eng20160265-SU Application.pdf0"Impouffifflw
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PROPERTY OWNER NA ME:
BUSINESS NAME:
BUSINESS OWNER NAME:
Pt -
ADDRESS OF PUBLIC USE:
DESCRIPTION OF PUBLIC USE:
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PERMIT #: ENG oAuff
7I'5—
STREET USE AGREEMENT
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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, �.-TiJ w , agrees to meet all requirements of the
Code Sections referenced above as well al as meet conditions listed below for the temporary object(s)
approved under Street Use permit ENG
➢ 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.
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SIGNATURE ��� ...... - � ..�-,� ' .. _.aa,._�..... _. DATE 71�
n rte ;ss Owner �_�
Property rilw�r rl 3us
MAILING ADDRESS: )7)Z PHONE:
FOR CITY USE ONLY
r
Engineering Appr airy. Date:
Revised 5111112 Page 2 of 2
DATE (MMIDD/YYYY)
'"�°'' CERTIFICATE OF LIABILITY INSURANCE .
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 policy(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 CONTACT
NAME:
Jacqueline Bristol(790331 N) PHONEC N. FAX, e425-774-5118 / No), 425-774-5119
______-
525 Main St &nnrzl<ea.� ih0Qtnl'.nA fnrrmmregmmnt rnnw
Edmonds WA 98020-3149
INSURED
MAIN STREET PLAZA COA
1212 NW CULBERTSON DR
SEATTLE WA 98177
$I AFFORDING COVERAGE _ _ _
NAII
INSURERA: Truck Insurance Exchange
21709
INSURER B: Farmers Insurance Exchange
21652
INSURER C: Mid Century Insurance Company
21687
INSURER F i
1 -UV CKA" CJ L MK.I mr-ILrAIM IVUIVI6cK: t"CC.VIw"i VrV IVUIVIOMM:
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.
INTR ".,., .. TYPE OF INSURANCE Aim cR Walk
( POLICY NUMBER ,,,,,,,,,,, (MMM DY�I (MMIDDY�) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
OAM
e.� � LIABILITYOCCUR MED EXPSIAnv ne�oersson) $ 75,000
A6E Yt'd-RENT0
X COMCLAIMS-MADEIAL E X C I 1 $ 5.000
A
GEN'L AGGREGATE LIMIT APPLIES PER:
p
X POLICY PRO LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
..AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS -MADE
605833096 06/10/2016 06/10/2017 PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
BODILY INJURY (Per person) j $
BODIL11 Y INJURY (Per accident) $
PROPERTY DAMAGE $
tP rc F� (qn4} _ _
EACH OCCURRENCE $
AGGREGATE $
2,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Peoples Bank Signage
CERTIFICATE FOLDER CANCELLATION
City of Edmonds Engineering
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.
ACORD 25 (2010/05) "1988-2010 ACORD
The ACORD name and logo re r here ma sof ACORD
WORKERS COMPENSATION
vvu a i,v i u i n
AND EMPLOYERS' LIABILITY
YIN
TnRv I IMIT5 _FR
INT
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?�
NIA
E L FJ{CH ACCIDENT
$
(Mandatory in NH)
E.L.DISEASE - EA EMPLOYEE.
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
DISEASE- POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Peoples Bank Signage
CERTIFICATE FOLDER CANCELLATION
City of Edmonds Engineering
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.
ACORD 25 (2010/05) "1988-2010 ACORD
The ACORD name and logo re r here ma sof ACORD