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1023 DALEY ST.PDFiiiiiiiiiiiiii 10717 1023 DALEY ST TAX ACCOUNT/PARCEL NUMBER: nl)'t-fiIZ-044 ()a3(3k_-) BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DISCRETIONARY PERMIT #'S: (, (A- 6 DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT FILE: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) GEOTECH REPORT DA STREET USE / ENCROACHMENT PERMIT DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver LID #: LOT: BLOCK: WATER METER TAP CARD DATED: OTHER:�O 1,1401 61skol 6yU-) aw L:\TEMP\DST's\Forms\Street File Checklist.doc �D� RETURN ADDRESS: �Cit} of Edmonds, City Clerk 4. 12.1" 5 1h Avenue North WA 98020 1. STREET FILP 1111111111 IN 1111111 Rill Hill 111111 fillp8,7 3 S 4.00 IS ROM SH COUNTY, 6SHINGTON .OTK9.-PF LIMITATION AND COVENANT ADULT FAMILY HOME Reference.$- Grantor(s): (2) Additional on pg._ Grantee(s): Legal Descriptioh (ahbr.!vialpti wn 24- Rng23 Qtr 56 "t Block Plat Assessor's Tax Parcel [W PQd.142C>44()33M (2) ----:•:�sessor's Tax Parcel ID# not yet assigned AU-6I0kIZEJY*FOR RECORDING City of Edmonds Dat j-. Page pp*. WHEREAS, the undersigned owners-4 gaoerty..focat� d at %023 iD A L-5-v 5TQ E C— T irp Ed.mofids,...-Washington legally described below or on the attached Exhibit A., have qpflieo for a building permit for compliance and/or to remodel a structure-loeat eid-b"n the**sJte; and WHEREAS, the applicant has notified the Ck Of appiicintls intention to utilize the improvements and/or to convert an existing, single mily..structure to an adult family home; and WHEREAS, under the Uniform Building Code '-thel..pohei.o f occupants of a structure trigger certain requirements relating to the fir4 supore!'sion and exiting ..... requirements; and ...... WHEREAS, the City has notified the applicant that khe 'peimil-4ili..be issued conditioned on limitation of residents to (0 or fewer*:*---* re0deots" .2)od their caretakers; and WHEREAS, the City has issued a permit based upon such repres' n0tions;--: NOW, THEREFORE, the undersigned property owners`(herejuafter. "Owner") in consideration of the issuance of a building permit a6d,ilk dirder-to confirm the promises upon which such, issuance is based while providing notice Co any future owners or mortgagors of the propertv,does hereby stipulate, c6VItnantj and agree as follows: 1. Covenant: Limitation on Residence. The owner hereby stipulates att4agrees that occupancy of the structure as an adult family home shall be limited to bi x or fewer adults and their caretakers as allowed by applicable Oroy#sions of state law. The owner acknowledges that in the event that the applicant seeks.rcvision of the applicant's state license to operate an adult family home with :an occupancy of greater than Si Y.residents or attempts to rent, lease or ' :'otherwise provide residence for additional residents above the .••,.pe"rinitted in the current occupancy classification, the structure shall be-vacated:;and all residential use ceased until such time as the property is brought itrto•t:6mV1iance'.,w'rtl}.Oe provisions of the State Building Code, under the edition of the ViiiforFn"$uilding Code then in effect. The owner further stipulates that this covenant' touches and .concerns the land so long as the present structure and use contift es and sl�ILtun with the land to all future purchasers and assigns. Subiect•Tract. The above stipulation and promises shall apply to and run with the•land,yvith+espect to a residential structure located at iQ2?j S>ALEY_ SrRr E� ,Edmonds, Washington and legally described as: CITY pF Ebl�dtJ(Y, pl'.I , ca44©-CC) - l-OTS 33-+-3.4 3. Notification to Future Purchasei's••ariil•'.Assi nees. This notification and covenant has been recorded in the records of Snohomish County, Washington in order to provide notice to any and all future owners`•of;Ahe property of the si limitation at the current level of improvement to ngfe'famijics apd adult family home residents fewer than f ix in number. 4. Enforcement. In addition to any and other' reteedies civil or criminal which the City may have, the property owner hereby agrees. and stipulates that this grant of covenant shall entitle the City to enforce by injunctlpn jtic.pfovisions of this code and, in so doing, to recover its reasonable attorney's fees•and'•cos,ts:': AUTHORIZED FOR RECORDING Cit of Edmonds ' By: Date: ` Page _,Z of DATED this day of Q11i![�i 2 C i o SIGNATURES eeP Property Owner %Anh BullisProperty Owner Building ©ffi'eial License Holder Building.'Pern)it No •.= License Holder AFH Lie Pr* Na: .Zz-a '...r - COVENANT AND NOI'IFiOATION ACKNOWLEDGED: NOTARY FOR•'pWNER SIGNS T.•I1•RES State of Washingion....•• -' -Ass ;. County of �1n),v�ySh) .•'' �... I certify that I know or have.satisfactvry evidence that signed this instrument, oit outb•stated'that he%she was authorized to execute the instrument and acknowledged it aS.tht'. (title) of a/1/,6e; aWrl Vte'O Arai!• fnEame of partynn behalf•on w om in trument was executed) to be the free and voluntary act of sµr: perry for the uses. and purposes mentions in this instrument. Subscribed and ��sw•o,rn to before me'this', day of .7aNE 260 rt� ublic in a or the•9(ate of Washington. My commission expiri g I certify that I'know or have satisfactory evidepbe that.. signed this instrument, on oath stated that he/ �he:was authorized to execute the instrument and acknowledged it as the (title) of (name of party on behalf on wham instrtment was executed) to be the free and voluntary act of such parry for the uses a. id purposes mentions in this instrument. Subscribed and sworn to before me this` flay of. 2 Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING `• Cit of Edmonds By: y Date: Page of L:\•1'ENIP\BUILDING\FORMS\COVFNANTS\AFH_COV.DOC9/07 4 •''•;.•••"""•. t APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No ........................................... NEW CONSTRUCTION 0 REPAIRS 118-04300 OWNER..........U..-•W,•••BUSb....................................•-•--•----•.......................... CONTRACTOR.--•---------..----.....--•--......--.....................-•----............................. ---- PERMIT No....................... ADDRESS ....... QZ3... Ddley... t.:. .............................................................. LEGAL DESCRIPTION: LOT No. -•--•----------•----.......................... BLACK No............................................. • NAMEOF ADDITION......-•...................•---••---....----.............................----...-----......----•-..............---........ _r �7 is n� Dye Tested On Sewer 1972 Approved: DATE................................................ By................--.................................................... 141 I �Y�r .mot_.:,.:'�-�-•"••-ct�-.—•`'ss=itavetvnzs. t CITY'OF•EDMONDSa 1r',fASHINGTON — DEPARTMA OF B-lILDINGS (BUILDING PERMIT at hereby certifies that a plot, plan, drawings, and sufficient details to indicate lfill'all requirements of this code are attached hereto. ° ti Beat iahhereby '�r for P" it to do the following work: C y 3 c 4 z � •r. i � yy T :...............................................................................................................0 .O w F i «...:.... .......... f£Fft �En.: _................_..........-.-..__...._...._..._... _...... ................... ........... ...._... �v i c itx ..._._.._._.__.._......_...._........................................................... �— s .fl i i d O -' t.. rr �% �uA o 8 •oa'tnA i. _ K � ....__..... ......... _...__..._ ...._...-............---.._ ..__......... _ ................. .._............_._.... /f/ _. >" ._..__.................. � • .............. I..... _.._._.. _. 41 ,n o •D, z t - ........... . _ ..._YR..._ ......................_...._.._ a ... D" • A ^"..,:�a.. .� (Street number and block nuabcrs)� �— a �� o F 2 tti 1 Building dimensions are............t.�...................x................7.........._........ of � � d a 2. Lot dimcnsi,hu are...........li............x._._........�.l__.....__....... _ '>" °� to z v ii Building well be ... ...... J............. stories in height. ❑ o > O 4. Number of basementz. i� °:.° z ...... ....... ar :� Y. Occupancy of building _.... _............................... �•'.;: " 6: o•. . $uilding.Cdlmwille 7. Owner .... ......--....... •_... -led cost S..... Eslm OGG� 1. i 8. Owner's' Address............ ......... _..............................•-------- ........ ........•------••----• •. ; i�- = '•a 9r Builder...........:......•--....,��C-......-----••-----............... -------- -------••--•---•-•--_...----•---... o. .................. ................... ' 10. �/r��--------- Group N_...... ' 1�.�$�ildeis Address....._...._............................-------�-••---•---....---••-----........--- / a 11. Architect or engineer ............ .__...... Life of permit�l.' _... 1. , ........-_........__ __...__ ...._......... Date ..........��...`......... l.� Applicant's Signature ....................... ..................... Pians filed: Year' o G { (Owner -r .,tend......•_•. i,' Permission is hereby granted to do the e.'ork described hereon, according to the approved plans and specificatioris pertaining hereto; • j', ' .'' .1•') abject to compliance with the ordiaances of the City of Edmonds. This copy is your receipt for the following,fees: 1. Building permit f.e.............................. .........------ _--- S..... 2. Sewer oermit fee ....................... _ ........ .._...._.........._.._. 5..................................... 3. Inspection and supervision fee ........................................ $--------••-•••-__-------• 4. Total . _ Received by f f PERMIT IN? 375 Dep�merit of•Sili7dins ';x City. of Edmonds: {=. 4 1. The building permit fee which applicant pays when petrtit is ismrd dull be based rn estimatedcostof the proposed rtntnure, at the tate.of ft.00 for each, rr -- floW.no of coat. If the actual cost of the rtruct::e, when finally determined• erc—b the estimated tort by more than 5%. applicant agrees w pay it oeti .dditll fee of•S2•0o lot each sloo0.op of such excess cost. In such even no use per. ;e shall be issued until such-ducrepanq fee" is paid. � '� � ,� ^•• ±•�- t Vbenever s contract for construction Is vecuted for cony snumtre costing usme than yl000.00 for which a licensed a;clRect ur eng:rteer ts!rwt requlted by ,•, :� "'Y:..;'��'., 'ding Code �f the City of Fdmomds, the applicatiaa for • building permit &ball be accompanied by a copy of the concoct :.nd a copy td the. decalkd C' Prior to em I labdr oa cavmetecin wmk, cots( [hellndurtnai irtsnnncr Uii?sian of•diet''. •..,.., `'i,' ' p oyfng aq 8 f Department of- and Industrfes. gf.ing an ealmete'of. . 1»" the payroll and mate munthy reports of payrolls. Fell instructions abo`uId be obninca"fror;[hesmeareAmSce of the Depatrm2n)i o! Labor and Industries. Hefon •Z- '• "' final pa; ment, the owner should obtain a release from the general coat —ors who In turn sbmdJ obtain release from all sutidontta[ton. The releases should be sneatrd by he Departmen[•of•46br and ,lndunrio. The above procedure, art"rrqutremana of•,ihe Sou fnduatrfd Immrance;Act. .. I `t - i OV� F oAf ln�. I SS�O STATUS: FINAL 6/17/2009 Expiration Date: 12/17/2009 Parcel No: 00434204403300 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS,WA 99020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 Permit #: BLD2009035& Project Address: 1023- DALEY ST, EDMON ANNIE'S OCEAN VIEW AFH, LLC ANNIE'S OCEAN VIEW AFH, LLC EXISTING 1023 DALEY ST 1023 DALEY ST EDMONDS, WA 98020- EDMONDS, WA 98020- (425) 678-8659 Ext. (425) 678-8659 Ext. ( ) - Ext. LICENSE #: EXP: DESCRIPTIONJOB ADULT FAMILY HOME COMPLIANCE PERMIT. VALUATION: $0 PERMIT TYPE: Residential PERMIT GROUP: 82 - Adult Family Home GRADING: N CYDS: 0 TYPE OF CONSTRUCTION: RETAINING WALL ROCKERY: N OCCUPANT GROUP: OCCUPANT LOAD: FENCE: N ( 0 X 0 FT.) CODE: 06 OTHER: N------- OTHER DESC: ZONE: RS-6 NUMBER OF STORIES: 0 1 VESTED DATE: NUMBER OF DWELLING UNITS: 0 ILOT #: BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0 BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 13RD FLOOR: 0 GARAGE: 0, DECK: 0 OTHER: 0 FRONTC 1REARSETBACK :EQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED: 1EIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED: IET BACK NOTES: I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, HISAPPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. Signature Print Name Released By Date ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED_ UBC109/ IBC110/ IRCI I0. TREE T FILE ONLINE APPLICANT ASSESSOR )L-OTHER vu v STATUS: FINAL BLD20090356 CONDITIONS • - State law requires Adult Family Homes to be considered allowed uses in all single-family residential zones. Must still provide the required two off-street parking spaces. No signs shown on building permit. Please contact the Planning Division at 425.771.02.20 for questions about signage - signs require a building permit. • Final approval on a project or final occupancy approval must be granted by the Building Official. prior to use or occupancy of the building or structure. Check the job card for all required City inspections including final project approval and final occupancy inspections. • Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable. Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. • Sound/Noise originating from temporary construction sites as a result of construction activity are�exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant'to ECC 5.30. 120. " " • Applicant, on behalfofhis or her spouse, heirs, assigns, and successors in interests, agrees to,indemnify defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of whatever nature, arising directly or indirectly fromthe issuance to this pen -nit. Issuance ofthis permit shall not be deemed to modily, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance provision. • Provide 2A:IOB:C portable fire extinguishers at locations as noted on approved plans. INSPECTIONS THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6) BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 771-0215 PUBLIC WORKS (425) 771-0235 PRE-TREATMENT (425) 672-5755 RECYCLING (425) 275-4801 When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection being requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon. • B-Building Final • F-Fire Safety and Evacuation Plan • F-Addressing Visibility • F-Fire Final �, v a . .Y • Permit Inspection Details PERMIT'-' BLD20090356 RMIT ,1158 - B-Building Final Complete? Y 06/19/2009 lawler 30 approved y Total Time: 30 :1950 - F-Fire Safety and Evacuation Plan Complete? 06/19/2009 Harrison 0 SIGNED OFF FOR MIKE SMITH, PERMIT TRAX WAS DOWN YESTERDAY. y Total Time: 0 '1980_-_F-A_ddr_essing_Visibility _ Complete?' Y 06/19/2009 Harrison 0 SIGNED OFF FOR MIKE SMITH, PERMIT TRAX WAS DOWN YESTERDAY. y c;. Total Time: 0 !1985 - F-Fire Final Complete?...'-, Y 06/19/2009 Harrison 0 SIGNED OFF FOR MIKE SMITH, PERMIT TRAX WAS DOWN, YESTERDAY. y Total Time: 0 Total Inspections: 4 Total Time: 30 5/12/2010 8:03:25 AM Page 1 of 1 D F-cy- Bedroom *1 151-1/2"x 101-6 T-11" Ceiling Height i AtJQ':'E',-) OC-F-p"N3 NV-tA LL-r- 10213 0-kLE-y 5TFZ—C--r v3P% Edmonds vp - -1 2A, [M--DIning, Room Kitchen 15'-3 1/4" x 111-6 1/2" Living Room Apt 22'-1"x 151-11 1/411, 13'-9 1/2' c e I Laundry room 5 1/8 x 51-211 T- :Ioset-L 11-7 1/2"x T-4 1/211 Wu' loset -R 2'-6 1/2"x 51-3 1/2" 0 -loset Entry 4'x 41 Bedroom *2 s Closet-C 2' x 41 1/211 N51- . -Ant( hall T-8" x 3'-7" _81IX 11 101-5 sit cel Bedraom *3 0s jjx BArocym J3 Bathroom A u U 10' -S"X 4'-11" 0 fUng-HeIght, l-12Z 10'-7 3/4"x 2'4 1/2,!' c 4 C 0+1 6111 DA,U�Y 5T K C_'ET A JtJFMAO KAt-L^t' O"Z006 Efto 1 .0 w/WAC Al *xftU L-12006;��:+cm IBC iv/WAC Anxndm u 132006. Uj>iC:,-dWAC .maft and per -ems A. B, Q 1 02006 Editkm i1i+IC wjWAC Aww&rW s 0 %006 Eftw IF C , IW A r ` 02006 Editwn VIAQ WAC 51-13 02006 Fiftion .W WAC fltj 1, . . Per IRC R 310: Provide one openable escape window in basement and in each sleeping room meeting all of the following requirements: 1. An openable area of not less than 5.7 sq. ft. (5 sq. ft. for grade floor opening) 2. A minimum clear opening height of 24 inches I A minimum clear opening width of 20 inches 4. Finished sill height of not more than 44 inches above the finished floor. A APPLICATION AND INSPECTION CHECKLIST - Adult Family Home Code References: 2003 IBC 310 (WAC 51-50) and 2003 IRC 110 (WAC 51-51) APPLICATION NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION• • • • • • SITE ADDRESS: I d23 OLkQ :st _ EcI niz)r —A& S c tea. -t Pn7 ASSESSOR'S TAX/PARCEL #: _ _ _ _ _ SECTION•• • PROPERTY OWNER NAME: -A r1► eyy-, a-,r % DAYTIME PHONE: aOh . 393 • G2-c LICENSEE NAME (tFDIFFERMT): ArAflleS I cen-Y 1 VIA A•;=. . U-6 DAYTIME PHONE: 2cxo•3(�2.3f�� SECTION• • A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components for exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) 3N 4 — DISCLAIMER/SIGNATURE RLC I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am requesting or 1 am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further certify that I am in the process of making an application to the Department of Social and Health Services for an adult family home license and that I have also made application to the applicable jurisdiction for the appropriate license(s) to conduct such business at this location. I further agree to " hold harmless the jurisdiction conducting such inspections, at my request, as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation of such claim), which may be made by any person, including the undersigned, and filed against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, includin its c nd employees, upon the accuracy of the information supplied to the jurisdiction as a pa i application. NAME/TITLE: DATE: (0/'9 /2-CJ-7 PROPERTY OWNER 0 APPLICANT 11 LICENSEE Note: Checklist to be completed by building department in the jurisdiction home will be located. Home licensed (or applying for license) on or after July 1, 2001 YE S NO ❑ SLEEPING ROOMS ❑ ❑ Sleeping Room #1 ❑ S JX NS 1 ❑ NS2 Bedroom door is openable from the outside when locked 0 ❑ Closet doors are readily openable from the inside 0 ❑ Smoke alarm is installed in the bedroom 0 ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 0 ❑ Sleeping room window has a maximum sill height of 44" 0 ❑ Sleeping Room #2 ❑ S NS 1 ❑ NS2 Bedroom door is openable from the outside when locked 0 ❑ Closet doors are readily openable from the inside Q ❑ Smoke alarm is installed in the bedroom IQ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 0 ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ Sleeping Room #3 ❑ S �1 NS 1 ❑ NS2 Bedroom door is openable from the outside when locked 8 ❑ Closet doors are readily openable from the inside 0 ❑ Smoke alarm is installed in the bedroom 0 ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 0 ❑ Sleeping room window has a maximum sill height of 44" 13 ❑ Sleeping Room #4 ❑ S ❑ NS 1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 Sf. (minimum dimensions- 24" high; 20" wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ Sleeping Room #5 ❑ S ❑ NS 1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ Sleeping Room #6 ❑ S ❑ NS 1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ GENERAL Bathroom doors are openable from the outside when locked ❑ Smoke alarms are installed on all levels of the dwelling ❑ All smoke alarms are audible in all parts of the dwelling upon activation of a single device ❑ Access road and water supply approved by Fire Department ,L ❑ ❑ PASSED ❑ CORRECTIONS REQUIRED ❑ PERMIT REQUIRED INSPECTOR: Z DATE: G it Ct_. 1-2--� Application and Inspection Checklist developed by Washington Association of Building Officials (WABO), in cooperation with Department of Social and Health Services (DSHS) for use by both departments and licensors. MEMORANDUM Date: November 17, 2006 To: File From: Pamela Lemcke Subject: 1023 Daley Street — Water Service Leak, Homeowner Side Cc: Dave Gebert, Don Fiene, Noel Miller On November 16, 2006 I was called out to 1023 Daley Street with a complaint of water bubbling into the residence. The homeowner thought it was caused by the 2006 Citywide Storm project down the street. Water was bubbling from an area approximately three feet north of the water meter (see photos). Rick Shore from Public Works Water Dept. met me at the residence. Rick shut off the water at the meter. The water bubbling up was from a service line leak on the homeowner side. The area directly surrounding the water meter was very saturated, in fact Rick commented that I shouldn't walk there as a sink hole was forming. On November 10, 2006 I had walked the alley known as the Glen Daley Storm Project with Don and Dave. We noted that the ground directly behind this residence had standing water. Site inspection this morning, November 17, 2006, revealed the same ground completely dried up. It is my conclusion that the standing water was from the private side water service leak. Attached are photos showing the service leak location and proximity to the neighbor (Sonjia Nelson) who had complained last week to me about her basement taking on water. I believe that was from the service leak. There is no probable explanation for the storm project to have caused water entry into a residence. Attached: Water Service Repair Permit, Photos City of Edmonds Development Services Department Engineering Division kV L ILYir-- - -l3£al v �E7S dr 7f, I�1C I f ; --. R .- - = l7�►,•-f y tl �IL,7y �9 v. R 7 f� 1 C 1, Gt� �P1r _^ oval. 1 4� `II2" v .w1M`4L'JC aM �� 1 [C !Cas LIC - ti I-C�'1�Jf u- 1 �-' '_� '�" _ -- S'g�?^ti��- -�-.-�®Rd �7t1 jav � OP➢:a •S 2C - LC=�C1`7 x.CL-N 11 -�`�'�-�" 's: _ ti'f'-�'" ,s•i- L ts:8 �k i•+, Ga-'i� Lti-�L L, L�� ��H'I t 4! r ,1•; yam, +' —� 7 la I a�I1I. yi7 "'�.1 .[ �-PJ l s" a aC7417C — _ �fl iT4` �i Yr?s i7,5 za- ti - Y .• I �.' ; 1 r y .i �. 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'N" 2006/1 1/17 Comm. W, Hall '1p_=1 S-90 f*..__JTY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS,WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 STATUS: ISSUED 11/17/2006 =� _ M permit # ;'BLD2006:1274 i , ExpTra;tTon Date 5i16%2007 Pro�eci Addresi. 102'3: DALEY ST„EDMO.NDS` Parcel No:0043420440330U GEORGE & CHONG WHITEHEAD GEORGE & CHONG WHITEHEAD PROPERTY OWNER EXEMPTION TAKEN 1023 DALEY ST 1023 DALEY ST EDMONDS, WA 98020-2943 EDMONDS, WA 98020-2943 425-778-6816 425-778-6816 LICENSE #: EXP: JOB DESCRIPTION REPLACE W SL FROM METER TO HOUSE VALUATION: $0 PERMIT TYPE: Residential PERMIT GROUP: 47 - Plumbing/Water Service Line/Fountain GRADING: N CYDS: 0 TYPE OF CONSTRUCTION: WSL RETAINING WALL ROCKERY: N OCCUPANT GROUP: R3 OCCUPANT LOAD: FENCE: N ( 0 X 0 FT.) CODE: 2003 OTHER: N------- OTHER DESC: ZONE: NUMBER OF STORIES: 0 VESTED DATE: NUMBER OF DWELLING UNITS: 0 LNISTING AREA BASEMENT: 0 IST FLOOR: 0 2ND FLOOR: 0 PROPOSED AREA BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 — Mwjm= 1 of I REQUIRED: PROPOSED: REQUIRED: PROPOSED: REQUIRED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O REQUIRED: PROPOSED: -ET BACK NOTES: 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR UISIHER DEPUTY AND ALL FEES ARE PAID 7/0 mt fWd"Ie c uate Released BY D to ATTENTION ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING ORSTRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI I0/ IRCI 10. ARCIRVE APPLICANT ASSESSOR OTHER 1 Il 0 F E.D k_ r1 ;•� IBRICK PLANTER IU U U DALEY ST CITY OF EDMONDS WATERLINE AS -BUILT A :::� ADDRESS, tf, 1 1023 DALEY ST CONTRACTOR: HOMEOWNER, XXXXXX W H ITEH EAD DATE INSPECTED= INSPECTED BY, DATE DRAWN, 11/17/06 1 J. McCONNELL 1 11/21/06 PERMIT N❑- BLD20061274 SCALE, NTS DRAWN BY, I. ABILA { p. - A "� f TAP CARD , t r �, t Date ..... . .... r � >No f t TNo �IVleter :u f W$q Y : Size ! Tap Size: ' r F: Mfgrs . v °For r! _ {= a �'T 'LotNo $lk No: ;s t � ' "Service � LocationY�� � f {, aIVleter L`pcation = F } +4 4 4E `E �UW t r t T Make Tap .. w. x: 1 !J f _ ` I , . 1 Plbs'" Test °Doti` ressure Send rBills , to ....... k; T Date o'f Work Y� �. 7. Y... ... Foreman r c ;Remarks - rr ............. r /�a •.: i ` .. r . r r L iY 'a l; 9 ° .l �S ti 4••t {II 'k yJ 1 t r OUa GOING "Index Reg Route xBk ' .Stencils:::: hNCOMhNG Index Reg Route Bk Stencll+� Card�'4 s,�f'� ? y4 r '-s ✓ e �, At4 t r � � .1'�r.f e �. f �c�� L,�X'-� 1 L ?aterial Chargeable to Installatioi'—"eters NO. DESCRIPTION RATE AMOUNT ........... -SIZE Meter ........... . ....... /,,*,* .......... Meter Box I/- Z r WK ------- * . . ..... I ............... .......... Meter Plate ............................ .............. ....................... .............. .......... Check Valve .......................... .............. . . .... . ... .......... .............. ......... Pipe, Galv. Screw .................. .............. . . ......... ...... ............. .......... Nipples .................................... .............. . . ......... .......... -.- ....... .......... Bushings .................................. .............. ............. .......... ............... .......... Plain Ells ................................ .............. ............ ......... I .......... . ... .......... St. Ells .................................... .............. ............ .......... ......... . ... .............. .............. ........... ... ........ * .. ............... ............... .............. ......... . ......... ................................................................ .......... I .......... . ........ .......... .......... Tees ......................................... ...................................................... ........................................ ............. ...................................................... ...................................................... ...................................................... ............. ........ . . . . . . . ................... ............... ........ ..... .............. .............. ............... .............. .............. ...... — ............ ............. ............. ............ ............ i ......... . ........... I ............ .......... ......... .......... .......... .......... .......... ........... .. --- Material Chargeable to Taps Connected NO. , SIZE DESCRIPTION RATE AMOUNT .............. .......... Pipe, Black Screw .................. ............. ............. ......... .............. .......... Pipe, Galv. Screw .................. .............. ............. ......... ff/'�r Lead Connections ................... Curb Cocks ............................ ............. .............. ........... . ..... ......... �Z.2 Corp. Cocks ........................... .............. ....... cz. .............. .......... Unions .................................... ............... ............. ........ .............. ---------- Saddles ................................ ... .............. ..... . .. . . ......... .............. .......... Nipples .................................... ...... ........ .......... . ......... .............. ......... Bushings ................. ................ .............. ............ .......... ............... .......... Plain Ells ................................ ............ ............. .......... ............. .......... Street rills .......................... ... ------------- ............. .......... ............ .......... Tees ........... .................... I ........ ............... ........... .......... .............. .......... Curb Boxes .................................................... .. .......... .............. .......... I ................ S. O. Extensions ;.." .............. ............ . ......... .............. .......... Gates ................................... : ..... ............... ............ ........... rf Plugs........... ------ Couplings .......... * -- ----------- ----.. ---------- " - ......• ---------- ........................ Gate Boxes ............................ .......... ....- ............. .... . .. .. ........................ F .......... .......... .......... ............. ....... ....... .............. ......... .... .............. .............. .......... .......... I .......... ......... . . ........................................... ........................................................... ............................................................ ........................................................... I ............ .............. .............. ... -7— ............. "&z� . ........ ............. .............. .............. ............... .......... .......... ........ ........................................................... ........................................................... .............. .............. ............. .............. ............ ............. .. .... ...... . ........ .......... r-7' ............... .............. -1 .... . .. .... ........................................................... Hours Time —Day Men ........ ............. .............. ............ ........ /.. ..... ............ Hours Time —Monthly Men...-----........ ....... .............. .......... Hours Time —Auto ............ ... .. . . ........ ...... W --- superintendence .. ............. ... .. 1- E-454 .. ........... .......... Total .................. ............. jo..... • 1.1 Authorization:to Utilize Public Rigllt-of-Way. In consideration of the Property Owner's promise to maintain, repair and replace 'the sanitary side sewer line from the house to the cleanout located in the street, made on behalf of itself as well as all successors in interest to the Property, the City authorizes the utilization of the public night -of -way to maintain said sanitary side sewer line within the City right of way in accordance with established City standards and the terms and conditions of this Agreement. 1.2 Nothing herein shall be interpreted to limit the City's authority as a public utility to establish standards for service, to charge appropriate fees and costs and, in its sole discretion, to order maintenance of the sanitary side sewer line in the event that said sanitary side sewer line negatively impacts or damages the City's sanitary sewer system or violates any condition of service adopted by the City. The City authorizes the Property Owner to maintain the sanitary side sewer line. in the public right-of-way, provided, however, that: 1.3.1 Said sanitary side sewer line shall be maintained, repaired and/or replaced in a manner consistent with all regulations lawfully enacted or promulgated by the City both in its capacity as a public utility and under its police power regulation. 1.3.2 ' Any maintenance, repair and/or replacement of the sanitary side sewer line which cannot be accomplished -from the property of the Property Owner shall be undertaken only in accordance with a right-of-way use permit from the City. 2. Undertakings of Property Owner. 2.1 On behalf of itself, its successors and assigns, the Property Owner promises to maintain, repair, and replace the sanitary side sewer line from the house to the cleanout located in the street at its sole expense to the standards established by the City in its capacity as a public utility and under its police power regulation. All such maintenance, repair or replacement shall be conducted solely at the Property Owner's expense. 2.2 The Property Owner, on behalf of itself and its successors and assigns, acknowledges that the City had no obligation to install the cleanout within the paved street surface to, avoid damage to ,the Property Owner's driveway, and that the agreements as contained_kerein, provide sufF�ce;�t ccarisideraion for the Property.Owner and its successors and assigns'to maintain, repair and/or replace said sanitary side sewer line from the house to the cleanout located in the street at their sole expense in perpetuity. 2.3 In the event that the sanitary side. sewer line should fail; cease to meet any adopted condition of service, or otherwise prove inadequate for its intended purpose, the Property Owner hall repair, .reconstruct, and/or replace it at the Property Owner's sole expense. Such repair, reconstruction, replacement or any maintenance of said line within the City right of way shall be :undertaken only. in accordance with a right -of --way use permit and shall meet all conditions imposed by the City, either as part of the right-of-way use permit process or utility service established by the City. as a public utility. Repairs of non -emergent situations shall be commenced within 45 days of the mailing of written notice by the City to the Property Owner, by U.S. Mail, postage paid. The notice from the City shall specify whetherr the required repair is an emergent or non -emergent repair. All repairs necessary to correct a violation of conditions of service shall be considered emergent. Any emergency repair, including any repair of a condition which violates a condition of service to the Property, shall commence within 5 business days of such notice. All repairs shall be completed in a timely manner, in no event later than 5 business days from the date commenced, without the express written consent of the City. 3. Location of Side Sewer, Sewer Lateral and Cleanout. The side sewer, sewer lateral and cleanout shall be located approximately as shown on the attached Exhibit A. 4. Touch and Concern the Land; Subject Property. This agreement touches and concerns the subject Property herein below described, and shall run with said property binding all future property owners, as well as their successors, mortgagees and assigns, and any other party acquiring an interest in the subject Property. The Subject Property is described as follows: City of Edmonds BLK 044 D-00 — LOT 33 & 34 This agreement shall be recorded by and at the expense of the City. In addition, the Property Owner promises to notify all offerers, purchasers, or any other party acquiring any interest whatsoever in the Property of the obligations imposed by this agreement. 5. Termination of Service. In addition to any other remedy provided for by law, the City reserves the right to terminate service in the event that the sanitary side sewer line shall not be maintained in accordance with the City's regulations as a public utility or conditions imposed by the City through its police power regulations. In the event that the sanitary side sewer line is not maintained in accordance With such requirements, the City may terminate sewer service and/or water service, at its sole discretion, as may be necessary to prevent damage to the City's sanitary sewer system, wastewater treatment plant, or any other public facility which may be impacted by the Property Owner's failure to properly maintain the sanitary side sewer line. 6. . Entire Agreement. This is the entire agreement between the parties. Any prior understanding or representation, written or oral, made by any party, shall be deemed merged with its .provisions. This agreement may not be amended except in writing in a document filed of record with the auditor of Snohomish County, Washington. 7 Not Severable. In the event that any provision of this agreement is struck down, the entire agreement shall be at an end. Property Owner shall immediately commence removal of its sanitary Side sewer line from theright of way and install a sewer lateral extension and clean ott at'the propety line, aod, the'Gitysha3i. be under no .obligation to continue water or sewer service until such time as said sewer lateral extension and cleanout are installed to City standard. • • DONE this _ day of 64 F ATTEST/AUTHENTICATED: Sandra S. Chase, City Clerk APPROVED AS TO FORM: OFFICE ';50RNEY: W. Scott Snyder. STATE OF WASHINGTON ) COUNTY OF CITY OF EDMONDS By: May Gary a enson PROPERTY OWNER t�1-) Larry T. Hunt On this day, personally appeared before me ��,� y 7- Hav tom/ , and declared that he/she/they sighed this instrument as his/her/their free and voluntary act and deed for the uses and purposes therein mentioned. SUBSCRIBE,]�,AAAQ�,WORN TO before me this day of C�cfv�e� , 2004. SON J. PpS,'��sit p v �pTA q N : PUBOG 2 NOTARY 9:i0s 9: o�• Print Name /���yOFWASO My Commission expires: 1023 i i i i i i � i SIDE SEWER � Y M0N 1 WMEB 0 CONCRETE CURB CLEANOUT LATERAL S" PVC SEWER MAIN 6 9 0. 1 9 4- . W City of Edmonds 9 , Wp;.�19,1�-WAY CONSTRUCTION PERMIT , Js Permit number: 9 - a 7 ENGINEONLt�f" Issue Date: A. Address or Vicinity of Construction: 1023 Daley Street �. B. Type of Work (be specific): Ins tall New Service ~ C. Contractor: Washington Natural Gas Company Contact: Gary Swanson Mailing Address: 815 Mercer Street, Phone: 224-2080 State License #: Seattle, WA 98111 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): a E. - ❑ Commercial ❑ Subdivision ❑ City Project Ig Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family Other INSPECTOR: F. Pavement or Concrete Cut : ® Yes ❑No (1) G. Size of Cut: x 4 H. Charge $ @Gas, @ Drive way -Jo Gv'z'5 APPLICANT TO,, AD AND SIGN ° INDEMNITY: Applicant understands and by his signature to this ap#liefibn a&(ees 11hpld fheCioll Edmonds harmlessfrom injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeen, that ma be mhde against the City of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings inchulif&defense�cjns,ta(tl la �ey fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECITON AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA770NFEES)WIU BE HELDIUN77 E FINAL S7REE7 PATCH IS COMPLETED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE THE APPLICANT 4w Construction drawing of proposed work required with permit application.. TRL ET A 24 hour notice is required for inspection; Please call the Engineering Department-. 771-32 FILE Work is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all times for inspection purposes. Signature: /Vim Date: Nnvember 7, 1991 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK NO WORK SHALL. BEGIN PRIOR TO, PERMIT ISSUANCE Engrg. Div. 1991 w Washington Natural Gas A Wash rxjt- Energy Canpaw Addendum to City of Edmonds .Right of Way Permit Application Submitted by: Kerry Walsh Engineering Aide Washington Natural Gas 622-6767 x2761 �COpager 99-5 T gLOq lt.oF—,(o tqa Wa un 2 -ant 815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767 4 of CITY CLERK CITY OF EDMONDS 121 5TH AVENUE NO. EDMONDS, WA 88020 r CONFORMED COPY 200507110898 5 PGS 07-11-2005 04:29pm $23.00 SNOHOMISH COUNTY, WASHINGTON AUTHORIZATION TO USE PUBLIC. RIGHT-OF-WAY. AND AGREEMENT TO MAINTAIN SANITARY SIDE SEWER AND LATERAL. ATri02K3 D7ALE�Y SyT�RM Legal ; N / Se all To17, A/R.3 �t,✓M TAX PARCEL: 00 4342 044 033 00 (s',7_r✓N 7AD 2 : OP Eocl rn o w,DS L d A M t / I. R U N WHEREAS, the City of Edmonds (City) is undertaking a capital project known as the Daley Street Sewer Line Replacement project (E3GC/C148), the "Project', which includes replacement of the City -owned sewer main and sewer lateral in the Daley Street right of way in front of the private property at 1023 Daley Street(the "Property), and WHEREAS, the City of Edmonds has established certain public works policies and requirements regarding public utility improvements construction, ownership, maintenance, and repair; and WHEREAS, these City policies and requirements include that, for sewer side services and laterals serving private properties, a cleanout is to be installed at the property line (i.e., the edge of the right of way), and that the private property owner shall be responsible for the ownership, maintenance, repair; and replacement of the portion of the sewer line from the cleanout at the property line to the house (the side: sewer), and that the City.shall be responsible for the ownership, maintenance, repair, and replacement of the portion of the sewer line from (and including) the cleanout at the property line to the sewer main in the street (the sewer lateral), and WHEREAS, these policies also include that, when City utility work disturbs or damages portions. of private driveways within the City right of way, repairs to the driveways will generally be made using asphalt concrete material, and WHEREAS, the side sewer and sewer lateral at the Property are located under the private driveway,. and WHEREAS, the undersigned owner of the Property has requested that the City install the new sewer lateral and cleanout to be constructed under the Project within the paved street surface of the right of way to prevent damage to their existing brick driveway, instead of installing the required cleanout at. the.property line, and WHEREAS, the Property Owner agrees to be responsible for the ownership, maintenance, repair, and replacement of the portion of the side sewer line from the house to the cleanout located in the street,. and to do so at its own expense and that of its successors in title in perpetuity, NOW, THEREFORE The City of Edmonds, Washington, a municipal corporation (hereinafter "City") and Larry T. Hunton (hereinafter "Property Owner") have entered into this. agreement in consideration of the mutual benefits to be derived and the promises contained herein. 1. Undertakings of Citv.