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324 MAIN ST.PDFiiiiiiiiii lill 14160 324 MAIN ST ADDRESS:' TAX ACCOUNTIPARCEL NUMBER: nfTff nMTI- P PDA41T f'KTP1,11 QTPTT(Tt rVP1- COVENANTS (RECORDED) FOR: CRITICAL AREAS:— DETERMINATION: E] Conditional Waiver 0 Study RequiredXWaiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATEI EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT FILE: SIDE SEWER AS BUILT DATED: /J241"e, v17— SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER:-tm I zolip -ffld) LID #: LOT: BLOCK: LATEMP\DS'rs\Fomis\Street File Checklist.doc When recorded mail to: City Clerk *a01100a2X7j-­ ­­­­--111 11111111111 milli lilt 1111 City of Edmonds 200110020367 - 121 Fifth Avenue North 10/02/2001 11:25 AM Snohomish Edmonds, WA 98020 P-0005 RECORDED County RECORDER'S NOTE: PORTIONS OF THIS DOCUMENT ARE POOR QUALITY FOR SCANNING. Le5Z�,,4L: SPACE ABOVE THIS LINE FOR RECORDER'S USE 996 Nz-, COP- J__o-r,6 7-,q k//_ YqZ 6 6,57� Assessor's Parcel No. I00 a 1/0 r-7- -Tli Alve-, F7- -rkl Project No.& Name: 4Wd. -41V6 A ?00 -bZ� .,�40 -7­72Y 4*6- 4 90X- 1-:E)e- 12-0 FF-7-0 POe t344 C- ENCROACHMENT AGREEMENT This ENCROACHMENT AGREEMENT ("A ient") is entered into between the CITY OF EDMONDS ("City") and WiGUAM �GRSOFI&r4 - ("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development Code. 1 The Proper . Owner is the owner of that certain real property located at ,32-V324 MMN 5-CP�EE , within the City of Edmonds, Washington, Assessor's Parcel Number w k -�"- 01CM5_0Z, and more particularly described in Exhibit "A" attached hereto and incorporated herein by reference. Business owner, WNCT9 A-9CktfTC­(_1_M is the business owner of that certain real property noted above. 2. The Easement. The City currently owns an existing easement over, under, and across Owner's property for street, alley, sidewalk, other ( which is described in Exhibit "B" attached hereto and incorporated by reference. 3. The Encroachment. The City hereby covenants and agrees and grants its permission to Owner or Business Owner to allow to remain in a portion of the City right-of-way/easement. A plat map showing the location of the encroachment is attached as Exhibit "C" and incorporated by reference. This Agreement is subject to the following terms and conditions: a. The encroachment shall be installed and maintained in a safe and sanitary condition at the sole cost, risk, 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 - I - construction, maintenance, use, repair or removal of the 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 Owner must remove or relocate any part of the encroachment within 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. 4. Entire Amemen . This Agreement constitutes the entire agreement between the parties with respect to the subject 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: If to the Cit : City Engineer City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 If to the Owner: which addresses may be changed from time to time by providing notice to the other party in the manner described above. 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 shall 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 of the Agreement. 2 0- 2- 7 0 111 0 0 '2 0 3 60 0 7. Successors and Assigns. This Agreement shall be binding and inure to the benefit 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. Capacity. Each party represents that the person(s) executing this Agreement on behalf of such party has the authority to execute this Agreement and by such signature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this day ofsqo—o--��,, 20&q 0 .7R( B . =L_ By: STATE OF WASHINGTON COUNTY OF SNOHOMISH This day, personally appeared before me, /,I'd M 15� V-.g V-4 to me known to be the person(s) who executed the within and foregoing document and that (helshelthey) signed the same as (hislherltheir) &'--i free and voluntary act and deed for the uses and purposes therein mentioned. Notary Public L 0-t itg y Typed or Printed Name My Commission expire CITY OF MONDS By: E GINEERING DIVISION G:\SHAM\TEW\BUILDINGUiANDOUrZncroachAgm.bc -3- �EXH1617- 14 Legal :EDMONDS PLAT OF BLK 016 D-02 - BEG :NE COR LOT 6 TH WLY ALG G ST 40FT :TH ANG L 90* FOR 120FT TH ANG L ... V01:1 Page :26 E .5x 3 � *-rcV 7/Z// Z -3 le-Y" >o 70 g 70 77 0 Alg A,, o 77 ly, Ay, 10.1y ar ri EL CAPIT'"Aff"' (A CON 0 1 4-051 31H 4-046 4H+H4H+H+ :4-041 4-. (6782) _ J#� L H tv ly-O."y Hy I 1:4- 4-082: 4-042 80 X 4-054 :4-039 i+H-tVvAY 4-049 4-040 + D DAYTOW — - - — - - -ST - ------- ................ to 'XI to :C SEWAGE + " : 1% 4-057+ H4H4 '4,jLo T :r Q '"0110020367 ENCROACHMENT PERMIT ROUTIN6 FORM PERMIT #: 2001 -.= DATE APPLICATION RECEIVED: ADDRESS OF PUBLIC USE: 3. -? z7l z22az� 6 PROPERTY OWNER: ONCE YOUR REVIEWIS COMPLETE., PLEASE ROUTE TO THE NEXT DIVISIONIDEPARTMENT ON THE LIST. * * * PLEASE ROUTE IN THE ORDER SHOWN * * * PLANNING DIVISION Date Stamp Received: LED) ET PUBL ORKS Date Stamp Received: F-] ENGINEERING DIVISION Date Stamp Received: J IJ �". 2 �4. nm1s,K*3 F-1 DS ADMI�HSTRATION Date Stamp Received: APPR OVAL SIGNA TURES AND REMARKS OR COMMENTS ARE TO BE MADE UNDER THE "'DEPARTMENTAPPROVALS'-SECTION ON THE PERMIT. RAengfformsTricroachment pennit routing IFA OV ED_4 0 si— . I gc)'J ENCROACHMENT PERMIT APPLICATION PROPERTY OWNER NAME: mu'oalm �(IL5R-gN Phone(20(Q6Z3-431a PROPERTY OWNER MAILING ADDRESS:?,, 4 �5- 1, G sa . 15SAduAU. LA),A CY.8 0 2,1 961 45U BUSINESS NAME for Commerical applications: W(Ak-re ADDRESS OF PUBLIC USE: '-�2-+ Mt�J Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of sidewalk, 10 foot City utility easement along north property line, etc): -C>F- SIOUPALk- F-6(L VAK)GLM6 Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet long, etc.): Lkh� S160 Specify the length of time for use (i.e. awning for life of building, espresso cart for summer months, etc.), ?��L M �' onva NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature and that no vested right is granted INDEMNITY.- The applicant understands and by hislher 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 departments or employees, including but not limited to the defense or any legal proceedings including defense costs, court costs, and attorneyfees by reason of granting this permit. In addition, the application understands that the City shall be provided a Certificate of Insurance to indemnity and hold harmless the City of Edmondsfrom all claims andlor property damage, and naming the City ofEdmonds as an additional insured. CODE APPLICA TION.- By signing the application below the applicant warrants that s/he 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 infull and this application andpermits therefore are subject to the terms of that Chapter. &I PROPERTY OWNER/BUSINESS OWNER Encroachho.docjlglO/00 El CRITERIA OF PERMIT APPROVAL The applicant shall follow the noted conditions on the building pen -nit. For applications that do not require a building permit the following criteria shall be maintained at all times. Provide safe pedestrian travel for sidewalk encroachments. Maintain a clear zone of 44 inches minimum. See definition of clear zone below. > Exterior light fixtures, banners and flags must be a minimum of 7 feet above City right-of-way. > Maintain clear landings on the exterior side of all required exit doors of 44 inches or no less than width of door, measured toward the street. > No projections into City alleys are permitted unless the projection exceeds 15 feet above pavement surface. > Do not block illumination from City light fixtures or hang objects from City light standards. > Architectural projections from buildings must be approved by the Design Board and conform to Uniform Building Code requirements. A building permit shall be required for such projections. > Maintain 3 feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts and valves. > Bistro dining tables and chairs must be placed in accordance with City Ordinance No. 3293. > Merchandise racks, espresso carts, flower planters, benches must not be located within the "clear zone". > Ramps require a separate building permit and must conform to UBC standards. Clear Zone Definition: Clear Zone refers to an area 7 feet in height and 44 inches in width providing a level, safe walkiniz surface along the public sidewalk (i.e. measuring 44 inches from edge of street tree grates or newspaper stands toward place of business and from the ground up to a height of 7 feet). ------------------ DEPARTMENT APPROVALS --- FOR CITY USE ONLY ------------------- Planning Division Approved B6i,,. Q ., -.f 1—cAZ Date -7 10� �b. . oADB# Dcc) Remarks or Comments: Public Works Approved By Remarks or Comments: ��, ffl� Engineering Division Approved By &Vt' . Bond Date-6116)(01 Remarks or Comments: /70/ AAW 9,Xr 70,50 s Certificate of Insurance Verified By Easement Agreement sent to City C ENCROACHMENT PERMIT# :::?,00/— QQQ(-� ISSUANCE DATE RELEASED BY BUILDING PERMIT # RECORDING # Encroachho.docjlgl 0/00 P_ -I DATE (MM/DD/YY) ACOM - CERTIFICATTUF LIABILITY INSURANCEW JUN 20 01 PRODUCER HUDSON INSURANCE AGENCY, INC. P. 0. BOX 1940 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 101 E. THIRD STREET POLICIES BELOW. THE DALLES OR 97058-0381 COMPANIES AFFORDING COVERAGE PHONE: 541-296-2268 FAX: 541-296-9427 INSURED COMPANYA: ALLSTATE INSURANCE CO. S C WAITE COMPANY ARCHITECTS 324 MAIN STREET COMPANY B: COMPANY C: EDMONDS WA 98020 COMPANY D: COMPANY E: 6UVLKAt3L0 THIS IS TO CERTIF Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDNY) POLICY EXPIRATION DATE (MMIDDffY) LIMITS GENERAL LIABILITY 050701718 SEP 5 00 SEP 5 01 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any One Fire) $ CLAIMS MADE OCCUR MED. EXP (Any One Person) $ A PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ _GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGE. $ 7 POLICY F1 PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per. accident) $ PROPERTY DAMAGE $ GARAGE LIIABILITY� AUTO ONLY - EA ACCIDENT $ AUTO OTHER THAN EA ACC $ H_�N�; AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU_ OTHER I EMPLOYERS' LIABILITY TORY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT 1 $ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS THE CITY OF EDMONDS IS NAMED AS ADDITIONAL INSURED. THIS IS FOR THE SMALL SIGN THAT STEPHEN WAITE IS INSTALLING. VL. CERTIFICATE'HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE CItYOF EDMONDS BUILDING DIVISION THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE -SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 121 5TH AVE N. EDMONDS, WASHINGTON 98020 Attention: AUTHORIZED REPRE NTATIVE 7 ACORD 25-S (7197) Certificate # 2805 t-4 Q Q " I When recorded mail to: City Clerk &=iieQi283Mi_­ ""' Milli 11111111111111111111 Jill fill City -of Edmonds 200110020367 121 Fifth Avenue North 10/02/2001 11:25 AM Snohomish Edmonds, WA 98020 P-0005 RECORDED County . RECORDER'S NOTE: PORTIONS OF THIS DOCUMENT ARE POOR QUALITY FOR SCANNING. L6Z�AL: SPACE ABOVE TMS LINE FOR RECORDER'S USE 9Z6 Ne Assessor's Parcel No. 110 F-7 —7// AAle, J_ q0*F0.4_, IZ- 0 Fr 774 Project No.& Name: ;:57t,�7/40- 111A112-- 4AWW. -4/06 4 ?t)-* ,�o -7--/W lige- / 2- 0 P7 7 -0 PO 2 91-4- C, ENCROACHMENT AGREEMEENT This ENCROACHMENT AGREEMENT ("Agreement") is entered into between the CITY OF EDMONDS C'City") and _ W i U 1A 14 0 KS 006�14 . ("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development Code. he —Prove Owner is the owner of that certain real property located at ........... within the City of Edmonds, Washington, Assessor;s Parcel Nf��b�er� and more particularly described in Exhibit "A" attached hereto and incorporated herein by reference. Business owner, gm�_WALU., is the business owner of that. certain real property noted above. 2. The Easement. The City currently owns an existing easement over, under, and across Owner's property for street, alley, sidewalk, other which is described in Exhibit "B" attached hereto and incorporated by reference. 3. The Encroachment. The City hereby covenants and agrees and grants its permission to Owner or Business Owner to allow - 'j& M UA I ki(a 5 16 N to remain in a portion of the City right-of-way/easement. A plat map showing the location of the encroachment is attached as Exhibit "C" and incorporated by reference. This Agreement is subject to the f6ll -owing terms and conditions: a. The encroachment shall be installed and maintained in a safe and sanitary condition at the sole cost, risk, 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 - I , construction, maintenance, use, repair or removal of the 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 Owner must remove or relocate any part of the encroachment within ten (10) days or such other time as specified in the notice after receipt of it from the City Engineer, or the City. Engineermay 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. 4. Entire A2reemen . This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes and replaces all other agreements, oral or written,. between the parties with respect to the subject matter. 1 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: If to the C : City Engineer City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 if to the Own q_g which addresses may be changed from time to time by providing notice to the other party in the manner described above. 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 shall 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 of the Agreement. -2- ,�IUOIIUV20367 0 1 0 7. Successors and Assigns. This Agreement shall be binding and inure to the benefit of the parties hereto and their respective legal representatives, successorsi 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. Capacity. Each party represents that the person(s) executing this Agreement on behalf of such party.has the authority to execute this Agreement and by such signature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this 7' day of 20 Oq ONB - By: STATE OF WASHINGTON COUNTY OF SNOHOMISH This day, personally appeared before me,\1/1- / NA r-� to me known to be the person(s) who executed the within and foregoing docwument and that (helshelthey) signed the same as (hislherltheir) Agig free and voluntary act and deed for the uses and purposes therein mentioned. "low Notary Public L A ILI - 449,0 Al Typed or Printed Name My Commission expires�l) CITY OF MONDS By: E9G'INEERING DIVISION Cr.\SILAMTEMPaUUMINGR4NWM�Erma"gm.dw - -3- X"'.00 110020367 �Exli 16 Ir /I Legal :EDMONDS PLAT OF BLK 016 D-02 - BEG :NE COR LOT 6 TH WLY ALG G STAOFT :TH ANG L 90* FOR 120FT TH ANG L Vol:l Page :26 110"1'020367 4�-� .,)(#I,ej7- c-'v ,--� 9 - 5x 31 -/- N 71VI Ae -3 ---- 4c.,?M 3 06, 70 774 70 "A"N" 4) OV o fe, %am U UAPI IAN (A CON 4-051 ...... 4-046 +H+H+H+H+N .............. 14-041 + H (67,92) 4-082 H j 4-042:1+ . ............. - ...... i .... 00 f 00 VIEW 4� +H m 1 4-054 AY 4 4-039 0 +Z 0 ZA x + 4- 9 194 -.0 114-040 4-04 - DAYTeN -------- ST ------- ............. ['&PH+HI4 :loot I ........... + to SEWAGE 4-0671 T :F 20+0110020867 7 ""e� I km-- rv"�� T OAT �u Sol L NIP4 AN' Villate8by R i've( 'up MCC "Y"IAX WIN, "Z-K' ZEN— sNyj 70", "S'P 0 W', 141 _J PUBLIC IN( 1M.03 'cz WROW— VOW A-T W 4 "A"j- , P40 j)ate!jtsrujj lit 11 Am Stump Received; Vol' Is 0'V E 11 Afo . si— . 1 S9\3 ENCROACBI\4ENT PERMIT APPLICATION PROPERTY OWNER NAMEE: �ULIAM Phone(WO 6 Z 3 43 to PROPERTY OWNER MAILING ADDRESS: ?� 49 61 t(,-zp�A- s-T- x55A w.A c�&ozj aim BUSINESS NAME for Commerical applications:_ W(Ak-re ADDRESS OF PUB'LIC USE:— VAAW Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of sidewalk, 10 foot City utility easement along north property line, etc): OV02AE�NO Ne-F_�A C>E SIMAPAL(�- F�)(L WXK1G*LMG SlEdJ Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet long, etc.): 419"4 W� SIM 1 i-k1ki Specify the length of time for use (i.e. awning for life of building, espresso cart for summer months, etc.), NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature and that no vested right is granted. MEMNI771- The applicant understands and by hislher signature to this application, agrees to hold the City of Edmonds harmlessftom 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 departments or employees, including but not limited to the defense or any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In addition, the application understands that the City shall be provided a Certificate of Insurance to indemnity and hold harmless the City of Edmondsftom all claims andlorproperty damage, and naming the City of Edmonds as an additional insured. 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 if setforth infull and this application andpermits therefore are subject to the terms of that Chapter. IGNATURE TY OWNER/BUSINESS OWNER Encroachho.docjlglO/00 0 CRITERIA OF PERMIT APPROVAL The applicant shall follow the noted conditions on the building permit. For applications that do not require a building permit the following criteria shall be maintained at all times. > Provide safe pedestrian travel for sidewalk encroachments. Maintain a clear zone of 44 inches minimum. See definition of clear zone below. > Exterior light fixtures, banners and flags must be a minimum of 7 feet above City right-of-way. > Maintain clear landings on the exterior side of all required exit doors of 44 inches or no less than W*idth of door, measured toward the street. > No projections into City alleys are permitted unless the projection exceeds 15 feet above pavement surface. > Do not block illumination from City light fixtures or hang objects from City light standards. > Architectural projections from buildings must be approved by the Design Board and conform to Uniform Building Code requirements. A building permit shall be required for such projections. > Maintain 3 feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts and valves. > Bistro dining tables and chairs must be placed in accordance with City Ordinance No. 3293. > Merchandise racks, espresso carts, flower planters, benches must not be located within the "clear zone". > Ramps require a separate building permit and must conform to UBC standards. Clear Zone Deflnition: 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 (i.e. measuring 44 inches from edge of street tree grates or newspaper stands toward place of business and from the ground gp to a heigJit of 7 feet). ------------------ DEPARTMENT APPROVALS --- FOR CITY USE ONLY ------------------- Planning Division Approved BQk-.. ().n- - +h..,aB# acol—SZ Date-7/a-o 10 1 Remarks or Comments: Public Works Approved By Remarks or Comments: Engineering Division Approved By Remarks or Comments: A&/ *-, , Certificate of Insurance Verified By Easement Agreement sent to City C ENCROACHMENT PERMIT#_cRC0/—e90Q(,o ISSUANCE DATE RELEASED BY BUILDING PERMIT# RECORDING # Encroachho.docjIgIO/00 U IL DATE (MM/DD/YY) ACOM. CERTIFICATTOF LIABILITY INSURANCEw JUN 20 01 PRODUCER HUDSON INSURANCE AGENCY, INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE P. 0. BOX 1940 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 101 E. THIRD STREET POLICIES BELOW. THE DALLES OR 97058-0381 COMPANIES AFFORDING COVERAGE PHONE: 541-296-2268 FAX: 541 -296-9427 INSURED comPANYA. ALLSTATE INSURANCE CO. S C WAITE COMPANY ARCHITECTS 324 MAIN STREET COMPANY B: COMPANY C: EDMONDS WA 98020 COMPANY D: COMPANY E: IAJV�wut'�.� 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDNY) POLICY EXPIRATION DATE (MMIDDIM LIMITS A GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE P�l OCCUR 050701718 SEP 5 00 SEP 5 01 EACH OCCURRENCE $ 500,000 FIRE DAMAGE (Any One Fire) $ MED. EXP (Any One Person) $ PERSONAL & ADV INJURY S AGGREGATE LIMIT APPLIES PER: POLICY F]PROJECT 171 LOC GENERAL AGGREGATE $ _dEN'L PRODUCTs-cbMPlOP AGG. $ —1 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 $ GARAGE UABlUTY HANYAUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS LIABIUTY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ WORKERS COMPENSATION AND EMPLOYERS'ILIABILITY I TWC STA;��. OTHER RY 1 7 E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT 1$ OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS THE CITY OF EDMONDS IS NAMED AS ADDITIONAL INSURED. THIS IS FOR THE SMALL SIGN THAT STEPHEN WAITE IS INSTALLING. %or-m i iri%,m I r. n%jL-ur-m I lvm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF EDMONDS BUT FAILURE TO MA L SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY BUILDING DIVISION OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. 121 STH AVE N. EDMONDS, WASHINGTON 98020 AUTHORIZED R7EPRE NTATIVE Aftentlon: ACORD 25-S (7197) Cerbficate # 2805 When recorded mail to: .City Clerk City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 #488110aao3G-". 200110020367 10/02/2001 11:25 AM SnohOMish P-0005 RECORDED County RECORDER'S NOTE: PORTIONS OF THIS DOCUMENT ARE POOR QUALITY FOR SCANNING. L6Z�.,4L: SPACE ABOVE TRIS LINE FOR RECORDER'S USE 996 A'-- CoP_ J-,o7-,6 7-11 17Z6- 6- 6-1 Assessor's Parcel No. 916 F--r —/ li A A);�, i- 12- o rr -rlq Project No.& Name: _5t4W AIV6 L ?0* cbc- ,�o /-7-77/ 4*6 90X- 12-0 F-F-7-0 Poe t344 C- ENCROACHMENT AGREEMENT This ENCROACHMENT AGREEMENT ("A m t") is entered into between the CITY OF EDMONDS ("City") and WiWAM ­ KSON�Kq ("Owner[s]"), in accordance with Chapter 18.70 of the Edmonds Community Development Code. I The Proper . Owner is the owner of that certain real property located at = 04=.!�fflq 0 150 F-19 _JF1_r1 within the City of. Edmonds, Washington, Assessor's.varc Um r F16 and more particularly described in Exhibit "A" attached hereto and incorporated herein by reference. Business owner, 1:3� �_ WA10'.. WIN (77W MCAWE�5L is the business owner of that certain real property noted above. 2. The Easement. The City currently owns an existing easement over, under, and across Owner's property for street, alley, sidewalk, other ( which is described in Exhibit "B" attached hereto and incorporated by reference. 3. The Encroachment. The City hereby covenants and agrees and grants its permission to Owner or Business Owner to allow-J& MM61M(a S16N to remain in a portion of the City right-of-way/easement. A plat map showing the location of the encroachment is attached as Exhibit "C" and incorporated by reference. This Agreement is subject to the following terms and conditions: a. . The encroachment shall be installed and maintained in a safe and sanitary condition at the sole cost, risk, 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 - I � 0 0 construction, maintenance, use, repair or removal of the 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 Owner must remove or relocate any part of the encroachment within 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 contm*ue 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. 4. Entire A2reement. This Agreement constitutes the entire agreement between the parties with respect to the subject 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: If to the Cit : City Engineer City of Edmonds 121 Fifth Avenue North Echnonds, WA 98020 If to the Owner: which addresses may be changed from time to time by providing notice to the other party in the manner described above. 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 shall 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 of the Agreement. 2- 200- Ala 110 O'D W� 6 0 0 7. Successors and Assigns. This Agreement shall be binding and inure to the benefit 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 this Agreement on behalf of such party has the authority to execute this Agreement and by such sipature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this dav of 200J R( ON B By: STATE OF WASHINGTON COUNTY OF SNOHOMISH This day, personally appeared before me, I Ld /4 e V to me known to be the person(s) who executed the within and foregoing do�ument and that (helshelthey) �e- signed the same as (hislherltheir) &�g free and voluntary act and deed for the uses and purposes therein mentioned. Notary Public 11\� V 4A2 A/ Typed or Printed Name My Commission expire CITY OF MONDS By: 7 ERGINEERING DIVISION G:\SHARE\TENQ\BUILDINGUiANDOUr%En=acMgm.doc -3- Emil 0 "F - - ,.r=, X11 16 17 /1 Legal :EDMONDS PLAT OF BLK 016 D-02 - BEG :NE COR LOT 6 TH WLY AiG G ST 40FT :TH ANG L 90* FOR 120FT TH ANG L ... V01:1 Page :26 0 0 ,�,y#XeI7_ el— 5X317N71Z1l k3Z_laM >o 4t- 70 Jyo > 77 p ly" ink, —ly 71 LL L;AtJI IAN (A CONDO) 1 4-05f 4-046 4+H+H+H+t"l+ �4-041 4- H4 (6782) 4-082 7 14 H H+ 4-0421, ............. co x + co VIEW 4-054 Isy 11 ' '42o43", I-Qff. 4-039 LAZA 4 4 046 COND oq 4-- _c Ink ...... 3' ! "ell ..... .......... co 3.: to Jj SEWAGE c + 4-057+ :F Lo to q 0 'o 1 [ 2 v U U a �J- f10110n2`3" . CA File No: b 0 Critical Areas Checklist Site Information (soils/ topography/ hydrology/ vegetation) 1. Site Address/ Location: '200:91 DtZ 2. Property Tax Account Number: 00-5-06-70000,3302- 3. Approximate Site Size (acres or square feet): 13, 900 5: f 4. Is this site currently developed? V'ves; — no. If yes; how is site developed? !!C4'-S1e 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet)., Other (please describe): 6. Site contains areas of year-round standing water: /VO ; Approx. Depth: 7. Site contains areas of seasonal standing water: 1v Approx. Depth: What season(s) of the year? 8. Site is in the floodway /- (2 floodplain __,f::�,_of a water course. 9. Site contains a creek or an area where water flows across the groundi'surface? Flows are year-round? &,,�± Flows are seasonal? — (What time of year.� Y 10. Site is primarily: forested M ow -shrubs mixed urban landscaped (lawnshrubs etc) 11. Obvious wetland is present on s ite: A. stuttykwid 7: V 6y; Critical Areas Checklist.doc/3.19.2001 Z� City of tdmonds Development Services Department Planning Division Phone: 425.771.0220 4c. %C)1� Fax: ' 425.771.6221 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 City Hall (Critical areas inventories, maps, or soil surveys). Date Received: 2f,4� City Receipt #-. Critical Areas File GA 0( - 1 (0 Critical Areas Checklist,Fee: $45.00 ,,pqte Mailed to ADDlicant: A property owner, or his/her authorized representative, 'Must fill out the checklist, sign 'and date it, and submit it t.o,.the City. The City will review the checklist, make a precursory site visit, and make a determination of the -subsequent steps necessary to complete a development permit application. I.. I 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 undersigned applicant, and histher/its heirs, and assign 's, 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 reasonable attorney's fees, arising from any action or infraction ba'sedrin whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify 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 appl�*Fation on the behalf of the owner as listed below. SIGNATURE OF APPLICANVAGENT DATE 7/,-t -s-/O/ Property Owner's Authorization By my signature, I certify that I have authorized the above Applicant/Agent.t.o 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. SIGNATURE OF OWNER DATE -7 A PLEASE PRINT CLEARLY Owner/Applicant: Name 'a-00 � i /v-% A Pi- a -v o c> 1 31 a Street Address L-./ 4 9 -ro 1-6 City State Zip Applicant Representative: Name Street Address City State Zip Telephone: 4D--) 6-)_� Telephone: Email address (optional): Email Address (optional): Critical Areas Checklist.doc/3.19.2001 APPLICATION for The City of Edmonds SEDE SEWER PERMlT EASEMENT No . ........................................... NEW CONSTRUCTION 0 REPAIRS 0 101-o8400 OWNER............... Block,— I Xalter ........................... I ............................... CONTRACTOR .................................................................................................. PERMIT No . ...................... 4 Main St. LEGAL DESCRIPTION: LOT No: ---------------------------------------------- BLOCK No . ............................................ ADDRESS........... ......................................................................................... Vol NAMEOF ADDITION ......................................................................................................................................... Dye Tested On Sewer June, 1972 Approved: DATE................................................ By ..................................................................... Mr. C. wayu Reid, Middl 324 gain St Edmonds, Wo Dear Wayne: Con be furnisht L.I.D. 131, Street. I!hl LRL:rf October 27, 1965 an eutiluate plans 01'. Casper v 1, 1965. Mr, James 14, Reld, K1404 3.24 Main Stl Edmonds. wx Dear Jim-. col a revised t] The revised plan refern and Rupaiks it -the Plannin ,include the Seotember 27, 1965 uested that lty of Edmonds. irsede the Clark, Coleman railable for I plan should A, The north a��of U966,4s not previouslY Included in B, to support C, affic.count plan and thoroughfare plan discussed). In addition to this Plant it Is requested that a strast plan be prepared for the area south of Main Street and between the City property an the west and Hbin Street on the east* (discussed with Leroy)' Yours very truly,, CITY OF EDMONDS LEIF R. LARSON city Engineer LRLirt 'PLANNING DATA: SIGtt i: *41 Name: Date: -o 1,1 0 C) (P SiteAddrbs9: Main .51ye,.e.+ Plan Check 0 + Project Description: pr-oj.t(_-hrJ53 '�,jpl Reduced Siteflan Provided: (9NO) I Zoning: Comprehensive Plan Designation: 90wV11-bWn Map Page: Corner Lot:KY'E—S) NO) Flag Lot: (YES 60�)) ADB File # (or datcwaiv�Dy TOTALAreap Typeofsi 9.1 Type of Sign Allowed in zone? Matrix conditions met? Allowed area per unit Unit TOTAL sign area allowed for this sign Proposed sign area Example Wall wAnternal illumination Yes, with conditions Yes sq. ft.fflneaift. attached wa# 41 ft. attached Wall 41 square feet 20 square feet Sign #1 P Mj e .7f� V1 L�o WA it Ifo X 2-cl.� X 7,57 LP Sign #2 Sign #3 TOTAL Sign Areatbr',Tenant1S&e- Max Permitted: Previous Total: X Fproposed Total: Sign Heigh Sign Type: �j aIVI V1 e9 MaxPermitted: At- I'C(46+' Actual Height: Sign Type: Max Permitted: Actual Height: Sign Type: Max Permitted: Actual Height: Sign Lohtiq4' Sign Type: �1 aA17 Proposed: Allowed in Zone: Sign Type: Proposed: Allowed in Zone: Sign Type: Proposed: Allowed in Zone: I 1-� M A X ( WA (I � � k ICA ,i5 1 vyt in ( h A oq qiv�� ) 'PLANNING DATA: SIGOO 11 STREET F=ILE Colors Proposed:,. le kx, 4, Cm Acceptaple?. C, --7 Requires ADB. Approva!'� J3 Q Sign Location If freestanding and 3-feet o� o�& (unless. a-fdhc"e) meets �etbabks? Required Setbacks Street: Side: Rear: Setbacks Street: Side: Side: Rear: LandsE�ping for Freestanding Signs Size: Critical Areas Determination M El Study Required Waiver Other Plan Review By: (I i r) 't, (, 0 6 6,1 - 4--- %"L� ST'RIEET FILE April 5, 1967 Mr. Earl Cline asociates, Inc. 98020 Re: Coronado Park - Sanitary and Storm Sewer Plan Dear Earl: In addition to the sewer charges indicated in my letter of March 31,, 1967, there is a $90.00 lateral charge for Lots 1 and 2, as the laterals wore put in by the City and not pr6viously assessed against the property. Yours very truly, EXIF R. URSON City Engineer By: Ron Whaley Assistant City Engineer LRL:rf ccs Public Works D4partment-,� COPY 4 'q, V. 6", rch A 1 1) W7 ar 1 n s�", )Ciated I11CO ReId . Middleton Ac,,( 'Q ;,"g-�.! �,q4gf I� -`3 2 1.1 14ain S t ve (-,Ct 98 0,20 �!,vdlirlpt on �-wl "t ido- Park "anitary, Pe U)ronz' �,Vtl -,lid Storm Sower Plan I'D car arl: We ubjact,plOn all 4 v" tllo 17011OW liavv veviavmd the s d Ilave fu(.1 I 9-1 ewer, im, appi: o 1. Dasig 'of sanit.iry.,s" n as olios-m. -g , V �P, of at6r pew�r "is Approved 20 Design, 14 T ym,b, oik ly fox� that portio, Within tho Pill). within vIling Ap'p' lII of' in th'od' of' contr A plo", 11oV each n ndividual',16t hauisl.' lot., a6 will be only on"A of handling i;*,v`�-,,'ij,' f.:Aowin grad s and the mea'n existing and proposed. f inisl for approval prior shall b6:'p b itte&',VoAwAepartment water ,.,u m q', 1�kl- � I.. I us - application for building:� Eli��ti�n lda'tum sla%ll be colitinulD, "I, ,4, the iq his plat we Al P Ir charges',, L:,Bnd of t ot for In regard to sewe 1.1). No, 94; .t �JlL'Ibe, no i.isficasment Fj e two lots Lots '�hrough- 6' Are. to' b4, 0`61111 ted to t1la faciliti 9 b d 'the ll-asis of $3.31 per" d 4!:v -n, . -1 411d, will� 'lid* �ia L.I.D. lo.' 4� 'A' ront, foot 1.lots T and- 6,,*per your 510sign hook 111) to fac t .. ..... z0h a goo, for thape vfo Kr alopq tho,P pro dec by the dev r All -ha -Aes all W-uie baned on $5.50 per,,, zoirm fro aae(. on thene c , T t i4t foott 30U.UO &jkdoigi for. tho­14,�,)tv; iu (vi fo)-lovio a pf, NIL� 41"! V. -:0 J �arl Cline p Age 2' 316 19G7 Lot No, Assessment, ? N Q Charge 2 50 300.00.minimum charge 3 4 300.00 5 300.00 A� 6 300,00t 7 423,43 420,33 TOTAL FOR.,VLAT 6- $20043.7 Thie above assessments do not Laclude,trunk "0 aswer,pemit charges. KY. f 7; ,vy f:F you have any quostionia concernog, the foreFoiug, ploase -contact -me. a Yours very truly Lur R. LARSON C�vy Engineer ex Sot onj,!� 3, 'By: Ron Whaley Assistant City Engineer e AW:rf Awr X,:77W 04 !4S December 23, 1970 XOid, Mi4, "*ton and Associates, Inc. 324 f$ain Street Ld%Ond$v Washington 98020 Attn% Jerry Lovell Ro: Underhill property at 9110 main street bear Jerry: Please stake the northwest property corner of the subject property at your earliest convenience, As discussed previously, the estimated cost is $35.00, The ewner stake apparently was loet during amotruttion of Main street. Yours very truly, CITY OF LDMONDS Richard H. Allen Ansistaut City Engineer IWA t cj p �j S i-"EET FILE T'i April It. 1960 Mr. Co Wayne Jon" Raid, Middlotoft & Assoai*Usg Inc. 324 *&,in Street Ldmondog Washington 94020 Door Waynot Pursuant to the City Councils direction, you are hereby authwisod, to proceed with sagineoring plans and specifications for the installation of swmrs under L.I.D. go. 161. It is requested that the Main Street sower Installation design be 000rdinatod with John Brooks* of Cray & Osborne, AT 4-0860. Yours very truly, cxTY or rimom LEIF R, LARSON city Eftineor LRLtrf "Lly opt�, I t ? 4 CITY of EDMONDS BUSI&S LICENSE APPLICATION DATE* LICENSE NO. Civic Center Edmonds, Washington 98020 City Clerk Phone 775-2525 ANNUAL FEES PENALTY AFTER FEB. 15 0 HOME OCCUPATION CLASSI YEAR_j LIC. EFFEC. DATE INSTRUCTIONS: IREA $10.00 (A) ADDITIONAL $5.00 El • All items must be completed. 0 SMALL BUSINESS. or application will. not be ac- RE C.EIPT NO. DATE PAID' $15.00 (B) ADDITIONAL $7.50 El PRINT 'X' IN SPEC. BOX cepted. `-1 711 C) El Business with 10 or FOR ISSUE OF • Sign and return application EEE PA!D,_ I PENALTY PAID CORRECTED more employees ADDITIONAL,$25.00 0 r I LICENSE WITH `0 with fee. Renewals received . L', . I L_J___I _L___j 'LC'ACTION. $50.00 after February 15 must pay 0 NEW APPLICATION (LA) penalty in addition to fee. � L: YJ RENEWAL (LB) NEET FN t-' NEW BUSINESSES AFTER 141— D CHANGE (LC) JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD) NAME OF FIRM BUS IN E�S-PHON NO.. OF EMPLOYEES ACICF.MIT MAILING ADDRESS 3 NATU R k--OF-,BUSI N ESS-----'-" 4 A I Ni T INTFRI[C]P OFCFIL�ATINI,' EDWINDS A 9 8 0 b U9 ,.�LU INDIVIDUAL PARTNEASH I P CORPORATION 3--�, fA A I ',I S T (S) (C) HOME ADDRESS T 8917 19?N0 ST S,4 HOME PHONE FDATE OF BIRTH PLACE 6 SOCIAL ��EURIT!m�M�ER 0 / 00 / fj 0 0 S AIK 11 S 471-;�0-5116 EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE "I C F 0 13 - I ( 1 - 5 (PLEASE LIST TWO) (2) NAME & TELEPHONE RICE 1) -7(1--J�25 WASHINGTON STAI . E TAX NO. APPLICANT'S SIGNATURE DO NOT WRITE BELOW THIS LINE STAFF REVIEW: FILL IN LAND USE CODE,-UFIR NUMBERS, ZONING, E . TC. *CHECK APPROVAL OR DISAPPROVAL, DATE, AND SIGN. IF- DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST. PLANNING DEPARTMENT E�'APPROVE ED DISAPPROVE DATE LAND USE CODE ZONING CODE SIGNATURE CONDITIONAL USE PERMIT' COMMENTS DEPARTMENT DATE ,?,ILDING APPROVE 0 DISAPPROVE SIGNATURE Building 31 Permit 0 Hotel/Motel 0 Apt. Bldg. * Office Bldg. (A) (0) COMMENTS: Occupancy Ej Restaurant (R) Group 0 Hosp/Nurs Home (H) CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS,STUDENTS) JCM 0- School (S) ,FPE DEPARTMENT DATE -"2 U. F. 1. R. Ix APPROVE 0 DISAPPROVE SIGNATURE COMMENTS: POLICE DEPARTMENT APPROVE 0 DISAPPROVE. DATE 2, SIGNATURE ZX;;�4 Z�L COMMENTS: PUBLIC WORKS DEPARTMENT EJ APPROVE 1:1 DISAPPROVE DATE S I G N AT U R E L COMMENTS: