An application was received from Yoki Restaurant, requesting permission for two projecting signs and two awnings at the premises numbered 1876 Massachusetts Avenue. approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Yoki Restaurant New Signs for Yoki Restaurant will be same size as existing ones and same quantity Existing Signage (Bruegger’s Bagel)

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Store Front Signs and Awning Yoki Express

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Yoki Express Poke Bowl & Ramen 1876 Mass Ave Cambridge, MA

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Store Front Signs and Awning Left Awning Right Awning Dome Yoki Express 70 in 40 in 34 in 298.52 in 34 in 239.21 in 20 in 134.86 in 9 in 4 in 20 in 134.86 in 9 in 4 in 400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Store Front Signs and Awning Yoki Express Qty 3 Awnings: Sunbrella Fade Resistant Fabric Awnings Qty 2 Exterior Signage: Laser Cut 1" Thick Routed & Painted Stud Mounted Acrylic Letters.

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Store Front Signs and Awning Yoki Express Paint the metal frame blue 30.00 in 30.00 in Blade Sign: Both Sides will have 3/16" White Lexan with Die Cut Exterior Translucent Vinyl

400 W. Cummings Park #1850 Woburn, MA 01801 [email removed] [phone removed] Yoki Express Poke Bowl & Ramen 1876 Mass Ave Cambridge, MA

Applicant Information Please Print Legibly Business/Organization Name:_________________________________________________________ Address:__________________________________________________________________________ City/State/Zip:_____________________________ Phone #:________________________________ *Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers’ compensation policy is required and such an organization should check box #1. I am an employer that is providing workers’ compensation insurance for my employees. Below is the policy information. Insurance Company Name:______________________________________________________________________________ Insurer’s Address:_____________________________________________________________________________________ City/State/Zip: ________________________________________________________________________________________ :eta D n oitarip x E # .ci L .s ni-fle S r o # y cilo P Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: ___________________________________ Permit/License #_________________________________ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen’s Office 6. Other _______________________________ Contact Person:_________________________________________ Phone #:_________________________________ 1. I am a employer with _________ employees (full and/ or part-time).* 2. I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers’ comp. insurance required] 3. We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers’ comp. insurance required]** 4. We are a non-profit organization, staffed by volunteers, with no employees. [No workers’ comp. insurance req.] Are you an employer? Check the appropriate box: Business Type (required): 5. Retail 6. Restaurant/Bar/Eating Establishment 7. Office and/or Sales (incl. real estate, auto, etc.) 8. Non-profit 9. Entertainment 10. Manufacturing 11. Health Care 12. Other _____________________________ www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114 www.mass.gov/dia Workers’ Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Business Signs, LLC. 400 W. Cummings Pk#1850 Woburn, MA. 01801 X 4 Printing of Vinyl Graphic Signs & Installation Hartford Insurance Co. of the Midwest 76 WEG AC1921 One Park Place, 300 S. State Street, 7th Floor 12-31-2019 [phone removed] Sean Shah [phone removed] X Syracuse, NY 13202 01-01-2019