1345 6TH PL S.PDFlillIIII iiiiiiii
5480
1345 6TH PL S
1�-A
*Whington State
DEPARTMENT OF
L HEALTH
SERVICES
Adult Famil
Home License
In compliance with and pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services a license is hereby granted
city of
t0 IXJWANA AND ELBERT AKRE
to conduct and maintain at
1345 6TH PLACE SOUTH
License Number
52 H 090642
EDMONDS , zip code 98020 . , county of SNOHOMISH supervision State of Washington, an Adult Family Home for the care and of adults as follows:
24-hour family care for no more than 5 adults
number
This license shall be in force from the 20TH day of
the 20TH day of MARCH
Special Terms:
0
MARCH , 19 95 , to and including
19 96 , subject to revocation for due cause.
,�-
Licensor Licensing Authority
NOTE: This license is not transferable, and is valid only for use by the individual(s) to whom it is issued and at the location above
described. Issued by Authority of Chapter 172, Laws of 1967, and RCW 70.128_ •
.L ti k ..4L..ERK
CITY OF EDMONDS U .
605 BELL STREET NOTICE OF LIMITATION AND COVENANT
EDMONDS, WA 98020 ADULT FAMILY HOME
WHEREAS, the undersigned owners of property located at 4 _ ,
in Edmonds, Washington legally described below or on the attached Exhibit A, -have applied
for a building permit for compliance and/or to remodel a structure located on the site; and
WHEREAS, the applicant has notified the City of the applicant's intention to utilize the
improvements and/or to convert an existing single family structure to an adult family home; and
WHEREAS, under the Uniform Building Code the number of occupants of a structure
G\j trigger certain requirements relating to the fire suppression and exiting requirements; and
WHEREAS, the City has notified the applicant that the permit will be issued conditioned
on limitation of residents to 5 or fewer residents and their caretakers; and
WHEREAS, the City has issued a permit based upon such representations;
NOW, THEREFORE, the undersigned property owners (hereinafter "Owner") in
consideration of. the issuance of a building permit and in order to confirm the promises upon
which such issuance is based while providing notice to any future owners or mortgagors of the
property does hereby stipulate, covenant and agree as follows:
1. Covenant: Limitation on Residence. The owner hereby stipulates and agrees
that occupancy of the structure as an adult family home shall be limited to 5 or
fewer adults and their caretakers as allowed by applicable provisions of state law. The owner
acknowledges that in the event that the applicant seeks revision of the applicant's state license
to operate an adult family home with an occupancy of greater than 5 residents or attempts
to rent, lease or otherwise provide residence for additional residents above
the 5 permitted in the current occupancy classification, the structure shall be vacated and
all -residential use ceased until .such time as the property is brought into compliance with the
provisions of the State Building Code, under the edition of the Uniform Building Code then in
effect. The owner further stipulates that this covenant touches and concerns the land so long
as the present structure and use continues and shall run with the land to all future purchasers
and assigns.
2. Subiect Tract. The above stipulation and promises shall apply to and nun with
the land with respect to a residential structure located at 1 3 d. 1; ti_ t r, pi s o
Edmonds, Washington and legally described as:
LOT 26 OF PARADISE LANE, RECORDED
3. Notification to Future Purchasers and Assignees. 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 the property of the limitation at the current level of improvement
to single families and adult family home residents fewer than 6 . in number.
L%Temp1FormsILMT Cov.Doc
7J6/95
voL. 34010m12103
4. Enforcement. In addition to any and other remedies 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 injunction the provisions of this code and, in so doing, to
recover its reasonable attorney's fees and costs.
DATED this day of 19
ACCEPTED BY: APPLICANT/PROPERTY OWNER:
A licant / ^ (/
eannine L. Graf Appli (�
Building Official�c ww
er SA:S�hr�%
�'GAZ-�
Owner
COVENANT AND NOTIFICATION-=
ACKNOWLEDGED: =m
Mortgagor
NOTARY FOR OWNER SIGNATURES I'
State of Washington) N
)ss f fV
County of
I certify that I know or have satisfactory evidence thatl�/a''ia ''�'ee signed this
instrument, on oath stated that he/6 was authorized to execute the instrument and
.acknowledged it as the 06U Ale .2 (title) of i�P of party on
behalf on whom instrument was executed) to be the free and v luntary act of such party for
the uses and..Jt�r�les;.mentions in this instument. Subscribed and sworn to before me
this of
19 9S
NOtg6 Public in and for State of Washington.
`My commission expires
r
1 certify that'14(n6W of.-J.iade satisfactory evidence that _ �/�,ef J ;�ke-e signed this
instrument, onz �oath';'stated tha0h0she was authorized to execute the nstrument and
acknowledged it as the o �,u PX (title) of ��, ' �o�i�/f (rme of party on
behalf on whom instrument was executed) to be the free and volu tary act of such party for
the uses and purposes mentions in this instument.Subscribed and sworn to before me
this ,� �{ day of .l2u�i�, , 19 Cs
Not Public in and f e State f Washington.
My commission expires ��- / 1%
L1Temp1Fom►sV-W Cov.Doc
216195
9503150267
VOI. 3010 PAGE-2 1 0 4
.L_ERK
CITY OF EDMONDS
605 BELL STREET NOTICE OF LIMITATION AND COVENANT
EDMONDS. WA 98020 ADULT FAMILY HOME
WHEREAS, the undersigned owners of property located at n. _ ,
in Edmonds, Washington legally described below or on the attached Exhibit A,have applied
for a building permit for compliance and/or to remodel a structure located on the site; and
WHEREAS, the applicant has notified the City of the applicant's intention to utilize the
improvements and/or to convert an existing single family structure to an adult family home; and
WHEREAS, under the Uniform Building Code the number of occupants of a structure
G\j trigger certain requirements relating to the fire suppression and exiting requirements; and
WHEREAS, the City has notified the applicant that the permit will be issued conditioned
on limitation of residents to 5 or fewer residents and their caretakers; and
CID WHEREAS, the City has issued a permit based upon such representations;
140 NOW, THEREFORE, the undersigned property owners (hereinafter "Owner") in
consideration of. the issuance of a building permit and in order to confirm the promises upon
which such issuance is based while providing notice to any future owners or mortgagors of the
property does hereby stipulate, covenant and agree as follows:
1. Covenant: Limitation on Residence. The owner hereby stipulates and agrees
that occupancy of the structure as an adult family home shall be limited to S or
fewer adults and their caretakers as allowed by applicable provisions of state law. The owner
acknowledges that in the event that the applicant seeks revision of the applicants state license
to operate an adult family home with an occupancy of greater thanes residents or attempts
to rent, lease or otherwise provide residence for additional residents above
the 5 permitted in the current occupancy classification, the structure shall be vacated and
all -residential use ceased until such time as the property is brought into compliance with the
provisions of the State Building Code, under the edition of the Uniform Building Code then in
effect The owner further stipulates that this covenant touches and concerns the land so long
as the present structure and use continues and shall run with the land to all future purchasers
and assigns.
2. Subiect Tract. The above stipulation and promises shall apply to and run with
the land with respect to a residential structure located at �a.� �tb scL
Edmonds, Washington and legally described as:
LOT 25 OF PARADISE LANE, RECORDED
3. Notification to Future Purchasers and Assignees. 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 the property of the limitation at the current level of improvement
to single families and adult family home residents fewer than 6 . in number.
LlTemplForms9-MT Cov.Doc
2W5
vot. 3 0 1 0 PA6E 210 3
4. Enforcement. In addition to any and other remedies 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 injunction the provisions of this code and, in so doing, to
recover its reasonable attorney's fees and costs.
DATED this day of 19�
ACCEPTED..•- OWNER:
. • Z
i
owner
COVENANT AND NOTIFICATIONa,
ACKNOWLEDGED: = W
O r*
X �
..4..
Mortgagor
NOTARY FOR OWNER SIGNATURES
I ''
State of Washington)
NJ
/ ` )ss
`
N
County of
I certify that I know or have satisfactory evidence that Z.&W,Q."a 'e' 1�9'�'ee- signed this
instrument, on oath stated that he/6 was authorized to execute the instrument and
acknowledged it as the O W Al e- (titre) of 4&-P /5 �, / i9dkit ,� of party on
behalf on whom instrument was executed) to be the free and v luntary act of such party for
the uses and.�p�r \dies.. mentions in this instument.Subscribed and sworn to before me
this =` ,�. day of �� , 19 9S
Not , Public in and for State of Washington.
My commission expires
certify that'I krioW or. -have satisfactory evidence that/P,Cf J'e signed this
, . t ...-
instrument, on;:,oath','stated tha�she was authorized to execute the )*�nstrument and
acknowledged it as the �w,� e� (title) of , ��, ' �`D���(fia�me of party on
behalf on whom instrument was executed) to be the free and volu tary act of such party for
the uses and purposes mentions in this instument.Subscribed and sworn to before me
this day of =���2ua��, , 19 �S
Not Public in and Yilie State f Washington.
My commission expires
L1TemplFormsv-mi �Covboc
29,(95
95315026'7
YOL. 3 010 PAGE-210 4
APPLICATION h ,
for � E t �
ET FILE CARD No . ...................... .................
The City of Edmonds 30 �- SIDE SEWER PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS ❑ EASEMENT No . ............................................
-G�dov
OWNER ..J..l.........!.!...!..............[.... .�.. CONTRACTOR ..... .!±...G,.... .A S ..7 ................ PERMIT No.
.......................................................
STREET
HOUSENo. .....:/........�j�.7...........ro.�....�L.'..................................................... AVENUE LOT No. ............................... :............ ........................ ......... BLOCK No.............................................................
. ANAME ADD........................................................:...:....:..............................................................................................................
...
L INE
f Is
R
City of Edmonds Permit No: 264�"41
RIGHT-OF—WAY CONSTRUCTION PERMIT Issue Date: b-1-61
A. Address or Vicinity of Con:
B. Type of Work (be specific):
C.
Mailing Address:
.n
D. Building.Permit # (if applicable): MA W r
Contact:
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable): / YA
E. ❑ Commercial Subdivision ❑ City Project ❑ EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
❑ Multi -Family Single Family ❑ Other r
INSPECTOR-
F. PAVEMENT: []YES 5�po
G. SIZE OF CUT X H. Charge: $
CONCRETE CUT: ❑ YES
"APPLICANT TO READ AND SIGN
IDEMNITY: Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from injuries,
damages or claims of any kind or description whatsoever, foreseen "Or unforeseen, that may be made against 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 and
attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL'
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. _
♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
♦ Three sets of construction drawings of proposed work are required with the permit application.
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINY COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
( 'ontractor or Agent)
j /l7 .
aJt
2,C.c..(E C% I) t'�t C E't V f t E. GI
CALL DIAL -A -DIG (1-800-424 555) PRIOR TO BINNING WORK
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED
INSPECTOR'S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
Fxls74
I
L�'�S