21609 79TH AVE W (2).PDF111111111111
6826
21609 79TH AVE W
r,i11ZJ1-T CLEPK-'b AVL S VC� /,�,j
CITY OF EDMONDS NOTICE OF LIMITATION AND COVENANT CEIVED
"505 BELL STREET
tF.DMONDS, WA 99020 ADULT FAMILY HOME JUN 2 6 t996
WHEREAS, the undersigned owners of property located at 41 L K? `�17
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 applicants 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 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 suc h 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 stnucture,as.an :adult family home shall be limited to Z or
fewer adults and their caretakers as allowed by applicable provisions of state law. The owner
acknowledges that in the event thatthe applicant seeks revision of the applicant's state license
to operate an adult family home with an occupancy of greater than lo residents 'or attempts
to rent, lease or otherwise provide - residence - for additional residents above
the �6 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 promi ' ses shall apply to and run with
the land with respect to a residential structure located at -�./ 40 �P-
Edmonds, Washington and legally described as:
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 in number.
LITemplFonnsILMT Cov.Doc YoL. 3 1 67PAGE1162-
2/"S
4. - .. Enforcement. In addition to any and other remedies civil or criminal which tile
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
ACCEPTED BY: APPLICANT/PROPERTY OWNER:
11kam 14'x,�Ze Applicant
Mannine L. LGrLaf f�(- Ap.plicAnt
Building Official
Owner
Owner
to
COVENANT AND NOTIFICATION
ACKNOWLEDGED: 3XI
MO
rtgagor
:< >
NOTARY FOR OWNER SIGNATURES
State of Washington
ss
County of
I certify that I know or have satisfactory idence that rwhlo, r� t, Ims V1 signed this
instru ment, on oath stated that h; rhe lwas authorized to execute the ins—trument and
-*4�,qk,rabwle�led it as the -(title) of (name of party on
4.'PNa-Jf pmwh6 m instrument was executed) to be the free and voluntary act of such party for
h�juse'9.�qnd purposes mentions in this instument.Subscribed and sworn to before me
day of J.A.— 1,9
0
Notary Public in and 6—r—the Stat Was
hington.
Op My commission expires_ 0?L421
I c6'Hff'y`-that I know or have satisfactory evidence that signed this
instrument,. on oath stated that he/she was authorized to execute. the instrument and
acknowledged it as the . —(title) of (name of party on
behalf on whom instrument was executed) to *bLs the free and voluntary act of such party for
the uses and purposes mentions* in this instument.Subscribed and -sworn to before me
this -day of 19
Notary Public in and for the State of Washington.
MY commission expires
LlTemplFormsUMT Cay.Doc VOL. 3167PAGE1163
VMS
9605290012
. ngton State
7tAF—w
F
��MMEALTOH
SERVICES
Adult Famil
Hom
ticen
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
to THELMA MILANOSKI
License Number 52 H 460204
to conduct and maintain at 21609 79TH WEST
EDMONDS I 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 adults
number
This license shall be in force from the — 7TH day of OCTOBER 19 95 , to and including
the 7TH day of OCTOBER 19 96
subject to revocation for due cause.
-- I V—
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,
10-173 (Rev, 1/91)
CJTY CLERK Fit
'V OF EDNI CEIVED
CIT ONDS NOTICE OF LIMITATION AND COVENANT
505 BELL STREET
tEOMU�DS, WA 99020 ADULT FAMILY HOME J U N 2
WHEREAS, the undersigned owners of property located at ' 416 0!9 — "QW8 0 4§1
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
:13
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
M
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 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 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 6 residents or attempts
to rent, lease or otherwise provide - residence - for additional residents above
the 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. Subiect Tract. The above stipulation and promises shall apply to and run with
the land with respect to a residential structure located at Z.1 60
Edmonds, Washington and legally described as:
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 in number.
L1Temp1Formsv-mrCov.Doc VOL. -3167PAGE 1162-
ZW6 %,�j �j 11 - - .7 FILE
4. Enforcement. In addition to any and other remedies (;ivil 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
ACCEPTED BY: APPLICANT/PROPERTY OWNER:
/�4gm 11'4'ye
Mannine L. Gra-f-U
Building Official
NOTARY FOR OWNER SIGNATURES
State of Washington )
)ss
County of NO a )
Omer
COVENANT AND NOTIFICATION
rn -ca
V
0%
ACKNOWLEDGED:
=
C_- CD
4
Mortgagor
C�
=C
-<>
>
Con
=C)
I certify that I know or have satisfacto idence that OA u� 40 signed this
ipstruirnpgtl on oath stated that h was authodzed to execute the instrument and
(name of party on
a,§qj6wIe84ed it as the
L(title) of
../,,4jP1-ta_jf 0',n,,wh6'm instrument was executed) to be the free and voluntary act of such party for
�and purp
hf pse9. oses mentions in this instument.Subscribed and sworn to before me
..3� i�4 day of rM AA,- 1 .9
Notary Public in and fo-r-tNe Stat�U Washington.
My commission expires
I ZMify-that I know or have satisfactory evidence that signed this
instrument, on oath stated that he/she was authorized to execute. the instrument and
acknowledged it as the . —(title) of (name of party on
behalf on whom instrument was executed) to'bO the free and voluntary act of such party for
the uses and purposes mentions in this instument. Subscribed and -sworn to before me
this day of '19
Notary Public in and for the State of Washington.
My commission expires
LlTempLvormsUAIT Cov.Doc voL. 3167PAGE1163
9605290012
IL *-J�5 3 S-/ S--
4
vashingron State
rDEPARTMENT OF
f
,(X
SOCIAL&HEALTH
7L�IF7 SERVICES
SINU flif
Adul-t family Home LicenQsc
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
to THELMA MILANOSKI License Number 52 H 460204
to conduct and maintain at �!2 1 *6 69 7 9 t h. A', ve, We I st
Edmonds zip code 98206 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 OOUR (4) adults
This license shall be in force from the 7th day of
the 7th day of Ocotber
Special Terms:
I
PSIIS 111.17:1 (1?(,v. 1/91)
number
Ocotber 19 91 , to and including
19 92 subject to revocation for due cause.
h
"o,
f Lirmor Liren.qng Authori�y
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.
No, 03515 LICENSE
T H Efi, I fY'- 0 F CORO N DS CLASS/yR.,4 19 6
BUSINESS L ENSE
This license is Issued 'in Womil with Ordinance No. 1828 and b =in conspicuous place at the
:e issued under thp provisions o s Is It ansferable or assignable.
ECTIVE I JANUARY -W;bECEME1ER OF
i a co 0 licft Lid NS YFAR a
location tor which d. N U
t I r
r) - r) 6
ATE ISSUE
BY:
CITY CLERK S1 8
MO. DAY YR.
so 4 W!"r 1' AMILY
z
E D NDS,* VA"' 9 8 026
MUST BE DISPLAYED ON LICENSED
Aging and Adult Services
0 OF
M C)C"
t%
AS FIRE SAFETY EVACUATION PLAN
An Adult Family Home shall have a posted plan for evacuation to safe areas in event of fire. Draw a plan for your home in the
space provided below, Indicate escape routes and designate where staff and residents should meet outside the residence.
Indkate location of fire extinguisher(s) and smoke detectors.
DSMS 21-054 tG/W) *S'j
instructions: Sponsor completes and posts in a conspicuous location
V
CITY OF EDMONDS
CMCCENTEA * EDMONDS. WASHINGTON 98020 0 (206)775-2525
FIRE DEPARTMENT
LOCATION:
2 3.609 79'r+1 At) j4
BUSINESS NAME:
8
MAILING
ADDRESS:
EDMONDS WA 98026
BUSINESS OWNER:
EMERGENCY-1-
KEY ACCESS-2:
0
l"IONS - N, H
PERSON CONTACTED: /W-
NAME OF INSPECTOR:
r
FIRE PREVENTION
SAFETY SURVEY
FREQUENCY S 'Fr "
FREQUENCY sH)Fr a STATior,
ST-AT10r,
J�17Frll
A D2
PHONE:
SCHEDULED
U
O�5 DATE DUE 1� (.3/0 1 /9 1,13
UFIR 0
OME PHONE:
77 5
ONIE PHONE:
'ONE
IOME PHONE:
481 4
411,1-31�',,;,,4
YESS
LETTER
NEEDED
INITIAL
�INSPECTI07NDATE
ENTER CODE ONLY ONCE VIOLATION CODE
ONLY 0 CE
V'O ATIO
2
2
3 ......
3
4
5
5
6
7
-0
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies In the City of
Edmonds.
You are to be congratulated on the relative good condition of Your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during our inspection which require attention to bring them Into compliance
with the minimum standards adopted by the City of Edmonds.
A re -inspection will be conducted in 30 days to confirm that the listed item(s) have been corrected.
Any overlooked hazwds Or violations of the fire regulations does not imply approval of such condit . ion or violation.
If you require additional information or assistance, please contact this office by calling 775-2525 between the
hours of 8 a.m. and 5 P.m., Monday through Friday.
SUSNESS COPY
7 1 Y V
W-e-A
CITY,01F,EOMONDS NOTICE OF LIMITATION AND COVENANT ECS1 E0
505 BELL STREET
tF.OMONDS, WA 99020 ADULT FAMILY HOME J U N 2 6 iggs
WHEREAS, the undersigned o'wners of property located at
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 applicants intention to utilize the
improvements and/or to convert an existing single family structure to an adult family home; and
WHEREAS, under the Uniform BuildingCode 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 tcl __&_ 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 strdcture,as-.p0.:adult family home shall be limited to 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 6 residents 'or attempts
to rent, lease or otherwise provide - residence - . for additional residents above
the 4 permitted in the -current -occupancy classificatlion, 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 79-v4S-
Edmonds, Washington and legally described as:
3. Notification to Future Purchasers and Assionees. 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 of in number.
MT . emplFormsV_MT Cov.Doc VOL. 3 16 7PAGE 1162-
M6
4. - .. Enforcement. In addition to any and other remedies (;ivil or criminal whA t'h'e
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 itsreasonable attorney's fees and costs. -
DATED this day of
ACCEPTED BY: APPLICANT/PROPERTY OWNER:
1;tlAw Applimnt
Mannine L. G-raf U Appflqant
Building Official
Owner
Owner
COVENANT AND NOTIFICATION
C:)
ACKNOWLEDGED:
'CS
4 :C
Mortgagor
C>
NOTARY FOR OWNER SIGNATURES
=C
State of Washington
)ss
County of5ND. )
wo
I certify that I know or have satisfactory dence that Lfwkhm' W t' Q
IMS4 signed this.
i.pstruW.pt t h; rhe Iwas authodzed to execute the instrument and
on oath stated tha
pft bwled_4ed it as the (title) of (name of party on
.49ftJfR'M',Wh�m instrument was executed) -to be the free and voluntary act of such party for
j
�4nd purpo
in this instumen-t.Subscribed and sworn to before me
ses mentions
day of
Im 7 1 0
14
0'.S Notary Public in ".and fo'�r t e Stat U Washington.
0'r My commission expires (.-?
I Zmifylhat I know or have satisfactory evidence that signed this
instrument. on oath stated that he/she was authorized to execute. the instrument and
acknowledged it as the (title) of (name of party on
behalf on whominstrument was executed) to'bd the free and voluntary act of such party for
the uses and purposes -mentions- in this instument.Subsc(ibed and -sworn to before me
this day of
Notary Public in and for the State of Washington.
My commission expires
1-1T@MPW0rM-SV.MT_C0V.Doc VOL. 3167PAGE11 6 3
9605290012
e City of Edmonds
APPLICATION
for
SIDE SEWER PER3HT
OUTSIDE,
'Q INSIDE REPAIRS E]
CARDNo . ............. ........................
EASEMENT No . ......................................
0 0
............. ............................... CONTRACTOR .............................................. .............. ....... .............................
OWNER A
PERMIT No.
STREET
HOUS� ....................................... ....... ......... ........... .......... .......... AVENUE LOT No . ....................... .............................................. BLOCK No . ................. ................
As�-- - ctj e 5 NAME ADD . ..... � I ........................... 4iz .......................................
Q-1
L—PIJ
PL
A V
Date
BACKIFILL WORK ORDER ISSUED ................... ................ DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED., ........ ....................
APPROVED
ii4
Approved:
'47
EYDATE -2�� ......................... ..............
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set for - th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empl-oyee-s o-r officers -shall be I -Jab -le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITTOF EDMONDS
Crry HALL — WATER -SEWER DEPARTMENI
SIDE SEW.Ek PE I RM[T
Call PRospect 6.1107 24 hours (plus
Saturday, Sunday and Holidays) be.
f,re work is ready for Inspection.
1V? - 930
ADDRESS ..... A ____ I i _4___ _'__ —
.00. _0� —
.............................
..................................
OWNER.............. ............................................................
Richardp-c .................................. ......
Permission is granted .......... ...............................................
..........................
cco" 4 for ........ .......
with City Sewers in a r a2bcekw11M' application on file and'go days, to REIF! ONNECT-a side sewer
verning ordinances.
ATTENTION IS 61
NOTE No. 1—The 4to
CALLED TO THE FOLLOWING:
Owners of the Property may obtain a Perin coustruct sewer
n de Sewer CorAraotor
must be employed to construct side sewer in itaroa. Do not cover any Portion sewgr eforT h
treet inside Property linet e it
NOTE No. 2—Obtain full information regarding Ordinanese of r b
G
11-16.030 and ReCulations governing SAsewei; Awlien You get Permit.
NOTE No. 3—Top of side sewer must have at least 30 inches "ir—w.
NOTE No. 4 /� wilf be Permitted. insfft'�]�?�eri�,Sline; minimum grade of
2%. No bends in grade sharper than 1 coverage at Property line and 12 inches
—Trenches in street must be water settled and surface of street restored to Oyiginal
failure due to improper work wh . ich may develop within one Year Of completion. condition. Contractors shall be responsible for
NOTE No. &--It is unlawful to alter or dotanY other work than is Provided for In the permit, or to do any work on the main sewer or its ap-
Purtenances —cePt to insert he Pipe into the wyc.
USE
0F:-E6M'0NDS ZONE PERMIT
CITY NUMBER' 960Z9 7
CONSTRUCTION PERMIT APPLICATION jo, etSITE/ PT
ADDRESS
OWNER:NA%iE4NAME.OF BUSINESS--?1-�*,',.',- Alf;
1 1-9,;1* 4 kv- 6a.;;r-
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
ASO.
W MAILING.ADDRESS -
Z 4
:01 111119,09, 71�17/'/_ 4ezesr PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 0
CITY TELEPHONE NUMBER Rw Permit Required 0
Zip EXISTING REQUIRED DEDICATION
Street Use Permit Req'd 0
Inspection Required 13
NAME Sidewalk Required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
ADDRESS YES 13 NO 13
w
REMARKS Z
cc ZIP ITELEPHON
_E-NUMBER U,
NAME
ADDRESS
0 ENGINEERING MEMO DATED REVIEWED BY
0
< CITY ZIP TELEPHONE NUMBER
Z FIRE MEMO DATED REVIEWED BY w
0 cc
0
STATE LICENSE NUMBER, EXPIRATION DATE V6
SIGN AREA SEPA R IEW ADS NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description ol Property - include alfeasemeints
SHORELINE# -7
Z
I W 0
AD
EXP
Aj
VARIANCE OR CLI PLANNING REVIEW BY DATE
0 tf4401610" 1440
U)
Lu V
0 1. - - 0
SETBACKS - FEE T HEIGHT L6T COVERAGE
FRONT SIDE REAR Z
wi Property REMARKS 5
4L
Tax�Account
Parcel No
Ail,
NEW Er'ZESIDENTIAL PLUMBING
COMMERCIAL
ADDITkON MECHANICAL
SIGN
0 REMODEL APT. BLDG.
GRADING' FENCE CHECKED BY TYP ONSTRU TION CODEa
OCCLIJPANT
REPAIR CYDS. x _FT) GRO
/7
DEMOLISH wooijst6VE SWIM PO L SPECIAL INSPECTOR AREA CCUP
H�6T TU
.0 INSERT . B/SPA REOUIRED MOLOAD
GARAGE RETAINlNd.WALlJ _FY01C 13 YES
C ROCKERY).
_ffi maw REMARKS
L3 (TYPE -OF PSE. SINESS CIR ACTIV[TY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 Z
rA NUMBER NUMBER OF CRITICAL
W
0 OF DWELLING AREAS
02 STORIES olle- I UNITS INUMBER
0
DESC BE O/R TJD BE DgNr.4ATTACH
XPOT Plj,� )!�:rj
AL ION. -REQUIRED
..INSPECT.
VALUATION
CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
PLUM13ING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONL GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
.,Pe."nitApplicotioT..,IOQ.Days� .=,; *
Permit Limit: I Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns an ENG. INSPECTION FEE
successors in interest, agrees to Indemnify, defend and hold
62 harmless the City of Edmonds, Washington, Its officials,
5 employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. IssuancPof thla-p4rmit'shall not be deemed,�to_ _RLJAN CHECK DEPOSIT
modify, waive or reduce ahy.reqUir6menVof any city ordinance
0
x nor limit In imy way the City�s ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
W
j
I hereby. acknowledge that I.have:read this application; that the
inform Iiifon- given is.correct; -and-Ahat I am the owner, or the duly. ATTENTION APPLICATION APPROVAL
to comply with city and
authorized agent of ' the owner..'�--I*i ; a THIS PERMIT This application is. not a permit until
state laws reg ulatl ng Construct lo ;�ind In doing.the -work autfioriz- AUTHORIZES
i, -ONLY THE signed by the Building Official -or his/her
ed t�eeeby,,.no:per.soh..w.11l:be'employied:ln , -violitibri-of the LiBbot,,N
Codd:of the State ofWashingtOn relating toworkmeri.'&Clom p*ensa;,' WORK NOTED Deputy� and fees are paid, and receipt is 41,
tion Insurance and RCW 18.27.
-, �. I "t .. 'INSPECTION-�-. ?k !acknowledged in space provided. 41
-AGENT)� ATE SIG D
SIGNATURE (OWNER OR DEPARTMENT A
RE
CITY OF
.70 EDMONDS .3-
JAN
L CALL FOR "RELEASED DYV DAT9
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUIPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADEAND APPROVAL OR 771-0220 ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
-HAPT-7 PIN!,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch ................
RetainingWall ............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -in .................
Commercial Final ........
HEATING:
Gas Test � ..................
Gas Piping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING .....................
FRAMING ....................
INSULATION:
Floor Insulation ...........
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE.
FINAL APPROVAL
FOR OCCUPANCY .....