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420 MAIN ST
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1994
STREET 1# PUBLIC WORKS DEPI
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STREET USE PERMIT APPLICATION
NAME OF APPLICANT:
NAME OF.BUSINESS
MAILING ADDRESS:
CONTACT PERSON AND PHONENUMBER:
ADDRESS OF PUBLIC USE: 4c�
Describe the public place or portion of public space to be utilized:
Attach a plot plan.
Specify the type of use
desired: _<1/42
Specify the length of time for use 110AQF)c��17��
NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature and that
no vested right is granted
INDEMN17Y- The applicant understands and by hislher signature to this application, agrees to hold the
City ofEdinonds 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 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 ofgranting this permit. In addition, thel'
application understands that the City shall be provided a Certificate ofInsurance to indemnity'�and hold
harmless the City of Edinondsfrom all claims andlor property damage, and naming the City ofEdmonds
as an additional insured
CODE APPLIC4 TION.- By signing the application below the applicant warrants that s1he has read or
had the opportunity to read Chapter 18 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 and permits therefore are subject to the terms of that Chapter.
SIGNAT ATE
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. This requirement is evaluated
by City Staff after the initial submittal of the application.
S�gnature Address
Signature Address
Signature Address
Signature Address
DO NOT WRITE -BELOW THIS LINE ... FOR CITY USE ONLY
Planning Division Review: ADB#
Approved By_ Date /I
Public Works Review: Approved Byn Date
Fire Department Review: Approved B ate
Police Department Review: A proved B Date_Z/—j 0 z/1
p
Permit Coordinator Review: Certificate of Insurance Verified qzl
Engineering Division Review: Bond Required Amount $ /b
Approved By -Dated 1 9 4__
Remarks or
Comments:
PERMIT # OF ISSUANCE
RELEASED Bya RECEIPT
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FISSUE DATE (MM/DD/YY)
10/28/94
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nODUCER
YNIS C2AW2CAY2 93 ISSUED AS A MAYYER OF INFORMATION ONLV AND
1_P_
CONFERS NO RMHYS UPON YNE CERTIFICATE HOLDER. THIS CERTIFICATE
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, i ckison Insurance Agency, Inc.
DOES MOT AMEND, ENTEND OR ALTER THE COVERAGE AFFORDED BY THE
0. Box 160
16
POLICIES BELOW.
COMPANgES AFFORINMIG COVERAGE
Edmonds, WA 98020
(206)771-7900
COMPANY A
LETTER Mutual of Enumclaw
COMPANY
LETTER B
INSURED
COMPANY
LETTER
Janice Trickell dba
Cinderella's
420 Main Street
Edmonds, WA 98020
COMPANY
LETTER
COMPANY E
LETTER
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 tTHIS
r
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.
CO
LTRI
TYPE OF INSURANCE
POLICY NU�.'
3LICY EFFECTIVE
IATE (MMIDD/YY)
POLICY EXPIRATION
DATE (MM/DDtYY)
LIMITS
GENERAL LIABILITY
BODILY INJURY OCC.
$
A
X COMPREHENSIVE FORM
B027800
10/6/94
10/6/95
BODILY INJURY AGG.
$
X PREMISES/OPERATIONS
PROPERTY DAMAGE OCC.
$
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
X PRODUCTSICOMPLETED OPER.
X CONTRACTUAL
INDEPENDENT CONTRACTORS
PROPERTY DAMAGE AGG.
$
BI & PD COMBINED OCC.
$ 1,000,000
BI & PD COMBINED AGG.
$ 1,000,0 -
PERSONAL INJURY AGG.
$ 1,000,000
X BROAD FORM PROPERTY DAMAGE
X X PERSONAL INJURY
AUTOMOBILE
LIABILITY
ANY AUTO
BODILY INJURY
(Per person)
$
BODILY INJURY
(Pe I
r acc dent)
$
ALL OWNED AUTOS Priv. Pass.
Other Than
ALL OWNED AUTOS Priv. Pass. I
PROPERTY DAMAGE
$
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
BODILY INJURY &
PROPERTY DAMAGE
$
I
COMBINED
EXCESS LIABILITY
EACH OCCURRENCE
Is
AGGREGATE
$
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
EACH ACCIDENT
$
AND
DISEASE —POLICY LIMIT
$
EMPLOYERS' LIABILITY
DISEASE —EACH EMPLOYEE
$
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
As respects insureds sign, the City of Edmonds is additional insured
City of Edmonds
0 - 5th Ave. N.
onds, WA 98020
Om
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
IRA DATE T F, T7
EXPIRAIV DATE T F, T , H.E—I§�SUIN(j_—C9MPANY WILL ENDEAVOR TO
DAYS NOTICE
MAIL,=:— DAYS RITTEN NOTICE TO THE ER F A E H DER NAMED TO THE
B I I T OL
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FAI CHTI
LEF-1 BUT FAI RE TO IL CH NOTICE HA M E NO OBLIGATION OR
C S LL I POS
T Y_
LIAB TY OF NY KIN PON MPAN , M ENTS OR REPRESENTATIVES.
AUTHORIZ PRESEN TIVE RosX)
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CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works e Plan ning/Building - Parks and Recreation Engineering - Wastewater Treatment Plant
February 13, 1998
Janice Trickell
Cinderella's
420 Main St
Edmonds, WA 98020
Re: Street Use Renewal #94-18
As required by City Ordinance #2972, Street Use permit renewal fees are now
collected every three years instead of yearly. Please remit renewal fees in the
amount of $25.00 to the City of Edmonds, c/o Building Division, Permit
Specialist, 121 5th Avenue North Edmonds, Washington 98020 within 15 days of
this letter.
If this permit is no longer applicable i.e., you no longer utilize that portion of the
City Right -of -Way granted under the street use permit; please notify the Building
Division in writing so that we may cancel the permit. As permit holder it is your
responsibility to inspect the permitted sign for safety hazards on a yearly basis.
As a reminder, your Certificate of Insurance has expired. Please continue to send
updated renewals.
If you have any questions, please contact me at 771-0220.
Thank you,
Vivienne Myers
Permit Specialist
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
11?C` 9(3
.19
August 3, 1998
. I P
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning /Building * Parks and Recreation e Engineering - Wastewater Treatment Plant
Ms. Janice Trickell
13711 68th Avenue West
Edmonds, Washington 98020
RE: Cinderella's @ 420 Main Street, Street Use Permit #94-18
According to City records we are in receipt of the renewal fee for the referenced street use permit
however, the required evidence of a current certificate of insurance is still outstanding. At your
earliest convenience please contact your insurance carrier and request that a current certificate of
insurance be provided to the City. If your agent has any questions regarding the policy please
have them contact me directly at 425-771-0220.
Thank you,
�&w X46
Jeannine L. Graf
Building Official
9 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan