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102 5TH AVE S (3)
1111111111115135 102 5TH AVE S • STREET USE PERMIT APPLICATIONKREET FIE DALNAME OF APPLICANT: NAME OF BUSINESS:"V- MAILING ADDRESS: CONTACT PERSON AND PHONE NUMBER: ADDRESS OF PUBLIC USE: V L ✓ Avt ***************************************************************** ibe Vle public place or portion, of public space to be utilized: Specify the type of use Specify the length of time for use: ►�G�P.�y�l NOTE: The issuance of this permit is understood by the applicant to be of a temporary nature and that no vested right is granted. INDEMNITY: The applicant 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 or any legal proceedings including defense costs, court costs, and attorney fees by reason ofgranting this permit. In addition, the application understands that the City shall be provided a Certificate oflnsurance to indemnity and hold harmless the City of Edmonds from all claims and/or property damage, and naming the City of Edmonds as an additional insured. CODE APPLICATION.• By signing the application below the applicant warrants that s/he has read or had the opportunity to read Chapter 18 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 this application and permits therefore are subject to the terms of that Chapter..,.,, SIGNATURE J `- DATE;" STRUSEHO.DOMG/2-95 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. Signature Signature Address Address Signature -,Address— Signature Address DO NOT WRITE BELOW THIS LINE --FOR CITY USE ONLY Planning Division Review: Public Works Review: ADB# Wg1ve Approved By Dat Approved By - Date Fire Department Review: Approved B Police Department Review: Approved B Date ? 7 Date Permit Coordinator Review: Certificate of Insurance Verified `�� S� Engineering Division Review: Bond Required Amount $ Approved By Dated & ,/=77 _ �; C Remarks or Comments: PERMIT # 9-, Lo DATE OF ISSUANCE RELEASED B Y,._� . /�. .) �i9 i RECEIPT # STRUSEHO.DOOLG/2-95 It x 3 0 /ADB wAMDu�16 S-lz� (2 (2 Iv2 r p-7 4-Z'2 ,or..x li I I rvqls IVAO r.v t � • ► o144 8 fie/ /Yl,�✓/MG�c- • • Cst. 189v • • CITY OF EDMONDS 250 5TH AVENUE NORTH • EDMONDS, WA 98020 • (206) 771-0220 • FAX (206) 771-0221 COMMUNITY SERVICES DEPARTMENT Public Works a Planning • Parks and Recreation • Engineering May 20, 1997 Dixie Smith Love In a Mist 102 5th Ave. South Edmonds, WA 98020 Re:. Street Use Renewal Fee Permit #96-16 BARBARA FAHEY MAYOR jqj 0 alig jo As required by City Ordinance #2972, Street Use permit renewal fees are now collected every three years instead of yearly. The first effective billing date was 1/1/96 however, due to staff shortages, the City was unable to send out this billing for the period 1/96 to 1/99. Please remit renewal fees in the amount of $25.00 to the City of Edmonds, c/o Building Division, Permit Specialist, 250 5th Avenue North, Edmonds, Washington 98020 within 15 days date 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 use for safety hazards on a yearly basis. As a reminder your Certificate of Insurance will expire on 7/l/97. Please continue to send us updated renewal certificates. If you have any questions please feel free to call me at 771-0220. Thank you, F 4\\ y Vivienne Myers ` i1 v Permit Specialist e Incorporated August 11, 1890 Sister Cities International — Hekinan, Japan oelso FALSy. Page 1 of I 4 4 46t -jll'�LL � .. I I . .. - ' LI THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE bwbined Ins. torvices Copp. 4405 Fromant Avenue North HOLDER. THE CERTIFICATE DOES NOT AMEND. EMNO OR 141) ALTER THE COVERAGE AFFORDED BY THE POLMES BELOW. COMPANIES AFFORDING COVERAGE Soadder, WA 98103 COMPANY A wastern Nadonal logurano KWRED COMPANY Love-ln-&Nlaf. LLC. a COMPANY "20 -222nd St &W Edmonds, WA 9"aOOM C COMPANY I-J 11 -l" i... 1-177� 7-71, I - ` , '�; i'�- I �� 1 f ;� ] , U 1. '.1 lz=-Zil' _k I '6644444, k -,1 -1 TIT -i- jd;�' , 1'1� �!' �.' E J-1:1 '1��l Z 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. CO LTR TYPE OF INSLIRANCE POLICY NUMBER POLICY DATE EFFECTNE (MMA)DNY) POLICY EXPIRATION DATE VMJDDW) LIMITS 0 GENERAL LIABILITY 11111148-2822 07411" 07101/97 GENERAL AGGFIEGATE 5114,000 PRODUCTS - COMMUP ACIG ;$ 5111101000 GENERAL X COMMERCIAL GERAL LIAELITY A —1 CLAW MADE 7x OCCUR PERSONAL & ADV INJURY Is amm EACH OCCURRENCE 1$ 500,000 A OWNERS & OoNnAcram PROT FFIE DAMAGE (Any one fie) Is 50;000 A X PZIIIISOKAL & ADVERT121,M0 IN I IVED EXP (Any ane pamm) S 51000 AUTOMOBILE LUIBLITY COMBINED SINGLE LIMIT 6 ANY AUTO GODLY INJURY (Pet Peraw) III ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO E)Cag LIAELITY i EACH OCCURRENCE AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM WORK.ERS COMPENSATION AND STAIU-T 6 I , T, r &1 El- EACH ACCIDENT ENPLOYERS'LIABLITY EL DISEASE - POLICY LIMIT $ THE PROPRETOPJ , INCL PARINER54DECUT" EL DSEAM - a EMPLOYEE IS OFFICERS ArE; EXCL OTHER 100444=4 404 AAMM. MAr TH qlxx Or 4no fto Ift 011410100"w 4 IM2909n: W iV6khl Ed -± L-H h, SHOULD ANY OF THE AMC DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Edmonds 200•G Ave W E)(PFIATK)N DATE THEREOF, THE SSUING COMPANY WILL ENDEAVOR TO MAL _A DAYS WRITTEN NOTCE TO THE CERTIFICATE HMDER NAMED TO THE LEFT, Edmonds WA 98020 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE Randy L Nair (622.121f) IT It? c 1 S')v. CITY OF EDMONDS BARBARA FAHEY MAYOR 250 5TH AVENUE NORTH • EDMONDS, WA 98020 • 1206) 771-0220 • FAX (206) 771-0221 COMMUNITY SERVICES DEPARTMENT Public Works • Planning a Parks and Recreation • Engineering June 27, 1997 Dixie Smith Love in a Mist 102 5th Ave. South Edmonds, Washington 98020 Re: Street Use Renewal #96-16 This is a follow up letter regarding your Street Use permit. 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, 250 5th Avenue North Edmonds, Washington 98020 within 15 days of this. letter. I 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 use for safety hazards on a yearly basis. As a reminder, your Certificate of Insurance will expire on 7/01/97. Please continue to send updated renewals. If you have any questions, please contact me at 771-0220. Thank you, Vivienne Myers V Permit Specialist ® Incorporated August 11, 1890 0 Sister Cities International — Hekinan, Japan ` CITY OF EDMONDS ,,. BARBARA FAHEY • w e MAYOR 121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 FAX (425) 771-0221 'j%%+wwre�aaw' COMMUNITY SERVICES DEPARTMENT c.1890 Public Works • Planning/Building• Parks and Recreation • Engineering • Wastewater Treatment Plant January 12, 1998 Dixie Smith Love -in -a -Mist, LLC 102 5th Avenue South Edmonds, Washington 98020 RE: Street Use Permit Insurance Policy @ 102 5th Avenue S The City has been notified that the Insurance Policy for the Street Use Permit at the • subject property is expired. Because a valid Certificate of Insurance.is required for every street use permit per the Edmonds Community Development Code 18.70.030, the permit at the subject property is now invalid. We consider this matter to be of extreme importance. Therefore, you must immediately provide a valid certificate of insurance or you must remove the permitted use of a hang sign over the sidewalk by January 20, 1998. Failure to take action to resolve the matter shall result in dispatch of the City crew to remove the sign. Thank you, r 1 0 Vivienne Myers t Permit Specialist cc: Building Official Permit Coordinator Erika K. Klein Construction Legal Consultant ® Incorporated August 11, 1890 Sister Cities International — Hekinan, Japan 01/21/1998 11: 39 206-632-3908 COMBINED INS SVCS CO 7b' /� PAGE 01 +� CY\TE (MMIDD/T1) ACORQ,# . G$ ;`' ' � r• if f s` 01/14/1998 " FROIwaIt (Z05)6�2-1211 FAX zombi ned Ins. Services Corp. ON4Y AND CONFIRM NO RIGHTS UPON THE OERTWICATE HOLDER. THIS CERTIFICATE DOES NOT AMEM EXTEND OR 4465 Fremont Avenue North ALTER THE COVERAGE AFFORDED BY THE POLIC416 BELOW. �eattl e I I WA 98103 COMPANIES AFFORDING COVERAGE coMPANv American Economy Insurance Co. A B koRandy Fxts................................................................................ . ........................................... Love -in a ......COMP -Mist, L.L.C. i ANY 102-5th Avenue South ................................................ Edmonds I I WA 90020-0000 CO C'IiW COMPANY D ►.F.! !! ►.(';'...i-.,rri3+i+;4w,wk;:+Fwf.s4..w.;»G�:i:L`Kt !efi:S::i`:: `i#'YAI;Id4 liii! tow _..:.:. a-_.._ -,;.. 5,. ..:�.<: THIS 18 TO CERTIFY THAT THE POLOES OF MISWIANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY RIEOIIIR6II W, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wTHIS RCSPOC I TO WHICH HIS CER7IFIQAT'E MAY BE 199U80 OR MAY PiRTARi, TWO 14UPANM AFFORDED BY THE POLIC= DESCRIS90 HEREIN 18 SLIEUECT TO ALL THE TERMS, Z=USMS AND CONDITIONS OF SUCH POLICIES. LMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS,. ............ .. ... i POLiev sFFGOTIVE POLICY gkomATIOY Type O/UiA11RANCi POL1oYmM"R DATE (MMR] " DATEINMIDDIYYj LIMIT6 OZIIERAL LIABILITY GENERAL AGGREGATE i 1,A 000,,000, X'' rnuueeGAL GENERAL LIABILITY ; PRODUCTS -COMPW AOO , S 1, 000, 000 #� "MS MAW OWMIR ° ; pER60►lAL A ApV IWURY f . SQo � 000 A ,.,�.a.,......; flZ606S3990-1 07/01/1997 07/01/1998......................................:: OWN&RIG A COWMACTOWS PIMT ; EACH OCCURRENCE 1 500,000 FIRE DAMAGE (Any one I* .:..S .. . .................50.000. r ! ..... ... ................ i MF.D EXP LUV — WOMI S 5,000 AUTOMDAnLE LIABILITY COMWNEDININGLELIMIT : ! ANY AUTO ALL OWMEO AUTOS BOWLY INJURY 6040WAD AUTG4 (P .. ........ . r IIIRCDAAJTO= eOdLY uu.MRY (Pw sedesllq • S ................................................... [ PROPERTY DAMAGE >i . OAAAO! 4wILITY ' f AUTO ONLY . EA ACCIDENT ......, ANY AUTO i i !! ..TITAN ALRO DNLY y , a i OTHER,.?>i..:; :..: -e :'.v$;.,.4': i EACH ACCIDENT; S AGGREGATE:I EACH OCCURRENCE S .................................................... LIMYAGLLA Rmtm i AGGREGATE ....... .......... .:. _..... . OTHRR THAN UMRRCLLA POW WORKp1iOOrIIW/AATIOMAND EMPWYERI L"UTr Ci SAC! ACCIDGuT : t ..................................................................... . : THE PROPRIETOR/ piCL ; EL D:BEA06 • POLICY LIMB t PARTNBRWMCLmvE . OFFK7ERD ARE: EKCL it oaiiAim . EA Empi-oYEE i OTHER Is understood and agreed that the City of Edmonds is Names as a Additional Insured. MU" ANT Or THE ADOYL DLOORRHID ►QI.IGIA W CAMD!LLED MWORE TMe EXPMATM DATE TNERMW. THE MBUV D GOWANT WILL CNOCAYGII TO MAIL City Of Edmonds 34R _ oiyov ITTLN NOTICE ToTHE 6ERTPICATE MOLDER NAMED To TRe LerT, Bui 1 i di ng Division !UT FAILURE TO MNL S ICI NOTION L WPOM NO OMLIGATMNI OR LwKITY 250 5th Ave North Or ANTKINOYI'ONTNEOONirA 1 ADLNrooII !F NT a. Edmonds, WA 98020 AI,TKOR11WA R■YKEaEYTATIVE N I Ihc.1S913 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 - Engineering - Wastewater Treatment Plant August 4, 1998 Dixie Smith Love in a Mist 102 5" Ave S Edmonds, Washington 98020 RE: Street Use Permit 96-16 This letter is regarding the Certificate of Insurance on your Street Use Permit #96-16. The insurance provides coverage for the anticipated risk of property or bodily injury due to the use authorized by the Street Use Permit. A valid Certificate of Insurance is required for every Street Use Permit, per the Edmonds Community Development Code 18.70.030. Please provide the City with a current certificate of insurance naming the City of Edmonds as an additional insured. If the 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. If there are any questions, please contact the Building Division at 771-0220. Thank you, 1 Vivienne Myers Permit Specialist • Incorporated August 11, 1890 a Sictor Citiac intornatinnal — Hokinan .TanAn 40 • Inc. is9"1 CITY OF EDMONDS BARBARA FAHEY 121 STH AVENUE NORTH • EDMONDS, WA 98020 (425) 777-0220 •FAX (425) 771-0221 MAYOR COMMUNITY SERVICES DEPARTMENT Public Works • Planning/Building • Parks and Recreation • Engineering • Wastewater Treatment Plant October 8, 1998 Dixie Smith Love in a Mist 102 5"' Ave S Edmonds, Washington 98020 RE: Street Use Permit #96-16 This letter is regarding the Certificate of Insurance on your Street Use Permits #96-16. The insurance provides coverage for the anticipated risk of property or bodily injury due to the use authorized by the Street Use Permit. A valid Certificate of Insurance is required for every Street Use Permit, per the Edmonds Community Development Code 18.70.030. At your earliest convenience please contact your insurance carrier and provide the City with a current copy of your certificate of insurance naming the City of Edmonds as an additional insured. If the 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. If there are any questions, please contact the Building Division at 771-0220. Thank you, Vivienne Myers Permit Specialist 0 Incorporated August 11, 1890 a /�. , ,. T , . 1 11 1 - I DATE: IO/19IS8 TIME: 10:11 AM TO: City of 6dmcada-Building niv a Id9R\ 7iin99'1 f/ .. ........... ... ..... ;.; ;.....................; ........... ........ - p -inDATE MMDD Y� }j O AC RD --x--, 1998 .x. n•. ....... :..................................... Ol 14 PRODUCER" �206)6iz-1z11 FAX ombined Ins. Services Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4465 Fremont Avenue North ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, S attl e, , WA 98103 COMPANIES AFFORDING COVERAGE COMPANY American Economy Insurance Co. RandyBlair Ext: A i�iu........................................................................................................................................................................................... Love-i n-a-Mist, L.L.C. COMPANY 102-5th Avenue South - Edmonds,, WA 98020-0000 COMPANY C ................................................................................................... COMPANY D ;THIS IS TO CERTIFY : H THAT THE POLICIES OF INSURANCE •LISTED BELOW HAVE BEEN ISSUED TO�EDTHE INSURNAA9ED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWFrH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.)ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ............................................. CO : TYPE OF INSURANCE POLICYNUMBER LTR : : PCLICY EFFECTIVE POLICY EXPIRATION: : DATE (MM/DD,'YY) DATE (MM/DCNY) LIMITS GENERAL UABIUTY ;..... : GENERAL AGGREGATE $ 11000 , 000 X ; COMMERCIAL GENERAL LIABILITY ; PRODUCTS- COMPIOP AGC ' $ 1, 000, Q00 : - CLAIMS MADE 000- R A `' ` 02B0663990-2 ; PERSONAL & ADV INJURY S SOQ , OOO : 07 01 1998 07 01 1999 ••..• OWNER'S&CONTRACTOR'SPROT: :EACH OCCURRENCE $ S00,000 FIRE DAMAGE (Any one iine) $ 50,000. MED EXP (A'y crs perern) $ 5,()()() f AUTOMOBILE LIABLITY COMBINED SINGLE LIMIT $ ANY AUTO :.......,ALLONNEDAUTOS I ;._.......i.'Yi.N........ BOD _ JURY S SCHEDULED AUTOS (Per person) ' ..: HIRED AUTOS ; ........................... ...---.............---- BODILV;NJURY $ NON -OWNED AUTOS :(Per acr �anQ t ; PROPERTY DAMAGE ; $ GARACELIABILITY ; AUTO ONLY - EA ACCIDENT I S ANY AUTO OTHER THAN AU?D ONLY: .............. ................. .........................:.. EACH ACCIDENT $ AGO REGATE}$ EX EXCESS LIABILITY: EACH OCCURRENCE ? $ UMBRELLAFOFM • : A ,gEGpTE L,.,,....,..._ OATS OTHER THAN UMBRELLA FORM S .,.. WORKERS COMPENSATION AND : TQRY OMITS Eq EMPLOYERS LIABILITY EL EACH ACCIDENT :� $ THE PROPRIETOR( INCL : PARTNERS/EXECUTIVE ;....; ; ; : ' EL DISEA SE -POLICY UMI7 S .....,.....�.......................... OFFICERS ARE., : EXQ; : EL DISEASE -EA EMPLOYEE; $ OTHER DESCRIPTION OF OPERATIONSjLOCATIONSjVEHICLES/SPECIAL ITEMS t is understood and agreed that the City of Edmonds is Names as a Additional, Insured. SHOULD ANY OF THE ABOVE DESCRIBED POUC1ESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City Of Edmonds 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Builiding Division BUT FAILURE TOMAILSUCH NOTICESHALL IMPOSE NOOBLIGATIONORLIABIUTY 250 Sth Ave North OF ANY KINOUPON THE COMPANY, ITS AGENTS ORREPRESENTATIVES. Edmonds, WA 98020 AUTHORIZED REPRESENTATIVE Randy L. blair (206-632-1211) Att, •/ STAFF A BUSINL S LICENSE APPLICATION cTIO CAT I 0 N REVERSE APPL. '`- CITY OF EDMONDS SIDE DATE-/"2 " A' 250 5TH AVENUE NORTH EDMONDS, WASH. 98020 iO APPLICATION FOR: T HONE (206) 775-2525 STREET FILE �o NEW ❑ LIC LICENSE ( BUS. RENEW YEAR �� )& 11� OFFICIALQ-�f_.QNLY INSTRUCTIONS 1. PRINT APPLICABLE LICENSE CLASS, FEE AND PENALTY PAID IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS RECEIVED BY CITY CLERK AFTER FEBRUARY 15, 2. NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES. LIC. RENEWAL: .REVIEW LICENSE INFORMATION BELOW. PRINT CORRECTIONS AND ADDITIONS AT RIGHT. 3. SIGN AND RETURN APPLICATION WITH FEE (AND. PENALTY). 4, .LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED TO APPEAR FOR APPLICATION REVIEW. LICENSE RENEWAL �. REVIEW BELOW INFORMATION. PRINT CHANGES AT RIGHT. 2. APPLICANT NAME SOCIAL SECURITY N0.' DATE OF BIRTH PLACE OF BIRTH HOME ADDRESS i I 3. BUSINESS IDENTIFICATION BUSINESS NAME NATURE OF BUSINESS BUSINESS PHONE WASH. STATE TAX NR. EMPLOYEES I ORGAN. JOCCUPAqCy ANNUAL FEES TYPE BUS. CLASS FEE PENALTY HOME A $10.00 $ 5.00 SMALL B 15.00 7.50 'GENERAL C 50.00 25.00 'OVER 10 EMPLOYEES, OR EMPL WORK OVER 120 MAN -MONTHS PER YEAR. CLASS I FEE PAID ` PENAA[ TY PAID T) :1A TYPE ORGANIZATION IF BUSINESS IS- TYPE CAPACITY ' C CORPORATION HOTEL/MOTEL L NR OF ROOM$'UNIT$ APT. BLDG. A NR OR APTS D L - LTD. PART OFFICE BLDG. 0 NR OF OFFICES I P-PARTNERSHIP RESTAURANT R NR OF SEATS S • SOLE OWNER HOSP./NURS. HOME H NR OF BEDS SCHOOL S NR OF STUDENTS 4. BUSINESS ADDRESSES BUSINESS ADDRESS LICENSE MAILING ADDRESS 5. EMERGENCY NOTIFICATION NAME AREA TELEPHONE (1) (2) OFFICIAL USE ONLY O.F.I.R. CODE BLDG, PERMIT OCCUP. C.U. PERMIT LAND USE I ZONING LICENSE NUMBER ACTIO -.NEW BUS J ` QQ RENEWALLA Le 11 LC - CHANCE LD - DELETE 1 CLASS YEAR LIC. EFFEC. DATE REASG. LIC. N0. SPEC 6 121 I I RECEIPT NO. DATE PAID ®� k RIN 'X' OX N $C<ETB FEE PAID PENALTY' PAID OR ISOF C0R EED CE SETH 'LC' ACTION. LICENSE APPLICATION AND CHANGES, PLEASE PRINT CLEARLY J 2. APPLICANT LAST NAME, FIRST INITIAL SOCIAL SECURITY NUMBER co 044 o DATE OF BIRTH PLACE OF BIRTH MO. I DAY I YEAR CITY STATE T T " HOME ADDRESS BLDG, NUMBER STREET -- // APT. NO. 'll r � CITY STATE I I ZIP CODE 3. BUSINESS IDENTIFICATION BUSINESS NAME (FULL) rr — NATURE OF BUSINESS,()RUG_5TOR' rP4 FTC) BUSINESS PHONE WASH. STATE TAX NR. (REGISTRATION) ANTICIPATED NR. EMPLOYEES TYPE OF ORGAN. OCCUPANCY TYPE CAPACITY L_ W <-- ENTER APPLICABLE TYPES AND CAPACITY T T -4. BUSINESS ADDRESS OG. tfUMBER STREET) APT. 0. tal �rl/'fl f/71 V I�I N I I ✓ I I I I - I , / LI�-E'NSE'M"A NG ADDRES BLDG. NUMBER I STREET el T u� F STATE I I ZIP �5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC:) LAST NAME, FIRST INITIAL AREA CODE TELEPHONE G (2) t LAST NAME, FIRST INITIAL AREA CODE TELEPHONE �IL�J 5S OFFICIAL USE ONLY U.F.I.R. PRIM. � UNITS 1 CODE CUND'. USE PERIMIT LAND USE L __W BLDG. PERMIT OCCUP. GRP. Z0NI( CITY CLERK'S APPLICANT'S SIGNATURE SIGNATURE ❑ APPROVED ❑ DISAPPROVED DATE BUS. TITLE , DATE / / / l ". STREET FILE6 ENGINEERING REQUIREMENTS FOR COMMERCIAL AND APARTME14T BUILDING PROJECTS Name SOUP'S ON RESTAURANT - OLD MILLTOWN Date July 3. 1974' STREETS AND ACCESS 1. Right -of -Way Requirements: 60-foot existing . 2. Road Bed Width: N/A 3. Turn Around: N/A 4. Sidewalks: 10-foot existing 5. Parking Strip: N/A 6. Access Easements: N/A UTILITIES 1. Water Mains: 12-inch C.I. existing 2. Fire Hydrants: Existing 3. Sewers or Septic Tanks: Existing building connected to sanitary sewer. 4. Drainage: Install all necessary storm sewers and drainage facilities per drainage plan and City Standards. Where drainage is across adjacent private property, all parties having any ownership interest in the lands being developed shall provide, as a restriction on the title running with the land, that the City of Edmonds shall be held harmless from any and all claims for damages which may be occasioned to adjacent land by reason of the construction and operation of the drainage system, unless, releases of damages and/or drainage easements are obtained from the other property owners affected by said drainage. Any drainage problems created by change of contour during development must be corrected.. prior to occupancy permits or release of performance bond. Final approval (or release of bond) will be withheld until actual drainage as installed has been inspected by the City Engineer. Engineerin ments for Comm'1 & ApartmentdProjects - Page 2 5. Utility Easements: 6. Underground Utilities: To be provided in accordance with Ordinance No. 1387. Street lighting shall also be provided with the necessary street light standards and underground wiring. TOPOGRAPHY 1. Excavation and Grading: Excavation and grading shall conform to the requirements outlined in Chapter 70 of the Uniform Building Code, latest adopted edition, Vol. 1. Where extensive gpgding and fill are involved in the development, a grading plan and specifications shall be prepared. QUOTATION FROM THE CITY CODE REGARDING IMPROVEMENTS 11.02.025(f) Utilities and Street Improvements. No building permit shall be issued for the construction of any building or structure of any kind or description unless the plans and specifications include the construction for curbs, gutters, sidewalks, paved streets, necessary water lines, sewer lines, and storm drainage necessitated by the new construction or improvement, to be built to applicable City standards, provided, however, if found by the City Engineer to be impractical to construct at the time of application for said building permit, construction may be waived by the City Engineer and in lieu thereof a performance bond filed with said engineer to cover the estimated cost of construction to City standards for said improvements, provided further, in areas zoned single family residential at the time of said application for building permit in which the applicant has received final approval for a plat or sub=division and has compiled with requirements therein compliance with this subsection shall be deemed by compliance with the sub -division or plat requirements. COMMENTS Rev. April 2, 1971 Form 5 i ity Engineer 4 r The City of Edmonds Side Sewer Drawing EASEMENT NO- ----- ------------ ------------------- - 104- 100 NEW CONSTRUCTION Ej REPAIRS D LID NO - ------------------ ASMT. NO . .................. OWNER ....... EM-P-'-S --- ON .-R-ESTAURA-N—T --- --- mI-=-c)TqN- CONTRACTOR ------------------------------------------------------------- ---------------------- PERMIT NO. .................... JOB ADDRESS ------- 5TH --- AVENUE --- S - ---------------------- ------------------- LEGAL DESCRIPTION: LOT NO. - ------------------------------------ BLOCK NO. ------------------------------- —.. ------- I --------------------------------------------------------------------------------------------------- ------------------------------------------------------ NAMEOF ADDITION .............................. ---------------------------------------------------------------------------------------- DYE TESTED ON SEWER Approved: PWW-0001-1 1/75 (REVA 1/78) DATE........................... I ................ By ............................................................ C. 1 Door Decal D. Window Graphics z C. 2 Door Window Decal Sign Type A = 8 sq. ft. Treasures & Teas L 5 t h A v e n u e c 102 5th Ave. So. Edmonds, WA. 98020 425.771.2601 Est. Storefront Street Frontage= 30 L. ft. Proposed Signage Sign Type A = 4-sq. ft.areai 0 • fo % '9� Sign Type B= 2, . (o 70 A. Main ID Wall Mount ) Qty B. Projecting Sign (1) Qty at main entry RECEIVED npc 19 2013 DEVELOPMENT SERVICES Published COUNTER Cmoss @ Formaseattle.com Clayton Moss Designer P R O P O S E D S I G N A G E f o r TREASURES& TEAS Direct:206-920-5912 96" r- Sign panel & letters- digital print Sign Outer, -Frame - black © Sign Inner Frame - med.tan Rolled Panel 1/4'IPVC or Alu= panel. Visillle edge ? col black - 3. , f f Mir,, 7 Zbove, Sign Type B Projecting Sign - 2 sided (1) Qty primary entry (north) Hidden mounting screws to support (behind inner frame board) ® Circle Panel -digital print with black edge Sign Type A Main ID Wall Mount @ Canopy Edge Digital print applied 2x6 Facia board + flashing Outer Frame 1x3 �4 Inner Frame 1x1-1/2 —Sign Panel 1/2" th. Digital Print graphic — Nautical Circle routed shape 12" dia. 1/4" th. with digital print on face toiface. Mount to existing canopy structure r Stainless Steel Hardware: Standard eye/ s bolt/ chain assembly '= 2 Qty. 1/4" dia. min. 2" embed into canopy v. i•�� frame. 2x6 Stud + 1/2"Ply Clad Est. weight of blade sign= 10 Ibs S I G N T Y P E S: Existing Wood Construction Architectural Canopy 1I� nl ZZ Sign Box Frame Blocking as req'rd for spacer Mount sign with 1/4" dia. anchor bolts Min. Qty (6) Notes: -Hidden anchor supports: locate screw heads behind inner face frame. -Use PVC composite material for sign panel, circle & frames. -Colors match to approximate print. PMS reference can be provided by designer. -All hardware to be non -corrosive, (gals. or stainless steel.) Note: Dimensional call outs are design intent -may vary slightly in final production. Sign Type D: fit to size of existing window. Field verify window size to determine vinyl length. Apply black vinyl stripe and lettering to exterior surface of g RECEIVED 1.13.13 nFC 19 2013 Published Date- eattle.c _ Cmoss Forrnaseattle.com 0EVELOPMENT SERVICES Clayton Moss, Designer A & B COUNTER Direct:206-9205912 City of Edmonds Building Department A.i PROVED PLAN CITY OF EDMONDS BUILDING DEPARTMENT WORK ADDRESS LOZ 7' 1471 L S OWNER 7T Aar ly S :� ` ,fgs APPROVED DATE: 7-7 BLDG. OFFICIAL PERMIT NUMBER , APPROVED BY PLANNING RECEIVED DEC 19 2013 DEVELOPMENT -SERVICES , COUNTER zowr- , w /4 Aur /o Z 5-AY S STREET FILE hLv- To+?d .56. Cf- 45 //Yo %i9C C C"P4NC / 4 d l3