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418 MAIN ST
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ACTION REPORT
1634
SUSPENSE DATE:
Date: ��-4jl?-
T i m e: 0/,t- F " 1 e # �,04&—t
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NAME: 1-.
ADDRESS:
PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE,,<�=
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RECEIVED BY: �-M OgLda4l�.�
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ACTION: A —
All Concerned Notified
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Action Completed/File
9
tity of Edmon
(17,
INTER -OFFICE CORRESPONDENCE
TO 15� FROM I_u DATE _LL67 /-712
SUBJECT
No -/ e, V tAl ZIC7�Z�
-P/f-rm
TAX ACCOUNT/PARCEL NUMBER: —
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: 'a
[] Conditional Waiver El Study Required W- iver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORTPLAT
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S)
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LOT: BLOCK:
L:VrEMP\DSrs\Fomis\Street File Checklist.doc
#F20
City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person. preparing a Development
Permit Application, for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
RRENTIMu r
Date Received:
City Receipt
Critical Areas File #:
Critical Areas Checklist Fee:— C$135.00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,'
must'fill out the checklist,. sign and date it, and submit it
to the City. The City will review the checklis% make a
precursory site vlsit� and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form.- In
addition, the applicant, shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The uridersigned applicant; and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including r . easonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant his/her/its agents or employees.
By my.signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of MY
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT�&L4� i�d I DATE
V
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for.the
purposes of inspection and posting attendant to this application.
DATE. .4 -aa -0
Owner/Applicant:
"5 A N INA 9 SLL I A-) Q �A
Name
I �5 C)s t (D+V- P I
Street Address
city State zip
Telephone: -;L� - � 19
Applicant Representative: .
Name -
Street Address
city State zip
Telephone:
Email address (optional): Email Address (optional):
.#P20 CA File No:
Critical Areas Checklist
Site Information (soils/topogra hy/hydrology/vegetation)
1. Site Address/ Location:
2- Pr operty Tax Account Number: 0 Q L4 3 4 4 0 1 -:s- OC) (0c)
3. Approximate Site Size (acres or square feet)- L4 6 9 0.
4. Is this site currently developed? Yyes; no.
If yes, how is site developed? C0MtVNe—nCcx-A )DO(
5. Describe the general site topography. Check all that apply.
on change over entire site.
Flat less than 5-feet elevati
Rolling- slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
i'N
cUstance of 6&feet).
Hilly: slopes present on site of more fia4gl'e� id 4&6 4�� 3�0, �g (a �veftical -rise of, 10-fedt
over a horizontal distance of 33 to 66-feq�r)
Steep: grades of greater than 30% prw4j=.Mli�o 6ntat
eW. r a 116riz
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water:
Approx. Depth.
7. Site contains areas of seasonal standing water: N 0 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway tJ 0 floodplain t�,J 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
" 0 Flows are seasonal? — (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn, shrubs etc) ZONE Z"i
11. Obvious wetland is present on site: t-j
For City Staff Use Only
1. Plan Check Number, if ap licable?
2. Site is Zoned? 37
3. SCS mapped soil type(s)? lvat ,;, - tiiderwaad -
4.
5.
Critical Areas inventory or C.A. map indicates Critical Area. on site? Alo,
Site %rithin designated earth -subsidence landslide hazard area? A/0
DETERMINATION
a- -ro 9 m(u,7—
Reviewed
STUDYREQUIRED
I -
WAIVER
ate: I k ?"Cl-
CITY OF EDMONDS DATE RECEIVED 7
7 -
COMMUNITY SERVICES DEPARTMENT
250 5th Ave N DATE ISSUED
771-3202
PERMIT NO. sly
APPLICATION FOR STREET USE PERMIT
Name of Applicant: A�/ rvzt�
Mailing Address: IWX -�l
Telephone Number: 3 Wb Date:
0
Description of Public Place or Portion thereof desired to be used: (exhibit
may be attached)
qtte4
fu '.
Type of Use desired to be made of Public Place:
If applicable, attach plans and specifications for any utility or structurd4�C L I '-V E D
be erected and/or maintained on the Public Place:
AW 3 11988
EEM S FIRE DEPT
TEMPORARY PERMIT: Unless otherwise designated herein, this permit is unders-l-,00d
by applicant to be wholly of a temporary nature, that it vests no permanent right
whatsoever. If the permitted use becomes dangerous or such structure shall
become insecure or unsafe or shall not be constructed, maintained or used in
accordance with the provisions of this title, the same may be revoked and the
structure and obstructions ordered removed by order of the City Engineer. If this
application is for a specified period of time, the terms of said application is:
INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages or claims of . any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its department or employees,
including but not limited to the defense or any legal proceedings including defence
costs, court costs, and attorney fees by reason of granting this permit. In
addition, applicant understands that the City shall -be provided a certificate Of
insurance to indemnify and hold the City of Edmonds harmless from all claims
and/or property damage, naming the City of Edmonds as an also insured.
APPLICATION OF CHAPTER 18.70 OF THE COMMUNITY DEVELOPMENT CODE: Applicant warrants
That -he has read, or had the opportunity to read, Chapter 18.70 o� the Community
Development Code, attached herewith, and understands that all terms of that
Ordinance are incorporated herein as if set forth in full and this application
and permit therefore are subject to the terms of Chapte
Code. o monds City
pplican�'s Signatu
v iv
H
-R
e
Cit� of Edmonds, Community Services Department
APPLICATION FOR STREET USE PERMIT - - Page 2
Approval (and Agreement, if applicable) of Abutting Property Owners:
SIGNATURE
PRINTED NAME
ADDRESS
DATE
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
City Council Approval (if appl.icable)(Attach Minute
ADB Approval (if applicable)(Attach Minute Entry):
Building Official Approval (if applicable):
Signature Date
Provision for Indemnity: &/7
Terms and Provision of Performance Bond, if applicable:
/�/4 —
PERMIT AUTHORIZATION BY:
PERMIT NO. 95--B
RELEASED BY 76
Remarks/Comments:
FIRE DEPARTMENT APPROV
POLICE DEPARTMENT APPROV
ENGINEERING DEPARTMENT A
0
Signa
Date Issued: (9471x?
RECEIPT NO. W(p I Ab
Date
42"_.C�o
Permit Fee:
BUILDING PERMIT i7t-obsss-
--DATE
AL DATE
PPROVAL DATE
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CITY OF EDMONDS LARRY S. NAUGHTEN
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202 MAYOR
COMMUNITY SERVICES: PETER E. HAHN
Public Works * Planning * Parks and Recreation 9 Engineering DIRECTOR
� 8 9 0 . 1 99 -
November 15, 1989
Seattle First National Bank
P.O. Box 3586
Seattle, WA 98124
RE: Hubbard Building
418-422 Main Street
Edmonds, WA 98020
Street Use Permit #88-8
Yearly Renewal Fee
According to building division records, yearly street use permit fees
are again due.
This payment is for 1989, the renewal fee is $10.00, please make your
check payable to the City of Edmonds, Building Division, 250 Fifth
Avenue North, Edmonds, Washington, 98020.
Please enclose a current certificate of insurance with your payment.
If you have any questions please feel free to call me at 771-3202.
Thank you,
4W --'�
eannine L. Graf
Permit Coordinator
STREEUSE/TXTJLG52
t� 0 XA� / Z-/Z -/19;P
8�
0
e Incorporated August 11. 1890 *
Sister Cities International — Hekinan, Japan
9
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202
COMMUNITY SERVICES:
Public Works * Planning o Parks and Recreation * Engineering
8 90 - 19 9
January 12, 1989
Seattle First National Bank
P.O. Box 3586
Seattle, WA 98124
LARRY S. NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
RE: Hubbard Building
Street Use Permit #8-88
Insurance Certificate
Thank you for the payment of your fee for yearly renewal of your Street
Use permit. However, it is necessary that we have a current
Certificate of Insurance on record (as was required with the original
submittal) in order to keep your permit active.
Please submit the necessary insurance papers to the Building Division,
250 5th Avenue N., Edmonds, WA 98020, by 2/1/90.
If you have any questions, I can be reached at 771-3202.
Thank you,
Jeannine Graf
Permit Coordinator
JLG/sfn
INSURANC/TXTJLG52
Incorporated August 11, 1890 &
Siste:Cities International — Hekinan, Japan
9 0
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works 9 Planning * Parks and Recreation 9 Engineering
March 31, 1992
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
Attn: Richard C. Posey
Seafirst Bank
Trust Real Estate
P.O. Box 3586 CSC: 7
Seattle, WA 981:24
Re: Hubbard BuOding
418-422 Mai n Street
Street Use Permit #88-8
Dear Mr. Posey:
In response to your letter of March 25, you will find copies of the
original Street Use Permit issued in 1988, and correspondence
pertaining to this permit for the following years, through 1991.
In researching your request, it was brought to my attention that Street
Use renewal fees were not paid for the years of 1990 and 1991 (see
attached correspondence); therefore ., the amount now,due is $30, not the
original $10 mentioned in our 1992 Street Use billing letter. Also, we
will need a current Certificate of Insurance for our files.
The City would appreciate any attention you could give this matter in
order for the Building Department to complete the billing procedure for
this year.
If you have any questions I can be reached at 771-0220.
Thank you,
Sharon Nolan
Permit Coordinator
Attachments
A S Aft
0 Incorporated Auqu5t 11, 1890 0'
Sister Cities International — Hekinan, Japan
890 C�
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works 9 Planning 9 Parks and Recreation o Engineering
March 19, 1992
Hubbard Building
c/o Seafirst Bank
Truct Real Estate
P.O. Box 3586
CSC 7
Seattle, WA 98124
Re: Street Use Annual Fee
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
According to our records, we have not received the $10 annual renewal
fee for your Street Use Permit as requested in our letter of 1/15/92.
If you no longer utilize a portion of the City right-of-way please
notify the Building Department in order that we may cancel your permit.
If we have not received payment by April 3, 1992, the Building
Department will take that as notification that you no longer require
the Street Use Permit and will cancel your permit and schedule an
inspection to determine that the City right-of-way is no longer being
used. If your permit is cancelled and you are still utilizing the
right-of-way it will require a new permit application, with a $25 fee.
Also, a current Certificate of Insurance is required to be on file with
the City at all times.
If you have any questions you may call me at 771-0220.
Thank you,
Sharon Nolan
Permit Coordinator
cc: Building Official
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS LARRY S. NAUGHTEN
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202 MAYOR
COMMUNITY SERVICES: PETER E. HAHN
9() Public Works * Planning a Parks and Recreation Engineering DIRECTOR
January 15, 1992
Hubbard Building
418-422 Main St.
Edmonds, WA 98020
RE: Street Use Permit 88-8
According to Building Division records, Street Use Permit renewal fees
are due. Street use renewal fees are collected in January for the
current year and are currently set at $10. Please remit fees within 15
days date of this letter.
If you no longer utilize the portion of City right-of-way under the
subject permit, please contact the City at your earliest convenience.
Also note, a current certificate of insurance is required to be on file
with the City at all times. Please check expiration dates with your
insurance carrier and include a current copy of your Certificate of
Insurance with your payment.
The City Council will be reviewing Building Department fee increases
during the next few months and it is possible that Street Use fees,
both original and renewal fees, will be increased for next year and
reflected in the billings for 1993.
If there are any questions contact the building division at 771-3202.
Thank you,
Sharon F. Nolan
Permit Coordinator
STREETLT/TXTDOS62
I
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0
0
YVONNE
0 k--:TH
422'MAIN ST.- EDMON JNTANAN DOWNTOWN EDMONDS
0 * SEA FIRST
0
March 25, 1992
Sharon Nolan
City of Edmonds
250 Fifth Avenue North
Edmonds, WA 98020
Reference: Hubbard Building
418 - 422 Main Street
Street Use Permit #88-8
Dear Sharon Nolan:
"Ne
4%.
1-904?
We are in receipt of your letter invoice of January 15, 1992 in which you
indicate a $10 charge for renewing a street use permit.
We have reviewed our records and have not found any previous payment for
street use permits based on research of invoices back to 1989. In addition,
in researching our files, we do not find a copy of the permit nor a
description of what the permit would be for.
Utilizing the enclosed, pre -addressed, postage -paid envelope, please identify
what exactly the permit is for; and if it is a right of way that we still have
need to use, we will gladly pay the $10.
You may also contact me at the phone number listed below.
Sincerely,
RICHARD C. POSEY
Real Estate Investment Officer
(206) 358-3416
2265H
Enclosures
Seafirst Bank Real Estate Investment Services 701 Fifth Avenue, 7th Floor/Post Office Box 3586, CSC 7
Seattle, Washington 98124
CITY OF EDMONDS
250 - 5TH AVE. N. EDMONDS, WA 98020 (206) 771-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
8 9 0 C5 Public Works * Planning a Parks and Recreation e Engineering
December 28, 1992
LAURA M. HALL
MAYOR
Hubbard Building
418-422 Main St. -
Edmonds, WA 98020
RE: Street Use Permit 88-8 (`�C_
According to Building Division records, Street Use Permit renewal fees
are due. Street use renewal fees are C-pllected in January for the
current -year and are currently set at('$16) Please remit fees within 15
days of the date of this letter.
If you no longer utilize the portion of City right-of-way under the
subject permit, please contact the City at your earliest convenience.
Also note, a current certificate of insurance is required to be on file
with the City at all times. Please check expiration dates with your
insurance carrier and include a current copy of your Certificate of
Insurance with your payment.
The City Council will be reviewing Building Department fee increases
during the next few months and it is possible that Street Use fees,
both original and renewal fees, will be increased for next year and
reflected in the billings for 1994.
If there are any questions contact the building division at,771-0202.
Thank you, b�,4(2_D /F
,Aci(.i-(y 4c(()1,1(_1
Sharon F. Nolan
Permit Coordinator
STREETLT/TXTDOS62
EXPENSE
CP I Z A 9 Ze
F,00. D c 'L e
all
e Incorporated Auqust 11, 1890 e
Sister Cities International — Hekinan, Japan
SAFEGn INSURANCE.CUMPANY OF AMERICA
'
Ho»»s^ cE*aanor '(uwAVE ICs.scAnLe.WAsmmorowyu1ou' Sp 2129616 �
* stock insurance �mpanV. "."=/^eclthe company)
aAFepuum RENEWAL CERTIFICATE
IINSURANCE IS PROVIDED FOR -THE NAMED INSURED WITH RESPECT TO THE DESCRIBED PREMISES AND FOR THE COVERAGES SHOWN BELOW: -
DESCRIBED pnexxoss —`
42/-422 MAIN STREET `
~~ EDMONDS SNOHOMIsH ` '' —WA' 98020
mAms OF THE |mSunso and MAILING ADDRESS pOuCvPcmOo
SEATTLE FIRST NATIONAL BANK, IRUSTEE OF THE HUSBARD FAMI from 12-06-92 tol2-06-93
C/O TRUST REAL ESTATE, P.O. BOX 3586 / CSC-7 mailing address of the Insured)
SEATTLI.:*.* WA 98124 REPLACES
ous/msssOpTHE NAMED |maunsoIS: THE NAMED INSURED IS:
BANK A CORPORATION
OTHERINTEREST
pAnr|
ONE
|
TWO|
oovcnAss
SPECIAL COVERAGE
PART ONE DEDUCTIBLE
BUILDING(S)
LOSS OF INCOME
LIABILITY & MEDICAL EXPENSE
MEDICAL EXPENSES
oc
u| am« umu of/nouamm omn um� of Insurance omo . m / /,mu,u
1
ALL
K
$50O
01 $276,500
ACTUAL LOSS SUSTAINED,
NOT EXCEEDING 12 CONSECUTIVE MONTHS
$ 300,000 EACH OCCURRENCE
$ 1,000 EACH PERSON
POLICY FORMS AND smoonosmsNTS: SP-0001 04-91 ANNUAL PREMIUM
SP-0131 04-91 SP-0408 05-87
Countersignature
City or Town Date
THE INSURANCE STORE' INC,
SAFETY PAYS ^^^BECAUSE YOU INCURRED NO
LOSSES LAST YEAR, A 10% LOSS FREE CREDIT
HAS BEEN APPLIED TO THIS RENEWAL PREMIUM. \
THIS CREDIT MAY HELP OFFSET THE EFFECTS ' �/ /�
OF INFLATIONARY INCREASES IN RATE OR THE '
VALUE OF YOUR PROPERTY. PLEASE DETACH
r
THE PAYMENT STUB AND RETURN WITH YOUR
T IN THE ENVELOPE PROVIDED. (THE
DM�� PAYMENT AMOUNT INCLUDES A $10~00SERVICE CHARGEO..
— `
Agem
|ou*n»m 11-02-9�
INSURED '
CITY OF EDMONDS
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
-6 Ic- ()Q�
June 26, 1997
COMMUNITY SERVICES DEPARTMENT
Public Works 9 Planning 9 Parks and Recreation 9 Engineering
BARBARA FAHEY
MAYOR
Attn: Richard C Posey
Seafirst Bank 1%A11-
Trust Real Estate
PO Box 3586 CSC 7 /vw -
Seattle, Washington 98124
Re: Hubbard Building /0
418 - 422 Main Street
Edmonds, Washington 98020
Street Use Permit #88-8
As required by City Ordinance #2972, Street Use permit renewal fees are now
collected every three years instead of yearly. The first effective billing date was 1/1/96
however, due to staff shortages, the City was unable to send out this billing for the
period 1/96 to 1/99. Please remit renewal fees in the amount of $25.00 c/o Building
Division, Permit Specialist, 250 5th Avenue North, Edmonds, Washington 98020
within 15 days date of this letter.
If this permit is no longer applicable i.e., you no longer utilize that portion of the City
right-of-way granted under the street use permit; please notify the Building Division in
writing so that we may cancel the permit. As permit holder it is your responsibility to
inspect the permitted use for safety hazards on a yearly basis.
Note, with the payment please include a current Certificate of Insurance since the
insurance policy on file with the City has expired on 12/6/93.
If you have any questions please feel free to call me at 771-0220.
Thank you,
Vivienne Myers
Permit Specialist
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0
-t.,? C. 18 9 �3
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning/Building - Parks and Recreation o Engineering o Wastewater Treatment Plant
January 12, 1998
Ann Turner
P.O. Box 458
Edmonds, Washington 98020
RE: Street Use Permit @ 418-422 Main Street
Our records indicate that the Street Use Permit renewal fee at the subject property has not
been received and the insurance policy is expired. Because the renewal fee of $25.00 and
a valid Certificate of Insurance are required for every street use permit per the Edmonds
Community Development Code 18.70.030, the permit at the subject property is now
invalid. We consider this matter to be of extreme importance. Therefore, you must
immediately pay the renewal fee of $25.00 to the Building Department and provide a
valid certificate of insurance or you must remove the permitted use of a canopy over the
sidewalk by January 20, 1998. Failure to take action to resolve the matter shall result in
dispatch of the City crew to remove the canopy.
Thank you,
Vivienne Myers
Permit Specialist
cc: Building Official
Permit Coordinator
Erika K. Klein
Construction Legal Consultant
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0
-1 - 91)
4c. is
August 3, 1998
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/ Building - Parks and Recreation 9 Engineering - Wastewater Treatment Plant
Ms. Ann Turner
Post Office Box 458
Edmonds, Washington 98020
RE: Hubbard Building @ 418-422 Main Street, Street Use Permit #88-8
According to City records we are in receipt of the renewal fee for the referenced street use permit
however, the required evidence of a current certificate of insurance is still outstanding. At your
earliest convenience please contact your insurance carrier and request that a current certificate of
insurance be provided to the City. If your agent has any questions regarding the policy please
have them contact me directly at 425-771-0220.
Thank you,
�� ;��r -
Jeannine L. Graf
Building Official
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
C M-OF EDMONDS
COMMUNITY SERVICES HPARTMENT
250 5th Ave NL
771-3202
S7
Name of Applicant:
Mailing Address:
Telephone Number
PERMIT NO. 6�43.
DATE RECEIVED
0 DATE ISSUED
APPLICATION FOR STREET USE PERMIT
Date: /0 — r — �F Y-
Description of Public Place or Portion thereof desired to be used: (exhibit
may be attached)
Type of Use desired to be made of Public Place:
applicable, attach plans and specifications for any utility or structure 'to
be erected and/or maintained on the Public Place:
TEMPORARY PERMIT: Unless otherwise designated herein, this permit is understood
by applicant to be wholly of a temporary nature, that it vests no permanent right
whatsoever. If the permitted use becomes dangerous or such structure shall
become insecure or unsafe or shall not be constructed, maintained or used in
accordance with the provisions of this title, the same may be revoked and the
structure and obstructions ordered removed by order of the City Engineer. If this
application is for a specified period of time, the terms of said application is:
lag
INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages or claims of . any.
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its department or employees,
including but not limited to the defense or any legal proceedings including defence
costs, court costs, and attorney fees by reason of granting this permit. In
addition, applicant understands that the City shall -be provided a certificate of
insurance to indemnify and hold the City of Edmonds harml*ess from all claims
and/or property damage, naming the City of Edmonds as an also insured.
APPLICATION OF CHAPTER 18.70 OF THE COMMUNITY DEVELOPMENT CODE: Applicant warrants
that he has read, or had the opportunity to read, Chapter 18-70 o� the Community
Development Code, attached herewith, and understands that all terms of that
Ordinance are incorporated herein as if set forth in full and this application
and permit therefore are subject to the terms of that Chapter of the Edmonds City
Code.
Applicankr7s S Oa—t0e
City of Edmonds, CommunRy Services Department
APPLICATION FOR STREET USE PERMIT Page 2
Approval (and Agreement,
if applicable) of Abutting
Property Owners:
SIGNATURE
PRINTED NAME
ADDRESS
0
DAT E
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
City Council Approval (if appl.icable)(Attach Minute Entry):
ADB Approval (if applicable)(Attach Minute Entry)- APS —36-89
Building Official Approval (if applicable):
Signature Date
Provision for Indemnity: e��Xh?&lr —ZV4f4,W4e A!�,�d'
/2-/&4� 40114ei
Terms and Provision of Performance Bond, if applicable:
PERMIT AUTHORIZATION BY:
Sig4ature Date
100 _CX>
PERMIT NO. ub—/3 Date Issued: —/0 —do'i Permit Fee:' ZS'l,
RELEASED BY �06 RECEIPT NO. q-41ZIJ� BUILDING PERMIT 7F,1V
Remarks/Comments:
FIRE DEPARTMENT APPROV
POLICE DEPARTMENT APPROVAL
ENGINEERING DEPARTMENT APPROVAL
a
PATE,,-10
DATE
DATE
0
E
OT
-1 #J
;4
Ede
J7
>c c V
kg�- a
Webb.
Ift STOREFRONT REMODEL
IN S EAF * 113ST TRUST BLDG,
C T .5th AND MAIN
Oete: ��1-1 � -
I . fit Revise
Drawn: i,r,.
9 v 9 9 v 9 9 9
i-IMP, CIMIRRV� A� r.v-y-_M1r.;4
0
06
FISSUE DATE DDNY)*
5-13-88
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
The Insurance Store, Inc.
P.O. Box 809
COMPAMES AFFORCING COVERAGUE
Lynnwood, WA 98046
COMPANY
LETTER Safeco Insurance Company
COMPANY
LETTER
INSURED
COMPANY @
LETTER
Seattle First National Bank,
Trustee of the Hubbard Family
Foundation & Jeanne Cootee, Indiv.
COMPANY
LETTER
P.O. Box 3586
Seattle, WA 98124
COMPANY
LETTER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI.
TIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDNY)
POLICY EXPIRATION
DATE (MWDDNY)
LIABILITY LIMITS IN THOUSANDS
EACIA
OCCURRENCE
AGGREGATE
GENERAL LIABILITY
BODILY
X
X COMPREHENSIVE FORM
SP 2129616
12/6/87
12/6/88
INJURY
$
$
PROPERTY
PREMISES/OPERATIONS
UNDERGROUND
DAMAGE
$
$
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
BI & PD
300
$
300
$
COMBINED
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
300
PERSONALINJURY
PERSONAL INJURY
$
AUTOMOBILE
LIABILITY
BODILY
ANY AUTO
NJURY
�PER PERSON)
$
ALL OWNED AUTOS (PRIV. PASS.)
BODILY
ALL OWNED AUTOS (OTHER THAN)
PRIV. PASS.
INJURY
(PER ACCIDENT)
$
HIRED AUTOS
PROPERTY
NON -OWNED AUTOS
DAMAGE
$
GARAGE LIABILITY
B1 & PI)
COMBINED]
$
EXCESS LIABILITY
UMBRELLA FORM
BI & PD
COMBINED
$
$
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION
$ (EACH ACCIDENT)
AND
$ (DISEASE -POLICY LIMM
EMPLOYERS' LIABILITY
$ (DISEASE -EACH EMPLOYEE)
OTHER
$250,800 Building
A
Property
L
SP 2129616
12/6/87
12/6/88
I
Special Form, &5106tit
Ou
_L
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Re: Alterations for the building located at: 420-22 Main Street,
Edmonds, WA 98020
A 91--111-4 , lonal -T
�QA
: 0.050VANT1 RE) N7
City of Edmonds
250 5th Ave. North
Edmonds, WA 98020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE13 BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NA14ED TO THE
LEFT, BUT FAILXRE TO�qAIL SUCH NOT)CE SHALL IMP
,PSE NO OBLI04TION OR LIABILITY
OF ANY KIND ONAJ4E COMPANYe1TS` AG&TS JOR REPRESENTATIVES.
le
,t�—
C . 1 S (),Zs
r]
CITY OF EDMONDS
0
OR
STREET ADDRE81 TILtHy 'y
PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. - EDMONDS, WA 98026
(425) 771-0235 - FAX (425) 744-6057 - E-MAIL: k1ein@ci.edmonds.wa.us
WEB SITE: www.ci.edmondsma.us
December 17, 1999
Attn: Ken Bellingham
Edmonds Bakery
418 Main St.
Edmonds, WA 98026
Subject: Water Leak Credit #110750
Dear Mr. Bellingham:
I have reviewed your account and will allow a credit for the billing period between
July 27, 1999 through November 24, 1999 in accordance with our City policy. The policy
states that the customer will be billed at the retail rate based upon the average water
consumption for the same period during the previous year. In addition, the excess water
lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three-
year period.
Should you have any additional questions after you receive your new billing, please
contact Denise Burke, Utility Billing Clerk, at 771-0241.
Sincerely,
Jim Waite
Water/Sewer Supervisor
JW/lk
cc: Denise Burke
Utility Billing Clerk
wordata\water\credit99\# 110750
Incorporated August 11, 1890
Sister City - Hekinan, Japan
49
I C) -7 5-0
R 1�1'-
00,
6LY�
Pacific. Northwest Plu ' mbing, Inc.
DBA IW, Inc. i
"Guarahteed With Pride"
(425) 778-6800 FAX (425) 672-P603
RO. Box 82239,9 "ore, W��gto� 98028-0239
HOME PHONE
SOLD TO: R '11E
VO
NAME
APDRESS
crry
DISRATCHA
WORKMAN
TRUCK#
H OMEPHONE
J013 ADDRESS: WORK PHONE.
NAME N.— -ce---. 4"
ADDRESS
CITY
COW . RACT NO. 237.50
E3 ESTIMATE". IGOOD 30 D
WORK AUTHdAlIZATION
I hereby authorize the work described be" and agree to the
*me and conditions," stated an both sides of this form. Being
now formamed 00 aged and deteriorated plumbl6g fixtures,
plift and appurtenarimis may no longer be serviceable, I agree
to hold PNP M6. blameless for'any damage or;destructl6ri to
same as a result of ow*tional re0air efforts. Piease see
rAdditional terms and -conditions of saie,,- on reverse
sitic
AGN061S 4 C_
ITkM
RIZED BY:
YR';
SOLMON
\U _%_j
A�
13ALANCE IS DUE FAYABLE ON RECEIPT. A- FINANCE
CHARGE AT THE RATE OF EIGHTEEN PERCENT (18%)
WILL BE ASSESSEIDON AC004NTBALANCESTHATARE
RFTEEN (15) OR MORE DAYS MT OUL
I PAM l3viss
It
A
JA
LA21I4
[3 ossh 13maswcwd
ferred fivice Membership: 1 Yr. 0 2 Yrs. E3. 3 Yrs. 0
D nM gonient Products: Bio Cle4n A Yr. 0 3 Yrs. 0_ii—
WARRANTY
sic.
a ALL MATERIALS SUPPLIED'BY PNP ARE COVERED BY THE
PLEASE PAY FRom THIS INVOICE -
MANUFACTURERS WRITTEN WARRANTY.
PNPS '��NSHIP AND LABOR ARE WARRANTED FOR 30
NO S-FATEMENT RENDIERED.
DAYS UNLESS OTHERWISE SPECIFIED.
WATER PSI
ALL DRAIN OPENINGS ARE WARRANTED FOR 30 0 AYS
EXCEPT VOID WHERE OUR TECHNICIAN HAS'DETERMINED
------
I
WArE R HEATER: 0 GAS E3 ELEC 1361ZE
THAT PIPING IS IN POOR CONDITION (IRREGULARITY,
SI 0 CLEAN
COUPON,
I BREAKS. EXCESSIVE ROOT, INFILTRATION, ETC.)
WATER PIPING:,'G GALV 13'C0PfPER:.l;.'.0 PLAS-nC
NO WARRANTY ONTORIET. BOWL STOPPAGES.
0 her* state that the abowe'desorlbed WWk has been�lnidaftl In a workmanlike irmum.
SD
Al
SUB -TOTAL
C-7
Z*E
the
hen M df *A obove
TAX
r%fv"UNT,DIJE
STREE?ADBR, FS3 FV
BARBARA FAHEY
MAYOR
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. EDMONDS, WA 98026
(425) 771-0235 - FAX (425) 744-6057 - E-MAIL: kIein@ci.edm onds.wa.us
4), WEB SITE: www.ci.edrnonds.wa.us
October 30, 1998
Edmonds Bakery
418 Main Street
Edmonds, WA 98020
Subject: Water Leak Credit Account (#110750)
Dear Edmonds Bakery:
I have reviewed your account and will allow a credit for the billing period between
May 2, 1998 through July 29, 1998 in accordance with our City policy. The policy states
that the customer will be billed at the retail rate based upon the average water consumption
for the same period during the previous year. In addition, the excess water lost from the
leak will be billed to customer at the City's wholesale rate with a 15% surcharge added for
administrative cost. Only one leak credit will be granted in any three-year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Jim Waite
Water/Sewer Supervisor
JW/Ik
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit98\##1 10750
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
I A6" W
Mr. Jim Waite
City of Edmonds
Water/Sewer Utiliy
Dear Mr. Waite,
water bill
October 20,1998
0
This letter is in regards to the Edmonds
Bakery's combined utility bill from 5/27/98 through
7/29/98. During that time we experienced a toilet,
that had been previously repaired by my plumber/
brother-in-law, that many times would stick open
a crack, no pun intended, and let the water run.
I kept adjusting the chain until it finally operated
correctly but not soon enough to prevent my water
usage from going through the roof. I never imagined
my bill would triple in just a short time. I wonder
if its possible for you to review our water usage
history and maybe grant some kind of adjustment
based on our average consumption. Thank you for
any consideration you may have in this matter.
Kindest regards,
Edmonds Bakery
Ken (the baker) Bellingham
418 Main Street
Edmonds, WA 98020
Page 1
RECEINFED
OCT 2 8 1998
PUBLIC WORKS DEP1
APPLICATION
for
The City of Edmonds SIDE SEWER PIERNIT
EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS 0
3 03 -073no
Edmonds Bakery
OWINM ........................................................ ................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
AeDRESS .............. �J� LEGAL DESCRIPTION: LOT No . ............
. _..M
..Ain..S.t.,k ---------------------------------------------------------
...... --- .................................. BLOCK No . ............................... . ...........
NAMEOF ADDITION ................................................................................... . ..................................
*I
0.
11
Dye Tested On Sewer
June, 1972
Approved:
DATE................................................ By ..............................................................
.,,I'S t . 18 9 %,3
CITY OF EDMONDS
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning a Parks and Recreation Engineering
September 30, 1996
Mr. Joe & Carol Erga
1027 Southwest Lake Roesiger Road
Snohomish, Washington 98290
RE: Edmonds West Tavern @ 418 Main Street Edmonds
Dear Mr. & Mrs. Erga;
BARBARA FAHEY
MAYOR
In response to a citizen inquiry, a City official has observed that areas of exterior building finish appear to
be in jeopardy of falling into the alleyway along the west exterior of your building. There are also areas
on the south facade that are in partial decay. We assume your maintenance people are unaware of this
potential problem and we bring it to your attention for immediate investigation and repair.
Thank you,
Jeannine L. Gf
Building Official
oli\ 'o
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
46'
890 - 194
0 . 0
CITY OF EDMONDS
250 - STH AVE. N.- - EOMONOS, WA 98020 * (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning o Parks and Recreation * Engineering
LAND USE COMPLAINT FORM,
DATE OF COMPLAINT Z(O
PROPERTY ADDRESS OF COMPLAINT- ve1<41
PROPERTY OWNER: '1/ �3 P+
Name Address Phone
TENANT:
Name Address Phone
/^/v
NATURE OF COMPLAINT:.. 161e)el�f
The City of Edmonds investigates possible violations on.a complaint basis only, therefore, the
name of the person filing the complaint must be provided.
Name (please print) - Phone: -77S--c9,S-61'-
Address: AV 1101,701ve-
Under the provisions of the Public Disclosure Act (RCW 42.17.310), if requested by the public,
do you want your name, address and phone number disclosed?
YES a --NO
Signature
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
-------------------------- : MetroScan/Snohomish : ---------------------------
Owner :TURNER ANN
C oOwner :
Site Addr:422 MAIN ST EDMONDS 98020
Mail Addr:PO B 458 EDMONDS WA 98020
Rec Date :01/19 6 Deed :WAR Y
Price :$225,0 FULL Loan :
Aud Fee #:590 MUL -PARCEL Ln Amt:
ActualUse:RETAI RE Lender -
Vest Type:SOLE PAR IntT :
Bldg Name:COMSTOCK J ELERS OE REPAIR
Land Use :53000 COM,R AIL,G ERAL MERCHANDISE
NbrhdCode:500
Zoning :BC ningRest:
Sub/Plat :EDMONDS PLAT 0
Legal :BLK 015 D-01 L 6 LESS W 45FT
........ . ........
Bedrooms 110 LotAcre:
Bath F3H 1st SF :4, 38 Lot SF
Stories :1 2nd SF Heating:SUS HTR
Fireplace: 3rd SF Roof :BUILT UP
Spa 4th SF View
Units :1 BsmntSF:672 WtFront:
RTSQ :03E-27N-23-SE
APN:4344 015 006 01 08
Struct:$140,800
Land :$44,400
Total :$185,200
LevyCd:00210
1996Tx:$2,148.84
Phone :
0-oOwned:50
-- Census --
Tract :505.00
Block :4
Easement:
Vol:1 Page:26
Year Blt:1959
EffYrBlt:
BldgGrad:AVG
BldgCond:AVG
WaterSrc:PUBLIC
Sewer :SEWER
* -------------------------- : MetroScan/Snohomish : --------------------------- *
Owner :ERGA JOE & CAROL A
CoOwner :
Site Addr:418 MAIN ST EDMONDS 98020
Mail Addr:1027 SW LAKE ROESIGER RD SNOHOMISH WA
Rec Date :03/00/84 Deed :RE CONTRACT
Price :$130,000 Loan :
Aud Fee #:MULTI -PARCEL Ln Amt:
ActualUse:RETAIL STORE Lender:
Vest Type: IntTyp:
Bldg Name:EDMONDS BAKERY / EDMONDS WEST TAved.^1
Land Use :53000 COM,RETAIL,GENERAL MERCHANDISE
NbrhdCode:500
Zoning :BC ZoningRest:
Sub/Plat :EDMONDS PLAT OF
Legal :BLK 015 D-02 - W 45FT OF LOT 6 BLK
.......... ........
Bedrooms : Bldg SF:3,600
Bath F3H : 1st SF :3,600
Stories :1 2nd SF
Fireplace: 3rd SF
Spa 4th SF
Units :1 BsmntSF:
RTSQ :03E-27N-23-SE
APN:4344 015 006 02 07
Struct:$53,900
98290 Land :$87,700
Total :$141,600
LevyCd:00210
1996Tx:$1,642.96
Phone :360-568-1209
'-.Owned:
-- Census --
Tract :505.00
Block :4
Easement:
Vol:1 Page:26
LotAcre:
Lot SF':
Heating:SUS HTR
Roof :BUILT UP
View
WtFront:
Year Blt:1920
EffYrBlt:
BldgGrad:LOW
BldgCond:AVG
WaterSrc:PUBLIC
Sewer :SEWER
The Information Provided Is Deemed Reliable, But Is Not Guaranteed.
0
--------------------------- : MetroScan/Snohomish
Owner :ACCTG
CoOwner .:
.�ite Addr:410 MAINST SULTAN 98294
Mail Addr:410 MAIN T SULTAN WA 98294
Rec Date Deed
Price Loan
Aud Fee #: Ln Amt-
ActualUse:BANK Lende
Vest Type: tT
Bldg Name:SEAFIRST BANK
Land Use :61110 COM,FINANCE, R,REAL ESTATE
NbrhdCode:270
Zoning :CB Z ningRes :FHZ
Sub/Plat :MAP OF SULTAN
Legal :BLK 004 D-00 - LTS 12-13-14 E
.......... .. .....
Bedrooms : B g SF:2,520
Bath F3H : t SF :2,520
Stories :1 nd SF
Fireplace: 3rd SF
Spa 4th SF
Units :1 BsmntSF:
0
- - - - - - - - - - - - - - - - - - - - - - - - - - -
RTSQ :08E-27N-05-NW
APN:5888 004 012 00 04
Struct:$178,300
Land :$56,200
Total :$234,500
LevyCd:00805
1996Tx:$3,118.33
Phone :
*-.Owned:
-- Census --
Tract :538.00
Block :2
Easement:
Vol:1 Page:91
Lot re: .29
Lot : 12, 63 2
Heating:HEAT PUMP
Roof :BUILT UP
View
WtFront:
Year Blt:1977
EffYrBlt:
BldgGrad:AVG
BldgCond:AVG
WaterSrc:PUBLIC
Sewer :SEWER
The Information Provided Is Deemed Reliable, But Is.Not Guaranteed.
DATE RECEIVE
PERMIT EXPIRES
140 [ r jr
CITY OF EDMONDS
USE PERMIT
ZONE
NUMBER L_V_dN-e&#g
CONSTRUCTION PERMIT APPLICATION
JOB SUITEJAPT
ADDRESS
1;en
,0"ER NAMI�/NAME QF BMES
ra)M�101` Gi kaYA)
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
Ix
III
go
MAILING ADDRESS
b—C N6iv-j
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AP_
Q,'
Rw Permit R .'.V
EXISTING — PROPOSED
Street Use Permit Re.,, -
Inspecdo Required 13
Sidewalk1equired [3
Undwwound
CITY ZIP
TELEPHONE
2q-'020
I sp-ob E I g .31
REQUIRED DEDICATION— FT
wiring required
NAME
METER SIZE LINE
SIZE I
NO. OF FIXTURES
PRV REQUIRED
�Iale*
I
YES C3 NO 13
'WE
ADDRESS
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
TELEPHONE
NAME jCBL#
bELL1
ENGINEERING REVIEWED BY DATE
ADDRESS
1005 L04"'t cj—,LjL Qd"
0
FIRE. REVIEWED BY DATE
CITY ZIP
9VQ'2_D
TELEPHONE
0
12
VARIANCE PR:CU::.;
:SHORELINEORADB#,"I
IN SPECTION I
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE.
is IE LL I Q. T
j13yES
ONO
$
SEPX'REVIEW,
COMPLETE r.'IEXEMPT"`J�,ALWWED-,�
SIGN AREA:-:'
";.PROPOSED
HEIGHT
PROPOSED
Qj
PROPERTY TAX: ACCPUNT PARCEL NO.
14
0 a 14'zi, L44, Of S-0 e) too
XP
NEW RESIDENTIAL E] PLUMBING MECH,
'66VE
LOT RAGE
ALLOWED
REQUIRED SETBACKS (FT),,�
FRONT SIDE BEAR
,T ROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
�.PROPOSED
CEO
COMPLIAN R
ADDITION COMMERCIAL.
'CHANGEOFUSE.
z
.0
REMODEL MULTIFAMILY SIGN
CL
..,PAR ING
',AEOD PROVIDED
LOT�AREk�
I PLANNING �REVIEWEO_BY DATE .
GRADIN
REPAIR 6 FENCE
�. �: CYDS FtI'
:REMARKS
OTHER.
to DEMOLISH 0 TANK
11 GARAGE RETAINING WALL,, FIRE SPRINKLER'
F RE ALARM
z
CARPORT ROCKERY
(rYPE OF USE, B E S OR ACTIVITY) EXPLAIN:
rz
Mki!�R_241
CHECKED BY
U ION
E
OCCUPANT
0
I
A
R7
GROUP;�2/
to
W
NUMBER NUMBER fiF
CRITICAU/M
SPECIAL INSPECTION
OCCUPANT
a
OF DWELLING
AREAS
AD
o
STORIES UNITS
NUMBER '7
REQUIRED 0 YE
JAREA
LOAD
D RK
(5CRIBE WO
E
t�E
REMARKS
PROGRESS INSPECTIONS, PER UBC I 08/FINAL INSPECTION REG-0
FA4'MA -IrW �60a - CC? 9 (cit
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HF4TJOURCE GLAZING % LOT SLOPE %
f.Building,permit City Surcharge
PLAN CHECK N25�1 VESTED DATE
Plumbih
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISDDAYS
PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
et
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
M
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 MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp. Total Amt. Due
XO
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
I HERESY 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-
This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ON 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.
...-St"
0 IALS SI TUBE DATE
SjGNATURE qbWNER R,�G�. DATE SIGNED
IA9�5)
771-0220
REILEA§ED BY- DATE
ATTENTION
M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING