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20050850.pdfDATE RECEIVED L nPERMIT EXPIRES CITY OF EDMONDS ZONE t" NUMB PERMIT CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS 41, OWNER NAME/NAME OF F BUSINESS 75 V /K(. PLAT NAME/SUBDIVISION NO. LOT NO. LID NO, Lu MAILING ADDRESS LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved q RW Permit Floquirod O CITYstreet Use Permit Roq'd [] ZIP TELEPHONE EXISTING PROPOSED— Inspection Required Cl sidewalk Requited ✓V\p� �8(�Z� , Y7 4'-?? l/ REQUIRED DEDICATION FT Underground J % -S l� Widngrequired q NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED l7 YES ❑ NO ❑ z = ADDRESS m REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP TELEPHONE .7 -% NAMEC.� u Itasil roa 014tail CBLy� ENGINEERING REVIEWED BY DAT rs ADDRESS s �z� 2.6�51t� Si X23 2�� Z CITY ZIP FIRE REVIEWED BY DATE I , TELEPHONE I O I6OS6 -•lc*3 I 1 n . VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND M STATE LICENSE NUMBER EXPIRATION DATE CHECK D BY ED'�^v r u QS F I-1I'7 c >"1 lkd `'^r^ A - �j �J 10YERS D NO S POSTED SEPA REVIEW SIGN AREA HEIGHT a PROPERTY TAX ACCOU PARCEL NO. X COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED _ EXP /� L.S X 6.5 efig CC 0 M t b1A m v ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED ETBACKS (FT.) O ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0 �j ADDITION COMMERCIALCOMPLIANCE OR �, 1 /�_ ' 1 17 z 0 C 2 �—+ ❑ CHANGE OF USE I `► ,v = m PARKING LOT AREA PLANNING REVIE ED BY DATE g ❑ REMODEL ❑ MULTIFAMILY SIGN R!21PROVIDED I a m Z FENCE 1c)�_ ❑ REPAIR ❑ GRADING CYDS ❑ C Z ( X Fr) REMARKS 11 '^ p '^ D OTHER � W a i n G f 1 e/ r'+ z' �i0 � r ❑ DEMOLISH ❑ TANK ❑ _ bid Ppry e t�h' to S i h FIRE I ❑GARAGE RETAINING WALL LER ,S h a CARPORT El ROCKERY FIRE ALARM `o D M (TYPE OF USE, BUSINES OR ACTIVITY) EXPLAIN: I VtDAMOA CHECKED BY ITYPELOFAN§TRUC ION CODE,7 OCCUPANT _ 1 GROUP IT1 r11 CNUMBER NUMBER OF CRITICAL ' ❑ OF ' UNITS G AREAS SPECIAL INSPECTION AREA OCCUPANT O r O STORIES UNITS NUMBER REQUIRED ❑YES LOAD C DESCRIBE WORK TO BE DONE N REMARKS m K iA 0 c PROGRESS INSPECTIONS PER UBC 108/I8C109/IRC109FINALINSPEC71ONRE01D ? r M S. r m v X -1 2 VALUATION D Z 2 Description FEE Description FEE Z Plan Check © State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % n Building Permit 00 City Surcharge M PLAN CHECK IN VESTED DATE Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical C BE DONE ON PRIVATE PROPERTY ONLWANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN .(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE ran g SEPARATE PERMISSION. LU PERMIT APPLICATION: 180DAYS Engr. Review d PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION NEW 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk, Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due = NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION' Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees aro paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. FFI LS SIGNA RE DAT 105 SIGNATURE NER AGE T) DATE SIGNED (425) . A E TION i71 022 D BY /, DATE EXT 1333zr r AWE WFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILARNAL , ' INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- PANCY HAS BEEN GRANTED, UBC109 / IBC110 / IRC110. ORIGINAL-FILE • YELLOW - INs ECTo PINK-OWNER GOLD•ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES RECEWED of ED4 SEP 0 9 2005 Ell ti�J, PERMIT COUNTER PERMIT #: 45'0005 STREET USE PERMIT co 1894 00)(IZ�t S is Z r O PROPERTY OWNER NAME: `���2 �1��"�'lrwiu�� a�Phone -54 2 n BUSINESS NAME: �IGi AVA0 rn �Mn BUSINESS OWNER NAME: Phone 7 US 4l y _ ADDRESS OF PUBLIC USE: 5114 (y1,m u "f O APPLICANT MAILING ADDRESS: ren e O •ice p � 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 _ Development Code. "n 18.70 STREET USE AND ENCROACHMENT PERMITS rn m 17.65 LIMITED OUTDOOR DISPLAY OF MERCHANDISE - v 17.70.040 TEMPORARY USES; Bistro and outdoor dining n m icC0 PERMIT ISSUANCE r m 0 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, parking strip and/or sidewalk, including the air space above them, if they are placed incompliance with the above referenced Code Sections and the following criteria are met: Z y ➢ It has been concluded.that the proposal will not adversely impact public space open to vehicular or pedestrian travel; to ➢ Architectural Design Board approval has been granted or the process has. been administratively O approved; n The proposal will not unreasonably interfere with the rights of the public; m ➢ 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 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 is greater), measured t 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 CITY COPY Revised 2/6/43 l SAEngrUFomis\Strect Use Permit.doc t. 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. measurinP, 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). �niiwiriiuiiiiivu"iiiuiiirzziiiiviiii w>iw,ii.►..►.iiiiiivruisiivuiiiiiiciiviiiivaiviiriiiiziiviiiiz:►.ziiv"ir.riiiviurii"rziiiiiriiiiuiiririi iuivin� Z /. DESCRIPTION OF PROPOSED STREET USE: r ► m I ��1► 0 r i . -n i om WWWW rliWIiiiiiiiiuliziiiiiiiiiiiiiiiririiiiiiiiiiv"Wvi~lAriiiiiviiii'dff,W Mo APPLICANT TO READ AND SIGN o c NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature, shall vest no m . permanent right and shall be issued and may in any ca10 se be revoked at the sole discretion of the City per z ECDC 18.70.040: By signing this application, the applicant accepts responsibilityfor all existing and/or _ future street uses. Applicant is responsible to pay an annual renewal fee for this permit. Failure to do so Mn will terminate this permit application and require removal of any temporary structures granted by this � permit. MM INDEMNITY: The applicant understands and by his/her signature to this application, agrees to hold the v N Cityof Edmonds harmless from any injuries, damages or claims of any kind or description whatsoever, n m foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its m � departments or employees, including but not limited to the defense of any legal proceedings including Z defense costs, court costs, and attorney fees by reason of granting this permit. In addition, the applicant understands, that he/she shall provide and continually maintain during the term of the permit a certificate X of insurance naming the city as an additional insured, with respect to liability, and providing that it shal be D primary as to any other policy of insurance. ; Z CODE APPLICATION: By signing the application below the applicant warrants that s/he has read or had _ the opportunity to read Chapter 18: 70, 17.65, and 17.70.040 of the Edmonds Community Development z Code and s/he understands that all terms of the adopted ordinance are incorporated herein as if set forth in full and this application and permits therefore are subject to the terms of those Chapters. m SIGNATURE DATE' 1 AM62,S operpy wnerBusiness Owner FOR CITY USE ONLY [ApprovedbCyW Street Use Fee: t.., Receipt No: Issued by: Issue Date: Sep 20 05 1L:8a Andy Dulin 4257453726 P.1 t7 CERTIFICATE OF INSURANCE ..� This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ❑ STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: Policyholder Glazed. b Amazed LLC Address of policyholder 5405 Ballard Ave NW Seattle, WA 98107-4052 Location Of operations 514 Main' Street Edmonds, WA 98020 Description of operations Business Mercantile The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described.in these policies is Z 'f subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder If any of the described policies are canceled before It is understood. 6 agreed that .the city is named as an their expiration date,.State Farm will try to mail a Z Additional Insured written notice to the certificate holder,45 (""days before i OZ City of Edmonds cancellation. If however, we fail to ma%uch notice, Development Services Dept- no obligation or liability will be pos on State m 121 5`�` Ave North Fa or its age r repres ti IALCI Edmonds, WA 98020 Sig ature VAutorized Rep tive j,lG True Date Agent NameLI SEP f�t1 Telephone Number )E 126 6 2005 Agent's Code Stam �f qe� I Agent CAe OUI.�N 4T2324. BUILDING DEPANTMEN t' AFO Coif1G 4T I CITY OF EDMONDS 556&94 a.5 Rev. 11.08-204 Printed In U.S.A. NORTH SOUND INFO F486 . i POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date I Expiration Date (at beginning of policy period) 98 -E2 -0825-9F Comprehensive 07/18/2005 07/10/2006 BODILY INJURY AND Business Liability PROPERTY DAMAGE This insuranceincludes: f Products - Completed Operations ❑ Contractual Liability Each Occurrence $ 1, 000, 000 ❑ Personal Injury ❑ Advertising Injury General Aggregate $ 2, 000, 000 ❑ Products— Completed $ 1, 000, 000 ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Dale (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ POLICY PERIOD Part I - Workers Compensation - Statutory Effective Date Expiration Date Workers' Compensation Part II - Employers Liability and Employers Liability Each Accident $ Disease - Each Employee $ Disease - Policy Limit $ POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCEEffective Date ;Expiration Date (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder If any of the described policies are canceled before It is understood. 6 agreed that .the city is named as an their expiration date,.State Farm will try to mail a Z Additional Insured written notice to the certificate holder,45 (""days before i OZ City of Edmonds cancellation. If however, we fail to ma%uch notice, Development Services Dept- no obligation or liability will be pos on State m 121 5`�` Ave North Fa or its age r repres ti IALCI Edmonds, WA 98020 Sig ature VAutorized Rep tive j,lG True Date Agent NameLI SEP f�t1 Telephone Number )E 126 6 2005 Agent's Code Stam �f qe� I Agent CAe OUI.�N 4T2324. BUILDING DEPANTMEN t' AFO Coif1G 4T I CITY OF EDMONDS 556&94 a.5 Rev. 11.08-204 Printed In U.S.A. NORTH SOUND INFO F486 . i