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-
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'"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
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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
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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
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:TH ANG L 90* FOR 120FT TH ANG L
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. 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-
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Legal :EDMONDS PLAT OF BLK 016 D-02 - BEG
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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)
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