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18400 90TH AVE W.PDFlill iiiiiiii 8752 18400 90TH AVE W 0 0 /5* — � ADDRESS: 'OVA AN/- 9) TAX ACCOUNT/PARCEL NUMBER: 40 01CW01 BUILDING PERMIT (NEW COVENANTS (RECORDED) FOR- lq"7& -ot q 0 11P--Hku,,1je. 37-25VI ( I Uo pq oqq� CRITICAL AREAS:— %. —�Q DETERMINATION: Xconditional Waiver Ej Study Required E] Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: 14 11'7 SEWER LID FEE $: LID SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: '11-761-110 SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED. OTHER: L\TEMP\DS'Ps\Forms\Strect File Checklist.doc USE PE MIT ZONE ER BUILDING DEPARTME-MdK ApplicantFilf 7L !ij PERMIT APPIUCATIO�Wlnside Heavy Lin.es 7557�— ADDRL !NAME PR NAME PF 9USINCSS) ss ,c LEGALZOT LOT AREA IVISION NO. Y W M At L L_—IM -'e'ly, X4,11-41 'YES C2 NO VARIANCE OR ADD NO. CON 0. USE NO. G 2S. - [ PHONE NUMBER ;7 PROPOSED YARDS e— ;G Hr s 'Z 1 2 Z '10( FRONT SIDE REAR Z PTA—M E ___L Z) A LOWABLE PR OPOS ED j SIGN AR E A SION ARE ADDRESg'— OTHER REQUIREMENTSJ Ir CITY JTELrPHONE NUMBER APPROVAL ITE NAM E STREET R/W r a: ';DD.'7ESS XISTING STREET R/W.5_,,,�—o FT. DEFICIENCY -rHis PnOPERTY 0 I- COMP. PLAN ST. R/W,;�/.-�o FT. 0 FT, U Ct ..Y TELE HONE NUMBER R11AR Driveway sloDes nol_- to exceed those Z Z 0 indicated an 9antlard Ng. No. I C.1 W STATE.LICENSE NUMBER CITY LICENSE NUMBER ICHECKED BY W Legal LL--cription cf Property (Show Below or Attach Four Copies) Z STREET AND/OR UTILITY YES W WORK REQ'D N 0 UNDERGROUND YES Z W 0 MING REO'D C3 NO de A&L; TYPE CONNECTION ]VERIFIED By U \J_ SEPTIC SYSTEM Y W APPVD By CITY ENG. NO REMARKS W METERS17E ISERVICESIZE CLEARANCE CHECKED BY W DRESIDENTIAL AS FIRE ZONE N, Co.. .0*.-R.S:.ENT.ALj ION TYPE 0 1 9 �7 - AD 0 !04 RETA NING SPECIA SPECTO"APEA CCUPANCY UPP.NT DEMOLISH I R-C 'DN Ro OUP_ -LT.R ..CAVAT. E] FENCE YES No OR FILL WALLI REQU I— X—FT) PLAN CH H S Sl By T I TF ISLOCATED 1 N THE CITY W ..Pl.R PR.-.OV. OF EDM S, LOCAL SALES TAX 0 INSP. 1OOL DED 31,04, 0 PINIM SOVL,��D NUMBER C?� STORIES NUM 13ER OF ARK 0 'LLING WE UNITS 7 S/1 L - 4 I�ATURE OF WORKJO BE DONE PROPOSED USE VALUATION FFr: Z Z PLAN CHECK 2 N 0.— I PLOT PLAN (INDICATE BUILDING SETBACKS, ABUTTING STREETS) OU ILDING -c/ Id PLUMBING al U FENCE SIGN RETAINING WALL SWIMMING POOL I N1111111 .-ro-l.d9e that I have read this application; that the In- TOTAL AMOUNT DUE lorm:111n given." �Orl�l; —11 that I — the owner. or the duly "tbor- Ized Kent of . wiser. I aaree to Cocarly with city e.nd atat* laws regu- IAtInK Constriction: and in dolog the Ork authorized thereby, no Person ATTENTION 'ON APPROVAL will be traployed In violation of the Labor Code of the State of Waablitirton TF41S PEnMIT APPLICATI relating to Workm�n'. Cozzpc ... tio. Inau—ce. At�THORVZFS This application is nct a permit urall NOTE: Permit Limit One Year (E.Cept DEMOLITIONS �htch ONLY THE algtled ')y the Building Official or his Dep- hall b leted 1. .1..ty d'.ys; MO*-'!�04111 BUILDINGS hall b, W.- WORK NOTED uly; and fees are pa!d, and receipt is ac- I knowledged in space provided. + 0 AGE I NSPECTION s!1, _f" V R, E (0 �,,Ao Tt SIG RTME H — 7 OCJ`A N T 60N^rU E v C:TY OF EDMONDS Mal NOTE': AppliCant Subject to Pbn bicrk F�c 775-2525 This POrMill Covers work be tione on private property ONLY. Any construction oa thl putoi d c ornain (curbs,sidewm;ks, drivewsyv, OPICINAL - Filc YELI.CW - 1%j,yl(.r marquees, pIc.: will requ—jopartIte p0rm;5gioj,. I P$NK GOLD NOTICE: '0"Wa r-r a n ty ... o N' The -in . ormation shown on the attached map(s) was compiled for use by the City of Edmonds,; its Employees and Consultants. Th,..e City ofEdm.onds does. not . warrant the n these accuracy of anything set for * th o . - rn a p A n . y person or entity -requesting a copy should conduct an independent inquiry regarding the infcbrm'ation shown, or ff�e -map(s)l including, but not limited to, I er -stub shown. Suc the lotation of any sew ewer stubs may or may- not exist and may or may not exist at the location shown. Neither the city of Edmonds nor its ernpl-o-yee*s o*r office-rs -sh-a-1.1 be I -Jab -l-e for the I n on this map(5)) nor for information g ve ovided baseu any one representation pr upon said map(s), APPLICATION for Ae City of Edmonds EASEMENT NO - -------------------------------------------- SIDE SEWER PERMIT FE NEW CONSTRUCTION REPAIRS LID NO - ------------------ ASMT. NO - ------------------ OWNER ---- -.4 ------------------------------------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO - -------------------- JOB ADDRESS ---- .... . .. ------------ LEGAL DESCRIPTION: LOT NO - -------- -------- --------------------- BLOCK NO - ------------------------------------ 0 E a 11 NAMEOF ADDITION ---------- - --------- ------------------------------------------------------------------- Approved: DATE -------------- By ly ------- 4' PERMNIT WNW) bi SEM 'CITY Of EDIM ER DEPART4ENT' WATEA�SEWW e. AMIT �,PEJR JA portion:. of- the ronsfru&ion.� 1% �735_2525- for side sewer,: inspections, BEF,ORE� covering .any Sun., holiday tnsp _ ections;, st NO�'Sat or (11' p e c t I o n. w I I V be, Provided within. 24. hours. after requ R, 11V ................... .... 100 -got �, .( . - ............ ......... 7� '77,77", ............. ....... �'ADDRES&LOCATIONI OF� CON$TRUCTION ... ...... ........ I ........................ — ......... ii, F:�nt ................. ........... ........ .............. ........................... PROPERTV)LEGAL 'DESC RIPTION ... 7 ...... .................... .. ; ........................... ....... ........ .......... .................................................... ....... .......... ...... ................. . ........ .................... ........ ............... .......................................... . ...... .. ...... T 411 .... 7 ............... ff WM5 ........................................ .......... ................ ...... 10—"ER AND/qR BUILDER.-Y .... 7 ... 07 ..... . .. ....... ... 7 .......... .... : ............ , 01 ........................ I ............................ C(I *�CTI IS, NAME,& ADDRESS .............................................. I ................................................... ty'�, w of -a side sewer to, the el sanitary se er 1v ........ ........... . Pal connect on Permission, is �granted*.� ........ ....... 19!K." for re r aiid,/or� Slv_llem 1n-acc6jdance�.wft1f,.,C1ty of, Edmonds -ordinances., �T�j4F -FOLLOWING:_ A'J�ENTION' IS 'CALED, TO; . I . I I - 11ne. A licensed Side Sewer Contractor must, be employed to�construct y�'obtaln,a Permit. to, construqt�.,aewej f the� p�operty�linb. Inside property 'NOTE No� .1—The��owners, o I 1 .1 cted, de�siiwe in Do no�,cover any portion 'of sewerlbefore it baabeen � nspe, L si t�,e�t area�j `�o i �Rt -of-W&Y. Permit obtainable from. the City Engineer'& office� i � f; a 'requires,;, NOTE No. 2 ork r.f - y * ght 8 whem you get Permit. olitain full in ormatton reg r '�jia e of 2%. No 'bends In grade I lnm�c,- 4T..&'0313�s - i�e tiOns. governlng�sl, "ese:yer :-NOTE, �& 3 line; minimum.,grad line. and- 12,qnc es Inside property NOTE NO: 4'.. -1-0 0 st e sewc mus I have t '36, in&s co�,erage.at property h In - sf�arper I - n w II'lid.liermitted. tt be responsible f or failure due improper t r,settled',and surface of street restored- to, original- conditiom Contractors shall 'to NOTE, No. 5.�Trbj�ches.in street.must be wa e worg-!�hich'7 d I p" within one. year. of :completion.. except 'to in- m y cave 0 an is . provided, for in' - the PC 0 do any work on the mairi, sewer or'Its �appurtenances %a rmit, :or s*unls.W� , �q -&-No; 6L404 other work �th :NOT 0 1 t,the'�pipaflnto the,wyei, ................ MISAVED� -,E3i �Dat ................ Date.. ....... By ................ Date ........... .............. -PP]Wql� 74 BY 601.... , V-1 ................................................... ------ - By ............. .......... ........................... APPROVE6,, ( . ......... .................................... ......... .................... ................................... ........................................ .................... ....... 1 41- 'Da R,6inarks:� ....... . .. . .... .................... ......... ............. ............................. ................... ..................... ............. ....................... ................... ......... ......................... .......................... orm' , n ' on ction PRIOR To Re(juest, For, Inspection, ed. By"Owner of'Firrrf'.Perf 1 g-C. s ru ��_�,,BOTH; Fermit,Ccipics, MU ST Be Sfg�n ........ hereby certify,that 'the side sewer ins tallation: constructed under'this-,�fiermlt ...... .............. ................. ............. ................. ...... (Owner of Con��actlng Firm Performing Construction) ,W." installed, in, accordance, with all governing:ordiiiances- of'the� City of Edmonds,., .............. �Dafedt thi& .. ........................ day, of ............................... . ...... ........ r, E], iSewer E]; other Check BEFORR.You,�dig. for: Water �Ell Gas Telephoile-,Ej,.. POWe APPUCA110N �The City qf Edmonds for EASEMENT NO - -------------------- -- -------------------- SIDE SEWER PERMIT NEW CONSTRUCTION REPAIRS 0 LID NO.. 0 - -------- --------- OWNEP- --------- ---------- ------------------ JOB ADDRESS ....... ......................... .......... ------------------------ 0 0 a � op, C'. � t CONTRACTOR ----------- ------ ...... PERMIT NO. LEGAL DESCRIPTION: LOT NO - ------- -------------------------- BLOCK NO - ------------ ----------------------- , N --------------------- ----- / ---------- --- -r .......... ............................. ------------------------------------------------------------- 'A --/ 4 S NAMEOF ADDITION ------------------------------------------------------------------------------------------------------------- --------- RECEIVED JUL 7 1976 Public Works uvvt. Approved: W� DATE-------------------------------------------- BY --------------------------------------------------- i - i7ig P44A) Wr 1.�� Af K- -- -1-7 z - I - = LZ&JPC L, J,Ajjr�,�'>4 I.;-- I-' Lor 1, -i;&L-L M�s Wa 4P,q 119ss /\Pprrlot,r>/", oov�� ,& K- MRqMr'S,,qMV KW5HPre- I e400 q0ti Ave. W, 1��IPP t:6� 14,AsH b 0 zO I ( -Zol6 � —7 75 — 3 &q ADD IT(jM$1 1 07-144 zf 7 'PF -7 fil J- 0'-41 op o' ell % o oo, ol F-oC4 41 IF:-. o7e.3- -f741 P-- 9344375 �' Lo -4C) 0 r CIT. J144)1� AJA-r 0 FAVWCI A Pff 6444e* r, Gr itical Areas Checklist -si W te Informatioxk..(sd'ils�graphy/hydrology/vegetation�' Sitp,4 e-6 _&4:�!(� ion: ddress/ Locati —Ono 2.- Property Tax Account Number. --'3. 1,40roximat16 Sit6 Size (acres or square feet): 'Af 4.. Is this site currently developed? _42yes; no. If yes; how is site developed7 -w Z7,�L= .5. Describe the general site topography. Check all din apply. Flat: less than 5-*feet elevation change over entire site - APR pERMIT'd6UNTER Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet)- Hilly. slopes present on site of more than 15% and less than 30% a vertical rise 111's. .1 of 10 eet over a horizontal distance of 33 to 66 eet). Steep: grades of greater than 30% present on site (a vertical rise.of 10-feet over a horizontal distance of less than 33-feet)- Other (please describe): 6. Site contains. areas of year-round standing water. /00 ;,Approx. Depth: 7. Site cotitains area of seasonal standing water IJ 40 Approx. Depth: What season'(s) of the yea&. S. Site is in t6 flood A)O floodplain A) 0 of a water course- 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are sewonal? (What time of year? Y 10. Site is primarily: forested meadow ;shrubs mixed urban landscaped Oawn,shrubs etc) L/ 11. Obvious wetland is present on site: IUo� For City Staff Use Only 1. Site i s Zoned? 2. SCS rnapped soil type(s)? -Z Ulfff*10 LW9 3.. Weiland inventory or C.A. nup indicates wedand present on site? 80- 4;-�- !,)Critical Areas inventory or C.A. map indicates Critical Area on site? d 5.:1 ite within esignated earth subsidence landslidehazard area? djo 6.. Site jes,ignated on the Environmentally Sensitive Areas Mao? Ajp DETERbMATION 'STUDY REQUIRED CONDITIONAL WAIVER < NAIVER e5 Reviewed by; Plann ate A V� OW810440% RECEIVED." Z% 96,7 "*4 V;t 7� 04 ER NT�IER b qf* Ito 0 - I City of Edmonds v". bI,QTX-.n. " 1: 4,'d 0 k IT Critical Are''as' C h7d`� "kii c st". 71beClitiCalAreaSCh�C�eWtg6edo--�,;,--�,,�_,,,r.,�.I W&M city., 7wi (IW Will this form is to be filled out by -my person 910. a Precursory site preparing a Development Pexmitz;,;w�tvrn�,*;-1 wtvfl S, Application for die City of Edmonds tocomplete to his/her submittal of a pennit application, permit to the City. �v. t lfof WithaOVmedeopy.oft.hi.s.forindw.,,,.- Illepurpose of the Clie-cklist is to enable 'Wr=M dwuld also submi(a viciniJ6�. map' City staff to determine-whet1w any or plot Phu.. individual lots Of the ,yarcel potential Critical Arcai'a-mi or may' be,.---�.. A_ - �Idi 4111eQr dw .", enou9b can find . . I ., ON I present on the subject propertyiJ7be J9W Irkik'46;I J ft andiMenWilw�sWJect- infommfion needed to complete the addW=4 the �pplican� shaU, hm:lude� CheckUst should be easily available fiom-- '-4tJj&pa*nent Wonnation (e.&4fte", I _�' i , '. I '. ., 4, , & I , �.vu �tx 1 5 11 observations of the siteor data availabli a'i, "PUY awav, etc.) or stu in City Ha (Critical Areas inventories,, nl*,. 'Cordurictionval-, c6dat or sod' surveys). _!StWIn6mpktIng their p reirmfinary T.-,,v'aSses5inent of the site.- fii)-i mi;frl - - -)�,iz An applicant, or his/her representative, - must fill out the checklist, sign and date it, I have completed the attached Critical Area Checklist and 2tie�:t'that the answers . provid . ed are factual, to the best of in y knowledge (fill out the appropriate column Owner I Appficant: Applicant Repres . entative: Name Narn� 2� 7 StrWA Addr= StreetAddim A— Y( 1 G� ne City* 'City, State, ZIP.I State� P,.,- P No n 0== Ro, Date X �1?_ k LOT 1� 1/111 -1 '�W� 11,110. r i?A ll"� .-APP r1larl/0%la)rl- 15,1-00 cW4 '25,620 cv K7 oP� 2-7 4.,o cl- Lk-LIO Zlx 2d Pe i 0 0 City of Edmonds Critical Areas Determination Applicant: Steve asner etern-iination #: 1 96-51 Project Name: Permit Number: Site Location: [18400 90th Avenue West Property Tax Acct #: 1 6385-000-001-0001 Project Description: The subject site is within 1/4 mile of an active eagle nest. The Washington State Department of Fish and Wildlife has strict regulations for the development of properties within one mile of an active eagle nest site. Therefore the approval of any building permits for this site shall be subject to the requirements of the State Department of Fish and Wildlife Waiver Criteria (all criteria must be found to apply): --Ax There will be no alteration of the Critical Area or its required buffers; --AX The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; --Am The development proposal meets the numimum standards of the Critical Areas ordinance; --AX The above findings are based on the following conditions of approval: 1. The applicant must show written evidence of compliance with the requirements of the Department of Fish and Wildlife prior to or with the submittal of any building permits or other development permits for this site. 2. SEPA may be required with a building permit submittal at the discretion of the Department of Fish and Wildlife or the City of Edmonds. Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby. Waived, as authorized by Chapter 20.15B. 150 (B) of the Edmonds Community Development Code. Name §gw2ture DYte ATE RECEIVED PERMIT EXP IRES CITY OF EDMONDS PERMIT NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS OWNER NAME/NAME OF BUSINESS 11,4 T"4 KA^10"4 1,R &A 4 L4<6 AFAI, 11V M,4 r PLAT NAME/SUB DIVISION NO. LOT NO. L�D NO. W z MAILINGADDRESS L D FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED REQUIRED DEDICATION FT TESCP Approved RW P mil Required 13 on Street Use Permit Required E3 Inspection Required 13 Sidewalk Required 0 Underground Q Wiring required [3 CITY ZIP L_Y1V1\1W0C?V TkV371 TELEPHONE _SZ4i-7 NAME METER SIZE LINE SIZE NO. OF FIXTUR ES PRV REQUIRED lu YES 13 NO[3 (3D cc R L) ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE UJI W PTY ZIP TELEPHONE NAME ENGINEERING REVIEWED BY DATE ADDRESS 0 U 0 FIRE REVIEWED BY DATE Uj cc CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINEORADB# INSPECTIO RECI'D 13 YES GKO� SEPA COMPLETED I EXEMPT CA# ek Env_ WAIVER 13 STUDY 0 ZONE SIGN AREA ALLOWED , PROPOSED iVA HEIGHT ALLOWED PROPOSED LU PROPERTY TAX ACCOUNT PARCEL NO. 0063?_5700000/00 NEW XRESIDENTIAL COMMERCIAL PLUMBING / MECH ADDITION COMPLIANCE4890 MIXED USE C REMODEL MULTIFAMILY SIGN GRADING FENCE REPAIR CYDS ( X FT.) OTHER DEMOLISH TANK LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) PROPOSED FRONT SIDE REAR FRONT SETBACKS (FT.) URSIDE REAR IV (, 0 3 z z REQ*D PARKING DED 2 IPROVI Z_ LOTAREA I PLA E EWEDBY DATE %�� ) REMARKS :(=,I, z 0 U Lu 0 o GARAGE c3 RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIREALARM All V r4 5 AL^ KM 7wt (TYPE OF USE, BUSINESS OR ACTIVITX) EXPLAIN: TYPE RUCTION CM I OCCUPANT GROUP NUMBER OF STORIES NUMBER OF DWELLING UNITS I SPECIAL71NSPECTION REQUIRED 1-1 YES CON SULTANT OCCUPANT LOAD DESCRIBE WORK TO BE DONE REMARKS _j n GEOTECH REPORT BY: Je STRUCTURAL DESIGN BY: VALUATION $ Description FEE Description FEE Plan Check State Surcharge z_S7 HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge PLAN CHECK NO: Plumbing Base Fee Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC �-DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review 2 Lu 06 PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection (n to 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Reyiew'�,. 'Plan Chk;!Deposit Uj _j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL.CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FR�M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. j ,gAMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. Due 0 ��NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT:AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL: I THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. \,WORKMEN'S 5WNSATION INSURANCE AND RCW 18:27. —0 FICAS SIGNATU DATE N (425) /' DATE SI NED 11 �,5" 0 /9 � 14 771-0220 �R�7 LAI AT'fEN:FfON EXT. 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE - YELLOW INSPECIOR' FICATE OF OCCUPANCY HAS BEEN GRANTED. USC109 / IBC110 IRC110. PINK -OWNER - GOLD - ASSESSOR Adu 1 t License Number: 322501 Pursuant to of OCT 2 12005 EDMONDS CITY CLERK icense 1� d,`1h_`. M* in'r,,j equirements aws &f.:the.SWI�6.0 4,-A-�iiington an e ..TihnblumLicens, �artment,.of-,S,66 and Health ServiQ*es, d1id-o'n'k4s herebygri`fi�ted to REAL CARE, AFH INC C= C= en'ed 14 YA� C114 If! P ai-fieri Cqploration,repres t by QN� co _j .:.to conduct and maintain at 1840,0 9.0TRAVE W go C_> Cit,,,-, otEDMO-N.-P.- ',,"Zip Code 98026 County. of;,.�8NDBOMISH State of Wa§hingfon _y an Adult'Family Home for the care and su : b&vi.sion of adults as f6ilow-s:, 24-h6ur careforno rnore� than- .6 adults & bj ect to sus ei 6.ati6h for -due baus" This license shall be in force'. orn-th'19th of,, iober'! siomor,:rev This home has a special design.4tion to pjrovide�,servip`-e' to..- ersons with�:- Dementia P Conditions on ticense, if any: Licensing Authority NOTE: The department renewal of a license does�ii tpreclude the.dep.aftme,rit ftom tak�i,&,Any -action under WAC 388-76-705, based on inspection. This license is not transferable, and is valid only for use by the 6664a' o v�rt ", I 410*1 p0hp. or:ifidividual(s) to whom it is issued and at the location above described. Issued by Authority of Chapter RCW 70.12 FINAAPROJECT APPROVAL FOIA4, TO: DATE: MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: z�;� FIRE DEPARTMENT DATE PLEASESIGN ENGINEERING DIVISION DATE PLEASESIGN PLANNING DIVISION DATE PLEASESIGN PROJECT 1? SITE ADDRESS Q ',+VV— L41 PERMIT #aQQJ_- (-3 ZJ ef _ADB# DATE INSPECTED DESCRIPTION OF WORK TO BE INSPECTED A field inspection was conducted to determine compliance with -approved plans. Final approval denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS and the granting of: GRANT FINAL PROJECT APPROVAL GRANT PROJECT APPROVAL WITH CONDITIONS NOTED 1:1 Copy of CONDITIONS given to owner/contractor by inspector I . FAILED FINAL INSPECTION - OUTSTANDING ISSUES El Copy of CORRECTION NOTICE given to owner/contractor by inpector I . 0 3.. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Signature 1:temp:b1dg-fonns:ocaprv1 3/25/04 SEP 2 7 2005 PERM17, COUNTEF1 REQUEST FOR INSPECTION- Adult Family Home APPLICATION NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION 1 - PROPERTY INFORMATION I "0M."t PROPERTY OWNER NAME: M-MoMARIA r-41rAA10141 DAYTIMEPHONE: 42--5-77E-5-247 UCENSEE NAME (wowFsowq� tf,&A--Z- C,410E Atzr//, 11VC DAYTIMEPHONE: 425 77S -5247 A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components, for e)dting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) ON 4 — DTF%CLATlVlFR /-qTr.NATt]RF RLF I certify under penalty of perjury that the information furniished by me is true and correct to the best of my krowledge, and that I am authorized by the owner of the above premises to request inspection for and operate an Adult Family Home at this location. I further certify that I have made application to the Department of Social and Health Services and the jurisdiction for the appropriate license(s) to conduct such business at this location. Ifurther agree to hold hanniess the Jurisdiction conducting such inspections at my request as to any da im (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, including its officers and employees, upon the accuracy of the information supplied to the jurisdiction as a part of this application. NAME/TITLE: MY 1A DATE. A710,5-- Pr PROPERTY OWNER APPLICANT 0 LICENSEE SECTION 5 - INSPECTION CHECKLIST YES NO Home licensed (or applying for license) on or after July 1, 2001 El-' 0 SLEEPING ROOMS Sleeping Room #1 0 S F1 NS I KINS2 Bedroom door is openable from the outside when locked Closet doors are'readily openable from, the inside Smoke alarm is installed in the bedroom Rol 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 2-4"high; 20"wide) f4e 0 Sleeping room window has a maximum sill height of 44" - Roo" 0 Sleeping Room #2 11 S 0 NS I ff"NS2 Bedroom door is openable from the outside when locked Cl' El Closet doors are readily openable from the inside Pr' E) Smoke alarm is installed in the bedroom ff, 11 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24"high; 20'vvide) W-1 0 Sleeping room window has a maximum sill height of 44" n- Sleeping Room #3 o S 0 NS1 f�I'NS2 Bedroom door is openable from the outside when locked [1-," 0 Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom 130, 13 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 #4 0 S 0 NSI 9"N'S2 Bedroom door is ope'nable from the outside when locked Closet doors are readily openable from the inside W 0 Smoke alarm is installed in the bedroom F-4", 11 Sleeping room window has a minim urin net openable area of 5.7 sf. (minimum dimensions-. 24" high; 20' wide) Sleeping room window has a maximum sill height of 44" le 11 Sleeping Room #5 0 S 0 NSI [5NS2 Bedroom door is openable from the outside when locked (9" El Closet doors are readily openable from the inside 0 Smoke alarm is installed in the bedroom 19" 11 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 0 S 0 NS I WNS2 Bedroom door is openable from the outside when locked e El Closet doors are readily openable from the inside 14' El Smoke alarm is installed in the bedroom 1q, 0 Sleeping roorn window has a minimum net openable area of 5.7 sf. (minimum dimensionis- 24"high; 2W wide) @11� 0 Sleeping room window has a maximum sill height of 44ff UK E) GENERAL Bathroom doors are openable from the outside when locked lq" E) Smoke alarms are installed on all levels of the dwelling El All smoke alarms are audible in all parts of the dwelling upon activation of a single device Pr 0 Access road and water supply approved by Fire Department W 0 PASSED 0 CORRECTIONS REQUIRED 0 PERMIT REQUIRED INSPECTOR: S�_n U34\-- DATE: 0 '051�117 C er—L) /' 6�_. f 2- _0 37 RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab IrIsulation .......... PLUMBING: Underground ............. Rough -In ................... Commercial Final ...... HEATING: Gas Test .................... Gas Piping ................. Equipment ................. Commercial Final ....... EXTERIOR SHEATHING NAILING .......................... FRAMING ........................ FIRST FLOOR FRAMING ... INSULATION ................... Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION ... MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. vv\% 00,TftO 7 V Ilf LU Cn I 0 cli 0-1e� *1i E 14OT "OtF IAL& It' SERM ES Adult Famil Az Home Licefl8e In cOrflPliance with and pursuant to the laws of the State of Washington and the Minimum Licensing Requirements of the DeparWient of Social and Health 8 ervices *a I icense is hereby granted to LETTY V. KRASSNER to conduct and maintain at LicenseNumber 31 R 40322500 18400 - 90TH AVENUE WEST Ci tY of EDHONDS gip Code 98026 _, County of SITOMMISH I State of Washington, an Adult Family Home for the care &nd Supervision of adults as follows. 24-hour fainfly care for no more than - six (6) _ a(jults 11tinter This fleelftse shall be in force ftom the 22ud day of AUGUST —) 19 96 ) to and including the 22ncl day of AUG179T 19 97 ject to revocation for due cause. sub Special Terms; Te%A"n- 10-11 Ja 09 ThoxiaGn LVeewfog NOTE: This license is not transferabtA artd Is valid only for use by the indivifti(s) to villola it is Jimued and at the location abo . ve describod, Issued by Authority of Chaptw 172, Lava of 1967, and ROW 70.128, B311S 10- 173 (uev. j,,a 1) C1TY Of EDMONDS 505 BELL STREET EDMONDS,WA 9 802fOF LIMITATION AND COVENANTC1- 1 7 C`--` NOTIC ADULT FAMILY HOME IL WHEREAS, the undersigned owners of property located at 19voo '90-�� C- uwer in. Edmonds, Washington legally described below or on the attached Exhibit A, have applQ 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 improv I ements 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 applicant that the permit will be issued conditioned on limitation of residents to 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 6 building pennit and in order to confirm the promises upon C� which such issuance' is based while providing notice to any future owners or mortgagors of the I". 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 e; 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 thq applicant's state license to operate an adult family home with an occupancy of greater than Z residents or attempts to t lease or otherwise provide . residence for additional residents above the-!Lpermifted 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 Edmonds, Washington and legally described as: ler / 7-4LL,�qltf 4Vdlow 41b. ?- 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 - r7 in number. (6 0/, �,Wj L1Temp1FbrmsV-MT cov.Doc VOL. 3 2 0 5- Pni 0 5 216Y95 8, �3 4. Enforcement-fn 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 afforneys fees and costs. DATEDt his day of 14U-?&sr ACCEPTED BY. APPLICANT/PROPERTY OWNER: AVA6ft1o;r13VA JoKnine L. Graf Building Official F/W�& Applicant Applicant -it Owner' COVENANT AND NOTIFICATION ACKNOWLEDGED: CL� IrVtagaagor_� NOTARY FOR OWNER SIGNATURES State of V_ a ))Ss Gewy of 1"� I certify that I know or have satisfactory evidence signed this instrument, on oath stated that he/she was authorized o exe6ute the instrument and acknovAedged it as the nw ri e- ie 5 (title) of A- (name of party on behalf on whom instrument was executed) to be the free �nrf voluntary act of such party for the uses ang.(purposes mentio ir� this. instument. Subscribed and sworn to before me this ay of L'� d ,1994 Notary Public in and for the State of Washingtm.C" 4-1 0 My commission expires 22 I NOT AM 'y I know or have satisfactory evidence that signed this I s n on oath stated that he/she was authorized to execute the instrument and A *--.ac ged it as the (title) of (name of party on 01 "If h whor� instrument was executed) to be the free and voluntary —act of such party for e uses and purposes mentions in this instument. Subscribed and sworn to before me this day of .19 ID C:) �.'Lj Notary Public in and for the State of Washington. 0 My commission expires Cn W CM I 1.0 CD cn, X tn LiTemplForms1f.Mr Cov.Doc VOL. 3.20.0PArA584 9" 60 8 2 9 0 4 9 9 4 CITY CLERK CITY OF EDMONDS 505'BELL STREET EDMONDS, WA Q8020 COVENANT Whereas, the Grantor(s) YhVE I- Lic-TTY MAT hereaft referred to as "Grantor(s)", have received a Building Permit #J��for property which is zoned singje. family residential, and is located at— IR400 tax account parcel number(s) 636:5-- -co / -ow and legally described as follows: A-67 Whereas, the City has received a building permit application for an Adult Family Home with a second kitch'en to be located in an existing single family residence in a single family residential zone. Whereas, pursuant to WAC 388-76-190 an adult family home is considered a residential use of property for zoning purposes, and are permitted in areas zoned for single family dwellings. Whereas, the City desires to approve utilization of a secQnd kitchen in the Adult Family Home as a reasonable accommodation to the facility as care provider to the disabled for so long as the second kitchen is utilized, and only utilized, in conjunction with the Adult Family Home use. Therefore, in consideration of the City of Edmonds, Washington approving the second kitchen as a reasonable accommodation by issuance of a building permit, the Grantors agree as follows: 0 1 . This covenant and all terms hereof shall be binding on Grantor, heirs, assigns and successors in interest, (M and shall be deemed to run with the land and bind all future owners to the real properties described above. 1110JO 2. This covenant shall be recorded with the Snohomish County Auditor and Grantors shall pay for all recording fees. (X 3. Grantors hereby covenant that the kitchen on the lower, basement floor of the subject residence can be Q used only in conjunction with the Adult Family Home and that the said kitchen shall be removed immediately.upon termination of the Adult Family Home State License # for the subject facility or cessation of use.of the properiy-as an Adult Family Home, unless, or until, zoning laws allow otherwise. 4. The provisions of paragraph 3 above shall be specifically enforceable in the Superior Court of Snohomish County. The prevailing part shall be entitled to its attorneys' fees in such a proceeding. 5. Prahtors acknowledge and agree that approval of the second kitchen for the Adult Family Home use and the creation of this Covenant are a reasonable accommodation of Grantors' rights as a care provider to the disabled and of its clients' f'oreseeable needs. The Grantors, therefore, on behalf themselves, their successors and assigns do hereby waive any and all claims of the Americans With Disabilities Act or the Washington Law Against Discrimination which they may have as of the date of the,execution of this Covenant and promise to hold harmless and indemnify the City, its officers, agents and employees from any cost, claim or liability which may be incurred in defense of such a claim. signing d' 'c 19 u ion of this Covenant, the parties hereto agree that Grantors are in compliance with existing zWngZe -D 9$ti X 0 E 1L- >: -,- Signed Cn T Subscribed ind s me this day of 1996 61 PUB00 0 co:- P Notary Public in and for the State of Washington. Residing at 4�� . Z f2 VOL. 3 9 0 PRE ^Td-)YEET FILE CITY OF EDMONDS PUBLJC WORM - EMINEERING ACTION REPOR SUSPENSE DATE: Date: I bo I / Time: File # Attachments: SUBJECT: Zlkj 06�zal" ) �y r-j"n REQUESTOR: 'M �Zov 6( ADDRESS: V�Wgqjoo- =q, %Kgrn PHONE: 77 REQUEST RECEIVED BY: TELEPHONE CONTACT IN OFFICE OTHER: - RECEIVED BY: 4-121 F--lYes 11�zl No All Concerned Notified F-1 Act�in Completed/File �M 7 77— City of Echnon -OF-WAY CONSTRUCTION RIGHT PERMIT Issue Date: 3 Permit Number. A. Address or Vicinity of Construction: 18400 90th Avenue W. GTE to place I rtgain a buried s—ervice. s4erate, and mai, B. T cific): wire f r6�i e'xi n5 pedestal # 9 located at 18406 01ge of Work (be spe_, 7k890_1o� 9 Av. W then north $o a residence at 104UU VUtn Ave. W. feet, _!'R'U!'w95Te0't. push 1 driveway and push no road. Please see attached sketch GTE Northwest Incorporated C. Contractor: Marilyn Holmgren, Permit Coo rd i natooContaci:f iiwll�,.-*'-�'A exa nde r 771-9036 moirile 388-1358 2312C W. Casino Rd Mailing Address: Fyprptt - WA qR?QLL-141L0 Phone: State License #: D. Building Permit # (if applicable): Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. n - Commemial E] Subdivision El City Project [D Utility (PUD, GTE, VING, CABLE, WATER) Multi -Family El Single Family Other GTE W.O. # 2100-9POOIDB 242310 INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut 0 Yes filNo G. Size of Cut: x arg4�_$_ 917, Please see attached sketch. APPLICANT TO READ AND SIGN INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds 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 or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit. 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7119APPLIGANT. 4 Constr cti drawing of proposed work required with permit application. u -ion A 24)16 y nt� in tice i�Lre uired for inspection; Please call the Engineering Division, 771-0220. W1 a+T-*al t b i spected during progress and at completion. d Drya -It ,&o ein I Res ration is't6 lie;pf accordance with City Codes. Street shall be kepi -clean at all times. Traffic Control and Public Safety shall be in accordance with City reg I s as required by the City Engineer. All street cut ditches shall be patched with asphalt or City approved mX'yX4!1Pr;ri0f1�o(th end of the working day; NO EXCEPTIONS. 7 Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be available on site all tin rl*';�Inspectton purposes. Signature* _�X:ax Dave Squires Date: 2/26/97 F orAlkent) Sec Mgr -Access Design CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR'CITY USE ONLY APPROVED BY: RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND III: SPECIAL CONDITIONS: WA RESTORATION FEE: L PERMIT FEE: �O TOTAL FEE: COMMENTS: RECEIPT FEE: DATE: ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 0 0 FIELD INSPECTION NOTES Comments: Diagram.: (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION 0 YES Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: El NO PERV17 SUBMITTED BY G T:-- 0 ro 0 0 w 0 0 w LEGEND PEDS a POLES 0 ROAD BORES OVERHEAD LINES- I.D.UTILITY POTHOLE 1= UG TRE14CHINC ----JJG7- R. 0. w. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - EOP A -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - N". ro En ro m z CUTS. 1;3 --anow— C) Q5 9 0 - 19 ..s.City of Edmon(e RIGHT-OF-WAY CONSTRUCTION FILE Permit Number: ?3 SIK� Issue Date: 5"- 69 - C/ A. Address or Vicinity of Construction: 1R400 9MAy. W. (9315096) B. Type of Work (be specific): Install Nal Service C. Contractor: Washington Naturql Mug rn. Mailing Address: 81 r) Mprf-Ar State License #: D. Building Permit # (if applicable): Contact: Frank Swan Phone: Liability Insurance: _ Bond:$ Side Sewer Permit # (if applicable): E. [-] Commercial 0 Subdivision 0 City Project &k Utility (PUD, GTE, WNG, CABLE, WATER) F1 Multi -Family E] Single Family 0 Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut: J�Wes 0No G. Size of Cut: 4@Wa er H. Chargc�,$ APPLICANT TO READ ANID-SIGN INDEMNITY. Applicant understands and by his signature to this application, agree the City ofEdmonds harmlw &nriOuL, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be d. against the City of Edmonds, or any of its departments or setosts, and attorney fees by�reoson ofgran4ing this permit. employees, including or not limited to the defense of any legalproceedings includin d.4 s-' I X FINA LS THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FO A PERIOD OF ONE YEAR FOLL L INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILEAF 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. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220. Work and material 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 requil%d 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 Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit will be available on site at all times for insneeti-np Sin -nature: Date: April 28, 1993 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORIC FOR CITY USE ONLY APPROVED BY: RIGHT OF WAY DEPOSIT TIME AUTHORIZED VOID AFTER -1 3 DAYS DISRUPTION FEE/FUND Ill: SPECIAL CONDITIONS: RESTORATION FEE: PERMIT FEE: TOTAL FEE: ' ;7t3 COMMENTS: RECEIPT FEE: DATE: ISSUED BY: 0 NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Fn&rg. Nv. 1991