17926 180TH ST SW.PDFIIIIIIIIIIIIII
14989
17926 73RD AVE W
TO
DATE
TO:
FROM:
PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
OWNER AuA -a ADDRESS 12TZ6,
PERMIT# T801 22 ADB# INSPECTED ON.. i -2. 1q1q7
A field inspection was conducted to determine compliance with approved plans. Final approval
denotes there are no objections to the granting of
:�__Occupancy for the building Performance Bonds may be released
—Landscaping is approved
Other inspected zJf:?J c6MA i—t
X<PASSED FIRST INSPECTION - CONDITIONS NOTED
I .
—FAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR
INSPECTION
I .
2.
3.
H
:5�OCCUPANCY OR FINAL APPROVAL
R -INSPECTED -APPROVED
RE INSPECTED - FAILED
2
RE -INSPECTED APPROVED
/OCCAPRVL 12/96
hle
DATE -kaI417��m
DATE B)
.DATE BY
DATE BY
I ashington State
FrDEP',ART'MENT OF
7 S
So
()C
CIAL&HEALTH
�tlF SERVICES
'tl 7
Adutt Family t1ome ticen(�se
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
to
MARIA LETTY V. KRASSNER T . 'KT
to conduct and maintain at
cense uniber
17926 - 73RD AVENUE WEST
430600
city of EDMONDS zip code 98026 county of SNOHOMISH
State of Washington, an Adult Family Home for the care and supervision of adults . as follows:
24-hour family care for no more than sIx (6) adults
number
This license shall be in force from the 3 OTH day of DECEM13ER 7 19 97 , to and including
the 30TH day of DECEMBER ) 19 98 , subject to revocation for due cause. .
Special Terms:
%
Richard Blackburn Licensor Mary DeLange "-9censing Authority \J
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.
DSHS 10-173 (Rev. 1/91)
ashipi�topi State
FrDEP',ART'MENT OF
7 S
SC
0
);C��IAL&HEALTH
ItIF SERVICES
'tl 7
Adult family Home Licen8e
7 77
7'
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
to MARIA LETTY V. KRASSNER License Number
to conduct and maintain at 17926 - 73RD AVENUE WEST
430600
city of EDMONDS , zip code 98026 , county of SNOHOMISH
State of Washington, an Adult Family Home for the care and supervision of adults as follows:
24-hour family care for no more than SIx (6) adults
a
numbet
This license shall be in force from the 3 OTH day of DECEMBER 19 97 3 to and including
- the 30TH day of DECEMBER ? 1998 , subject to revocation for due cause.
Special Terms:
(L
n.4/
Richard Blackburn Liceusor Mary DeLange ��censiug Authority '10
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.
DSHS 10-173 (Rev. MI)
CITY OF EDMONDS
PUBLIC WORKS DEPAC NT FOR INSPECTION CAL Permit N? -6281
SIDE SEWER PERMIT 775-2525 Ext. . 220 Issue Date !��Ub
§* PERMIT MUST BE POSTED ON JOB4IdrB-ait__( 0 U_LLIZ
1. Address �FConstruction
2. Property Legal Description (include all, easements)
LL=
"��A k4hy Residence.jel"�Multi-Family No. of Units
Commercial
4. Owner jand,/ox-atyl-1-der -J-aa &S ALIJ?
5. Contractor & License No. 0 .-S9 -:T 2-1-7-!T (7-7 (ens m)64"op
6. Invasion into City,Right-of-Way: No vel*� Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation) .
E-1 7. Cross other private property: Yes No Easement required
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
04
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
0 d. Side sewers may not be installed.closer than thirty inches ('30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade of 2% (1.15
0 and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/81bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap
g. No down spouts, footing �rains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only (2) working
days notice required.
DATE:
I c rtify'that I,,fave read
and.,phall comply'./with the above
0
PERMIT FEE: �,o ( to -Do I
7 APPROVED BY: Date:
�j 4-Wi By: -Date:
CONNECTION FEE: Gvu� APPROVED By: Date:
PEP141T MUST BE POSTED ON JOB SITE
Side Sewer Drawing
The 'City of Edmonds EASEMENT NO - --------------------------------- ..........
NEW CONSTRUCTION REPAIRS LID NO. .— .............. ASMT. NO - --------------
OWNER ...... ��X� .. .... . . ........................... CONTRACTOR .... ............ PERMIT NO.
JOB ADDRESS .......... LEGAL DESCRIPTION: LOT NO . ......... ---5�,7 ------------------- BLOCK NO . ....................................
................................................................................. ................................................................................
NAME OF ADDITION .... ....... L�, — >- —1
........................................
0
PWW-OWl-11/75 (REV.11/78)
Approved:
DATE.......................... By ---------------------
"CITY. OF EDMONDS
FOR INSPECTION CAI*
�_'PUB L IC 'WORKS DE-POMENT
775-2525 Ext. 220
Permit N? - - 6201 k,
Issue Dateq-13 J -7 9
E ON 'JOB SITE.,
KUS .-B 1 P.
L
7C
i�yAddre s'b,_X0t1" -ti6n.
a1l V1 ct,(�
-'P.Toper-ty,'Legal bescription (include. -,easements):
ng-le Family Residence-�V,., i i
.3. Si*, Multi' -tam y No.,X1 of:. Units
Commercial
4. Own e,r.,afidvKox_-Be+t&5 r ZT,
5. Contractor &--License No.
V_U
.'Invd,s,ion. into..,.City Rig4t-of -Way,: No Yes -(If Yes Right"of-
way Construction Permit Required Call'-Dial.Dig.(342-5344) before
excavation).
E-4 '7.'.- Cross'.other-.�riVate ,property: Yes No Easement requi re '. d.
U. attach legal*..description and county easement number.
READ THE. FOLLOW!-NG AND. SIGN:.
04
P4*
a.--P� -er-t in a pLe rmi t to.install side"sewers on
op , y owners mus t obtai
theirlpro'peity., -A 'licensed -side 'sewer.icontra:ctor must be employed to
s18, e se L wers.in the public —right-of-way
c6nstruc
The. side sewer c-nt
o tactor assumes full reponsibility for each
installation for one year...
�_C.:COM
mercial establishment requires aminimum of a six inch (6")
04 s ide s*ewer� line"L
.0 -d.- .-.Side 's-ewe'rs may not be.ihstal-led'closertthan thirty inches (3 0
U
to any,-�structure.
e.__ Side"' sewer lines.must be laid At. a;' minimum grade of 2% (1.�150)
0 and.L maki ' ffium�- grade of 100% (4501) 0
f.- o.' turn in side s8wer greater than 45 (1/81bend) is allowed
01
-between-cleanout. All 90 turns must be constructed of a 45 (1/8
bend') .,and- wye with removable cap.
g No'down spouts, footing drains or floor drains can beconnected
to side . S ewer system.
h. 'Pea gravel is requited for bedding when installing sewer lines
_�htough other than granular soil. L
are required at 30"-66"-from each plumbing exit line
and at minimum int ervals of 100' along sewer.line run.
j.- Trenches within City right-of-way must be re.stored to original
condi t,ons. Contractors shall be responsible for right-of-way failure
due-to-goor compaction of fill.
k,;,-Side.sewer must be left.uncovered until inspected and approved
L by _,thel"City.
1;_`14inspection during normal working -hours only.. Two,(2) workin
days t ice: requi d.
no re
.DATE:
I cdrtify..that. ve read
and 'shall comply 'With the above
ODI SAPP ROVE D: BY: Date:
'PERMIT FEE- 7 (--rl n
By:
Date:
CONNECTION FEE: APPR OVED By Date:
PERM . IT MUST BE--.,PO.SiTELE�ll.DZI-.,LJOB, L ..,S I TE.,
CITY OF EDMONDS
USE PERMIT
ZONE. NUMBER
P. — 19
CONSTRUCTION PERMIT APPLICATION
oa
ADDRESS 7 ?2 (a
/7
o NER NAMEINAME OF BUSINESS
W AMPARC4
�.CJT y /I All
lq
LEG.Al. DESCRIPTION CHECKJ§UBDIVISION
NO.
LID NO.
-�WFF?,
a:
W
Z
3:
MAILING ADDRESS
FP
.
0
PUBLIC RIGHT OF W AY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
TESCP Approved C3
RW Permit Required 13
Street Use Permit Req'd 13
CITY IP
U)
z V,
TELEPHONE �UMBER
4 1 0 .7 '9'. .
(U.4- � V
. i��
I
PROPOSED
Inspection Required 13
Sidewalk Required El
NAME
METER SIZE
0. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
uj
t:
ADDRESS
REWKS
e e 4r V e-, /V c 0 -Inol, 0 F
M
W
M
Zi P
TELEPHONE NUMBER
<
CITY
W
/Pvd f �Mess X-V
Z,
NAME
;V/jl
cc
ADDRESS
ENGINEERING MEMO DATED REVIEWED BY-1
0
0
<
Ir
CITY ZIP
TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
of Property - include all easements
Z
01
L) �z
-i Property
Tax Account
47V-040e-03 -7-000c?
Parcel No.
NEW
RESIDENTIAL
PLUMBINGIME CH
COMPL ANCE OR
ADDITION
COMMERCIAL
CHANGE OF USE
APT. BLDG.
REMODEL
SIGN
GRADING
FENCE
E]
F REPAIR El CYDS.
X_ FI)
WOODSTOVE
DEMOLISH
SWIM POOL
INSERT
HOT TUB/SEA
GARAGE RETAINING WALL/
(Oqfzh�
CARPORT ROCKERY
4&EWA1!/"
(TYPE OF USF. BUSINESS OR ACTIVITY) EXPLAIN:
cc
to NUMBER
UM
N BER OF
CRITICAL
0 OF
2-
W LL,
E NG
AREAS
FNUMBER IM
CO STORIES
U N ITS
0
DESCRIBE WORK TO BE DONE (ATTACH PLOI.PL N)
VARIANCE OR CU ADB # SHOFIEUNE#
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (F.) PROPOSED SETBACKS (FT
ALLOWED I PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA R�ANININGftEVIEW BY DATE
REMARKS
A.
TYPE'bF CONSTRUdTfO
,HECKED BY OGCCL
SPECIAL INSPECTOR AREA occu
REQUIRED 0 LOAD
PROGRESS INSPECTIONS PER UBC 108
11ftl 06 OC)
7-3
# 1�21-2 0
4?0 4
7 V
FINAL INSPECTION REQUIRED
mop - VALUATION FEE
PLAN CHECK FEE
:BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any Construction on the public domain (curbs, sidewcMks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, 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 from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE]
L, I -A - that I IN... read this - licati— that the
"ere y a, — w VK i ' '
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city
state laws regulating construction; and in doing the work authoriz-
II
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby, no person will.be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compe Sa_
WORK NOTED
Deputy; and fees are paid, and receipt is
jand
tion Insurance arid RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGN TURE (OV 08 AG7TI DAT;E 9IGNED
V>1111
7
DEPARTMENT
OFF CIA 'S SIGNATURE DfE
V4 I 11�
CITY OF
EDMONDS ,
;Nw Z
CALL . 'FOR
kaFLEASED BY( DATE
ATTENTION,
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. - UBC
SECTION 109
PINK — Owner GOLD — Assessor
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch ................
RetainingWall ............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final ........
HEATING:
GasTest .................
Gas Piping ................
Equipment ................
Commercial Final .........
/WEXTERIOR
SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floor I nsu lation ...........
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY .......
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
98GE040107
02/04/98 10:26
p.0003 Recorded
Snohomish County
NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
Reference #:
Grantor(s): (1) I -CITY If. Milj��eA�2) Additional on pg.
Grantee(s): City of Edmonds
Legal Description (abbreviated): See Twn 27- Qtr 5wy
OR Lot Block.Plat
Assessor's Tax Parcel EDN(s): (1) .4-7!-;1-W.)- 03--�-OQ041' (2)
___Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
B 'M
Y:- .3 Date: d2-2
Page ( of 3
WHEREAS, the undersigned owners of property located at /7 P1
in Edmonds, Washington legally described
below or on the attached Exhibit A, have applied for a building permit for
compliance and1or to remodel a structure located on the site; and
WHEREAS, the applicant has notified the City of 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 trigger certain, requirements relating to the fire suppression and exiting
requirements; and
WHEREAS, the City has notified the app icant that . the permit will be issued
conditioned on limitation of residents t( 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. Covenaut:— Limitation on Residence, The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to rhc 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 PAI_ . residents or attempts to rent,. lease or
otherwise provide residence for additional residents above the
Jr/ 4 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. Subject Tract The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at L&APvE
4)e7!L —,Edmonds, Washington and legally described as: 73—.,1,,,r
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 Z in number.
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.
AUTHORIZED FOR RECORDING
. City of Edmonds
By: J24 Date: 4�ZJAV
Page 2— of X
v^8020401^7
U
.421
DATED this Iff -day of
ACCEPTED BY:
OWNER:
Jeannine L . Graf
Building Official
AcH # 1-30600
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
State of Washington )
County of SVC )ss
APPLICANT/PROPERTY
Applic
Applicd"t
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
I certify that I know or have satisfactory evidence that IMNF-R.
signed this instrument, on oath stated that he/she was authorized to execute the
instrument and acknowledged it as the AA01-,, Ce9_8Lr_ — (title) 0fA02aZZA&'.
e,acg_ .4 ;rd. (name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purposes mentions in this
instrument Subscribed and sworn to before me this I? day of
19 9�' L%
A4
N 141
lei
Notary Public in and for t tate of Washing 0
My commission expires
I certify that I know or have satisfactory evidence that
signed this instrument, on oath stated that he/she was authorized to e ec'ute-&-.'..'..
instrument and acknowledged it as the (title) of
(name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purposes mentions in this
instrument. Subscribed and sworn to before me this day of
.19
Notary Public in and for the State of Washington.
My commission expires
AUTHORIZED FOR RECORDING
City of Edmonds
By: -2?6 Date: 112VI9,6
Page 3 of -3 1
L.\TEMP\BUILDING\FORMS\ADF-COV.DOC