940288.pdf11
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USE
CITY OF EDMONDS ZONEPERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE APT n
OWNE-FI NAML NAML (IF tUSINESS ADDRESS j3 � r 76�
�� 1_ (ARILDE&N LEGAL DESCRIPTION CHECK SUBDIVISION NO LID NO
w MAII ING%A7r1HESS
O 1�� v t���'� �D� N�vv� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApprovVVed ❑.,
CA IV 111' TELEPHONENUMBER - EXISTING _1"' O / `V**4, �S 11 . �� REQUIRED DEDICATION RW et Use Permit
ed
+� "� 7C Y ��p Street Use Pequi Req'tl
Inspection Required
PROPOSED — Re, Cr NAME Sidewalk Re
C�1T�IL�La �F.StGtiN�R�tlP ING .
W
METER QIZEA LINE SIZE NO OF FIXTURES PRV REQUIRED H
I ¢
U ADDRESS , YE NO ❑ 3
U j �I T� REMARKS Q
a CITY ���� 1``'„ Z TELEPHONE NUMBER lir�r (�(J/�Q , �� w
Lei Y/'V?y�s.OSI� �A7/ 0
p �,,�� ' w
NAME \ /�I S� /��"r'/�� GAT *eve! £ G� L/ W
¢ ADDRESS
p _ 1 L r .� ENGINEERING MEMO DATF,�� /
¢ CITY ZIP I TEL HO E NUMBER
1 Gl� FIRE MEMO DATED REVIEWED BY cr
7��A 6i�� �3 - -/� �� W
STATE LICENSE NUMBER EXPIRATION DATE
�vLvCC� /_ lJ SIGN AREA SEPA VIEW JE01
Legal escriptilonn of Property - include all easements ALLOWED PROPOSED COMPLET EXEMPT I/Vt
Z ��� 1 SHOR INEN
O I, V V p� ,fir L s ,fir
~ E/I /�L f �- EX
5T/�Ll CT L`J VARIANCE OR CU PLA VIEW BY 3 f pA E
a.
¢ /q
(n �--
SETBACM FEET HEI LOT COVER GE i
w FRONT SIDE REAR Q z
u Property
Tax Account GM9004>r 0001 .. 40Z0::7A REMARKS a.
Parcel No. %ftap�� /
NEW RESIDENTIAL ® PLUMBING - `i����
L .2r.,s /
ADDITION � COMMERCIAL p MECHANICAL REMODEL El�/`� APT BLDG. El SIGN r ~ `� ) —U
REPAIR ® GR DI G CYDS FENCE X—� HECKEO�B TYPE OF CONSTRUCTION CODE occu PANT
DEMOLISH WOODSTOVE SWIM POOL /
INSERT ElHOTTUB/SPA SPECIAL INSPECTOR AREA f� OCCUPAN
REQUIRED YES � 112 61 LOAD
®SeGARAGE
C4QQUT ROCKERY WALL ❑ RENEWAL REMARKS
P0 (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN, PROGRESS INSPECTIONS PER UBC 305 Z
cc
�SiNv �ic+�t�.Y 'i2��tflEr -�-
rn NUMBER �- NUMBER OF CRITICAL 'C
o OF DWELLING AREAS ip
at STORIES ( - ,(,✓ UNITS NUMBER ideP ��y�
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) LIT—: (JOO C '
i° ^V' utr SF 4.si &v4L, FINAL INSPECTION REQUIRED
/X r, VALUATION FEE
//�� l/ T j� PLAN CHECK FEE /
6-`M.�� ��r BUILDING Q v�
HEAT SOURCE GLAZING .� )03
41PLUMBING
:a.
} Plan Check No. C� — MECHANICAL �l
�� ... rJ�
This Permit covers work to be done on private property ONLY. GRADINGIFILL e—
Any construction on the public domain (curbs, sidewalks, �-
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE [ •�
Permit Application: 180 Days 166.
Permit Limit: 1 Year - Provided Work Is Started Within 180 DaysSTORM DRAINAGE FEE
Applicant. on behalf of his or her spouse, heirs, assigns and ENG INSPECTION FEE
u s.iccessors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
i whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit. Issuance of this permit shall not be deemed to qscu6
modify, waive or reduce any requirement of any city ordinance
0 nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE / (c�c
provision."
1 hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz• AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• WORK NOTE^ Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTIC6: acknowledged in space provided.
5 NATURE 10v.NEA OR ENTI DATE SIGNED DEPARTYE'+'
O FI IAL S SI NATURE DATE
94 CITY OF
EDMONDS
CALL FOR PEDtTE
LEA. Wlj
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� � 11 oAAo
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — E• e YELLO:'J — Inspector
A CERT!cICATE OF OCCUPANCY HAS BEEN GRANTED UBC
0
v
0"er: THOMAS .i. ANn wan vm ., v
ago ,1g'1-
fl$t8 Posted
EXp i l'Gati on
80nd N0. 1289066 '
Premium: $1,650.00
I Acerif 3. htAUGH1rj%1
20 -57�f AVE X • EY UGNOS. WA 9E-= •} (nCJO 77 t.32a? MAYOR
COMi NNITY SERvIcES:
Public Wadta Pt&%,tng • Paiiu1 artd AecraauW Engineering P 0,M ENA�H�N�
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CITY OF EDMONDS
EARTH SUBSIDERCE PERFORMANCE BOND
DEGAS_ . Permit ���.�.
ace W6st, Edmonds�,W 98020
WHEREAS', THOMAS J. AND MARILYN�4o K. DEGAN hereinafterroerre
to as ' "The fleiva ", has ttgo9 � 'tute C y of Edtaonds o hereinafter
referred to as uThe City, iXI GOnStIrUCt: NEW RESIDENCE _
Iota ted at 15520 - 75th Place West within City m ts• ----
WHEREAS, as required LPY Ci:tY Ordinance #2661, this fortm w•tl'f
certify that this institutiar. 114s a bond "Or the above-referani;cd
Project. This bond is establishAd for restoration and/or other repw,rs
or stabilization measures, as req iced by Edmonds Coalmunity Developmout
Code Chapter 19.45450 A & Be
NOW, THEREFORE, the undersigned Pi�,incipal and bonding company,
AMWEST SURETY INSURANC CO ANY a corporation authorized to traiislict
surety bus ness in e s l o*F Waishington, hereinafter referred to as
"The Surety": agree and hiAd theiase]ves, their heirs.. executors,
admi nistratQrs and assisrns, unto the C9 ty i n the scam of
lawful money of the united SttxtQ according to the FallctHng terms and
1) The total suet indicated will b� withheld by tfiis institution frog
disbursements, _
designeeto any entity other than the Ce ty Of Edmonds or it's
2) . If the principal does not cctnpl6te all repaf rs r n4lor restoratiolls
within 24 hours of service of V'ritten notice, then, the Surety shall ,
upon demand by tho City rem4t to the C ty� within tern t10) days i:,f
receipt of said demand, the Fame-unt of this bond or such lesser amour t
as may be specified in the demand, so fxi.lt the repairs can be instaTled
or compTetdd immadiately to "UtY standards. Such funds shall also fee
Paid 'to the City for eraergency 4 :*apaa rs ti nde t+Aken to stab i i ze the site,
public improvements, or ut1 i 9 A es' acnd ror adjacent stmctures, .where it
Is impossible or impractical to prdivide that 24 hour notice to icormct•.
The institution steal] not, bc0 liable to th® owner for disbursement 60
said ,:Funds 'to the City of Edmonds gar on it's behalf_
r_
••`s _4
to
"Op ,
lrip
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to
City of Edmonds
Earth Subsidence Landslide Performance Bond
Page Two
}
3) In the event the Pri nci r411 f ai l s to comp'l cots any of the: above
repairs or restorations within the time period specified by the City,
its employees and agents shul1 have the right a{; their solo eieation to
enter onto said property for the Purpose or completing .the repairs.
This provision shall not be cc n'$trued as creating an obligation cart the
part of the City or its: representatives to complete such repairs or
restorations.
4) In the event any lawsuit is instituted by the CSty, the Principal or
the Surety to enforce the targis of this bond or to determine the rights
of any party hereunder, the propi1ing party in such. litigation shall
be entitled to recover #trot;, the lasing party its costs, including
reasonable attor neys ° feea p i nti..!^r ed as a result of sucil l aa1suit..
5) This bond shall remain in full force and effect until oc ,- cc�gt�nc:y of
the structure is granted and worri tten noti f mti on of bond rel eF.s�e is
ss : .
iaaued by the City. : -
DATED this da bf
..Zgjh �Apri1 n 19g4 '
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AMWEST SURETY INSURANCE COMPANY
So g Company er
V1,41.1A
t! icer a Kristine T. Byer ermlt C04r nator
Attorney -in -Fact City Of Comands
19515 North Creek Pk 3
*Mdress/Phone Bothell, WA' 980114200
(206) 485=6334
SURETY ACKOWLEDGEMENT
STATE OF WASHINGTON )
} S5.
COUNTY Of King )
On this 29th day of April '199i4 r before me:, the
undersigned, —s No ry . Publi e� and •for he state of Washington,, duly F
commissioned and sworn, per:;ontl Yy+appeared Kristine T. Snyer to me know
to be the Attorney -in -Fact Of Amwest Surer Insurance Company
the corporation that ei:ec*ted the fbregooing instrumonrr and
acknowledged the said inst.rMent to be the free and voluntary at:•t and
deed of said corporation, for the uses and purposes therein weratloned,
and on oath stated that. ''she was authorized to execute said
Instrument and that the se"i aWixe is the corporate seal of said
corporati or:.
WITNESS my hand and o ffi ai ai eaz hereto affixed the day any ! year
first above written. per
qir� [at Try ,a an nPita CYat• nt'
Was;,in9 ton
T'1T:Ji ? GI?
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• -890 19q,
CITY OF EDMONDS
250 - 5TH AVE. N. • EDMONDS, WA 96020 • (206) 771-0220 • FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works • Planning a Parks and Recreation Engineering
June 30, 1995
Amwest Surety Insurance Company
Attn: Kristine T. Snyer
195151`Torth Creek Parkway, #314
Bothell, WA 98011-8200
Thomas J. and Marilyn Degan
15520 75th Place West
Edmonds, WA 98020
Re: Earth Subsidence Performance Bond
Bond No. 1289066
The City of Edmonds hereby authorizes the release of the above referenced Perfi
Bond in the amount of $33,000. All interested City departments have inspected
and approved release of this portion of the bond.
S
If there are any questions contact the Building Division at 771-0220.
Thank you,
Sharon Nolan
Permit Coordinator
cc: File
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UTEMP/BONDSMOC
e Incorporated August 11, 1890 e
Sister Cities International — Hekinan, Japan
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NO IN IN 'a Iff ON 0 IN Iglo-
�N` �F�Y .,........,...,.,.,..
.dWO."WIN "Pd"IkaWl" Ihrlm"u UIL7U1JUUa7®0UC
VAL I'D`�FOO : .
�2���`�ONDS
EXECUTED ON OR AFTER
8-18-94
. r.'.'� (,,r•, �i "'. i,1'•!'Fi-0•r1'�'?F7r f• warY♦♦Y,��YY■
POWER NUMBER X
0263760�65 s�
This document is printed on inulti•colored security paper with hl:tck and red ink, with border in seal of Ablue ink and bears the Wised
mwert Surety Insurance Company (the "Company"). Only unaltered originals of this power of Attorney are valid. This
Power of Attorney is valid solely in connection with the execution and delivery of the bond noted above and may not be used
in conjunction with any other power of attorney. No representations or warranties regarding this Power of Attorney may be made
by any person. This Power of Attorney is governed by the laws of the State of California. Any power of attorney used in connection
with any bond issued by the Company must be on this form and no other form shall have force or effect.
KNOW ALL MEN BY THESE PRESENTS, that Amwest Surety Insurance Company, a California
tlir 14Cor w 1 does hereby make, constitute and appoint:
AS AN EMPLOYEE OF A.S. I.C. OF PORTLANO, OR
_3
its true and lawful Attorney -in -Fact, with limited power and authority for and on behalf of the Company as sure to execute, deliver and affix the seal of the Company thereto if a seal is required on bonds, undertakings {� ego ynances or other written obligations in the natre thereof as follows: �-
�l t' bonds up to $**1,6 00,0000001
r
Contract (Performance Payment), Court, Subdivision $*r3,000,000.0i
License & Permit Bonds up to $**3,000,000.00 r�
Miscellaneous Bonds up to $*"%Px3,000,000.00
Small Business Administration Guaranteed Bonds up to $**1,2500000.0Q
••v
and to bind the Company thereby. 'Phis appointment is made under and by authority of the By -Laws of the Company, which are now in full force and effect. All
CERTIHCAT'E
4 III
I, the undersigned secretary of Amwt :st Surety Insurance Company, a California corporation, R I DO HEREBY CERTIFY that this"Power of Attorney remains in full force and effect and has not been revoked At
and furthermore, that the resolutions of the Board of Directors set forth on the reverse, and that the relevant ; 1 provisions of the By -Laws ol' the Company, are now in full force and effect.
ld number —_ 1289066 Signed and sealed this 29th day of* —April 19 24•
0000263760 - 65
-- r OR00
Karen G. Cohen, Secretary Q�'air_'��;r�t�R.y��.r•�...�rrr;,'i•.^..•'r•i 1F�•(; •t?�"K^�,,',.'rr. (; •.r_J�/� /<J 1 �1�1❑lt7ti91[9R91l�RTQ11f11fa17l7r7�r■wwwwww...��� Al J e
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DATE REQUESTED:
TO: Permit Coordinator, Building Division
FROM: FIRE DEPARTMENT
ENGINEERING DIVISION
PLANNING DIVISION
OWNER ADDRESS 1552y gSrrfP6yd
PERMIT# O Z 22
ADB# INSPECTED ON I & HAa q*
A field inspection was conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the granting of:
Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released
Othr inspected
Landscaping is approved
PASSED FIRST INSPECTION - CONDITIONS NOTED
1•
2•
FAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR INSPECTION
2•
3•
4.
OCCUPANCY APPROVAL DATE 110 MA2 "115 BY Aa�&
FAILED FIRST INSPECTION DATE BY
RE -INSPECTED - APPROVED DATE BY
RE -INSPECTED FAILEDDATE BY
'•' 1L, i VS ;l; ..,.Y 17��•J:LJ+NWY, .aN J , I. ." r d;.') JJJrti t =.} r '•:H l.. '. 4 :.�*f !
1.
. ••� :; ti
RE -INSPECTED APPROVED DATE
'4 r 1�/6ltit r v -J: 1. ' ..'� .G J.' >- i - J �.4.it+ r i.. .1 r J .J J 1/
.4 n.•
FEES RECEIPT#14
OCCAPRVL/TXTRECEP/February.2, 1 yy
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rt .. -1 �('.., �, J7' Q h:., �l.tt� L,r. rri�'tu *,. -}: .'y �i... SV. j.•. ..111"`..l,oT. �..eMl•t.�i t•a_,.:,
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CERTIFICATE OF SINURANCE ISSUE DATE (MM/DD/YY) ,
"/. f.x y .. ,{✓ ...� �w _� rt •zn { 4 hf „e, MAY,1 _
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
INSURANCE SERVICES GROUP, INC. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE
P.O. BOX 33747 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
SEATTLE, WA 98133-9747 POLICIES BELOW.
PHONE: 206.467,0556
FAX: 206 369-7003 COMPANIES AFFORDING COVERAGE
COMPANY
A CONTINENTAL CASUALTY CO
INSURED COMPANY
DR. THOMAS AND MARILYN DEGAN B (CNA INSURANCE CO) '?•; ! '
COMPANY `
16620 - 76TH PL W C
EDMONDS, WA 98026 COMPANY
D
:OVERAGES i L %57'n �Ftl J �jNV ?: tj
THIS IS TO CERTIFY THAT THE 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DDNY) LIMBS
GENEY. GENERAL LIABILITGENERAL AGGREGATE S 600,000
COMMERCIAL GENERAL LIABILITY US000260331 MAR 22 95 JUL 26 95 PRODUCTS-COMP/OP AGG. S
�LAIMS MADE OCCUR. — `--r
PERSONAL & ADV INJURY S
OWNER'S 8 CONTRACTOR'S PROT. — -- ----
X US000250331 EACH OCCURRENCE _ $ — 6009000
FIRE DAMAGE(Any One Fire) S
MED. EXPENSE(Anv One Personbs
UTOMOBILE LIABILITY
I
COMBINED SINGLE LIMB
S
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
(Per Person)
$
HIRED AUTOS
BODILY INJURY
$
NON -OWNED AUTOS
(Per Accldenfj
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
A
UMBRELLA FORM
MAR 22 95
JUL 26 95
$
AGGREGATE
X OTHER THAN UMBRELLA FORM
EXCESS LIABILITY
WORKER'S COMPENSATION AND
STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT
DISEASE -POLICY LIMIT
S
THE PROPRIETOR/ INCL
PARTNERSIEXECUTIVEOFFICERS R
ARE: EXCL
DISEASE -EACH EMPLOYEE
$
OTHER
`" DESCRIPTION OF OPERATIONS/LOCATIONS/VICLES/SPECIAL ITEMS
RE: VERIFICATION OF INSURANCE REGARDING SINGLE FAMILY OWNER OCCUPIED DWELLING AT 16620 76TH PL W, EDMONDS, WA.
THE CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
260 - 6TH AVE NO
EDMONDS, WA. 98020
Attention:
OrE-�7'�i S��gs`
Ito
----I...
b01100
:� //��//������/��pp���� /����y//��{��� .r1 .r w+i-� Tr`(i'r'r rnt�t;.t rrM .n 1'" .,.... {a •,
. VlY11M�.r+.1!'�� Wi1�i s-r., � .•,lk, rt.SX;..li":1?-.Y-. r p.., c . tint { n.a, a>, r . .7
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
45 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, r.
BUT AILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF VY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHIOZRI REPRESENTATIVE
i
1 i
19
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS, 11#0
�Gac.tc7��, �.�L•i�s FOUNDATION:
Footing, ...................
Well.......................
Pier/Porch,,,,,,,,,,,,,,,,
Retaining Wall............
Slab Insulation ............
PLUMBING:
Underground ............. - J Z'1.3
�r
Rough -In ..•............ 0 ' 7� `•
C �o
/��� qA �E.��• j� Commercial Final........ too
SL,Acl3 D/1/ HEATING:
Gas Test "' ............. __ �—1 / !% 6
Gas r- in
�P�F l-e`t�CzGE�S
Equipment ................
Commercial Final.........
•C) f1,,oAEXTERIOR SHEATHING '
NAILING .
%-� ; FRAMING
I/, 7 *`Qt-o 10 INSULATION:
Floor Insulation ..........
Wall Insulation ............ .� -—� 0
�O �5 �e�u •Z✓�.T /f/i32wCeiling Insulation..to
.......
' )RADON
HEETROCK NAILING ......
PECIAL INSPECTION ...... - 't
•
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., oo.- MONITOR AT SITE .
/ FINAL APPROVAL
FOR OCCUPANCY.......:motK
•
COO? T000,010,
Z� L ,�.tl�e �l.Q,✓ �-' t/r9iltottl ECG f�+i yi-mil �OOPI&00
-- a