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21706 80TH AVE W.PDF111111111111 7195 21706 80TH AVE W ADDRESS:_ 6:ql 7" TAX ACCOUNTIPARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: 06 CR.ITICAL AREAS: DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: DETERMINATION: 0 Conditional Waiver Ej Study Required F] Waiver SEWER LID FEE $: LID SHORT PLAT FILE: SIDE SEWER AS BUILT DA SIDE SEWER PERMIT(S).#: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: LOT: BLOCK: LATEMP\DS'Ps\Fomis\Street File Checklist.doc 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 'Edm * onds does not warrant the accuracy of anything set for ' th on these map(�_). Any person or entity -requesting a copy should conduct an independent regardi ng the information shown on fh-e -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 emp-1-o-yee-s or officer-,-) -sha-111 be Hable for the information given on this map(s), nor for any one representation provided based upon said map(s), APPLICATION for I fie City of Edmonds SIDE SEWER PERMIT EASEMENT NO . .......................... .. .............. NEW CONSTRUCTION REPAIRS LID NO. ASMT. NO. OWNER ----- M.LJ F- E—i> ----------- ................................ CONTRACTOR ....... ------- PERMIT NO . . ............. JOB ADDRESS 7-7 ....... . LEGAL DESCRIPTION: LOT NO - -------------------- ----------------- BLOCK NO - ------------------------------------ /I-- I L. ....................................... *.j -- ----- -77ue-h.d . ........... .................. ..... ---------------------------------------------------- 11 I NAME OF ADDITION ---------------------------------------------------------- DATE ........... B - ------- 4 �-X- ..... ---------- J.. ij A `E EWMERVIPERMY11F TE.!l�SEWEW,!D PARTMkNTE- -ilPtIRMIT in sld;�"Sew;e 775;251 �iFORE _'�-ver 'g�any�.r n �r4cqqpl k,3�_-_ ,("C,a I,,. :.V� " ".: "'.. , tjont!,of, the" p_ s ection m 6e;'P*i�'videcl-,,,�41�� ?ur �fter lnsiie6tlons P ,ADDRESS','.L�OCA-ITON,�"OF-"CONST-RUCT-IbIN.,:..:.: .................. ............................................. �l .. . ................ ..................... ..... ............................... 14 T`.z" I, CRIP _ROPERTY� _ - '; �' ;5' TION ...................... 4' ........................ ...... -j :- ...... ..... ....... P ...... :7 .............................. . . ............. ................................................................................... ............. . ........................................ .............................. Irls. f ....... ......... AWPAOW BUILDhR.-.'.: .................... ... ... ............................ ............................ *ACT & * "DRESS ... ........................... :114,; h t ............................ . ........................................... .............. Y 4- 7� j. .;.zf6r -rep# r andYbn; connect on,- of 'a sid6* 'sewer 4�1:Aer,city Sanitary"" S, �,�f kdmonas.ordixiances,. i'�'TENTION',M,CALLEDfT61 T 0, ;I�OWIN6*: liE':F6L' T S,. No�;, l—Th e, o ' wriers, t c,-property*.may. obtain a--�errnit. Ao.;�c?nstr4ct sewer �act&� nj6j� slde�:sew Do'nof e Ide Sewer'Cont �r, Iri,.street.,areal. -cover any.. portion, of sewer'.before lt,-hasl,be6rrAfisIRFcte& "tA Ploxed O"Cpnstruct NOTE _Noi - 2—A ll,'workl.perf6r!riel.,�h'��,��k,',right,.' f7wayl wires**��n':'InVasiontof fil-g�t-*of-'Wayi 0, re .Pe�znit-bbfs�nkiI " � -1 leI from,.the,,Cjty',)�' W, .- .. n gipe.er's. office NOTE, No,_ -i.�'Obt--'tW,,fulik'in"f�'�matiog'- 0, &4h�j�lat,16�8L,' e�4sewers',,�yhenlyou�,get;�ermit'�lI �qgaqd ng�-Ordlnaft66rj-�.16*�03� gove�rnl�ng�sia ;rt ` I at; property I ne I :.tnc es '�6 I -'!p�l�e.;,,�roPe..XII ne:,'mlnJmum-,,grade*,6f- 20'.No),bends I!n;,gr"e' -.1 h.arp6��tham 1A.-wJW,bclpermltt`e& It -f �iiur,e�` �OTE No `5- —"trenches! ini�strkt',�_usj�jte! %�at'cr,:s6tt'16 ie�et,�est��r� 41 to,"o _-;shaIIl -.,respo- 40E, pr6p�ri,l- y. d� an sur�a�e,,,ofj'SL 'Wo�k'�',,kht6h,�'mik,'�d��relopl�within�:o'iie' rlg;n�l je - ond tolk�j be ns ble tlu&�to,,Inj .,ar,,6fIcompleti6m;' un pro,,id6& for.,-dn"* �Ork:jon.A�, te�an�es-excep '!t -Ell No!,;' 1�w ul..!to;'a'l,te" r. or:�doiia6y other �l work..,th m .,scrt' -the- pipe- mto,,thel S" thc4`pbrmIt;,,or A"": ISAPPROVED Dat'c! ............................ By ......... ............ �B ............ tej-. .............. .............. ............ ................................ A 7. iar isv..- ken, ] ................. ............................................... .... ..................... ............................. ......... ..... ........ I ..... ... . ..................................... .................. ................ ........... ............ ......... ...... ................. . .............. ...... ...... .............. ...... ................. -1 ---------- 11, enhit -Copfes- MUST Be.,S e r orming.,,IConstru6fi8n:.�-Plil6k,,,��.6 Rb�'�'6t,� �r'lng', <� BOTI . . . �kned; .... . .... ..... ..... 'idteduuiid6r,,thi��,Ve heieby,,,cer:t+ii��,t+'hhf��tlie,sidei�ew,�rl+-install�Lti6n�i66iigt'ii t - ----------- (O\k,ner',of':ConIra I I Performl 9 Const'rktio�.) ;lq, ,w nstdll Ig 1. 1 P I �SpHlgo,�,6erni.' �.ordinances -4'thb,�C*if� -*4' 'Ed'*m-o'nd-s"-.'-�+-+'�l-"""'-"','.'.�.'. p 4 ed'in accoraan .................... a.ted thi., therli P�1,1 ED f.0 V 'Y. 1.7 t'.LLI "A15 .1-1, T41City of Edmonds APPLICATION for SIDE SEWER PERMIT EASEMENT No . .......................................... NEW CONSTRUCTION REPAIRS M 14a 0 IINER �51 Ac ................................. V ............ ............................. CONTRACTOR ... PERMIT No . ..... . ............... 2 0 -r Y45!�' ADDRESS ................................................................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................ NAMEOF ADDITION ......................................................................................................................................... w flo 11-11 (? G I--- �� '-f S i'TT- 7- 1) -,F ! (::, 0 "), 1= -'r . �-- N c, Z,� S k,� - �q A/ 5; ��q & . -r /-� i� U,6 It CILIJ, RECEIVED MAY 31 W4 Approved: DATE................................................ By ...................................................................... 0 PLANNING DATA STREETF=ILE SINGLE FAMILY RESIDENTIAL Name: M a rf e, A m a d. ol, Date: Site Address: o)ol + 0 (V g OTH AVe, W Plan Check #: BLD - 1-'DO+ (P Project Description: 4GLtAJt faMil� HDMe- — GDMPL1,*J4CE Reduced Site Plan Provided: (YES / NO) Zoning: Map Page: I f; & I Corner Lot: (YES /40 Flag Lot: (YESGD Critical Areas Determination #: El Study Required El Waiver SEPA Determination: ff 0 Exempt 9 El Needed (Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form). e Setbacks Street: !�r: Side: Rear: ActualSetbacks Street: N de: Side: N Rear: El Detached Structures: El Rockeries: El Fences/Trellises: El Bay Windows/Projecting Modulation: El Stairs/Deck: Parking Required: Parking Provided: tj Lot Area: Lot Coverage: Lot Coverage Calculations: gy��,Height Datum Point: Datum Elevation: Maximum Height: Actual Height: ADU Created: (YES NO) Subdivision: Legal Nonconforming Land Use Determination Issued: (YES 00 Other Stlate law i equires Adult Family Homes he consoered al/owed uses m all single-farnily residential zones. 4 Plan Review By: ge� ao� PLANS MUST- BE 0) IM JOB SITE Carbon monoxide alarms shall be installed outside of each' separate sleeping area in the . immediate vicinity of the bedrooms and on each level in new construction And in existing dwellings when alterations, repairs or additions requiring a permit occur, or when one or more sleeping rooms are added or created. IRC R315 all, �oj APPROVED PLA"N 1 CITY. OF EDMONDS BUI G DEPARTIVI NT WORK C[C&�&k ADDRESS 2-1:Z 06 - 0 - 94-Ve- U OWNER _&f_&UV� �Tq APPROVED DATE::--- ZY-1 3 BLDG. OFFICIAL .4". - L Smoke alarms shall be installed in each sleeping room, )utside of each separate sleeping area in the immediate ;/icinity of the bedrooms, and on each level (including )asements and -habitable attics) in new construction and in -xisting dwellings when alterations, repairs or additions .-equiring a permit occur. Smoke alanns shall be hard- xired with battery backup, and when more than one ,moke alarm is required within an individual dwelling init, they shall be interconnected. Discuss exceptions to he-i power source requirements with the Building Inspector. PERMIT -NUMBER -73 -093';� �1 - V, co Py RECEIVED MAY 17 2013' DEVELOPMENT SERVICES COUNTER �. IRC R314 UBC 907.2.11.2 ,��T, AVU L-T FAW L-Y vzav — Ft,00 Fz e /- iv Llvi06 Poovy-- �.2 go -.5 � - 6-t . t CIO 006tttsic EE eppwb-�h,*j 6t goo Z-A �ar jo . *I tl STAu L tr-ta6a.) &"Tr4 7 APPWRIIV. F R DE N' (4p s$,bt, s P,00 vv�. -0:! 73 s I . :,:3 0 �, 3, e . fti tu E- " "kew S I (( W—A L -Y -960w, CAf#4k f AJ It &11 Cg* ot &4O&JI�QC RECEIVED (&f-f Uid W-S ?0- 0-3.7-s, T ray 7 2013, DEVELOPMENT SERVICES COUNTER �A UP kl*.- --tv, AD I-T FAMA 1-Y Ag)c .2 KA V-Ib� �.Akj x 1 (19" w �, V� ,P- 6, t,-) L P-o o vv-- a .4AS5 poo( i %W rA.4i A i c, VJ 76 c- P JZo 0 K-L F3 e D o vv- z q'7 (41 A If CLO S C, r OAT 61, _4 foil 'u"daw 33's, RECEIVE'P HIAAY 17 .2,013, 'DEVELOPMENT SERVICES COUNTER of I- DAI STATUS: 1SStfED 6/26/2007 Expiration Date: 6/26/2008 Parcel No: 27043000100�00 11 H, A" 38A, CITY OF EDMONDS 121 5TH AVENUE NORTH EDMONDS.WA 98020 PHONE: (425) 771-0220 FAX: (425) 771-0221 1-gre., ddresis:',21704�n` :w t.A .7-,Q6,23 PROPEKt'YOWNE& APPLICANT CONTRAC'FOR MARIE YAMADA FERNANDO PASCUAL N/A 21706 80TH AVE W 21706 80T H AVE W EDMONDS, WA 98026-7801 EDMONDS, WA 98026 206-S33-8806 425-771-8098 LICENSE,#: EXP: JOB DESCRIPTION ADULT FAMILY HOME COMPLIANCE PERMIT (3 BEDROOMS LOWER FLOOR USED FORCLIENTS. UPPERFLOORUSED FOR PRIVATE RESIDENCE.) VALUATION: $0 PERMIT TYPE: Residential PERMIT GROUP: 19 - Compliance Inspection GRADING: N CYDS: 0 T YP E OF CONST RUCT [ON: VB RETAINING WALL ROCKERY: N OCCUPANT GROUP� R3 OCCUPANT LOAD: FENCE: N ( 0 X 0 Fr.) CODE: 2003 OTHER: N ------- OTHER DESC� ZONE� RS-8 NUMBER OF STORIES: 2 IVESTED DATE� NUMBER OF DWELLING UNITS: I I I EXISTING AREA IBASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0 PROPOSED ARF,% �E�MENT 0 1 ST FLOOR: 0 ?ND FLOOR: 0 13RD FLOOR: 0 GARAGE: 0 DECK: 0 OT HER: 0 13 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 I FRONT S LTBACK SIDESETBACK REXRSETBACK REQUIRED: PROPOSED: �REQUIRED: PROPOSED: �Qul RED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O IREQUIRED- PROPOSED: SETBACK NOTES: No change to set backs/height/park in g/coverage. I AGREE TO'COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABORCODE OF THE STATE OF WASHINGTON RELATINGTO -,-,% WORKMEN'S COMPENSATION INSURANCE AND RCW 18-27. THIS APPYtATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HEOEPUTY AND ALL FEESARE PAID. �n.re Print Name Date Released y 'lay AT'TENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109/ IBCI 10! IRCI 10� r--] ARCI-HVE E-1 APPLICANT F—] ASSESSOR THER 0 STREET FIM RECEIVED JUN 12 2007 BUILDING DEPT, 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 I - PROPERTY INFORMATION SITE ADDRESS: 706 80b( ille q� 9-?"-2/-ASSESSOR'S TAX/PARCEL #: ------------ SECTION 2 - APPLICANT INFORMATION PROPERTY OWNER NAME: knA1'e1,L- PC- -Vq&tA-PA DAYTIME PHONE: W6 -,6--33 49 06 LICENSEE NAME (w DIFFERENT): PtocccA Pul-oKA WAJ-PO eASC-a4L- PHONE: //;a!;- - 771- 8099- DAYTIME A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components for exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) (. !�.ez ado-�J) SECTION 4 — DISCLAIM ER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am 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. I further agree to hold harmless the jurisdiction conducting such inspections at my request as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation of such claim), which may be made by any person, including the undersigned, and filed against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, including its officers and employees, upon the accuracy of the information supplied to the jurisdiction as a part of this application. NAME/TITLE: _F4!r—y'Jh1JP0 )04,5cadl- DATE: 611116 -I PROPERTY OWNER -��4PPLICANT 1— LICENSEE SECTION S - INSPECTION CHECKLIST YES NO Home licensed (or applying for license) on or� after July 1, 2001 SLEEPING ROOMS Sleeping Room #1 NSI Bedroom door is openable from the outside when locked I S kNS2 Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20"wide) Sleeping room window has a maximum sill height of 44" y :j Sleeping Room #2 S NSI NS2 Bedroom door is openable from the outside when locked 71 Closet doors are readily openable from the inside - I Smoke alarm is installed in the bedroom -1 Sleeping room window has a, minimum net openable area of 5.7 sf. (minimurn dimensions- 24" high;.20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #3 Ll S NSI )�NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 Sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #4 D S NSI NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #5 S NSl NS2 Bedroom door is openable from the outside when locked 1 Closet doors are readily openable from the inside Smoke alarm is installed in the be�room L j Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) L �j Sleeping room window has a maximum sill height of 44" Sleeping Room #6 71 S NSI NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) L Sleeping room window has a maximum sill height of 44" L _j GENERAL Bathroom doors are openable from the outside when locked Smoke alarms are installed on all levels of the dwelling All smoke alarms are audible in. all parts of the dwelling upon activation of a single device Access road and water supply approved by Fire Department )( PASSE CORRECTIONS REQUIRED PERMIT REQUIRED INSPECT DATE:Lalwv 0 _akAM,-_ . r ,4j , . C_- jr/—" P 10-IS-2- If _S3- 0 State law requires Adult Family Homes be considered alloweduse inall single-family residential zones. %oily IDS CITY OF EDA,40N. annirtment BUILDING DEPARMVENT ;A 00( �Acok WORK 101,12r Y4 ADDP2��Ie/;7, pLANNING Arp APPR _�LD3.071--it L I IAAAe �'RITL L- ��_Z Gompil anu-) PE P-auffi- NUMBER G, .0 T 1186. 664 ivi room .......... V. '7- W J. A%T A2003 Edition IRC %v/WACALmendmcnts 132003 Editioll A 6MA)6A45fi�W_ Z4,*1b6.'Cj . I '�;' Amendm=6 C 132003 Edition UP and Appen.,-ijee, Ar B, (i I Amendments RECEIVE C32003 w,'W.x"�C Airtendments 132003 Edition 1FGC WPOVAC Amendments JUN 1 2 2007 02003 Edflion 1FC w/WAC Amendments CITVCOPY C32003 Edition VIAQ WAC 51-13 BUILDING DEPT; 132004 Edition WSEC WA.0 5 1 - I ---------- State ADULT,,,;FAMIL---.,Y.,.H*O*ME"�"-�LICENSE License Number: 750683 Pursuant to� e laws -6f the Staie-:.6f. Washington and the+ Minimum Licens ing Reiquirerrients 00 e Departrnefit.of.�446�1 and Health Services,,a licens . dis,hereby granted TER.NANDO BTASCUAL and..REBECCA. A PULOKA to cor# uct and maintairian Adult Family Home at 21706'80TH AVE W City of EDMONDS, 98026 Snohomish County, State of Washington for the., care and supervision of adults. as folloWs: + 24-hour care for no more than S adults This liceAse shall be in force from the 24th of October, 2 .,subject to, suspension or 'revocation for due cause. --4 P7 :30 Dementia Specialty �-Mental Health Speqialt.y� rn RECEIVED rn NOV 0 5 2007 �n Licensing Authority J. �U EDMONDS CITY CLERK rn t"C�9-- 0 NOTf,: The department renewal of a license does not preclude the-depar.tmpt from,,takipg any a6tio n under WAC 388-76-705, based on inspection. This license Is not transferable, and Is valid only for use by the corporation, pariniersbio or Individual(s) to whom It Is Issued and at the location above described. Issued by Authority of Chapter RCW 70.128 0 10 RETURN ADDRESS: (�ffy of Edmonds, City Clerk 10:P 1h A venueNOTth 040127 5 PGS Ed6.nds, WA 98020 OH 12008CL.20yu DMISH NT NGTON 400 %N6TICE OF LIMITATION AND COVENANT ADULT FAMILY HOME Referenc�i Grantor(s): Additional on pg.15-- Grantee(s): Legal Descriptioli (ablilreviate.6): Se� 1—�AI—Twn aw Rng-4/—�Qtr ..,OR Block plat __j Assessor's Tax Parcil'1�09j: 0 0 0 0-,10 0 (2) ....----,,—A�sessor's Tax Parcel ID# not yet assigned AU.THQRIZEDYOR RECORDING mon s C fEd d J3� ': Date Page WHEREAS, the undersigned ownei-4.-o'fp�90�rty.-Iocat:ed at -?170(2 'in E ' dmofi . ds,.-Washington legally described below or on the attached Exhibit X, h.iv*'e 4piilied for a building permit for compliance and/or to remodel a structu�c.loca-t6�-,6' , i - fib.sitc; and WHEREAS, the applicant has notified the C ' ity Of appli6ant's intention to utilize tile improvements and/or to convert an existing �lfijle f�qitily structure to an adult, family home; and WHEREAS, under the Uniform Building Code thi..n�inb�r.pf occupants of a structure trigger certain requirements relating to 'the t, jrje st.�ppres.sion and exiting requirements; and *-1 ........... WHEREAS, the City has notified the applicant that:.tlie pi�m ' jt-`�vii ' I be issued conditioned on limitation of residents to or feweir"." re�side i d their ,n s ...an caretakers; and WHERJEAS, the City has issued a permit based upon such repr�s�'qtitio!)si. %--. NOW, THEREFORE, the undersigned property owll��!y"(hpr� juafte.r "Owner") in consideration of the issuance of a building permit to.. confirm the promises upon which such issuance is based while proviiji�.g ngtfce lo% any future owners or mortgagors of the property does hereby stipulate, co'VeMint..., and agree as follows: 1. Covenant: Limitation on Residence. The owner hereby stipulates an 'd agrees that occupancy of the structure as an adult family home shall be limited ........ .. ff to or fewer adults and their caretakers as allowed by applicable Pyoviisions of state law. The owner acknowledges that in the event that the applicant see.k� revision of the applicant's state license to operate an adult family home with ..;n�oiffEii)�ikncy of greater than S7 residents or attempts to rent, lease or qfherw�se provide residence for additional residents above the �rrmtte in the current occupancy classification, the structure shall b e-xatiated.afi-d' all residential use ceased until such time as the property is brought coniplIance-with the provisions of the State Building Code, under the edition of tl�i 161�f�rm. 11�1141n-g -Code then in effect. The owner further stipulates that this Co covenant t6uc �s* and ncerns the land so long as the present structure and use contiq*� and'ilialliud ith the land to all future purchasers and assigns. 'ict ;T�':tct. The above stipulation and promises shall apply to and 2, So run with -, t& la6d with respect to a residential structure located at 70 90H, aAA�, Edmonds, Washington and legally described as: ,L 0 7- M 'D N 0 A T E9 A0 0 V e7,<'CYe ( 13,5V /Al e-17-4 6T i:YD"A)0< s.Wooq:r- PI-A-r A/0. e, - 3 1 - 76 "1 1j_AJ D e7_2 QeCWe_D /A) Af— . ........ . 3. Notification to Future Purchas . ers aird-'kssign'bes. This notification and covenant has been recorded in the records of 5nohdiffi.sh .*County, Washington in order to provide notice to any and all futur(!: oWners'. ' of -."the property of the : in-0&jar-iii:0ei-*-;and adult family limitation at the current level of improvement to home residents fewer than in number. 4. Enforcement. In addition to any and othe.� remedits chil or criminal which the City may have, the property owner hereby agices"ind s0p'Vlates that this grant of covenant shall entitle the City to enforce by injunction the piovLs-Lons of this code and, in so doing, to recover its reasonable attorney's feeVapd cos.M. AUTHORIZED FOR RECORDING t f Edinonds By: Date: Page,,A Of 'T -1 0 0 TED this day of UZqL,� _2 SIGNATURES )Z Acc6pted 'By: Property Owner A f-V Property Owner Jei. nide L, Gr:,J. 9 Builain. License RoldV Build�pj'Perniit No':.).6'o- I 70(-Z3 !��We�Hol er Feg AFH Lic�li�c COVENANT AND:NOTIFICATION ACKNOWLEDGED: NOTARV FOR 01WNER S.16X'TURES State of Washingtoii-` . ......... County of I certify that I know or wavcr�'itisliictory.e�idcnce that �Xv3puff signed this instrument, od-q�tfi* st�td� J4i*'t he/she was authorized to execute insArument and acknowledged ' it'. m-de MMAU bwvvlv- (title) of X� �AA'-' iehalf�n wAom ii.Atrument was executed) to be �� (name of party �.n the free and voluntary act of s6vh.plirty for the.jfs'esjnd irposes mentions in this instrument. Subscribed and -w�rn to beforpt�e this day of 2 Ty %Sloe 7 Notary Aiblk6n-'a-n*&�4r thi�*§t-aretf —Washington-* 4WARy '10 My commission expir6s. ""sy 1"n PU N VS-20N I certify that I know or have satisfactory evidq�cqAat' ::. signed this instrument, on oath stated that he1sh0(!Kas'aujthorized to exe?"70wW�%1" instrument and acknowledged it as the % , - (title) of (name of party on behalf on whoih-iiiii ' r6me - nt was executed) to be the free and voluntary act of such party for the usesAnd- " os. purp �s mentions in this instrument. Subscribed and sworn to hefore me this: 'day of Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING By. aC t I Edmonds ,�W Date: Page —6 of"j, L kTE,%IKBUILDI�NG\FORNIS%COVENANTS\AFli-COV DOC9/07 �ATED this day of 20 A EPTED BY: CC APPLICANT/PROPERTY p liant plicant - MeX.-,Gf-a Applicant . Bp.��qjng PMcia1'*-. Owner Owner .. . ....... COVENANT AND NOTI FICAi..I9N`...'.. ACKNOWLEDGED: Mortgagor NOTARY FOR OWNiR..SIGrqXft I RES State of Washington )si County of ';1011nM1-'A I certify that I know or have.saji�fpeiory.-Mdence that FgrAtAryoa )3tkeNAvaA%= signed this instrument, on oat�.sfatedAfiat he/she was authorized to execute the instrument and acknowledged(t 4s-fhe tl-o--ouj'�v-k (title)of Akje-w name of party on"" behalf on �y,66rn instrument was executed) to be the free and voluntary act of such party foi the.tf9es aiid purposes mentions in this instrumeA13"Sub oto..Neforg-tiiedis IZJ� dayof TLkne , qcribed and swor b 200r? P41t:4nWt bli� in and fooe $6te o�Wjishington. (p PUCOC' oA .mission expires eP .9 ....... ... ceAlWjh4tAf' or have satisfactory evid6pce that let signed this instrument, on oath stated that he4e--%Yfi*s"�iithoriz4d to execute the instrument and acknowledged it as the title) of (name of party on behalf on whom instrijmen . t-.!�-as gxecuted) to be the free and voluntary act of such part), for the uses�.a - n 4 p*'j - irposes m ' entions in this instrument. Subscribed and sworn to before me this day, of Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING City,pf Edmonds By: J�J& P2gi__V Of L \TE,%1P\fflJ1LD1NGkF0RMS\AFH_C0V D0008t29/06 PATED this �4 d a y of 1:�10,elew ZJe,(- 22a SIGNATURES Tr Ac��pted By: _Prmwgrown ffP<!dAA)-r fw- Property Owner buildin"g Ortfi�i�i .. .......... License Holder Building-Verrr.jit No..--,."'.% License Holder AFH Lic % *. 16 N9," . ... .......... COVENANT . AND Nor IFIC'ATION ACKNOWLEDGED: NOTARY FOR Q�V� S!6"A�IfkES State of Washington County of Z1�1&yow,71s I certify that I know or hg . vesatj�h6oiy eyid'e.nce that signed this instrument, ottif ' o�th-itatedt , h9i lt!�she was autWorized to execute the 04d vvz,- (t i t 10 0 f 47404-A17- irls(rument and acknowledgOld it.a� tht.&�� ;=t. vAjwz (name of party.on�_.br6ha.lftin whom instrument was executed) to be the free and voluntary act of suih pz�ty for the useg-.,and purposes mentions in this instrument. -Subscribed and sw6r� to before in�'this"-- IZ-4L day of _ne-V SP 2 CO-1 Notdry Public in andfor the -State of Washington. Pfj 3r AO My commission expires. 4,:1 I cerilwffiat I know or have satisfactory evide��e!Jhdf'-, signed this instrument, on oath stated that he/§hc:,;vas.dutIiorized to execute the instrument and acknowledged it as the (title) of (name of party on behalf on who'nt.instiluffient was executed) to be the free and voluntary act of such party for the uses afid pu*rposes mentions in this instrument. Subscribed and sworn to before me thi§ day of ----------------- 2_. Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING ty f Edmonds Bv Page f L \rENIP\BUILDING\FORMSNCOVENANTS�AFli_(.OV DOC9/07 E RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 200312010386 3 PGS 1-2-01-2003 12:37pm $21.00 SNOHOMISH COUNTY. WASHINGTON NOTICE OF LIMITATION AND COVENANT ADULT FAMILY HOME - Reference#: Grantor(s):(l)E:L:eh1A- 0-- T\/W (2) Additional on pg. Grantee(s): City of Edinonds Legal Description (abbreviated): Sec—N5-L'9—Twn—c4?2AL—Rng—�/—QtrA/6— OR . Lot —Block --Flat Assessor's Tax Parcel ID#(s): (2 ssessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING Edmonds By: Date: Of age WHEREAS, the undersigned owners of property located at .21+06 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 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 applicant that the permit will be issued conditioned on limitation of residents to _6 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: LipAitation gn Residenge, The owner hereby stipulates and agrees that occupancy of the structure as an adult family bome.shall be limited to 57 -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 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 th ' e 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 a14-104z L-J , Edmonds, Washington and legally described as: Section 30 Township 27 Range 04 QuarterNE- S IOOFTOFN432.28FTOF E'90.2FTOFNEI/4 SWIM NEI/4..SP SEC EXC TH;PT-N LY WITHIN FDT - BEG NE COR SD SW1/4 NEIA TH S ALG E LN SD SWIM NEIA 332.28FT TPB TH CONT ALG. SD. LN.120FT TH W 16.59FT TH NELY TAP BEING 12FT W OF TPB.TH E 12FT TPB (lUx", t&C'ITY OF. ED:'PER QCD REC UND AFN 7609080269) AKA LOT I CITY OF ED SP S-31-76'REC UND AFN 76000802-68 3. NotificationAo 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 ' (a in number. 4. EnfQrcement. 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 0t of Edmonds By: �U,34 Date: 71,!O'� Page of 0 DATED this ACCEPTED BY: OWNER: / 6�- �4— Jeannine L. Gtaf.-/ Building Official day of 4c#4�;'avd-e /-7/4v 4r,-195-3,00 NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington ) - )ss County o6w"-4a—k� APPLICANUPROPERTY' Applicant Applicant 1�� d9q5A1W,- Owner Owner COVENANT AND ACKNOWLEDGED: Mortgagor I certify that I know or have satisfactory evidence that signed this instrument, on oath stated that he/she was authorized to execute the justKument and acknowledged it as the --a tz) H er -- (title) of kk#- tZW4 _gMa(pame of party on behalf on whom instrument was executed) to be the free and voluntary act of such party for the uses and purpons mentions jo.4his instrument. Subscribed and sworn to before me this day of q 110-6 j - - Notary Public.in and for the State of W My commission expires-'O 41611�? CONSTANCE M. CURTIS -NOTARY PUBLIC STATE OF WASHINGTON COMMISSION EXPIRES I certify that I know or have satisfactory evidence that - � � - - - � -w- --r, I 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 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 Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING By:4City of Edmonds 0U Date: 441 W5 4e—e of ,� P -3 LATEMP\BUILDINGWORMMADF COV.DOC —i 0 -4 D (S) rki DEPART OF SOUAL&FT-ALTH 5 F" LCES "'ENSE Anu)UL-----,T F AMILY HOME L1v License Number: 648300 Pursuant to the laws of the State of Washington and the Minimum Licensing Requirements of the Department of Social and Health Senices, a license is hereby granted to ELENA CRISTINA 11VAN' to conduct and maintain at 21706 80TH AVE W 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 care for no more than 5 adults This license shall be in force from the 17th'of October, 2003 subject to suspension or revocation for due cause. This home has a special designation to provide service to persons with: Dementia Conditions on License, if any: NOTE: The dt-parunent. renewal of a license does not preclude the Licensing Authority based on inspecfion. This license is not transfer2ble, and is valid oifly for use by the corporatlan� parc�t�ar individual(s) to whom It is issued and at the location abGVe descrtt�ed- Issued by Authonty of Chapter RCW 70.12 2000 UPC Effect .1-2002 7 ............... CITY OF EDMONDS 0 BUILDING DEPARTMENT Iwop!lf --J� ADDRESS 0 V! ;\ � I ol--- R --. A APPROVED DATE: 6 7 /Q5 BLDG, OFFICIAL PURMIT NUMBER C5�E L-62;19 — -i /4y xewoolelly-,AIWO�el-A 1�tCcle6VOO�'Alf— da't'o 174 opy ET' FILE BUILDING DEPT. Igo REQUEST FOR INSPECITOW Adult Family Home APPucATzom NUMBEIV. Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be proGessed. SECTION I - PROPERTY INFORMATION SITE ADDRESS: Q I-TQ (0 SO* *L)C- L'J eVM()i`J05 ASSESSORS TAWPARCEL *: - - - - - - --- - - - PROPERTY OWNER NAME: eL-ew A. o- Tv*N - DAYTIMEMONE: UCENSEE NAME (F MOW)' T Q DAYTIME PHONE: SECTION 3 - FLOOR PLAN A complete floor plan must Include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components fbr exiting, i.e. stairs, ramps, platform lifis and elevators.. (Attach additional sheets if neoessary) Oleo— ci,4aLe-44 +baor fQart— SECTION 4 — DISCLAIMER/ SIGNATURE BLOCK I cer" under penalty of pajury that the information furnished by me Is true and correct to the best of my knowledge, and Out I am authortted by the owner of the above prernises to request kqxxbm for and operate an Adult Family Home at this location. I huther ca" that I have made application to the Deparbrat of Social and Health Services and the jurisdiction for the appropriate ficense(s) to conduct such business at this location. I further agree to hold harmless the jurisdiction conducting such inspectiorts at my request as to any daim (including costs, m 1 1-4, and aftorneys' fees incurred in the investigation of such daim), which may be made by any person, including the undersigned, and filed against the jurisdiction, but only wbere such claim wises 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. KAME/TITLE: TO f10 DATE: PROMM OWNER- -&-APPUCANT d LXXNSEE J� SECTION 5 - INSPECTION CHECKLIST YES NO .Home lWensed (or applying fbr license) on or after July 1, 2001 0 .0 0 0 Sleeping Room *1. 0 S eNS1 0 NS2 Bedroom door is openable from the outsIde when locked F!r 0 Closet doors are'readify openable fian the Inside 4' 0 Smoke alarm is installed In the bedroom 0 0 Sleeping room vW.ndow has a minimum net openable area of 5.7 sf. (nirftn dWwWons- 24'h1gh; 2V wide) 0 0 Sleeping room window has a ma)dmum sill height of 44' R" 0- Sleeping Roo *2 0 S R/NSI 0 NS2 Bedroom door is openable ftm the outside when kdod 0, 0 Closd doors are readily 01)8nable horn the inside ET, 0 Smoke aWm is installed In the bedroom 0 Skq" mom window has a minimum net openable area of 5.7 sf. (ffdW=m- dnwsw& Whigh; 2V wide) 0 Sleeping room window, has a nwdmum sill height of 44' 0 Sleeping Roorn *3 0 S RNSI 0 NS2 Bedroom door is openable from the outside when locked 0 Closet doors are readily openable ftom the Inside 0 Smoke alarm is installed In the bedroom 0 0 Sleeping room window has a minimum net openablee area of S.7 sf. (ff&dmm dhawbrks- 24' high; 2V wide) V 0 SleepIng . 001, window has a ffodmum sill height of 44' 8", 0 sleeping Room *4 0 S &r-NS1 0 NS2 Bedroom door is ovenable from the outside when locked — ----- 0 -.0— Closet doors are readily openable from the inside 0 0 Smoke alarm is installed in the bedroom 0 0 Sleeping room window has a minimum net openable area of 5.7 sf. (rfonimum dimariom- 24* high; 2.(r wide) 0 0 Sleeping room wIndow, has a ma)dmum sill height of 44" 0 '0 Sleeping Room *5 0 S <�WNSI 0 NS2 t Bedroom door is openable from the outside when locked 0 0 Closet doors are readily openable from the inside 0 0 Smoke alarm is installed In the bedroom 0 0 Sleeping room window has a minimum net openable area of 5.7 sf. (rrdnimum dimensiom- 24' high; 2V wide) 0 0 Sleeping room window, has a mwdmum sill height of 44ff 0 0 sleeping Room *6. 0 S VNSI 0 NS2 Bedroom door is openable from the outside when locked 0 0 (3oset doors are readily OPenable from the inside 0 0 Smoke alarm is installed In the bedroom 0 0 Sleeping room window has a minimum net openable area of 5.7 sf. (rrdnimm dimmoons-,24* high; 20' wide) 0 0 Sleeping room window has a ma)dmum sill height of 44ff 0 0 Bathroom doors are openable from the outside when locked 0 Smoke alarms are installed on all levels of the dwelling 0 All smoke alarms are audible in all parts of� the dwelling upon activation of a single device 9- 0 Access road and water supply approved by Fwe Department 0 0( �PED �fii ONS REQUIRED 0 PERMIT REQUIRED t INSPECTQR: DATE: FIAL PROJEC"T APPROVAL&RM FROM: TO: DATE: EMT,'! Tol. ��R L Elf. G DIVISION DEPARTMENT DATE -7 /Z Lo 3� DIVISION DATE- . KEARSM PLANNING DIVISION DATE nZAn SM PROJECT 66-LC-1� / tr- 71 SITEADDRESS 7(706 E30-t-t_ /JLv_ zJ PERMIT #_03 ADB# DATE INSPECTED 12- DESCRIPTION OF WORK TO BE INSPECTED ACr� 0,0�1-4 - A field inspection was conducted to determine final compliance with approved plans. Mal 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 o Copy of CONDITIONS given to owner/contractor by inspector FAILED FINAL INSPECTION - OUTSTANDING ISSUES' a Copy of CORRECTION NOTICE given to owner/contractor by inspector 1. 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Sign, ocaprv1.doc.1:temp:b1dg:fonns 10/0 1 DATE RECEIVED PITY OF EPIVIONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEMAME Of"BUSINESS ELEM* C1 MVA-yd MAILING ADDRESS 6? 1 I-Lo 6 so-k kuv- CITY ZIP TELEPHONE CCC1,9- C�Dm 0&10�1 98oa6 I 906-737)Y-�Wco NAME ADDRESS CITY NAME ADDRESS CITY STATE LICENSE PROPERTY TAX ZIP ITELEPHONE PERMIT EXPIRES 01__ 6SE PERMIT ZONE NUMBER JOB WEAPT# ADDRESS VA Oj ;;�96 19 &/ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required Street Use Permit RoWd EXISTING — PROPOSED Inspection Required Sidewalk Required E3 REOUIRED DEDICATION— FT tindergirmmd Vhtng required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 1 1 YES 13 NO 13 .3 5 1 REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CBL # I—N ENGINEERI�l 7, BY DATE ANQEOFICLI-,,�'�, ��SHORE C SEPA REVIEW D -7,(P -3 R ADB#`! INSPECTION BOND REQ'D POSTED 13Y�§ 13NO I $ I AREA , " HEIGHT ',PROPOSED "ALLOWED PROPOSED NEW RESIDENTIAL;, PLUMBING / MECH LOT COVERAGE -.PROPOSED ICKS (Fr.)- REOUIR� PROPOSED SETBACKS (FT.) OR. ALLOWED �&Tl lor, IDE $EAR FRONT L/R SIDE REAR z ADDITION COMMERCIAL COMPLIANCE e LA"LTICAUILY CHANGE OF USE PARKING LOT AREA.: PLANNING R.EVIEWIF�BY DATE IL SIGN GRADING FENCE 0 REPAIR CYOS X:. FT), DEMOLISH TANK GARAGE RETAINING WALL FIRESPRINKLER CARPORT ROCKERY FIRE ALARM /Cx R WM K2 A =5Z L Lot jq t!_ -e (TYPE OF USE. BUSINI.S",RIACTIV" "PLAIN: CHECKED By LICTION CODE 1:7 OCCUPANT GROUP Ile NUMBER IF OF STORIES NUMBER OF DWELLING UNITS ARITICAL REAS N MBER U SPECIAL INSPECTION REQUIRED YES,' AREA OCCUPANT LOAD 5' DESCRIBE WORK TO BE DONE REMARKS PROGRES&INSPECTION&PE WUBC 1.08/FINAL INSPECTION RE010 akeldyr Ite VALUAMON Descriptlop ,-,fEE Descriptlon . FEE V, Plan Check 1k\ State Surcharge HEAT SOURCE GLAZING % 0' '�LOT,SLOPE % !Building�Perrnit`�' City Surcharge CHECK NO' -14 jq� VESTED DATE , in "Plurnbi' g-j Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Grading It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 32 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. PERMIT APPILICATION: ISO DAYS Engr. Review Engr. Inspection IL PERMIT UMfP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION— - — - 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review PIanChk.Deposft 57-V— IN INTEREST. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF a EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # 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 Landscapelnsp. Total Amt. Due 01 NOR LIMIT IN ANY WAY THE CrIYS 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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 COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE PaMTURE (DWNERF�IDR AGENT)i DATE SIGNED dA00% (I&A 06 06 (� A 41* A/Z9,3 tR*44t�� 771-0220 "RE DATE ATTENTION EXT 1333 R'La IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE YELLC PINK - OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING STREET ADDRESS FfIr. CITY OF EDMONDS BARBARA FAHEY MAYOR 7110 - 210TH ST. S.W. - EDMONDS, WA 98026 - (425) 771-0235 - FAX (425) 744-6057 COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION " -91) .,?C. is November 20, 1997 Davis L. Murdock 21706 - 80th Ave. W. Edmonds, WA 98026 Subject: Water Leak Credit (#444625) Dear Mr. Murdock: I have reviewed your account and will allow a credit for the billing period between August 12, 1997 through October 13, 1997 in accordance with our City policy. The policy states that the customer will be billed at the retail rate based upon the average water consumption for the same period during the previous year. In addition, the excess water lost from the leak will be billed to customer at the City's wholesale rate with a 15% surcharge added for administrative cost. Only one leak credit will be granted in any three year period. Should you have any additional questions after you receive your new billing, please contact Ilene Larson, Utility Billing Clerk, at 771-0241. Sincerely, Jim Waite Water/Sewer Supervisor JW/lk cc: Ilene Larson Utility Billing Clerk wordata\water\credit97\#444625 e Incorporated August 11, 1890 & Sister Cities International — Hekinan, Japan I . . . �'#_ - � .. 9 �IVA a Mr. Jim Waite Public Works Division 7110-210th St. S. W. Edmonds, Wa. 98026 Dear Sir: November 13, 1997 RECEIVED NO V 1 7 1997 PUBLIC WORKS DEp, About the middle of September our meter reader informed us that we pr�ob.abl.y—ha-d—a—maj�o-r—w-a-�e�r--lea-k-.-- I dug up much of our water line but could not find a leak. We thought that it must be under our drive- way. We contacted Bodine Construction and they fixed the leak by augering under the drive, connecting a new line at the meter, and joining to my line at the house. After we received our latest billing, naturally we noticed a bbiq increase. We paid it before it comes past due. However, we are asking if we could have some sort of an adjust- .ment if possible. Here is a record of our latest bills: 1/23/97 - 3/17/97 $ 78.36 3/17/97 - 5/15/97 72.86 5/15/97 - 7/21/97 72.86 7/21/97 - 9/18/97 145.73 --Thank -You-,. Davis L. Murdock 21706-80th Ave. W. Edmonds, Wa. 98026