20050642 (2).pdfDATE RECEIVEDF
PERMIT EXPIRES
PERMIT
CITY OF EDMOND.s NUMBER
CONSTRUCTION PERMIT APPLICATION JOB , SUITE/APT#
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ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE
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&COMMERCIAL COMPLIANCE OR �/ / / / _
❑ ADDITION' ❑ MIXED USE ❑ HANGE OF USE i
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit City Surcharge
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PLAN CHECK NO: Plumbing Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NO ED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Gradin
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE g
t SEPARATE PERMISSION,
Engr. Review
w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt#
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
G DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt, Due
a NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
Recording Fee Receipt # 1'!
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application s/ not a permit until signed p the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building receipt
i or his/her edgediDeputy: and Fees aro paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt s acknowledged m space provided.
WORKMEN'S COMPENSATION WN� NCE AND RCW 16:27. %O CIALS SIG TURE DTE
SIGNATUR (OWNER O AGE T): DATE SIGNED (425) i
5 771-0220 ` R ASED gY TE if
ATT NTION EXT. 1333
IT IS LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW • I SPECT R
FICATE OF OCCUPANCY HAS BEEN GRANTED, UBC109 I IBC110 / IRC1106 PINK • OWNER GOLD ASSESSOR
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JUN 10 2005
OF EUA.tQ�
BUILDING DEPARTMENT
�ti 4J, CITY OF EDMONDS
PERMIT
STREET USE PERMIT Z
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PROPERTY OWNER NAME: RC' ue /a4o /� Phone - .�'2
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BUSINESS NAME: He a < (J7 v XJaY( �(Skr%rV c rn
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BUSINESS OWNER NAME: Icw•a �% '�'�^ Phone X(2Z�)•S( �1�, -� n
ADDRESS OF PUBLIC USE: —�/ 9 lla: M LS'% Zzrm m
APPLICANT MAILING ADDRESS: X3/9 �/a;r, ^�a� s . �l�2, 34�o- jo � i
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i Placement of any temporary or movable objects in any portion of public space or City right-of-way shall
meet all Code Requirements as set forth in the following chapters of the Edmonds Community
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18.70 STREET USE AND ENCROACHMENT PERMITS c N
1.7.65 LIMITED OUTDOOR DISPLAY OF MERCHANDISE
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17.70.040 TEMPORARY USES; Bistro and outdoor dining..
PERMIT ISSUANCE
A Street Use Permit may be issued, at the discretion of the Development Services Director, City Engineer.
or their respective designee, for temporary objects located within any public space, right-of-way, roadway, i �,
parking strip and/or sidewalk, including the air space above them, if they are placed in compliance with the _
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above referenced Code Sections and the following criteria are met: z
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➢ It has been concluded that the proposal will not adversely impact public space open to vehicular or n
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travel; m
➢ 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;
y. Items shall be placed adjacent to the building and may encroach onto a maximum of two feet of the
public sidewalk; or in, accordance with Bistro and outdoor dining code; or per an approved building
If
permit;
➢ Safe pedestrian. travel area, or clear zone, of 44 inches. minimum width shall be maintained on City
sidewalks; (see definition of clear zone below)
➢ Exterior light fixtures, banners, signs and flags must be a minimum of 7 feet above City right-of-way;
Clear landings of 44 inches or no less than the width of the door whichever 'greater),measured
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: toward the street, shall be maintained on the exterior side of all required exit doors;
➢ Illumination from City light fixtures shall not be blocked;
➢ No objects shall be hung from City light standards; and
SAEngrUonns\Slreet Use Permit.dce Revised 2/6/04
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➢ 'Three feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts
and valves shall be maintained.
Clear Zone Definition: Clear Zone refers to an area 7 feet in height and 44 inches in width providing a
level, safe walking surface along the public sidewalk (e.g. measuring 44 inches from edge of street tree
grates or newspaper stands toward place of business and from the ground up to a height of 7 feet).
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DESCRIPTION OF PROPOSED STREET USE: rn
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APPLICANT TO READ AND SIGN
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NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature, shall vest no c
permanent right and shall be issued and may in any case be revoked at the sole discretion of the City per
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ECDC 18.70.040. By signing this application, the applicant accepts responsibility for all existing and/or _
future street uses. Applicant is responsible to pay an annual renewal fee for this permit. Failure to do so
will terminate this permit application and require removal of any temporary structures granted by this
I permit.
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INDEMNITY: The applicant understands and by his/her signature to this application, agrees to hold the n m
City of Edmonds harmless from any injuries, damages or claims of any kind or description whatsoever, C to
foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its N
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departments or employees, including but not limited to the defense of any legal proceedings including r �'-
defense costs, court costs, and attorney fees by reason of granting this permit. In addition, the applicant X
understands that he/she shall provide and continually maintain during the tern: of the permit 'a certificate ;
of insurance naming. the city as an additional insured, with respect to liability, and providing that it shal be
primary as to any other policy of insurance.seem
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CODE APPLICATION: By signing the application below the applicant warrants that s/he has read or had z
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the opportunity to read Chapter 18.70, 17.65, and 17.70.040 of the Edmonds Community Development O
Code and s/he understands that all terms of the adopted .ordinance are incorporated herein as if set forth in n
full and this application and permits therefore are subject to the terms of those. Chapters. m
SIGNATURE L DATE
Prop rty Owner/Business Owner
FOR CITY USE ONLY
Approved by: � � � n`{.Ul Street Use Fce: s ion
Receipt No: AQC��
Issued by: .1-�,ti-t/l Issue Date:
StNI bY: ALLb IAlt JUMIV r\WUIV'J Ur r iior 447 UWl UUUi iui m)
ALI..STATE TNSURANCE C7
JOHN KWI)N AGENCY
2272.7 HIGHWAY 99, STE 104
EDMONDS. WA 98026
ru:.425-670-8900
AMate
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1•AX: 425-697-6001 Youlre in good hands.
EVIDENCE .OF INSURANCE POLICY NUMBER USU777953
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Customizer® Policy LOAN NUMBER
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U Business Package Policy SECOND LOAN NUMBER
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Insured's name, mailing address, and zip code: m
} IMA . JIJIV(; KIM DBA 1MA' S STU )IO NAILS & SKIN
-419 MATN STREET
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E.1I>IONDS, ATA 98026
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MC')RIGAGEE, ADDITIONAL INSCJRE'h, I UCS PAYEE m
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CITY OF EDMONDS BUILDING DIVION _-.._ p C121 918 AVE N
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ErMCMS, WA 98020. `p Zi
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I i Policy Period: {:
8/16/2004 8/10 2005 x ' m m
From To -, r✓ 12:01 A.M. U 12:00 Noon
Slandard.lima at the address of the insured elated above I O CO)
Insurance Is provided as follows: POLICY TYPE VALUATION C � (,�
Policy Llrnit of Liability U . Named Peril U Actual Cash Value } rn
BUSINESS CCF!ERAGE : S 1.0 , U(H) Basic Replacement Cost i -Zi rnrn"
1ALiIlxry: SLoutuop000 El Broad I. D
BUSINESS 1, M
rsandl & adxrerti.ain injury. s'O(1,U0� Specie!
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*P1:Cxx=1rI.y doin<age: 5100,000 I -I SUPRA
*Si,nuld arty of the atxwe de.k;(%rit.ied r)o1icaes be c��ncelJ.ed Uefore i;he c;xl�ir�ai;i.P71 (late j Z
t*Ltereaf, Lhc . i.�ottinr7 cc:mrariv wll ma.1}. 45 DAYS w :.`ten ncr, icr: i.cl r-.ert:ifc:rahe: l•t�TlC1er. I _
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This policy 1 will be sub'eot to a property insurance adjustment program which will automatically adjust tho building limits on I Z
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an annual basis, ❑ Yes R No. _I
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DEDUCTIBLE — will be deducted from each adjusted loss to covered proporty.
Building Coverage $ _Business Contents $ 250 Combined $
PROVISIONS: This form is not the contract of insurance, The provisions of the policy shall prevail in all respects.wk
All premiums for the insurance policy shall be computed in accordance with Allstate's rules, rates and forms, which are in
effect at the inception of the policy and upon each anniversary thereof, including the date of interim changes.
It is understood that should the insurance protection evidenced herein terminate for any reason, due notice will be given to
the Insured and to the mortgagee. I .
A c o the d larations pa reflecting the annual premium will be sent, if required, to the mortgagee and to any other
erested I .
P as I
4?.5-670-8900 7/15/2005
Authorized a Phone Number Osfe
U10728.1 i
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