCE ANY ORDINANCE PROVISION.-
LandscapoInsit.
Receipt #
BY
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMA71ON
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APAPROVAL
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
appli-Mon Is not a penoitt untif &Ign0d by the
TION; AND IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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ding OM.Isl .1 hs/her Deputy: end Fes... Peld, end
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WAS14ING70N RELATING TO
WORKMEN'S COMPENSATI SURANCE AND RCW 18.27.
FOR INSPECTION
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OFFICIALS SIGNATURE
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771-0220
IEL�A
ENTION
EXT 1333
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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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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Avenue North, Edmonds, WA 98020
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Location of Violation (Address and/or description of location: Tosco Marketing dba 76111 Station
Q 22625 Highway 99, Edmonds, WA 98026 Tax Account Parcel No. 2704-3000-404-200
Issued To: Linda Hodgins, Licensing Revresentative
Address Of Person This Order Is Issued To: P.O. Box 52085, Phoenix, Arizona 85072
Code Section Violated: Edmonds Community Development Code Chapter 19.00 and 20.10. Uniform
Building Code Sections 106 and 108 and 109.
Description of Violation; Remodeling (interior and exterior) without first obtaining a remodelin
permit. In response to the noted violation the gpplicant submitted Wlication for the proper permit on
March 15, 2002. On March 20". 2002 the Assistant Building Official sent a corrections notice that
listed 6 outstanding items that must be resolved before the permit can be issued. Due to lack ofresponse
by the @Rplicant a second cony of the corrections was sent on May 2. 2002. As of this date, the aRplic
has not rest3onded to the outstanding issues and the permit cannot be issued until all of these items are
Corrective Action Required: READCAREFULLY. Respond to the attached building corrections by
resubmitting revised Wans, 2) Obtain the reguired remodeling pennit. 3) Make reguired field changes to
comvly with the approved plans and 4) Call for required in§Rections to verify coLnpliance to the code
and obtain final proiect approval.
Correction is Required no later than: 5:00i)m (thne) July 31, 2002 (date)
If all noted corrections are not complete by the date and time specified in the Order,
(including final project approval) a Notice of Civil Violation shall be issued. The
Notice of Civil Violation shall assess fines of $100.00 per day, or portion of a day,
during which the violation continues.
Date Posted —Date Mailed: May 23, 2002 . Date Served
issuing Party Jeannine L. Graf Title Building Official
Signature
Cc: Tosco Ma,�eting (& 3977 Le',� Way NW. Seattle, WA 98017
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SNOHOMISH
HEALTH
DISTRICT
ENVIRONMENTAL HEALTH DIVISION
3020 Rucker Avenue, Suite 104
Everett, WA 98201-3900
425,339.5250 FAX: 425,339.5254
Healthy Lifestyles, Healthy Communities
June 26, 2002
Fiona Yin Cutner JUN 2 7 Z002
RHL Design Group, Inc
1550 140' Avenue NE Suite 100
Bellevue, WA 98005
Subject: Remodel — Edmonds Tosco AKA
22625 Highway 99, Edmonds
Dear Ms. Cotner:
The information you submitted regarding the remodel to the Edmonds Tosco at 22625 Highway 99
in Edmonds has been received. This information indicates the intent to add a bar sink, a new counter
and provide accessibility upgrades to the restroom.
After a review a this information it has been determined that in this particular case no plan review or
inspection of the facility is required by the Health District provided that the proposed changes do
not result in a change of facility classification.
This facility is currently classified as a limited grocery. As such, foods at this facility are limited to
prepackaged food items only. Any changes to this classification such as the addition of espresso,
hot dogs, nachos, fountain pop or like items will require plan review and pre -opening inspection and
permit reclassification and completion of applicable permit application process
If you have any questions in regard to this matter please contact me at 425.339.5250.
WSince ,
Rrt A. Hoppa S.
, , nr�� .I H.1
Environmental Heaith Speciallist
RWek
cc: City of Edmonds Building Department
Kris Mullen, R.S., Environmental Health Specialist
Everett Office, Washington State Liquor Control Board
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CITY OF EDMONDS
DEVELOPMENT SERVICES DEPARTMENT
121 5th Ave. N., Edmonds, WA 98020
Location of Violation (Address and/or description of location):
22625 Highwgy 99, Edmonds WA 98020
Issued To: U-Save Oil Conumny
Address Of Person This Order Is Issued To: 9076 Holman Rd Nw, Seattle WA 98117
Code Section Violated: Edmonds Community Development Code Chapter 19.45, Sign Permits and
Chanter 19.00 for Building Permits.
Description of Violation: 1) Signs installed without first obtaining required sign permits. 2)
Remodeling (interior and exterior) without first obtaining a remodel permit.
Corrective Action Required:
I . Remove signs OR, 2. Submit required Encroachment Permit application and fee of $305.00, 3)
Submit required sign permit gpylication and remit all quired sign permit fees. Note, permit fees shall
be doubled since signs were installed Rrior to permit issuance. And 4) Submit for required buildin
remodeling Permit, note double permit fees shall be assessed. Also note the Architectural Design Bo
anoroval may be required which also includes a fee.
Correction is Required no later than: 5:00 R.m. (time) December 7 1h , 2001 _(date)
If correction is not made by the date and time specified in the Order, a Notice of
Civil Violation will be issued. Upon issuance the Notice of Civil Violation will assess
fines of $100.00 per day, or portion of a day, during which the violation continues.
Date Mailed: November 19, 2001 Date Poste
Issuing Party Jeannine L. Graf Title Building Official
Signature — - 4A�! 4��n
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4477Q smoliomism ENVIROr4MENTAL HEALTH DIVISION
!n 1 3020 Rucker Avenue, Suite 104
HFALTH Everett, WA 98201-3900
425.339.5250 FAX: 425.339.5254
&VBSTRICT
Healthy Lifestyle$, Healthy Communities
June 18, 2001 01-
Linda Hodgins
Licensing Representative
Circle K Stores, Inc.
PO Box 52085, DC-36
Phoenix, AZ 85072-2085
Subject: Change of Ownership — Circle K # 5927 (formerly U-Save Nfini Mart), 22625 Hwy 99,
Edmonds, Washington
Dear Ms. Hodgins:
The Snohomish Health District has received your application for operating permit for Circle K
#5927, (formerly U- Save Mini Mart) at 22625 Hwy 99, Edmonds, Washington.
Your application is for a grocery and deli. Health District records indicate that this facility does not
have a deli. This facility has been licensed only as a limited grocery. Prior to permit issuance and
operation of the deli, plans and specificabons for the deli, a plan review application, plan review fee
and a copy of the proposed menu must be submitted to the Snohornish Health District.
Please note that prior to opening of the deli facility, after the Health District plan review process is
completed and construction is finished a preoperational inspection must be conducted.
If you hav" questions, please co ct me at 425.339.5250.
'/ z7
SincewK
0 obe�' Hop a,
E v,
nvirro'nol.,italpIlli Specialist
RIUsm
cc: City of Edmonds Building Department
Everett Office Washington State Liquor Control Board
Steve Wentzel, Store Manager
David Compton, RS, Environmental Health Specialist
Enclosures: Plan Review Construction Guidelines
Plan review application
Fee Schedule
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FINAL PROJECT APPROVAL FORM
TO:
DATE: —
MEMO TO: PERMIT COORDINATOI?, BUILDING DIVISION
PROM: FIRE DEPARTMENT DATE-Z/-t
E G ERING DIVISION DATE —
PLANNING DIVISION DATE
PROJECT - 2C. 60 PS
SITE ADDRESS '--� a -2 �� a(,, Y � �
PERMIT 9'2 QQ -2- -Q:� Z�- ADBk--DATEINSPPCTED—
DESCRIPTION OF WORK TO BE INSPECTED 7—,4 Z
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
PERFORNL4,NCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
c3 Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
ocaprvl.doc.l:temp:bldg:fo=10/01
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FINAL APPROVAL FOR
OCCUPANCY ..................