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104 5TH AVE S_Redacted104 5TH AVE S • I —i ✓ i ��ri c.�� j i � I! l( � j i ! i I I� i9 'z' ' i� I!� I I �1 i /�✓L� II 1 I I I I I I � j I I �� 8 ! � l i ! I I I �! �l;jl!�,i ;_/! I (►. i i I I F�C0 + ' Vie: '41 qroasp-&:10511 j j . Ed►nonds w�I I802'6Wra'a'-' \\oTNP, I Cc Ihea.F rrOn�" e I Ar�S-fu Ea., I i I 1 i d �y °f (, $ �p �° i i E>1+rand (0 ` =! Cie/�s/S j i i � ', � I � I i � ,� I � I i ' � I '� I� I � i i I j I (�!� I -a %-A' ILI — yl� c1. j e l l l l I I I �I I l l; j � ; j I �� l i i t '�� I I ,� I 1 . i I ; 1 I I I ! i i �� I I `�� i 1 li I II I I I i i l l l� j l l i i I l l j l l l I�I i ,!II I �I�,I Iijil�ll li� �i�lllilli I --- iilili�IlIliillllllllilil��l!Illilll!II I 1"1S\�"-^r•.',T'-�_"y '-_.T ./ 7% -_--pl�d��• -�7�% � i ` � I� �j��� j•^��'-�/—•I--t--� ��_• �/� '/ -,{- �� /•�,.�o I // , I �l `.i-�� �_. ��'lL [___��. r nib -I (�� AI TIF i(��.�✓,i1(�v�yr1�j �a�8 Yl'p-D u?JM 911'7y Ap-0 �-- I I, II - I + aU.l� 79T Ci 01154, PIS? M)A A 3tv,/ I I 3 (-"= 3 ' , double faced blade sign, mounted beneath existing awning with (light weight aluminum framing File Name: "C:\SCVNEW\ARISTA.SCV" Designer: Customer: Arista Wine Cellar Date: 08/12/97 14:39:06 Comments: D/F 10mm intercell, capped oval,mounted to existing awning with aluminum bracket, colors per customer approved call -out & desing19�(J1;'/ I{'1}1�i�' I I z 2.8 5 vil V% �Ovj -V - 4-t - \A/l lrLj ow SIP Is 5, sl5 vi 3 The City of Edmonds Side Sewer Drawing EASEMENT NO- ---------------- ----- 1 0 2 — 0 71 0 0 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO. ------------------ -ASMT. NO. ----------_------ OWNER .-HUBBARD..-DEAL --- ESTATE --------------------------------------- CONTRACTOR---------•-••----------------------------------------------------- ---------•----- PERMIT NO. --------•--•-------- JOB ADDRESS ----- 1.04... ----- TH--AVE._---8------------------------------------ LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO. ----------------------------------•. U. uj j �+ �y 1.�.. PWW-0001-11/75 (REY.11/78) NAME OF ADDITION--..-.--- DYE TESTED ON SEATER Approved: DATE --.-. BY------------------------- 't S72EET FILE 0 1 STREET USE PERMIT APPLICATION 9DMONDS MERCANTILE 104 Sth Ave. S. Edmonds, WA 9W20 Date Received z a6/fo (206) 774.9391 Date Issued 3-22- 0 C7/�6 ,�G�Ytc .Sv+Ur Permit No. Name of Applicant or Business: F—OMovas /t/lE&CAA.Frrt'E Mailing Address: /Dy S' 4✓E S. Telephone No:774-9391 Address of Public Use: SA wtc ********************************************************************** 1. DESCRIBE THE PUBLIC PLACE OR PORTION OF PUBLIC PLACE TO BE UTILIZED: Attach an appropriate plot pan or elevation view. 2. SPECIFY THE TYPE OF USE DESIRED• f AyYCS aw S/ Gt/41*—T. 3. SPECIFY LENGTH OF TIME FOR USE C/�G°�/►�/ 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 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 1'egal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In addition the applicant understands that the City shall be provided a certificate of insurance 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 that Ordinance are incorporated herein as if set forth in full and this application and permit therefore are subject to the terms of that Chapter. 49 �14 L 2' 2 4r Applicant Signatur to Page 6 of 8 1/89 `1 Street Use Permit Application Page Two SIGNATURE OF APPROVAL FROM ABUTTING PROPERTY OWNERS When applicable; •if the street use proposal is for utilization of City right-of-way that may directly impact any adjacent business or private property owners, the applicant shall obtain written approval from the neighbors. (This requirement will be'evaluated by the City after initial submittal of the permit has been made by the applicant.) SIGNATURE PRINTED NAME ADDRESS DATE ********************************************************************** DO NOT WRITE BELOW THIS LINE FOR CITY USE ONLY Ab�3;—l0-0,—$R OV, City Council Approval Date A/V ADB Approval Date 1/.-77 Certificate Of Insurance Posted 3/ 0 Bond Required Ahy SIGNATURES OF PERMIT APPROVAL FOR ISSUANCE Fire Department A Date — l®/o Police Department 0/IJ/ytG+J% , `� Datey Engineering Dept �f� �l C � Date.3A P Building Official Date 3/20190 Public Works ze 4p'l DateeJ-2d.. pD REMARKS/COMMENTS: osle.1 12)10 PERMIT NO. ���� DATE OF ISSUANCE 3--2-Z­ 0 RELEASED BY 119-(7 RECEIPT NO. lz6ffW BUILDING PERMIT NO. /Y 4 Page 7 of 8 1/89 f Q'1 A FIPMONDS MERCANTILE 104 5th Ave. S. Edmonds, WA 98020 • (206) 774-9391 BUILDING • REVISED 1/89 Page 5 of 8 TYPICAL DIAGRAM FOR SIGNS THAT REQUIRE STREET USE PERMITS Need measurement sign �S �xtend rom bl d5 --fl 5j6� o� y� SIGN Need measurement from ( sign to edge of curb i 8" Need measurement from sidewalk to bottom of sign I 1 Z'1 FWW41- Isa Need mea Vementfromlding to curb SIDEWALK/CURB .•APOLLO INS AGENCY P 0 BOX 969 EDMONDS WA 98020 X` U,LI- EDMONDS MERCANTILE 104 5TH AVE SOUTH EDMONDS WASH 98020 :SSUL UAT!3 2/28/90 T�IIS CERf:rICA7 :5 lSSi,..) A , ,V;AT7'R OF I:.F=ORI A'1!JL CN:A, 11110 CC;N;-LR5 NO R:Gr:'ft, UtON THE C_RTIFICATE Ii0'_JER. C'C.:2Y1:':CATI_ DOES NOT AMEND, _XTEND OR ALTER YHE COV_:}d- 9U1-: AF; Oi 0,-r) 3Y T;-;E POLICIES :-3�HLOW. I COMPANV LL-i :_R WESTERN NATIONAL CC A,r '/1NY - -. Uivi�'/1iMY („ ' i-L-i-fi_:R rCOMPANv J — LLT, LR ^- - -- - — ---- — — — ICOM?ANC/ ` LETTER i 'IS !Li TO CERTI; Y fl-IAY POLICIES OF INSURANCE LISTED 3LLOW HAVt: SEEN ISSUED I O Y:-:� ;,LS i:ED NAMED A30VE ::!IC)I) INDICATED. NOI_WITHSYANDING ANY REQUtlt! 'ii :NT, -t I:I:M U:I CONDITION OF A.MY COIMTRACT Oil OTI1-;L:-2 I')CCUV,_E,"1-I SPLC-i TO WHICF-I -IRIS CLRTIFICATE MAY UE ISSU'LD OR MAY PI?RYAI.M, YI-IL lNSUaF1ilC'c A,:' :OROETJ BY YHE POLICIES DES;;:::.;!.:. liR iIN IS SUBJECT,'0 ALL YHE TERMS, EXCLUSIONS, AND CONDITICK5 O: SUCH POLtCIFS. -_I— I - _ ----- -- 1POL.IC`/ LIAB;LITY LI,VlFfS IN THOL SAi\DS I POLICY Li F, CTIVE L)flINA'fiOl; V?=_ OF INSURANCE ?O:_IC!� iM :.i.V:1=:: I DATL- 1:-: :aDOIYYI i DAT_- _ OCCI:LI;:F Vt-f: CPP46500617 ! 410818 4/08/90iXD:L Irr:.',a�RLns:v� taH:.l I i t ,;i'.:I:iLS/CPERATIOl3 PROPEH": V '-I' I,SLJE.;GROUND � :DA'.iACL RPLOSIO.l' Fa COLLAPSE HAZARD PHOOUCTS/CO?4PLETED OPERATIONS I CC?1"fNAC7UAL 300 I;1::Jr.Y %DA—fCOIiTAACrORS OH:.; PROPLHTY JA'.1AGL XI' �A: MAR 2 i I P�so�nt 1NuRvi' l 300 i I;tr,1JILY �...'! AUTO i I i..JUHY f ial.L c:.trD auTos � i� C':.^iDf:UTI� D AUTOS 'L.Aiiar-.t _;Ai:'!'_:TY _ _ CO'id I,Y L-J { -- T n PU !_LLA POR.II k;c.,JDIm_Di IO(H i T!-IA%U7.BNLLI A I ORM, : S.AFUTCAY -- ILACA ACCID c't; I„ IT ION UNDERSTOODLOAND AGREED SLjP. LTHE SCITY OF EDMONDS IS NAMED AS AN INSURED AND HELD HARMLESS FROM ALL CLAIMS AND/OR PROPERTY DAMAGE AS TO THE NAMED PERMIT. IFITY OF EDMONDS—BLDG DIVISION ATTN-KIM NORDSTROM 250 5TH AVENUE NORTH EDMONDS WASHINGTON 98020 ADDITIONAL PERTAINS r0t1 ;: X?IRAf10N DA,L .HERE01, T;-II' SSU!N'G COV:PL'A`! billI.t1)):.AVO.:CO(;All. 30 A"ibVtIf. 110. L) Yri:_ C:=Rl"1F:(:A`ff 'HOLY)'. :MA:L... fO _;U-: MAP. SUCX 1W :,\%POS.° .YO 03L 1A? C)ti 0:! 1 ',A3;L:. '.r AXY A::M L S-J:M _ ii Y, : fS AGE.NYi: ALIT:-IrAr`_; R � _ , .'aH 0 �� :�/jj� S • 89p.19 s CITY OF EDMONDS 250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202 COMMUNITY SERVICES: Public Works - Planning - Parks and Recreation • Engineering January 18, 1991 Edmonds Mercantile 104 5th Avenue South Edmonds, Washington 98020 RE: Street Use Permit #90-2 LARRY S. NAUGHTEN MAYOR PETER E. HAHN DIRECTOR Street Use permit renewal fees are due for the year 1991. Please remit $10 fee within 15 days date of this letter. If you no longer utilize the portion of City right-of-way under the subject permit, please contact the City at your earliest convenience. Also note, a current certificate of insurance is required to be on file with the City at all times, you may want to check expiration dates with your insurance carrier. If there are any questions contact the building division at 771-3202. Thank you, Jeannine L. Graf Permit Coordinator 10 �% (61 / o ,V • Incorporated August 11, 1890 • Sister Cities International — Hekinan, Japan Advice of EX cancellation, ❑ non -renewal ❑ re -write CITY OF EDMONDS — BLDG DIVISION ATTN: KIM NORDSTROM 250-5TH AVENUE NORTH EDMONDS, WASHINGTON 98020 C54 Agency: APOLLO INSURANCE AGENCY Policy No.: CPP46-500617 Insured: GREGORY E. AND GAYLE A. SZALAY DBA; EDMONDS MERCANTILE Address: 104-5TH AVENUE SOUTH,EDMONDS, WASHINGTON 98020 Be advised that your interest in the above policy as a certificate holder, loss payee, mortgagee or contract seller is being terminated effective 7-1 —91 , or upon the effective date of a replacement policy, whichever date is first. ®C This cancellation/non-renewal applies to ABOVE STATED LOCATION ❑ This coverage has been or is being rewritten and certification of your interest, if any, in the rewrite policy will be forwarded. Reason for cancellation or non -renewal: BUSINESS SOLD 6-14-91 EC Sincerely, WESTERN NATIONAL ASSURANCE COMPANY L-1 WN-U(59)08/05/89.5M • CITY OF E D M O N D S LARRY S. NAUGHTEN 250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202 MAYOR COMMUNITY SERVICES: PETER E. HAHN Public Works • Planning - Parks and Recreation - Engineering DIRECTOR `890-19y July 8, 1991 Greg & Gayle Szalay 104 - 5th Avenue S. Edmonds, WA 98020 Re: Street Use Permit #90-02 The City has been notified by Apollo Insurance Agency that your insurance for Street Use Permit #90-02 has been cancelled. If the new owners decide to keep the sign and boxes, they are required to apply for a new Street Use Permit and pay the $25 permit fee within the next 10 days. Otherwise, you are required to remove the sign and planter boxes that were covered under this Street Use Permit within the next 10 days. If you have any questions, you may call me at 771-3202. Thank you, Sharon Nolan Permit Coordinator • Incorporated August 11, 1890 • Sister Cities International — Hekinan, Japan APOLLO INSURANCE AGENCY C54 REINSTATEMENT OF INSURANCE CC SEATTLE OFFICE BVILD111G APOLLO INSURANCE AGENCY CITY OF - BLDG CITY BANK, II.TSSSS000ESSORSvISION &/OR ASSIGNS JUL 15 1991 It is agreed that the policy which was cancelled effective 7-1-91 is reinstated as of the effective date of this endorsement. A return premium of to is pro -rated for the lapse period from THIS ENDORSEMENT IS EFFECTIVE FROM THE 1ST DAY OF JULY L tg_al— NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE, OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THE UNDERMENTIONED POLICY OTHER THAN AS ABOVE STATED. THIS ENDORSEMENT IS HEREBY MADE A PART OF POLICY NO. _CPP46 50061 7-5 ISSUED TO: GREGORY.E. AND GAYLE A. SZALAY of DBA: EDMONDS MERCANTILE Western at' s Ace, , pan y DATED THIS 15TH DAY JULY �g�l BY EC Authorized Repres;ntrtlw WN•U(94)12128189-1M 0 BY/(D1N0 AUG 20 Advice of 10 cancellation, ❑ non -renewal 1991 ❑ re -write CITY OF EDMONDS—BUILDING DIVISION ATTN: KIM NORDSTROM C54 250-5TH AVENUE NORTH Agency: APOLLO INSURANCE AGENCY IN[ EDMONDS, WASHINGTON 98020 Policy No.: CPP46-500617 Insured: GREGORY E. AND GAYLE A. SZALAY DBA: EDMONDS MERCANTILE Address: 104-5TH AVENUE SOUTH,EDMONDS,WASHINGTON 98020 Be advised that your interest in the above policy as a certificate holder, loss payee, mortgagee or contract seller is being terminated effective 9-22-91 , or upon the effective date of a replacement policy, whichever date is first. 19 This cancellation/non-renewal applies to COMMERCIAL GENERAL LTARTLTTy ❑ This coverage has been or is being rewritten and certification of your interest, if any, in the rewrite policy will be forwarded. Reason for cancellation or non -renewal: BUSINESS SnLn Sincerely, WESTERN NATIONAL ASSURANCE COMPANY 8-8-91 EC WN-U(59)08/05/89-5M • CITY OF EDMONDS PUBLIC WaW - EMDUMUNG ACTION REPORT SUSPENSE DATE: -�-- Date:- Time: ( File it Attachments: SUBJECT: r I 1 ne6 a Ll%,,-, o u r -� REQUESTOR: NAME: ADDRESS: _ ` ("� • PHONE: REQUEST RECEIVED BY: TELEPHONE CONTACT IN OFFICE C� OTHER: RECEIVED BY.�. C, � p � • 6 N° 257m C7Yes [QNo ACTION: UNIT 13 <HEc�!Efl �1l\T i`� TALL[ f� Tn C�CG r�r AID All Concerned Notified Action Completed/File Q • CITY OF EDMONDS P[IBLI— C WMM — ENGII� ACTION REPORT 'EET FILE ® 4198 SUSPENSE DATE: Date: � Time: File # Attac REQUESTOR: NAME: ADDRESS: lL PHONE: _ 7 _ / j 7�2 REQUEST RECEIVED BY: TELEPHONE CONTACT IN OFFICE OTHER: C:--3 RECEIVED BY: All Concerned Notified- i�'-1 �� Action Completed/File - - • sy�!'EErFiLe � CITY OF E®NIONDS 200 DAYTON ST. • EDMONDS, WASHINGTON 96020 • (206) 7713202 OFFICE OF THE CITY ENGINEER May 2, 1983 dtx'"� -e�l is y ,rt-h S. Edmonds, Wa. 98020 Gentlemen: HARVE H. HARRISON MAYOR The City of Edmonds is currently experiencing a serious storm water problem. Our sewage wastewater treatment system is being overtaxed by large volumes of storm water from roofs, drains, driveways, and parking lots. If this water is not eliminated from the system, the sewage treatment plant will require expansion much sooner than it otherwise would. A series of tests were completed, identifying your property as one of the infiltration sources. This storm water must be removed from the sanitary sewer system as soon as possible. The attached drawings indicate several solutions to this problem, one of which should be applicable to your property. The City has established this as a top priority project, and your cooperation is urgently needed. Please contact Dan Smith or Jerry Hauth at 771-3202 for assistance prior to installation of your modified system.. Sincerely, JAMES E. ADAMS, P.E. City Engineer DTS/st Attachments (2) cc: file 517, ti�an Smith I I Dt This letter sent to the addresses on the attached list. IT �. Cui P, PE 2. CEMCNr OVER PAIN 3- A?p E-Lww 4 I)IZt cT w•-�rEe To •9r-ywEcL. (fH15 15 SIMIOLy A VAOLt r.ILL6'p jvjT•tl 61RAVCL LT'ERNATe SjTE S-& rlUrQ 'PIPE, : z. cExtcNr o✓EF{ oRAiiv 3• ADD: EL13OW AND RVAJ DRAIN FIDE To N-Tee-Vr,,r �a -5ozo wN 3 AOD Fc PoAl To END • of N1per ,Sv��o,N9 Iwo 1AR o , 6/ "y i GK.AVE L I cur P,PE -2. CCMwT' 0✓CL t AA(bi SQLunb I. i. I, CL)r DPAJn! PiP6- 2 CEMErJT DV'C:tZ DkAW i 3 K uN wA rE e TZ) -SrcAz M P►Pr WATEe- SysrEM 3. To ty,,rt tit To 5A►J I rq2� f�IOTF: All- W0v, % fN ro r( L-IL R,�,�r_ SEwEe or-vJgy To 13C PotJe -5y t-iCCN569 aOflDFrJ CONrK.AGro2 i6 M4T ►ceQU�a.�p. � . i I � . �EP t- QLE C; LL it RE3AR� - -....__ _.. _.. _... ►"'^yP �� '. ''�.:�I;'..'; .� �':�. • ... Y�ATF'¢- . eft O M _. �_!-.__.�_.. WCN r ac ► i "�� �`- pnWN'SPvurS S r'ri toPr- i i �. NEW PPG 15 Gor,f ST(1, t_ D UNDE2' 51f->E WAL�c_ AND 7tfFj curl-r3. No-r-E: AL-L W02.4- Potjk- tN 1-tie- Fo(f t_tG R►C,►rr or-wqv ML)Sr 13Cvoaa g l iGc:N SED C0NJ'[ RAt:TUP-- , 'f-IRM ► r Rt� clU ►peo 2. WA Tom- it, VI P C-O 'Tb C U T6 tr-, I N3 5 T Z C L T- V" "'2�E ►-r r-OkJs To CATCH OP-- MAY;!F YoU NE -CO TO G�Nrllcr' Ak/ EnICIn/�c,�iNy fLM TO DE'V/SF• /I YL,?N FomC y/O(/. ZcOK U!' F�GiNEE�;S - Ct7A/5v1-rW6" /N rNE �/6CLac✓ 1�%94c S . Inc c F,,S,ys in�CCvvE ; M/oOz E*TM/ d' f1S.Sa, rivl ye-- 924 A-M llv ST �o�rro�vOS Z34z3 f1r�✓�! 9g �o��a�✓os : : Ph'- 7753934- :3/O/ LD dEL L - S.q l/E,K L � U �� iT SSo • .INC . .._.--•-- - 23/oG /ao 7XI y - �7s ass 3 ITT * 3 0/ 0 A//r r 3 CITY of EDMONDS BUWESS LICENSE APPLICATION Clvic'Center • E ToDds, Washington DLICENSE NO. City Clem Phone 775 2525 ST BEET FILE TYPE OF BUSINESS ANNUALFEE AFTER FEB. 1$ ❑ (A) HOME OCCUPATION $15.00 $22.50 CIASSYEAR LIO. EFFEC. DATE REASG. LIC. BO.SPEC VSTRUCTIONS: 91 1 (BI BUSINESSWITH $20.00 $ 30.00 All items must be completed gECE1Pr N0. DATE PAID 1TO 3 EMPLOYEES Or application Will not be ac- Pd � P"OSPE' Iry sPEc. BOX BUSINESSWITH ❑ (CI $22.00 eTOBEMPLOYEES $ 33.00 cepled. a FOR ISSUE OF Sign and return application FEE PAID PENALLY PAID 20i00 CO flRECTE0 LICENSE wRH 'LC ❑ to) BUSINESSWITH IO $75.00 OR MORE EMPLOYEES $ 112.50 with fee. Renewals received Acnarv. after February 15 must pay ❑ NEW APPLICATION (LA) penalty in addition to tee. ❑ RENEWAL (LB) NEW BUSINESSES AFTER 10 CHANGE (LC) JULY 310 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD) NAME OF FIRM I BUSINESS PHONE I NO. OF EMPLOYEES Western Wire Insurance, Inc. 778-3177/745-4233 DECEIVED MAILING ADDRESS NATURE OF BUSINESS P. D. Box 've JAN 24 1983 Edlmnds, Washington 98020 Insurance Sales EDMONDS FIRE DEPJ BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION 104 5th Avenue S. C(S) (P) ® (C) UwIvtHJ NAME HOME ADDRESS Melvin D. Pountain 1006 Barborview Lane, Everett, WA 98203 EMERGENCY NOTIFICATION (1) NAMEa TELEPHONE (PLEASE LIST TWO) (2) NAMES TELEPHONE WASHINGTON STATE TAX NO. C 600 396 750 APPLICANT'S SIGNATURE71y-4"��(jf"�� DO NOT WRITE BELOW THIS LINE STAFF REVIEW: FILL INLAND USE CODE. UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST. PLANNING DEPARTMENT 1�APPROVE ❑ DISAPPROVE DATE LAND USE CODE S _ SIGNATURE rrZggO--N��IAaN--IGI--C--O��D��E � L1115/FE-1 CONDITIONAL USE PERMIT COMMENTS m 1--= m BUILDING DEPARTMENT DATE I'Z4.83 L�✓KPPROVE ❑ DISAPPROVE SIGNATURE _ N - CVVea6' Building ❑ HolellMotel Permit ❑ Apt. Bldg. (A) ® ❑ Office Bldg. (0) COMMENTS: Occupancy ❑ Restaurant (R) Group ❑ HOSP/Nurs Home (H) ® CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS) ® ❑ School (S) FIFE DEPARTMENT DATE 3 U.F.I.R. APPROVE ❑ DISAPPROVE SIGNATURE �a APPROVE ❑ DISAPPROVE DATE T7!/� SIGNATURE PUBLIC WORKS DEPARTMENT ❑ APPROVE ❑ DISAPPROVE DATE SIGNATURE PLEASE RETURN TO CITY CLERK CITY Our ®� usl V,6 ! T Olt Name of Applicant: OEDMONDS, PU$LIC FORKS DEIRTMENT 200 DAYTON STREET E;DMONDS, IJA .98020 775-2525 APPLICATION FOR STREET USE PERMIT N V G/, FILE Mailing Address: `� l /�% �l- �� 5 t a SC' H zt IVA Telephone Number: Date:�y� Description of Public Place or Portion thereof desired to be used: (exhibit may be attached) 15 1K 4 ' Type of Use desired to be made of public Place: h If applicable, attach -plans and specifications for any utility or structure to be erected and/or oiai ntai.ned. on the Public Place: TEMPORARY PERMIT: Unless otherwise designated herein, this permit is understood by . applicant to-6e wholly of a temporary nature, that it vests no permanent right whatsoever. If the permitted use becomes dangerous or such structure shall become insecure or unsafe, or shall not be constructed, maintained or used in accordance with the provisions of this title, the same may be revoked and the structure and obstructions ordered removed by order of the City Engineer. If this application is for a specified period of time, the terms of said application is: INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages or claims of any kind or descrip- tion 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, applicant understands that the City shall be provided a certificate of insurance to indemnify and hold the City of Edmonds harmless from all claims and/or property damage, naming the City.of Edmonds as an also insured. APPLICATION OF CHAPTER 6.40 OF THE EDMONDS'CITY CODE: Applicant warrants that he has read, or had the opportunity to read, Chapter 67TU oft -'Fe —Edmonds City Code, attached herewith, and understands that all terms of that Ordinance are incorporated herein as if set forth in full and this application and permit therefore are subject to the terms of that Chapter of the Edmonds City Code. c6e, -TY) VV • pw.,— 6 /-- 6cti ldwf 1�?psf � G1��p/ "e . Appl icant'sj-�Y' gnature 11/7/74 rev. City of Edmonds Public W s Dept. APPLICATION FOR STREET USE PERMIT -- Page 2 • Approval (and Agreement, if applicable) of Abutting Property Owners: Signature Printed Name Address Date DO NOT WRITE BELOW THIS LINE (To' be completed by Issuing Agency) City Council Approval (Attach Minute Entry): 'i>,T't> 4'i e- 7-21 1S19c) Permit Fee: Annual Fee: due January 1, 19 Amenities Design Board Approval (if applicable) Attach 'note Entry:l>rro- �( Building Official Approval (if applicable): Signature y;. to SOD I IN I2a _ 5-5-Sa Provision for Indemnity: Terms and Provision of Performance Bond, if applicable: (Reference 6.40.050 of applicable Ordinance) PERMIT AUTHORIZATION BY P.W. DIRECTOR i�inatu PERMIT NO. 6-80 Remarks: 11/7/74 rev. s"//z /fD . DATE Clay 15, 1980 n I c-, 4 ,hfE AND ADUMCJJ Vr .aLM.r COMPANOES AFFORDING COVERAGES Pettit-Morry Co. P.O-Box C19107 COMPANY r LETTER General Insurance Company Seattle, WA 98109 COMPANY LETTER NAME AND ADDRESS OF INSURED COMPANY Cam -West Inc & George W. Campbell LETTER Kly COMPANYLETTER f� L� s Verona M. Campbell Individually 3541 NE 92nd St., Seattle, WA 98115 COMPANY fy LETTER L'_ This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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. C LETTER Y TYPE OFINSURANCE POLICY NUMBER POLICY EXPIRAIION DATE Limits of Liability in Thousan s EACH OCCURRENCE AGGREGATE GENERAL LIABILITY A ©COMPREHENSIVE FORM BODILY INJURY $ $ ❑ PREMISES —OPERATIONS 8403205 2/ 1 /82 ❑ EXPLOSION AND COLLAPSE PROPERTY DAMAGE $ $ HAZARD ❑ UNDERGROUND HAZARD ❑ PRODUCTS/COMPLETED ❑OPERATIONS HAZARD BODILY INJURY AND CONTRACTUAL INSURANCE ❑ BROAD FORM PROPERTY PROPERTY DAMAGE COMBINED $ 300 $ 300 DAMAGE ❑ INDEPENDENT CONTRACTORS ❑ PERSONAL INJURY PERSONAL INJURY $ t i AUTOMOBILE LIABILITY BODILY INJURY A ❑ (EACH PERSON) $ ' COMPREHENSIVE FORM ❑ OWNED 8403205 2 / 1 /82 BODILY INJURY (EACH ACCIDENT) $ ❑ HIRED PROPERTY DAMAGE $ ❑ NON -OWNED BODILY INJURY AND $ 1 PROPERTY DAMAGE 300 COMBINED If I EXCESS LIABILITY ---------COMBINED --- ❑ UMBRELLA FORM BODILY INJURY AND ❑ OTHER THAN UMBRELLA - PROPERTY DAMAGE $ $ FORM COMBINED f WORKERS' COMPENSATION I sTnTurolTv and - $ EMPLOYERS' LIABILITY (LACY T) ACCIDEN OTHER I I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES It is understood and agreed that the City of Edmonds is named as an additional insured and i held harmless from all claims and or property damage as pertains to the marquee located at: 100-104 5th Avenue North, Edmonds, WA 98020 Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will er)4x0o >0,§ mail 30_ days written notice to the below named certificate holderXkX; KW1.VftkX �iici�cx1t�CNchF�c3€fi�cxi'e"�Kx'3cR5cIIJ�xxxxSex�tx�a�cxi�xwxxxpExDy. by cert i f i, ed ma i, 1 . NAME AND ADDRESS OF CERTIFICATE HOLDER: City of Edmonds Department of Public Works 200 Dayton Street Edmonds, -Washington 98020 DATE ISSUED: S 12 K"M MORRY CO. :ACORD 25 (1-79) u 'l, X lam`' r I io.'.'�f fi:'�T� o7:r _� •q;l,) I_(: ,c_�aAAa.Y�Tti: ".rl'�oftluJd� �'• ',I� c%a��i57($i I-`C�triq^. I:):�.(oaCS AND ADDRESS OF AGENCY — — — LCOII�IPANIES AFFORDING COVERAGES 1 Pettit-Morry Co. P.O.Box C19)07 Seattle, WA 98109 NAME AND ADDRESS OF INSURED COMPANY LETTER COMPANY ni LETTER L) General Insurance Company - COMPANY {I - Cam -West Inc C George W. Campbell LETTER V C Verona M. Campbell Individually COMPANY r( )" L� 3541 NE 92nd St., SEattle, WA 98115 LEnER — {� ! COMPANY I' - LETTER L , This is to certify that policies of insurance listed below have bean issued to the insured namcd above and are in force at this time. Notwithstandin of any contract or other document with respect to which this certificate may be issued or may pertain, tho insurance afforded by the policies ,__terms, exclusions and conditions of such policies. COMPANY LETTER TYPE OF INSURANCE POLICY NUMBER ICY Limits OP LI< AT EXPIRATIQN DATE i GENERAL LIABILITY BODILY INJURY iI A ❑COMPREHENSIVE FORM ❑ PREMISES —OPERATIONS ❑ EXPLOSION AND COLLAPSE PROPERTY DAMAGE ❑HAZARD UNDERGROUND HAZARD 8403205 2 / 1 /82 ' ❑ PRODUCTS/COMPLETED i OPERATIONS HAZARD ❑ BODILY INJURY AND CONTRACTUAL INSURANCE BROAD FORM PROPERTY PROPERTY DAMAGE i DAMAGE ❑ COMBINED INDEPENDENT CONTRACTORS ❑ PERSONAL INJURY requirement, term or condition bed herein is subject to all the y in Thousan S nd EACH AGGREGATE OCCURRENCE $ 1$ $ g s300 s300 PERSONAL INJURY AUTOMOBILE LIABILITY - BODILY INJURY A 8403205 t I , (EACH PERSON) $ ❑COMPREHENSIVE FORM 2 / 1 /82 BODILY INJURY $ OWNED I +. } (EACH ACCIDENT) ❑ HIRED PROPERTY DAMAGE $ ❑ NON-OWNLO BODILY INJURY AND PROPERTY DAMAGE $ 300 EXCESS LIABILITY __ COMBINED • � ❑ UMBRELLA FORM BODILY INJURY AND OTHER THAN UMBRELLA PROPERTY DAMAGE $ FORM COMBINED WORKERS' COMPENSATION -- — and STATUTORY EMPLOYERS' LIABILITY --� OTHER ---t — DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES " �i As respects building Marquee at: 100-104 5th Avenue North, Edmonds, WA 98020 $ I i (EACH ACCIDENT) I F i Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will endeavor to mail 1.0.— days written notice to the below named certificate holder, but failure to ? mail such notice shall impose no obligation or liability of any kind upon the company. I NAME AND ADDRESS OF CERTIFICATE HOLDER: • City of Edmonds Edmonds, Washington 98020 ACORD 25 (1.79) DATE ISSUED: 4/11/80 6 PEM-MORW CO. F I Pettit-Morry Co. Insurance Brokers R EC i V E 7) P.O. Box C 19107, Seattle, Washington 98109 191 ag Telephone (206) 284-2700 • Cable Address PETCO SEA TTLE Office • 200 First Avenue West • Telex No. 32-0374 Dir. Of Pnhh,; lNorks February 23 , 1982 City of Edmonds Dept. of Public Works 200 Dayton Street Edmonds, WA 98020 RE: Cam -West, Inc. We are enclosing the following: ❑ Your policy as requested. ❑ Your renewal policy continuing similar insurance. ❑ Your copy of the policy. The original has been forwarded to the mortgagee. ❑ Endorsement for attachment to your policy. . ❑ Invoice in the amount of $ 0 Certificate of insurance to cover your interest as requested. ❑ Loss payable endorsement. ❑ Form for your completion, signature and return to our office. u Please contact our office if you have any questions concerning the enclosed. Sincerely, PETTIT-MORRY CO. By M. Suther nd P-M 009 (5-77) a NAME AND ADDRESS OF AGENCY COMPANIES AFFORDING COV ERACES Pettit-Morry Co. COMPANYA General Insurance Co. of America LER P.O.Box C19107 Seattle, WA 98109 COMPANY LETTER NAf.E AND ADDRESS OF INSURED e COMPANY CAM -WEST•, INC. AND GEORGE W. CAMPBELL AND LETTER 110 VERONA M. CAMPBELL, INDIVIDUALLY COMPANY 3541 N.E. 92nd St. LETTER 90 Seattle, WA 98115 ` COMPANY as LETTER t- i his is to c3rtify that policies of insurance listed bafov have bean issued tothe insured named above and are in force at this time. Notviithstandi of cny contract or other document %with respect to a✓hick this certificate may be issued or may pertain, the insurance afforded by the policies tsrms,_e_xclusions and conditions of such policies. COl,PANY POLICY LETTTER TYPE OF INSURANCE POLICY NUMBER EXPIRATION DATE A COMPREHENSIVE FORM CP 8403205B ❑ PREMISES -OPERATIONS ❑ EXPLOSION AND COLLAPSE HAZARD ❑ UNDERGROUND HAZARD ❑ PRODUCTS/COMPLETED OPERATIONS HAZARD ❑ CONTRACTUAL INSURANCE ❑ B,:OAD FORM PROPERTY I),4'::AGE L_I PEN DENT CONTRACTORS L J 'ERSONAL INJURY A F❑j CO'.',PREHENSIVE FORTS BA 8403205 u OIYNED ❑ HIRED ❑ NON -OWNED ❑ UMBRELLA FORM ❑ OTHERTHANUMBRELLA FORM L:r � 2/l/85 BODILY INJURY requirement, term or contrition bed heroin is subject to all the EACH I AGGREGATE OCCURRENCE $ 1$ PROPERTY DAMAGE 1 $ 1 J BODILY INJURY AND PROPERTY DAMAGE s 300 s 300 COMBINED PERSONAL INJURY BODILY INJURY $ (EACH PERSON) 2 / 1 /83 BODILY INJURY 3 (EACH ACCIDENT) PROPERTY DAMAGE J BODILY INJURY AND PROPERTY DAMAGE ' 300 BODILY INJURY AND I PROPERTY DAMAGE COMBINED STATUTORY S DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES AS RESPECTS: ADDITIONAL INSURED AND HELD HARMLESS FROM ALL CLAIMS AND OR PROPERTY DAMAGE AS PERTAINS TO THE MARQUEE ON BUILDING LOCATED: 100-10.4 STH AVE. NORTH, EDMONDS, WA. 980.20 5 S (EACH AC(:IDENT) Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will W)dN.xlXJtpAmail _34D.... days written notice to the below named certificate holder,)kwAA,*;kxxAR X7c1Ci�XDf�rRfticiiefrRcS3id�fiiPf'�dh�iihyc32C��t52cx�3($i�ic�Xx by certified ma i I. NAME AND ADDRESS OF CERTIFICATE HOLDER: DATE ISSU CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 200 DAYTON STREET EDMONDS, WA 98020 PETTIT-MORRY CO. ACORD 25 (1.79) - F THIS CERTIFICATE DOES NOTAMEND, EXTEND OR • •• • BY THE POLICIES LISTED BELOW. NAM AND ADDRESS OF AGENCY COMPANIES AFFORDING COVERAGES Pettit-Morry Co. .P.O.Box C19107 COMPAN Y A The American Insurance Company Seattle, WA 98109 LETTER COMPANY B LETTER NAME AND ADDRESS OF INSURED COMPANY LETTER Cam -West, Inc. 3541 NE 92nd St. COMPANY LETTER LETTER Seattle, WA 98115 COMPANY E LETTER This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. 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 of Liability in Thousands 000) COMPANY LETTER TYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION DATE EACH OCCURRENCE AGGREGATE GENERAL LIABILITY BODILY INJURY $ $ A ❑x COMPREHENSIVE FORM L 86 ABC 80001007 E f : 2/1 /84 t PREMISES —OPERATIONS ❑ 2/1 /87 PROPERTY DAMAGE $ $ ❑ EXPLOSION AND COLLAPSE HAZARD ❑ UNDERGROUND HAZARD ❑ PRODUCTS/COMPLETED OPERATIONS HAZARD BODILY INJURY AND ❑ CONTRACTUAL INSURANCE PROPERTY DAMAGE ❑ BROAD FORM PROPERTY COMBINED DAMAGE ❑ INDEPENDENT CONTRACTORS ❑ PERSONAL INJURY AUTOMOBILE LIABILITY ❑ COMPREHENSIVE FORM ❑ OWNED ❑ HIRED ❑ NON -OWNED EXCESS LIABILITY ❑ UMBRELLA FORM ❑ OTHER THAN UMBRELLA FORM NORKERS' CCM PENSATION and ".Al PLOY LIABILITY OTHER $ 300 1 $ 300 PERSONAL INJURY BODILY INJURY $ (EACH PERSON) BODILY INJURY $ (EACH ACCIDENT) PROPERTY DAMAGE $ BODILY INJURY AND PROPERTY DAMAGE $ BODILY INJURY AND PROPERTY DAh4AGE $ COMBINED STATUTORY $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES AS RESPECTS: Additional Insured and held harmless from all claims and or property damage as pertains to the marquee on building located: 100-104 5th Ave. North, Edmonds, WA 98020 $ $ TEACH ACCIDENT, Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- pany will eockaxii=Do mail III— days written notice to the below named certificate holdel:,�(Jt�fi�1WJ%,1k9 xl���(��axl�aa�a�a��cr�xxlxxxl�c>��yx�xx�cx�c,�x;sxl�ls NAME AND ADDRESS OF CERTIFICATE HOLDER: City of Edmonds Department of Public Works 200 Dayton Street Edmonds, WA 98020 DATE ISSUED: 84 PETTIT-MORRY CO. ACORD 25 (1-79)