20151027150246.pdfPROPERTY OWNE
BUSINESS NAME:
BUSINESS OWNER
ADDRESS OF PUBI
PERMIT #: EN! : r ( „ " a )M(
STREET USE AGREEMENT
DESCRIPTION OF PUBLIC USE:
18.70 STREET USE AND ENCROACHMENT PERMITS
17.65 LIMITED OUTDOOR DISPLAY OF MERCHANDISE
17.70.040 TEMPORARY USES; Bistro and outdoor dining
20.60.080 TEMPORARY SIGNS
PERMIT CONDITIONS:
The Property and/or Business Owner, v, agrees to meet all requirements of the
Code Sections referenced above as well as meet the conditions listed below for the temporary object(s)
approved under Street Use permit ENG ,
)0- It has been concluded that the proposal will not adversely impact public space open to vehicular or
pedestrian travel or interfere with the rights of the public;
➢ Requirements of the State Building Code, including but not limited to all provisions relating to disabled
accessibility and barrier -free design requirements shall be met;
➢ Architectural Design Board approval has been granted or has been administratively approved;
➢ Any mobile vending units shall be properly licensed pursuant to Chapter 4.12 ECC;
➢ All temporary objects, excluding approved awnings and wall signs, that project more than 24 inches
into the right of way shall be removed each day at the close of business or by l Ipm whichever is
earlier.
➢ Items shall be placed adjacent to the building and may encroach onto a maximum of two feet of the
public sidewalk; or in accordance with Bistro and outdoor dining code; or per an approved building
permit;
➢ The design and use shall comply with all requirements of State law, City ordinance and City policy;
➢ Storage Containers or Portable Storage Units, if approved, shall be limited to a maximum of three (3)
days in right of way. Such storage units will be approved per site specific determination of setback
from travel lane, etc. Approved reflective traffic control devices shall surround at all times;
➢ Safe pedestrian travel area, or clear zone, of 5 feet minimum width shall be maintained on City
sidewalks; (see definition of clear zone below)
➢ Exterior light fixtures, banners, signs and flags must be a minimum of 7 feet above City right-of-way;
➢ Noncommercial off -premise signs shall be only portable freestanding signs and are limited to six(6)sf in
size and no more than 3ft in height;
Revised 5111112 Page I oft
➢ Noncommercial off -premise signs are limited to a cumulative display time of 60 days per calendar year
(excludes campaign signs). If related to specific meeting or event then must be removed within 48hrs
following the conclusion of the meeting or event;
➢ Commercial off -premises temporary signage is prohibited, except for real estate signs as permitted by
ECDC 20.60.065.
➢ Clear landings of 5 feet or no less than the width of the door (whichever is greater), measured toward
the street, shall be maintained on the exterior side of all required exit doors;
➢ Illumination from City light fixtures shall not be blocked;
➢ No objects shall be hung from City light standards or Flower poles; and
➢ Three feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs, cleanouts
and valves shall be maintained.
Clear Zone Definition: A Clear Zone refers to an area 7 feet in height and 5 feet in width providing a
level, safe walking surface along the public sidewalk. Clear zone on sidewalks shall not include any
curbing, planting strips or ramps.
PROPERTY/BUSINESS OWNER TO READ AND SIGN
NOTE: The issuance of this permit is understood by the property/business owner to be of a temporary
nature, shall vest no permanent right and shall be issued and may in any case be revoked at the sole
discretion of the City per ECDC 18.70.040. By signing this application, s/he accepts responsibility for all
existing and/or future street uses. Property/business owner is responsible to continually provide a current
copy of the insurance certificate to the City.
INDEMNITY.- The property/business owner understands and by his/her 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 of any legal
proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In
addition, the property/business owner understands that he/she shall provide and continually maintain
during the term of the permit a certificate of insurance naming the city as an additional insured, with
respect to liability, and providing that it shall be primary as to any other policy of insurance.
CODE APPLICATION: By signing below the property/business owner warrants that s/he has read or had
the opportunity to read Chapter 18.70, 17.65, 17.70.040, and 20.60.080 of the Edmonds Community
Development Code and s/he understands that all terms of the adopted ordinance are incorporated herein
as if set forth in full and permits therefore are subject to the terms of those Chapters.
SIGNATURE '' ZL) DATE'
Property Owner/Business:'Owner
MAILING ADDRESS: PHONE:
FOR CITY USE ONLY
la IEngineering Ap�provl.�i� ;;,�� Date:
.
Revised 5111112 Page 2 of 2
ACC> rO CERTIFICATE OF LIABILITY INSURANCE DATE (MMI°DIYYYY)
^'° 1012212015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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 pollcy(ies) 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 NAME: NTAC' Wynn Ayers
Wynn Ayers(790333A) rEqu.xll: 425-771-3535 (.Ne� 425-776-7353
PHONE FA1i
400 Dayton St Ste C A00119S$: WaversO-farrnersaaent.com
Edmonds WA 98020-3584
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INSURERS: Farmers Insurance Exchange
21652
ROXANNE MARLIN
INSURER c .'Mid Century Insurance COn1Danv
21687
DBA: GARDEN GATE GIFTS & HOME DEC
INSURER D
407 MAIN ST
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EDMONDS WA 98020
INSURE.,. RF.
COVERAGES CERTIFICATE DUMBER:
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 INSUjZANCE 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.
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DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
407 MAIN ST, EDMONDS, WA 98020
IT IS UNDERSTOOD AND AGREED THAT THE CITY OF EDMONDS IS NAMED AS AN ADDITIONAL INSURED FOR THE STREET USE PERMIT
LOCATED AT 407 MAIN ST., EDMONDS, WA, IN THE CITY RIGHT-OF-WAY.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF EDMONDS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ENGINEERING DIVISION ACCORDANCE WITH THE POLICY PROVISIONS.
121 5TH AVENUE N AUTHOREZENRR]SENTATWE
EDMONDS WA 98020 04— � ow�
ACORD 25 (2010105)Is
88-2010 ACORN ORPORATION. All rights reserved.
The ACORD name and logo are registered mi of ACORD
POLICY NUMBER: 605891352 BUSINESSOWNERS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR POLITICAL
SUBDIVISIONS - PERMITS RELATING TO PREMISES
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
State or Political Subdivision:
CITY OF EDMONDS, ENGINEERING DIVISION
PRIMARY NON-CONTRIBUTORY
The following is added to Paragraph C. WHO IS AN
INSURED in the Businessowners Liability Coverage
Form:
4. Any state or political subdivision shown in the
Schedule is also an insured, subject to the fol-
lowing additional provision:
This insurance applies only with respect to the
following hazards for which the state or political
subdivision has issued a permit in connection with
premises you own, rent, or control and to which
this insurance applies:
a. The existence, maintenance, repair, con-
struction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances,
coal holes, driveways, manholes, marquees,
hoistaway openings, sidewalk vaults, street
banners, or decoration and similar expo-
sures;
b. The construction, erection, or removal of ele-
vators; or
c. The ownership, maintenance, or use of any
elevators covered by this insurance.
*Information required to complete this Schedule, if not shown on this endorsement, will be shown in the
Declarations.
BP 04 07 01 87 Copyright, Insurance Services Office, Inc., 1985 ;E
r 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY E3306
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY 1st Edition
AGAINST OTHERS TO US
10/21/15___.._...__..._.. w 60589-13-52
Effective Date Policy Number
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COMMON POLICY CONDITIONS - BP 00 09
SCHEDULE
Name of Person or Organization:
CITY OF EDMONDS ENGINEERING DIVISION
(If no entry appears above, information required to complete this Endorsement must be shown in the Declarations as applicable to
this endorsement.)
The provisions of the Businessowners Common Policy Conditions are modified by this endorsement as follows:
Condition K. Transfer Of Rights Of Recovery Against Others To
Us in the Businessowners Common Policy Conditions is amended
by the addition of the following:
3. We waive any right of recovery we may have against the
person or organization shown in the Schedule above because
of payments we make for injury or damage arising out of your
ongoing operations or "your work" done under a contract with
that person or organization and included in the
"products -completed operations hazard." This waiver applies
only to the person or organization shown in the Schedule
above.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the
policy.
91-3306 1ST EDITION 8-97 Includes Copyright Material Insurance Services Office, Inc., 1992 E9906101 PAGE 1 OF 1