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THEWI-1 OP ID: HE01
R TIFICATE OF LIABILITY INSURANCE
DATE (MMIDDNYYY)
F 04114114
E16�,1rAi9dg5WD',KS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
THIS CER;f:1
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les). must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 425-489-4500
Hub International, NW/Meier
PO Box 3018 425-489-4501
Bothell, WA 98041-3018
Michelle Hedin
CONTACT
NAME:
PH E FAX
('VC�N . (AJC, No):
N Ext):
E-MAIL
-ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERA: Continental Casualty Cc
20443
INSURED The Wishing Stone
Janet Yoshikawa
INSURER B
623 Main Street
INSURER C
INSURER D:
Edmonds, WA 98020
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDDJYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 4,000,000
1p)REMMU1SF-EST0_RENTEr3__
(Ea occurrence)
$ 300,000
A
X COMMERCIAL GENERAL LIABILITY
5094590203
09/18113
09/18/14
CLAIMS -MADE 7X OCCUR
M ED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
I GENERAL AGGREGATE
$ 4,000,000
GEN'L AGG APPLIES PER:
1 PRODUCTS - COMP/OP AGG
$ 2,000,000
Roi F-1 LOC
POLICY F PE
IJC
$
AUTOMOBILE LIABILITY
MBINED SINGLE LIMIT
(CEO .. dent)
$ 1,000,000
BODILY INJURY (Per person)
$
A
ANY AUTO
5094590203
09/18113
09/18114
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PR P.ERT DAMAGE
(Pero . dent)
$
X NON -OWNED
X HIREDAUTOS AUTOS
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESS LIAB
CLAIMS -MADE
5094595935
09/18/13
09118/14
DED I X I RETENTION$ 10000
$
A
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDEI
(Mandatory In NH)
N/A
5094590203
STOPGAP
09/18/13
09/18/14
TWC STATU- T__1 OTH-
CRY LIMITS I I ER
E.L. EACH ACCIDENT
$ 1,000,000
E. L. DISEASE - EA EMPLOYEE
$ 1,000,000
mIt es, describe under
SCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S 2,000,000
A
Property
5094590203
09111/13
09/18114
BPP 30,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
It is understood and agreed that the City of Edmonds is nam d as an
additional insured for the sign/street use permit #20140228 located at,523
Main Street, Edmonds, WA 98020 in the City =ight-of-way. Coverage is
primary and non-contrIbutory.
City of Edmonds
Engineering Division
121 5th Ave N
Edmonds, WA 98020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@ 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Inte na,�
12100 NE 195th Street, Suite 200
RO. Box 3018
Bothell, WA 98041-3018
Office 425/489-4500
Fax 425/485-8489
HUB Intemationall Northwest, LLC
Surety Bonds. Insurance
Why We Are Using the Latest ACORD 24 & 25 Certificate of Insurance
In September 2009, ACORD revised the ACORD 24 and 25 Certificate of Insurance form. One of the
major changes was the removal of the cancellation notice provision. For the following reasons, we are
unable to issue an older edition of this form, modify the current form, or complete a proprietary form you
provide.
Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this certificate is
able to provide the cancellation notice you desire by endorsement. For example, the insured can cancel
immediately, so it would be impossible for the insurer to give you the notice you request. State law also
grants the insurer the right to cancel for reasons such as nonpayment with less notice than you require.
For the reason just cited, if our agency was to issue a certificate that provides the cancellation notice you
request, we would do so with the full knowledge that it would be impossible to actually give that amount of
notice under certain circumstances. As such, the certificate could be alleged to constitute a.
misrepresentation or fraud which could subject our agency and staff to serious civil and criminal penalties.
If a certificate purports to provide a policy right different from that provided by the policy itself, then the
certificate effectively purports to be a policy form. Policy forms must be filed and approved by our state
department of insurance. Use of nonfiled policy forms is illegal and.could result in legal sanctions distinct
from the assertion that the certificate is fraudulent.
Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms can be used
for one year from the time the new forms are introduced. Beginning in September 2010, this is another
reason we cannot use an older edition of the ACORD 24 or 25. Doing so would violate ACORD's
licensing agreement and, as a copyrighted document, federal copyright law.
Likewise, we are unable to modify the new certificate to add a notice of cancellation. ACORD forms are
designed to be completed, not altered. ACOFJYs Forms Instruction Guide says that a certificate should not
be use "To waive rights... To quote wording from a contract... To quote any wording which amends a
policy unless the policy itself has-been amended." In addition, our insurance company contracts only allow
us to issue unaltered ACORD forms.
We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our
insurance company contracts only allow us to issue unaltered ACORD forms. Many proprietary
certificates include broad, vague or ambiguous language that may or may not be incompliance with state
laws, regulations, and insurance department directives. Therefore, we cannot issue any proprietary
certificates that have not been reviewed by our state insurance department.
You may be interested in how the City of Atlanta, Georgia is now reportedly dealing with this issue based
on a very detailed study they conducted in 2008. They decided to no longer require direct notice of
cancellation; accordingly, no conforming certificate or endorsement required. They also require
contractors to fax a copy of insurer's cancellation notice within 2 business days of receipt.
For their complete analysis: htip://tinyuri.com/26quax8.
We appreciate your understanding of the legal restrictions on our ability to fully comply with your request.
This document was produced by the Independent Insurance Agents & Brokers of America (2010).
STrRIEE H E
MEMORANDUM
CITY OF EDMONDS
PLANNING DIVISION
TO: Street File No. 523 Main Street
FROM: Wendie Schulenburg, Associate Planner (�D
SUBJECT: Administrative Approval of a Minor Change in Exterior Building Colors
DATE: June 1, 1993
The tenant and owner of this subject tenant unit requested to change the color of the
canopy fascia board and the one column which supports the canopy. Both the canopy
and the support are in need of painting, and the change is from a cream color to a
"Peach Parfait" with a "Peach Velvet" trim. I visited the site and -reviewed the color
change, taking into consideration # the adjacent tenant unit colors. I felt that since the
minor change would not require a building permit and is not consider a significant
change to the building, that ADB review was not necessary, and that the color change
approval could be made at an administrative level.
A color sample is attached and the approved colors are indicated.
Syc"
COTY ED P E 0 M 0 PMUC-) 1F., HARVE H. HARRISON
IY I 1�, MAYOR
200 DAYTON ST. - EI)NiONDS, WASHINGTON 960,'�-O - (;.'C)t,) IP-1...
DEPARTMENT OF PUBLIC WORKS
0
Dear Resident:
March 16, 1981
On February 17, 1981, the Edmonds City Council passed
Resolution 488 for construction, reconstruction and repair
of deteriorated sidewalks. A public hearing will be held
in the Council Chambers at the"'Civic Center on April 21,1981
at 7:30 P.M. You are invited to at.t.c.nd-,this hearing for -
discussing repair of portions of deter iora"-ied`,,"-"`--�'
-si ewa1k
abutting your property"--�'The'improvement of S'idewalks in
need of repair at the expense of the abutting propertv
owner is provided bv City Ordinance, Chapter 7.20 and'
Revised Code of Washington, Chapter 35.68.
The areas needing repair have been marked in paint on
the sidewalk adjoining your property. Reconstruction and
repair of these sidewalks must be completed on or before
September 1, 1981. In the event improvements are not
completed within the above specified time, the City will
perform and complete the improvements at.the expense of the
abutting property owner.
This action is in response to many citizen requests
and pedestrian falling accidents which have been increasing
in recent years as a result of sidewalk deterioration and
increased pedestrian traffic.
Sincerely,
FRED F. HERZBERG '
Director of Public Works
BUILDING
DIVISIO'W
Applicant Fill
PERMIT - APPLICATION
Inside Heavy Lines
NAME JOR KAME
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:)RAINAGE IMPROVEMENTS REQUIRED
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:)RAINAGE PLAN REQUIRED
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iEPTIC TANK PERMIT REQ'D 1:1
NO,
-_LEVATION OF PROPERTY CORNERS
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& FOOTINGS REO'D
SEE ENGINEERING MEMO DATED
CHECKED BY /1 17—
SIZE I BUILDING SUPPLY SIZE
SIGN AREA JCOMENV. REVIEW
ALLOWED I PROPOSED PLETEI EXEMPT
REMARKS
VARIANCE OR CU 1PLANNING REVIEW BY I DATE
YARDS ILOT COVERAGE
NEW
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P LA N H
PLAN CHECKED BY
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REPAIR
PRE -MOVE
DINSP.
swim
POOL
R M AR K S
REMARKS
Z NUM13ER OF STORIES
INUMBER OF
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NATURE OF WORK TO BE DONE
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PLAN CHECK FEE.
PLAN
RECEIVED BUILDING
APR9 1981 PLUMBING
MECHANICAL
Dir. Of Public Works FENCE
SIGN
III "Applicant, on behalf of his or her spouse, heirs, assigns and
W
-) successors in interest, agrees to indemnify, defend and hold harmless
I the City of Edmonds, Washington, its officials, employees. and TAINING WALL
0: It claims for damages of whatever nature,
agents from any and a
SWIMMING POOL
x arising directly or indirectly from the issuance of this permit. Issu- I
SIDE REARI
NSTRUCTION I CODE 1HEIGHT
AREA OCCUPANCY _—JOCCUPANT
L
IGROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
ance of this permit shall not be deemed to modify, waive or reduce
any requirement of any city ordinance nor limit in any way the
0
PUBLIC UORKS DEPARTMENr CHEacusr
BUILDING PMUT REVIEW 3171*%& A/A/
(address) (date)
0
Street Rig�ht-of-`Way Exist
Z
Access Easements Existing
REQD
H
cd
Utility Easement Existing
REQD
W
Lot Per Subdivision Plat
Assessor
W
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy o)"ega;MeScript�on
Z
Review by
Date
Existing Water Main Size -19
Water Main Required A11A
Service Line Required
Hydrant Size Existing
94
Hydrant Reqd Per Fire Code IVIA
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
:3:
Water Yeter Charge Reqd.
Review by
Date. �Z� Z
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj
Dra:wing No - 5-, 1 e0 ./ 3-,t/ 71,-q-T
File No.
Side Sewer Availability /
P4
--
94
Sanitary Sewer Cony9ction Fee Reqd.
:3:
Review by_
Date
Open Ditch Existing__A�#
Reqd.
Culvert Reqd. A
Size
i:d
Catch Basin Reqd. &'A Ll-
Indicate on Site Plan M L;r
0
Shoulder, drainage maintain collection on
swale open runoff zg�Cez-�
Indicate an Site Plan
Soil Conditions and Ground Water Field Checked
Review by,
Date
Revised: MO-1977
0
Page 2
Revised: lv 10-1977
Az
DATE:
1117,1110 TO: Building Divisiol,
('01111"Ll"iLY DevelopmeriL F)c pa
FROH; E i i. n . eering Divisiol,
Public Works DeparLmenL
-7
SUBJECT: 37/ A
AfLer review of chc subject building pej.-mic IpplicaLioll,
the followinp commeTILS: e Ila v e
— P-A- I CI A J-0
Aj LT3M I
-7-n tq R- P�� 4 r PI —A Al
/I
DATE 11(2 �160 _FILE # 6 -'� _-
CITY OF EDMONDS
APPLICATION
to the
ARCHITECTURAL DESIGN BOARD
6 SITE PLAN
BUILDING PLANS (3): ELEVATIONS
LANDSCAPE PLAN
ENVIRONMENTAL DATA Receipt #
SIGN EXHIBITS (3)
PLAN MODIFICATIONS TO FILE NUMBER:
HEARING DATE /— -7—Sl
OWNE4tiREPRESENTATIVE �WAW PHONE
'21&0 MW W� S64W
ADDRESS c, WA� q?t77 ZIP CODE_(?<9/7'7
CONTACT PERSON PHONE S4Z_: &Qq 7
ADDRESS ZIP CODE
ARCHITECT/DESIGNER
PROPERTY ADDRESS
LEGAL DESCRIPTION
PLANS SUBMITTED FOR APPROVAL:
1. Building Plans — Preliminary Final—x
PHONE
ZONING j6 (�
Site Plan. Landscape Plan Elevations X
2. Sign Elevations Site Plan Landscape Plan.
3. Modification of previous approval
EXISTING USE OF PROPERTY
DESCRIPTION OF PROPOSAL
2129 4- 2 e-D
APPROXIMATE DATE WORK WILL BEGIN
ON PROJECT
6.1�3t
ESTIMATED TIME FOR COMPLETION OF
WORK
&
11 e>z-
I (we) hereby certify to the best of my (our) knowledge, that the statements and
information contained herein are, in all respects, true and correct.
of Ap�4cant)
12/78
CITY OF EDMO14DS PROJECT NAME
ENVIRONMENTAL ASSESSMENT DATE SUBMITTED 14/vi /1�0
The inforTriation on this form will be used to determine the effect of your action upon the
environment of the City of Edmonds. Please answer each question as thoroughly as possible.
I . LAND
Area
3 a Acttss- Soils Type
6v (,0
W
Limitations
WtJ6
Description
of topography (140' slope)
If grading
or filling will
Gradip'g:
Estimated cubic yards
—NOTE:
exceed 500 cubic
yards a grAding
and filling plan
must be sub -
Filling:
Estimated cubic yards
mitted with the
application.
Estimated
area to be paved (including
buildings)
Gaj-QV_r_' '�Itr_- ow
�iweD 40ceve(ep.
Estimated
area in open space (pervious
surface)
owc- e*4_(7AFC-)
2 . V.A T E R
Strea-,r, - Es,timated flow (cubic feet per second)
Will stream be altered? If yes, to what degree?
Other water bodies?
Impact on storm drainage Method of handling runoff
Adjacent to shorelines zone? Within 200 feet of MHHW7
3. VEGETATIO':
Type and approximate number of trees 00&)(6
Minimum diameter of trees to remain % of trees to be removed
Groind cover % to be removed
Proposed landscaping, if any
4. EXISTING LAND USE WITHIN 300 FEET RADIUS OF PROPOSED DEVELOPMENT:
Single Multi -
Vacant Family Family Commercial Other
North
South
East
West
5. CIRCULATION
Estimated increase in auto trips daily -
Availability of public transportation 80s SY1 re-m
6. AREA OF IMPACT
Neighborhood t%'-' City-wide Regional
7. EFFECT ON AIR QUALITY /00'vt7
8. CHANGES IN NOISE GENERATION W=__PY L4,M8 . WW PlnVC6
11178) %_
N
ENVIRONMENTAL CRECKLIST
Introduction: The State Environmental Policy Act of
1971, Chapter 43.21C, RCW, requires all state and local
governmental agencies to consider environmental values
both for their own actions and when licensing private
proposals. The Act also requires that an Environmental
Impact Statement (EIS) be prepared for all major actions
significantly affecting the quality of the environment.
The purpose of this checklist is to help the agencies
involved determine whether or not a proposal is such a
major action.
Please answer the following questions as completely as
you can with the information available to you. Where
explanations of your answers are required, or where you
believe an explanation would be helpful to government
decision makers, include your explanation in the space
provided, or use additional pages. You should include
references to any reports or studies of which you are
aware and which are relevant to the answers you provide.
Complete answers to those questions now will help all
agencies involved undertake the required environmental
review without unnecessary delay.
The following questions apply to your total proposal,
not just to the permit for which you are currently
applying or the proposal for which approval is sought.
Your answers should include the impacts that will be
caused by your proposal when it is completed, even
though completion may not occur until sometime in the
future. This will allow all agencies involved to complete
their environmental review now, without duplicating
paperwork in -the future. -
NOTE: This is a standard form b eing used I by all state
and local agencies in the State of Washington -for various
types of proposals. Many of the questions may not apply
to your proposal. if a question does not apply, just
answer it "not applicable" (N/A) and . continue on to the
next question.
S
ENVIRONMENTAL CHECKLIST
A. BACKGROUND
1. Name of Proponent
2. Address and Phone Number of Proponent
3. Date Checklist Submitted
4. Agency Requiring Checklist
5. Name of Proposal, if applicable
6. Nature and Brief Description of Proposal (including but not limited to
its size, general design elements, and other factors that will give an
accurate understanding of its scope and nature:
7. Location of Proposal (describe the physical setting of the proposal, as
well as the extent of the land area affected by any environmental im-
pacts, including any other information needed to give an accurate under-
standing of the environmental setting of the proposal):
t3l(S nl�,k 4S_ k)060 bcweif u�D MMU Y .6
8. Estimated Date for Completion of the Proposal jutic- /'7gZ--
9. List of all Permits,' -Licenses, or Government Approvals Required for all
Proposal (federal, state, and local — including rezones):
61j1C'OioG &�14(
I ftt:F�L_
10. Do you have any plans for future additions, expansions, or further
activity related to or connected with this proposal? If yes, explain.
A)O
11. Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain.
A)
12. Attach any other application form that has been completed regarding the
proposal; if none has been completed, but is expected to be filed at
some future date, describe the nature of such application form:
I
-I-
0 , 1 0
B.
ENVIRONMENTAL IMPACTS (Explanations of all 11yes"
and "maybe" answers are required).
YES MAYBE NO
1. Earth. Will the proposal result in:
a. Unstable earth conditions or in changes
in geologic substructures?
b. Disruptions, displacements, compaction
or overcovering of the soil?
c. Change in topography or ground surface
relief features?
d. The destruction, covering or modifica-
tion of any unique geologic or physical
features?
e. Any increase in wind or water erosion
of soils, either on or off the site?
f. Changes in deposition or erosion of
beach sands, or changes in siltation,
deposition or erosion which may modify
the channel or a river or stream or the
bed of the ocean or any bay, inlet or
lake?
)<
Explanation:
2. Air. Will the proposal result in:
a. Air emissions or deterioration of
ambient air quality?
b. The creation of objectionable odors?
c. Alteration of air movement, moisture
or temperature, or any change in climate,
either locally or regionally?
Explanation:
3. Water. Will the proposal result in:
a. Changes in currents, or the course
or direction of water movements, in either
marine or fresh waters?
b. Changes in absorption rates, drainage
patterns, or the rate and amount of sur-
face water runoff?
-2-
0
YES
C. Alterations to the course or flow
of flood waters?
d. Change in the amount of surface water
in any water body?
e. Discharge into surface waters, or in
any alteration of surface water quality,
including but not limited to temperature,
dissolved oxygen or turbidity?
f. Alteration of the direction or rate
of flow of ground waters?
g. Change in the quantity of ground
waters, either through direct additions
or withdrawals, or through interception
of an aquifer by cuts or excavations?
h. Deterioration in ground water -quality,
either through direct injection, or through
the seepage of leachate, phosphates, deter-
gent$, waterborne virus or bacteria, or
other substances into the ground waters?
i. Reduction in the amount of water
otherwise available for public water
supplies?
Explanation:
4. Flora. Will the proposal result in:
a. Change in the diversity of species,
or numbers of any species of flora (in-
cluding trees, shrubs, grass, crops,
microflora and aquatic plants)?
b. Reduction of the numbers of any
unique, rare or endangered species
of flora?
c. Introduction of new species of
flora into an area, or in a barrier
to the normal replenishment of exist-
- ing species?
d. Recution in acreage of any agri-
cultural crop?
Explanation:
MAYBE
NO
_1�
Y_
ly,
Y_
Y_
W-4
_X
5
-3-
0 " -
.
YES
MAYBE NO
5. Fauna.- WIll the proposal result in:
a. Changes in the diversity of species,
or numbers of any species of fauna (birds,
land animals including reptiles, fish and
shellfish, benthic organisms, insects or
microfauna)?
b. Reduction of the numbers of any
unique, rare or endangered species
of fauna?
c. Introduction of new species of
fauna into an area, or result in a
barrier to the migration or movement
of fauna?
d. Deterioration to existing fish or
wildlife habitat?
Explanation:
1
6. Noise. Will the proposal increase
exisfing noise levels? X
Explanation:— 1&)CRJ5AAC- or- PWPW Itiro 60(LO1(')4& kt&i,&
W-u4i ho rr) tgA�F�O -
7.
Light and Glare. Will the proposal
produce new li�ht or glare?
8. Land Use. Will the proposal result
in the a teration of the present or
planned land use of an area?
Explanation:
9. Natural Resources. Will the proposal
result in:
a. Increase in the rate of use of any
natural resource?
b. Depletion of any nonrenewable
natural resource?
Explanation:
-4-
YES MAYBE NO
10.- Risk of Upset. Does the proposal involve
i risk of an explosion or release of hazard-
ous substances (including, but not limited
to, oil, pesticides, chemicals or radiation)
in the event of an accident or upset condi-
tions?
Explanation:
11. Population. Will the proposal alter the
location,'distribution, density, or growth
rate of the human population of an area?
Explanation:
12. Housing. Will the proposal affect existing
using, or create a demand for additional
housing?
Explana tion: Me6e tO b�U3F, LDtjxC6Y6eS OF TOOC-A)7T OF-
13. Transportation/Circulation. Will the pro-
posal result in:
a. Generation of additional vehicular
movement? Y-
b. Effects on existing parking facili-
ties, or demand for new parking?
c. Impact upon existing transportation
systems?
d. Alterations to present patterns of
circulation or movement of people and/or
goods?
e. Alterations to waterborne, rail or
air traffic?
f. Increase in traffic hazards to motor
vehicles, bicyclists or pedestrians?
Explanation:. W(t4- t4c- MaNse 9W-TAALP ApAeg fa,114'�j
IRO QuotnwtJ AgeA Akee IlAeow_ n4ifnc wiL-4-
A (5 bl2k�[C 7-7-0.3 Ckiff"N6 DC!mA-PD r&- �LkM�X
j
-5-
YES MAYBE NO
14. Public Services. Will the proposal have
a7h effiCT up -on, or result in a need for
new or altered governmental services in
any of the following areas:
a. Fire protection?
b. Police protection?
C. Schools? Y,
d. Parks or other recreational
facilities? N
e. Maintenance of public facilities,
including roads?
f. Other governmental services?
Explanation:
&Oec- BoIL'Olfual W�m I. -Ike tPoucle
t�U&W447'--J' I I v
15. Energy. Will the proposal result in:
a. Use of substantial amounts of fuel
or energy?
b. Demand upon existing sources of
energy, or require the development
of new sources of energy?
Y-
-><
Explanation: �Jew t&vabf'�J6
&OuO724�
/,?JO Dr)�c& t()&Jz
Qr7LJZZ(Fs-.
16. Utilities. Will the proposal result in
a neeFfor new systems or alterations to
the following utilities:
a. Power or natural gas?
b. Communications systems?
c. Water?
d. Sewer or septic tanks?
e. Storm water drainage?
f. Solid waste and disposal?
Explanation: LL;'-W UL ADDIM-IiJ
G)g --- Pak)
'A
0 '
YES MAYBE NO
17. 'Humart Health. Will the propos al result
in the cr on of any health hazard or
potential health hazard (excluding
mental health)?
Explanation:
Aesthetics. Will the proposal result
in the obstruction of any scenic vista
or view open to the public, or will the
proposal result in the creation of an
aesthetically offensive site open to
public view?
Explanation:
19. Recreation. Will the proposal result
in an impact upon the quality or quan-
tity of existing recreational oppor-
tunities?
Explanation:
20. Archeological/Historical. Will the
proposal result in an aTteration of
a significant archeological or his-
torical site, structure, object or
building?
Explanation:
C. SIGNATURE
I, the undersigned, state that to the best of my knowledge the above information is
true and complete. It is understood that the lead agency may withdraw any declaration
or non -significance that it might issue in reliance upon this checklist should there
be any willfvl misrepresentation or willful lack of full disclosure on my part.
PROPONENT: ,
-7-
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . ..........................................
0
OVVNER-------- vtyx �.� ------------------------- * -------- * --------------------- ** ---------------- CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS
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LEGAL DESCRIPTION: LOT No . .......................................... --- BLOCK No . ............................................
NNAME
OF ADDITION .........................................................................................................................................
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Ap 01'. , / q 7=2
DATE.......................................... ..... By ... ..................................................................
CITY F EDMONDS
3ULDING QEPARTMFN'7_ I
WORK S �'_V APPROVED DIV PLMMS
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APPROVOI)AM
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Mma�-- 16502 4th Ave. N. E.
Shoreline, WA 98155
Phone 206-383-1429
Email mkinn2@comcast.net
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SWARM=
M. Kinnunen
DESIGNER
11111194"
V mak" 1'"^ -r-, latxj�
ffibi�gStoneNewLocationSignRev2.cdr
FILE NAME
ronaso"-
February 14, 2014
UMM -
.=8=IIIIiIi_
DATE
CUSTOMER SIGNATURE
—hanger
1/4"- 20
cm
.9
bolts
U
wl
silic.ned Into M
drilled hole
4-
M
00
with 11V
It
spacer
White
at
Sintra
Side View
Front View - Non illuminated letters - scale 1 1/2"= 1'- 0'
AJAR I -
DAT9 " " * -7 201-17
7 1-1phr":51-r
I ON ) -s�
DATE
The
Wishing
Stone
99 'h" STREET Fk�.88 square foot total Edmonds, WA.
�4 6, 1,
This original artwork is protected
under Federal Cpyrkht Law.
No reproduction of this design
concept Is to be made without
permission from Phase 1 Design.
tA
rn
r4
Ln
New Sigr
0
Z
16502 4th Ave. N. E.
Shoreline, WA 98155
Phone 206-383-1429
Email mkinn2@comcast.net
M. Kinnunen
DESIGNER
fthinotoneNewl.ocatiod�nllev2xdr
FILE NAME
February 14, 2014
DATE
A
REVISIONS
V
CUSTOMER SIGNATURE
17 2014
DATE
The
Wishing
Stone
Edmonds, WA -
This original artwork is protected
under Federal Copyright Laws�
No reproduction of this design
'cept is to be made without
permission from Phase I Des1pL