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Encroachment Application.pdf
-1 Of >` DA.p . il ENCROACHMENT PERMIT #: ., e Z dIM S/P PERMIT #: .PLN 02.. —1495 RECORDING #: '? 116 50,50 6 ENCROACHMENT PERMIT APPLICATION -(Nc. 1. SV ❑Check box for Enc:roaclinient Including Artwork in the Public Right -of -Way �" lh,otc PROPERTY OWNER NAME: PROPERTY OWNER MAILING ADDRESS: 1 Lr .............. �h _ BUSINESS NAME (for Commercial applications): BUSINESS OWNER NAME: ADDRESS OF PUBLIC ENCROACHMENT: v,.;.P"✓. ,D.nm �,,. M*. wA +'�",.� ��,,,an „i.� e0%',�s ,n, i m.f. .r ✓n 1',, 1 rt ' — _ n v --1 '11 - n.. dr o'4,..��M ,e n.rD t„m.n , m �^.�/Y';.A v.11M1ev.:,v 2 �!MQ4'011&'',CI,�1—, WE,'"N::j",,I�,',,*P,.,.'6� Permanent structures encroaching upon any portion of public space, City right-of-way or easement area shall meet all Code Requirements as set forth in the following chapter of the Edmonds Community Development Code. 18.70 STREET USE AND ENCROACHMENT PERMITS PERMIT ISSUANCE An Encroachment Permit may be issued, at the discretion of the Development Services Director, City Engineer or their respective designee, for permanent structures encroaching upon any portion of public space, City right-of-way or easement area , if the structures are placed in compliance with the above referenced Code Section and the following criteria are met: 1. It has been concluded that the proposal will not adversely impact public space open to vehicular or pedestrian travel; 2. Architectural Design Board approval has been granted or the process has been administratively approved; 3. The proposal will not unreasonably interfere with the rights of the public; and 4. The proposal either benefits the public interest, safety or convenience (e.g., supports or protects the City street) or is an accessory structure such as a fence normally associated with residential use of the property as fully complies with the requirements of Criteria 3 above. s. Edmonds Arts Commission has reviewed the required materials and made a favorable recommendation. DESCRIPTION OF PROPOSED ENCROACHMENT: (include total square footage of encroachment and give specific on such a s 5' west of ace of and 10 south of c/1 of driveway entrance)_w� S:\Engr\Forms\Encroachment Application.doc Revised 10/9/2007 07 Oct 2008 3:05AM John Evans Insurance 206.284.0252 p.2 ACORDm CERTIFICATE OF PRODUCER EVANS INSURANCE AGENCY 215 NE 40th Ste C2 Seattle, WA 98105 1206)284-0730 ."...�. INSURED �.-.RICHARD CROSBY .... .....� PAMELA CROSBY_INSURER 22207 93RD PLACE WEST EDMONDS , WA 9 B 02 0 I LIABILITY .. INSURANCE ioi6//2ooe _ 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 POLICIES BELOW, INSURERS AFFORDING COVERAGE NAICN SURER A: L. � PAR[Q6RS INSURANCE COMPANY OF WASHINGTON ....� -.. �� . B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN9 R LTR NaRD TYPE OFINSU.m. —..... INSURANCE ....._... POLICY NUMBER }a N"r'E'�^ �CT1T° SOL C7i17 (,TAM✓00,"YYI POI., ICYk:XPI4V-,TFO DAIS MPJ'ytYY' ................ LIMITS � ... GENERAL LIABILITY EACH OCCURRENCE S ...� COMMERCIAL GENERAL LIABILITY PREP»+IISESEa Dcr,arara•••.ra%_ ....__ — --- S ..........� ._ ..._... CLAIMSMADE J OCCUR MED EXP (Any one person) $ PERSONAL&ADVINJURY $ ............... GENERAL AGGREGATE ......_ ...... ..., $ .................. ....,........._., .._..... ._..,,�..._.__..............� _ ...._..._...�. GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOPAGG $ POLICY P£e _.._ LOC.... �__ .. AUTOMOBILE LIABILITY ICOMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS I BODILY INJURY $ SCHEDULED AUTOS IPer person) HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccidant) PROPERTY DAMAGE $ (Pe(eccident) GARAGE LIABILITY AUTOONLY-E.AACCIDENT $ . ANYAUTO EAAGG AUTOONLY: $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR U CLAIMSMADE AGGREGATE _.m. $ mITITITITIT ITITIT .......I �� DEDUCTIBLE $ RETENTION $ — pTH Tn�i WORKERS COMPENSATIONAND IfyllrS ER.,. EMPLOYERS' LIABILITY ......, ....... .. .......-.... E,L. EACH ACCIDENT S ANY PROPRIETORTARTNERID(ECUTIVE ••°--•----- OFFICERIMEMBER EXCLUDED? E L. DISEASE - EA EMPLOYE. $ Myes, dascYrLarunder SPECIAL PROVISIONS below ....,.......�m..�_... .................... .....___.._ E.L. DISEASE POLICY LIMIT $ OTHER `-� 79 91421 32 8 -0-5/2-2-/-08 0 22%(19 500 , 000 A COMPREHENSIVE PERSONAL LIABILITY INCLUDES PERSONAL INJURY AND PROPERTY DAMAGE PROVISIONS 05SCRIPTION0FOPE RATIO NSILOCATIONSIVEHICLES/FXCLUSIONS ADDE0BYENDORS EWNT/SPE CVL P IT IS UNDERSTOOD AND AGREED THAT THE CITY OF EDMONDS IS NAMED AS AN ADDITIONAL INSURED. PERMIT FOR 00544300001102 LOCATED IN CITY RIGHT-OF-WAY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION CITY OF EDMONDS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ENGINEERING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL 121 5TH AVENUE NORTH IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR EDMONDS, WA 98020 REPRESENTATIVES. /_ AUTHORIZED REPRESC _ �W ACORD25(2001108) ©ACORD CORPORATION 1958