303 DAYTON ST.PDF11111111111111
13879
303 DAYTON ST
ADDRESS:
0
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS.: DETERMINATION: Ej Conditional Waiver 0 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: hdgg
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT FILE. LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#: oc
GEOTECH REPORT DATED: //Aw
STREET USE / ENCROACHMENT PERMIT #: 49 S�
WATER METER TAP CARD DATED:
OTHER:
BLOCK:
LATEWDS'PsTornis\Street File Checklist.doc
PLANNING DATSTREET FILE'
NAME: -
SITE ADDRESS: DATE:
ZONING: PLAN. CHK#:-
�w (��!
PR?f T DESCRIPTION:
14
USE(S) PROPOSED: (9fj:iCC 4- f--db ALLOWED?:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (YIN)
CUP File:
ew
ADBFiLE#: 70�' OR DATE WAIVED:
PLANS MATCH APPROVED PLAN:
PARKING: I
Use: No. Spaces Required:
X (floor area, # employees, etc.)
Use: No. Spaces Required:
. X (floor area, # employees, etc.)
Total Required: Actual Provided: to
SETBACKS:
Required Setbacks:
Front: r-) LeftSide: RightSide: Rear:
Actual Set si Right Side: Rear:
nha-c-lb
From-
t: Left Side:
Street map checked for additional setback required? —_(Yes/No)
MAXIMUM FLOOR AREA:
Maximum Allowed:— Actual:
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Modulation Allowed?: Modulation Height:
Datum Point: Datum Elevation:
LANDSCAPING:
Matches ADB approved:
Bond:
SUBDIVISION:
I.,
CRITICAL AREAS #:
4Af11WpvmWPLANDAc.D0C . C ov-&- )
S9PA DETERMI,NATION;-'-�
SHORELINE REQUIREM:
LOT AGGREGATION REQUIREM:
OTHER:
Plan Review
-1
1� � k 1:
cAfl1c3\pcffnj%-FLANDAr—D0C
of EDAfo
C)
0 0
�j Riji �Ti i .
ENCROACHMENT PERMIT #: f-6 5--Oos�-
BUILDING PERMIT #:
RECORDING#: k-65'093611346
ENCROACHMENT PERMIT APPLICATION
PROPERTY OWNER NAME:0-hAt 16 M. &kmoah
PROPERTY OWNER MAILING ADDRESS:
&4 AAR. c:bMCNbc. u,,,4 qr W.2-0
BUSINESS NAME (for Commercial applications);
BUSINESS OWNER NAME
ADDRESS OF PUBLIC ENCROACBMENT:
Permanent structures encroaching upon any portion of public space, City right-of-way or easement area
shall meet all Code Requirements as set forth in the following chapter of the Edmonds Community
Development Code.
18.70 STREET USE AND ENCROACHMENT PERMITS
PERMIT ISSUANCE
An Encroachment Permit may be issued, at the discretion of the Development. Services Director, City
Engineer or their respective designee, for permanent structures encroaching upon any portion of public
space, City right-of-way or easement area, if the structures are placed in compliance with the above
referenced Code Section and the following criteria are met:
1. It has been concluded that the proposal will not adversely impact public space open to vehicular or
pedestrian travel;
2. Architectural Design Board approval has been granted or the process has been administratively
approved;
3. The proposal will not unreasonably interfere with the rights of the public; and
4. The proposal benefits the public interest, safety or convenience.
DESCRIPTION OF PROPOSED ENCROACHMENT: (include total square footage of encroachment and give
specific location such as, 5' west of face of curb and 10' south of c/l of driveway entrance) kVA&VbAAfAj
Rea K I 3� Aivio, 2' Soyt6 0+ -�ACe AtJb 4 t0a-F o-C h4ftij fmv&�
CAIWAce
SAEngr\Forms\Encroachment Applicati.on.doc Revised 2/6/04
APPLICANT TO READ AND SIGN
NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature, revocable by
the Cityper ECDC 18.70.040 and that no vested right is granted.
MDEMNITY.- The applicant understands and by hislher signature to this application, agrees to hold the
City of Edmonds harmlessfrom any injuries, damages or claims of any kind or description whatsoever,.
foreseen or unforeseen, that may be made against the applicant or the City ofEdmonds, or any of its
departments or employees, including but not limited to the defense of any legal proceedings including
defense costs, court costs, and attorneyfees by reason ofgranting this permit. In addition, the applicant
understands that helshe shall provide and continually maintain during the term of the permit a certificate
of insurance naming the city as an additional insured, with respect to liability, andproviding that it shall
be primary as to any other policy of insurance.
CODE APPLICATION: By signing the application below the applicant warrants that s1he has read or had
the opportunity to read Chapter 18.70 of the Edmonds Community Development Code and s1he
understands that all terms of the adopted ordinance are incorporated herein as ifsetforth in full and this
application andpermits therefore are subject to the terms of those Chapters.
SIGNATURE.��4_�aa DATE 14142w>_ 1414
&Property Owner
******* DEPARTMENT APPROVALS ***** FOR CITY USE ONLY *******
Planning Division Approved by: ADB#
Remarks:
Public Works Approved by:
Remarks:
ate
Engineering Division Approved bG���..�.Date
Certificate of Insurance verified by wzmmw —Date.
i�Sl I
Encroachment Agree
_pient sent to Cit Clerk for recording: Date
91114k 2_7710 4,
4�qoe—' �_
Receipt No: VAdrA
Issued By: Issue Date:
SAEngr\Fomis\Encroachment Application.doc Revised 2/6/04
When recorded mail to: CONFORMED COPY
City Clerk 200508301346 5 PGS
City of Edmonds 08-30-2005 03:47PM $36.00
121 Fifth Avenue North SNOHOMISH COUNTY) WASHINGTON
Edmonds, WA 98020
SPACE ABOVE THE LINE FOR RECORDERS USE
Assessor's Parcel No.:a?7Q.3.V30040.C&00
Applicant: (2AAP-Jes ;T. _gPE&iseer, .
ENCROACHMENT AGREEMENT
This ENCROACHMENT AGREEMENT ("Agreement") is entered into between the
CITY OF EDMONDS C'City"):andCh&f,1t_s, t+. "ee%t1c1,q o_hA 14&V4 a
C'Owner[s]"), ifiaccordance with.Chapter 1830 of the.Edmonds Community Development
Code. t sq, —r-2,7,. A-3
1. The'Proper Owner is the owner of that certain real property located at
-pA-qJnt-J siae&
0 within the City of Edmonds,
Washington, Assessor's Parcel Number
0
and more particularly described as follows ge-e- "A, a & "A
..or
as described in Exhibit "A" attached hereto and incorporated herein by reference.
2. The Easement.. The City right-of-way adjacent.to owner's property or an.
J
existing easement used for (�trike those that don't apply s >0ad, alley, trail, sidewalk,
bikepath, pedestrian easement, sanitarysewer, *water, storm, o er
1. The Encroachment. The City hereby covenants and agrees. and grants its.
permission to Owner t6'allow6;EF_
it at
-PA; 6,12-
to remain in a portionof the wayj asemen
Cit� -ri t A p�rtial site plan, scaled 121=20
showing the'location of the encroachment is attached. as - Exhibit- 'V.' and -incorporated b
y
reference. This Agreementis subject- to the following terms and conditions:
I of3 -
a. The. encroachment shall be installed and maintained in a safe and
sanitary condition at the sole cost, nisk, and responsibility of the owner and its successors in
interest.
b. The Owner shall.agree at all times to indemnify and hold the City free
and'harmless from any and -all -claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair. or removal ofthe structure installed hereunder,
including any loss, damage or expense arising out of (1) loss or damages to property and (2)
injury to or death of persons.
c. The' Ownermust remove or rel I ocate any part of the encroachment
-w . ithin ten (10) days or such other time as specified in the notice after receipt. of it from the *
City Engineer, or the City Engineer may cause. such work to be done and the reasonable cost
thereof shall constitute a lien upon the property.
d. Whatever rights and obligations were acquired by the City with respect
to the easement shall remain and continue in full force and effect and shall in no way be
affected by City's grant of permission to construct and maintain the encroachment structure
e. The property owner is required to provide and continually maintain
during the term of the permit a certificate of insurance naming the City as an additional
insured, with respect to liability, and providing that . it shall be primary as to any other policy
of insurance. A copy of the insurance certificate shall be rovided to the City at the beginning.
p
of each calendar year, no later than the 21" day of January.
4. Entire Agreement. This Agreement constitutes the entire agreement between
the parties. with respect to the matter.hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
5. -Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in writing. by United States. mail, first class, postage pre -paid,
registered or certified with. return receipt.- requested, or by other comparable commercial
means and addressed as follows:
ff to the C�W
City.Engan eer
City of Edmonds
121 Fifth Avenue North
Edmonds,'WA 9.8020
Kto the Owner. -
which addresses. may be changed.from time.to time by providing notice to -the other party in
the manner.described. above.
-2 of 3 -
6. -Waiver. City's consent,to or approval of any act or omission by Owner shall
not constitute a waiver of any other default by Owner and� s . hall not be deemed a waiver or
render unnecessary City's consent for approval.to any subsequent act by Owner. Any waiver
by City, of any default must be. in writing and shall not be a waiver of any other default.
concerning the same or any other provision�ofthe Agreement.
7. Successors and A�signs.' This Agreement shall be binding arid inure to the
behefit.of the parties hereto and their respective legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference in any subsequent deeds to the
property, but any failure to do so does not invalidate this provision.
.8. Capaci Each party. represents that the person(s)� executing tins. Agreement
on behalf of such party has- the authority to execute this Agreement and by such sign (s)
i ature
thereby bind such party.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this
day of 20
OWNER(S)--
1�y: 1AA By:
STATE OF WASHINGTON
COUNTY. OF. SNOHOMISH
0,Au-, les 1�7, eeee �1,v eAnj 9VOI
This day, personally app* d before me, `e
eare _koea_geiewl,;&� 7
to. me known to be the person(s) . who executed the within and foregoing document and , that
-hel ey ez, signed the same as (hislherltheir) -1A- e free and- voluntafy act
shelth AA
and deed for the us7eand purposes therein mentioned'.
Votary Publi6
Z60
�,OTAq
Theld or Printed Name
z
.0
'0(�PA'. 7,
MY Commis� expires:
on
'0 41b
BER N
WAS0
CITY.
OYEDMONDS.
by'
ENGINEERINGDrVISI0N\
-3ofl-.
�x
LEGU -DE,
Comm6nd'
dng Ot the NEmm er zf P-a nd
Ppyton st-eets In 'the dty of Edmidnds, Sndhomisb doanty, Wa�shlm'
gton, gnd
ing 't quarter of.the southeast- q6art�r of s�_-�ctoqt,2, tow
b6' , In the northeas. nshio.
2-7, north range 3eastW,M then -e ilOrth alcng- tl3e east boundary. line
. . . . 1.1 c of said
street, 60 feet;.thence easberly along a Me partjl,�l wtth the -south boundary
line of fands formerly belorYgIng to Eda F. Ruzet, 75 feet tl-knc4- so
pOrinton the n6fth line of Dayton- str �-- wNch Is 7.5 feet ea -of the pQlnt Dr
6L St
bq -g -e stal'ong Oe north flne of Qa� str - -7tS, f
ginnii) 0:4enc we
n -eet. -eet to. �h! e
-qf IZO
ginning,
Z/x
.4 cLy.
zzz/
Ex 30, 75.00'
R/W
(TV)
(TYP)
'11-wl=Apc��r-liwlll� zltis�)
Lu
GARAGE FLOOR PLAN
2703230044450D
SEE ACHITECTUAL PLAN, US BkNl< CORP
Lu p I SHEETA OF 7 FWDETAILS
PARKING
AREA 4,500 Sq. FT.:k LOT
rfs' MP)
P. 24'
cl IKE R ACK PRO 5TjAGINO
AREPA � TEMP.
B 6HMAfiK cv) R
EN EASEMENT W/OWNE
TOP WESTERLY UE
tN FIRE HYDRANT 875,
48.58
DAIM WLIW
S:4( X
&
EX am
4
OFA&EWAIX
a
ix 34! PARIC NO LANE
R/W
SET' TACK &oW NO ---- - -- DAYTON STREET
—V. STREET INIERSEQnOm 0
OF PRemouic . ..... . ..........
'RECORDED BftASS--OISC
MON. BASED ON
--77
'A' R.P. MAILS. N -B91915' E
I T ?LA N
S,
0
DATE (MWDDNYYY)
ACORD
. CERTIFICATEOF LIABILITY INSURANCO GR C SR. � m, 08/19/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hall -Conway -Jackson, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND. OR
P.O. Box 8010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Mill Creek WA 98082-8010
Phone:425-368-1200 Fax:425-368-1290 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: First Specialtv Ins. Corp.
Charles Greenberg . . I INSURER B:
Marsha I. Dickow-Greenberg
Triad Law Group INSURER C:
126 Third Avenue INSURER 0:
Edmonds WA 98020 INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN K
LTR
Auu'�
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DDIYY)
POLICY EXPIRATI N
DATE (MWDDW)
LIMITS
A
X
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
ICLAIMS MADE rX] OCCUR
FGL 229004868000
08/18/05
08/18/06
EACH OCCURRENCE
$ 1,000,000
AMAI E 'U 'ENCI 1-u—
PUREMI ES (E. . urence)
$100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
rx-1 POLICYF—] jPERCO� F__] LOC
PRODUCTS - COMP/OP AGG
$2,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
AUTO ONLY: AGG
$
$
EXCESS/UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
Ifixes
E6,describe under
S AL PROVISIONS below
C ' JA- U� _[7
TWORYSL MIT E
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEEI
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I LXCLU51ONS ADDED BY ENDORSEMENT I 5PPE;IAL PROV151UN5
It is understood and agreed that the city of Edmonds is named as an
additional insured.
Revised to correct policy number 8-19-05.
CERTIFICATE HOLDER CANCELLATION
City of Edmonds
Building Division
ATTN: Jeanne
121 Fifth Avenue North
Edmonds WA 98020
CITYEDMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. I . / .01
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)
L -Nichol
@ ACORD CORPORATION 198
6THLET FILE
STREETUSE PERMrr APPLICATION
F #% /—T� /�'
NAME OF APPLICANT:
NAME OF BUSINESS-__
MAILING ADDRESS� jaQ 6tk
CONTACT PERSO N AND PHONE NUMRER:
J(-0r7173
��201k —4
i�� - -441 - �0 0571
ADDRESS OF PUB5LIC USP: 3tn.3 144P—d
Describe the public place or porCiorl of
-public space to be utilized:
t?h type of use desired
W5 0 r— Y/1044
Specify the length of time for use: AE00b
1VOTE: 7he Issuance of this permir is rinderstnod by the applicant to be of a temporary nature and that no %,esred±ig11_ts,.
grantra.
INDF111VITY.- The applicant understands and by hiiAer"signafure to this opplication, agrees to hold the City of Edmond;
harmlessfrom any Injuries. damages or claims of any kind or description whatsoever, Jnreseen or unforeseen, that ma ' Y
be made against the applicant or (he City nf E, dinonds, or any ofits departmen.t-. or employees, inciruding bur norlimited'
to the defense or any legal proceedings including defense costs, court costs. and attorneyfees ky reason ofgranting this
permit In addition. the application understands that the City shall be provided a Certificate ofInsurance to Indemnity
and hold harmless the City of Edmondrfrom a// claims andlor property dainnge, and naming the City of Fd)nonds as an
addItional Insured
COI)PAPPLIC47YON.- By signing the applicalinn below the applicant warrants that.vhe has reador had the
opportunity to "ad Chapter 18 of the Fdtnondr Community DeveInp,nent Code and.vhe understands that nil rer"is nf the
adopted ordinance ore incorporated herein as If serforth in full and this application and permits therefore tire subject to
the terms of that Chapter.
r-1
M
S'I*RUSEtIO.DOCJLCi/2-95
SIGNATURE OF APPROVAL FROM ABUTTING PROPERTY OWNERS
When applicable, if the street use proposal directly impacts any adjacent business or private property owner
the applicant must obtain written approval from the affected parties. Note, this requirement is evaluated by
City Staff and, when required, the applicant will be notified.
dognature
signaturd
Address
Address
Signaturq_......Address
Signature Address
DO NOT WRITE BELOW THIS LINE --FOR CITY USE ONLY
Planning Division Approved By___.� �ta> ADB# AM-iq'-1, V Date C
Public Works Approved By
Fire Department Approved
-D--at-
n - -pprove
-.
�Police-Dfl_piiftfi6 tA--__"dE 3iA
Uertincate of insurance Venfi Date -F-1
4*e gineering Division Approved B Bond Date -7/6
mrsorComm t 25�9�r —
a k enS: 15*P ZAS" V F_ 11/0/ FS 0 A/ PtAW 0 n A M tJ :(A v%-Pp d
- P� I
"-7-
STREET USE PERMIT#
RELEASED BY
-Y-0
BUILDING PERMIT 0-?,6 DATE OF ISSUANCE
Stweho.docj1g6/98
--7,9
L/11-6119
ACQ��D CERTIFICATE OF
DATE IMM/DD1YY)
LIABILITY INSURANCE 9/07 99
PRODUCER
Aon Risk Services, Inc. of WA
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
1420 5th Avenue, Suite 1200
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle, WA 98101
COMPANIES AFFORDING COVERAGE
COMPANY
206-749-4800
A Assoc. Indemnity Corp. (F.F.)
INSURED
COMPANY RECEIVEE)
rine Business International
B
t, Sound, Investments
COMPANY SEP 0 9 jogg
1 Sixth Avenue, #1301
C
Sea
attle, WA 98121
COMPANY UNUOPUENT SERVICES CTR.
D CRIC OF EDuONDS
COVERAGES
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.
Co
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMM/DDNY)
POLICY EXPIRATION
DATE (MM/DDNY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
s 2,000,000
X
PRODUCTS - COMP/OP AGG
s 2,000,000
COMMERCIAL GENERAL LIABILITY
MXZ80742814
9/07/99
9/07/00
CLAIMS MADE OCCUR
FX-1
PERSONAL & ADV INJURY
s 1,000,000
EACH OCCURRENCE
s 1,000,000
OWNER'S & CONTRACTOR'S PROT
DAMAGE (Any one firo
s 11000,000
-FIRE
MED EXP (Any one person)
$ 10,000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
.............
.......... . ...................
...... ................................
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXC ESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYEI�� LFABILI1 Y
OTH-
IER
..................
EL EACH ACCIDENT
$
EL DISEASE - POLICY LIMIT
$
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
EL DISEASE - EA EMPLOYEE
$
OFFICERS ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
RE: 303 Dayton Street, Edmonds,:WA.
City of Edmonds is named as an
Additional insured as respects the above location.
.CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Edmonds
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Building Division
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
121 5th Avenue North
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Edmonds, WA 98020
OFOitYM_ KIND UPON THE COMPAN�n ITS-z-AG%TS OR REPRESENTATIVES._
AUTOa-PRESENTATIVt- - 396092000
4�
MD 25-S (1195)
OACORD CORPORATION 1988: