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22432 99TH AVE W.PDFlill 11111111 9755 22432 99TH AVE W ashington State I)NPARTMENT OF JOC SOCIAL &HEALTH 177 SERVICES -Adult Fami1v Home Liccn8c . 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 tn JOY L. MONTGOMERY License Number to conduct and maintain at 22432 - 99TH AVENUE WEST 425300 EDMONDS , zip code 98020 , 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 THREE (3) adults number I This license shall be in force from the 23 RD day of OCTOBER 519 97 , to and including the 23RD day of OCTOBER 7 19 9 8 , subject to revocation for due cause. Special Terms: Mary DeLange Authority �J NOTE: This license is not transferable, and is valid only for use by the individual(s) to whom it is issued and at the location above described. Issued by Authority of Chapter 172, Laws of 1967, and RCW 70.128. DSHS 16!'173 (Rev. 1/91) i77shington State DEPARTMENT OF SOCIAL&HEALTH SERVICES ���,` T-T 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 JOY L. MONTGOMERY License Number to conduct and maintain at 22432 - 99TH AVENUE WEST 425300 EDMONDS zip code 98020 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 THREE (3) adults number H This license shall be in force from the 23 RD day of OCTOBER 1 19 9 7 to and including the 23RD day of OCTOBER 119 98 , subject to revocation for due cause. Special Terms: V0 Mary DeLange `�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. DSHS M173 (Rev. 1/91) TO DATE TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: FIRE DEPARTMENT DATE ENGINEERING DIVISION DATE PLANNING DIVISION DATE OWNER_&J�/A�r LAlt�� Sr— ---ADDRESS PERMIT # ADB# INSPECTED ON A field inspection was conducted to determine compliance with approved plans. Final approval denotes there are no objections to the granting of : Occupancy for the building Performance Bonds may be released —Landscaping is approved Other i '!5�3 . 4v PASSED FIRST INSPECTION - CONDITIONS NOTED I ---FAILED INSPECTION - OUTSTANDING REQUIREMENTS.- RECALL FOR INSPECTION I 2. [is OCCUPANCY OR FINAL APPROVAL R -INSPECTED - APPROVED RE INSPECTED - FAILED I 2. RE -INSPECTED APPROVED DATE �-2--IV— BY5� C —I DATE DATE --BY DATE BY /OCCAPRVL 12/96 "Z4 - -:- MEMORANDUM Date: November 19, 2001 To: File Cc: Duane Bowman, Noel Miller, Jim Kammerer, Don Fiene, Darrell Smith, Lyle Chrisman, Jason Tourtellot From: ave Gebert Subject: Drainage Problem, Joy Montgomery, 22432 99th Ave W. Attachment: Fax from Joy Montgomery dated Nov 15, 2001 Attached Fax identifies a drainage problem at 22432 991h Avenue West. Don Fiene and I met with Joy Montgomery at her residence at 22432 991h Ave W on November 19, 200 1. We advised her that 99th Ave W at this location is a private road and the City does not maintain private roads. She acknowledged that she knows it is a private road. We advised her that any drainage corrections or road maintenance would have to be done by the property owners along the road. We gave Ms. Montgomery some ideas as to possible solutions to consider to correct the drainage concerns. No ftu-ther action required on this request. City of Edmonds Development Services Department FROM : SUNSET WEST Ln _,�_ - FAX NO. : 4256723643 Nov. 15 2001- 07:47PM Pl Cl DATE FIAX m_)�` -2 -"2 PHONSI., 7764283 FAXIP WTAL PAM OtCLUM. 0 Ttla .a. �_cr_ Zz'T00e 7/7 uie4-eil-� I s IA,)SW P,6( 4C.", :2 (Le �,A Z) te s d 10 s X,) =4-s oc�4 t oQ I mlg-qbe- 4,��442,c co-e, (d (L4-p 0 (D 1/7 V Z, 4,3 Afvc -9,Q Jqn _. , , )/, c / .1 DATED this day of 19 �� ACCEPTED BY: OWNER: 4an�� Jeannine L. Graf Building Official 4t AF11�12-15360 ,4Z # -4-33 / NOTIFICATION NOTARY FOR OWNER SIGNATURES APPLICANT/PROPERTY Applicant Owner COVENANT AND ACKNOWLEDGED: Mortgagor State of Washington ) County of )ss I certify 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 k (title) of A2)vj�-r ,CA&LL1--y—ALL-, �-� .(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 I ts Notary Public in and for the il$te of Washington::' X -4� My commission expires CA2 <1 z I certify that I know or have satisfactory evidence that signed this instrument, on oath stated that he/she was authorized to e'xee-�te:tb`e',`.'."�,-` instrument and acknowledged it as the (title) of (name of party on behalf on whom instrument was executed) to be the free and voluntary act of such party for the uses and purposes mentions in this instrument. Subscribed and sworn to before me this - day of � 19 .Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING - City of Ednionds By:_-,.176 Date: Page 3 of L:\TEMP\BUILDINQFORMSUDF-COV.DOC RETURN ADDRESS: 16 27 03/11/98 1 : p.0003 Recorded county City of Edmonds, City Clerk Snohomish 121 5th Avenue North Edmonds, WA 98020 00 NOTICE OF LIMITATION AND COVENANT ADULT FAMILY HOME Reference #: Grantor(s):Aac"— /,f L14, Additional on pg.— Legal Description (abbreviated): Sec� �2`T`wn-��­Rn Otr 56 OR Lot Block lat Assessor's Tax Parcel ID#(s): (1) 401-WS--4W -61-06- - (2) ---__Assessor's Tax Parcel 110 not yet assigned AUTHORIZED FOR RECORDING City of Edmonds - B V: J 747 D a te: Page / Of 3 WHEREAS, the undersigned owners of property located -,X&--� - oq . ix),e"W , 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 utilizie 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, ffie 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 thep"romises 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 he limited to —3 —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. _J? residents or attempts to rent, lease or otherwise provide residence for additional residents above the 3 permitted in the current occupancy classification, the structure shall be vacated and all residential use ceased until such time as the property is brought into compliance with the provisions of the State Building Code, under the edition of the Uniform Building Code then in effect. The owner further stipulates that this covenant touches and concerns the land so long as the present structure and use continues and shall run with the land to all future purchasers and assigns. 2. Subject Tract, The above stipulation and promises shall apply to and ru ith the land with respect to a residential structure located ata-?!�O .q wi Edmonds, Washington and legally described as: The west 122 Fe6t of the east 317.27 Feet of Block 5, Fourtner's Homestead Plat.' according to the plat thereof recorded in Volume 1 of Plats, page 97, in Snohomish county, Washington; EXCEPT the north 220 feet thereof. Together with easement,for ingress. aqrpss, and titilitips over and across the west 30 feet oi the eas-t 255.27 feet of said block 5 as established of record by agreement recorded under Recording Number 1289921. 3. Notiflcation 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 .4 in number. 4. - Fnforcement, 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 covena7nt shall entitle the City to enforce by injunction the provisions of this code and, in so doing, to recover its reasonable attorney's fees and costs. AUTHORIZED FOR RECORDING City of Ednionds By: 126 Date: Page 2— of 3 9803110566 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAMF OF BUSINESS T MAILING ADDRESS j CITY ZIP TELEPHONE NUMBER' — A NAME ADDRESS i P ITELEPHONE NUMBER NAME ADDRESS. - CITY ZIP I TELEPHONE NUMBER STATE LICENSE NUMBER EXPIRATION DATE Description of Property - include all easements ­7"y Tax Account ;Z_&4V5_12V_ 0:7-0s Parcel'No. ._159 FINEW ful RESIDENTIAL PLUMBINGIMECH DADDITION COMPLIANCE OR COMMERCIAL CHANGE OF USE REMODEL APT. BLDG. SIGN GRADING FENCE REPAIR DEMOLISH CYDS. WOODSTOVE 1:1 INSERT x_ ( FT) SWIM POOL E] HOT TUB/SPA` FGARAGE � t RETAINING'WALL/ CARPORT F� pnrlwpav D;�j aitmrvja� TYPE OF USq, BUSINESS OR ACTIVITY). EXPLAIN NUMBER NUMBER OF CRITICA OF DWELLING AREAS 111A STORIES UNITS NUMBER / I" DESCRIBE WORK TO BE DONE IATTACH PLOT PLAN) omolmlvce 4ezA4t-oL y4A" AW6,1, ZONE PERMIT JOB NUMBER ADDRESS LEGAL DESCRIPTION CHECK[ IVISION NO PUBLIC RIGHT OF.WAY PER OFFICIAL STREET MAP. TESCP App'o4edl 11 R, Par.!. R uied 11 EXISTING R OUIRED DEDICATION E_ Stree!9W_erjp_it Req'd 13 PROPOSED InSPection Required 0 Sidewalk Required 11 METER SIZE LINE SIZE NO. OF FIXTURES PRV REOUIRED I I I YES 0 NO 13 REMPRKS "Vy 4".A�Verlle-vl 4 FIEWEVVE013Y Tel, r /e/ e'Al y VARIANCE OR CU SEPA REVIEW COMPLETE I EXEMPT EXP LOT COVERAGE ALLOWED I PROPOSED ADB # SIGN AREA ALLOWED I PROPOSED III HEIGHT ALLOWED I PROPOSED LIUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT UR SIDE REAR #^A e-ILO"if �xpk .4F k01--tj A( A __PffrMi�" LA.4e _j t, �i OCCUPA ,HECKED BY "TYPE OF CONSTRUCTION SPECIAL INSPECTOR AREA OCCUP REOUIRED LOAD 13 YES I . VPROGRESS INSPECTIONS PER USC 108 0 FA INSPECTION REQUIRED hir"If t1oln C VALUATION FEE PLAN CHECK FEE BUILDING HEAT SOURCE: GLAZING PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Any Construction on the public domain (curts, sldewplks, STATESURCHARGE driveways, marquees, etc.) will require. separate permission. Permit Application: 180 Days Permit Limit: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on -behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE successors in interest, agrees to indemnify, defend and hold harmless the. City of Edmonds, Washington, its officials, employees, and agents from'any and all claims for damages,of whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT modify, waive or reduce any requirement of any city ordinance X nor limit in any way the City's ability to enforce any ordinance provision." TOTAL AMOUNT DUE (709-0Z I 111 1; h ere I hereby acknowledge that I have read this application; that the I n I 0 ma information given is correct; and that I am the owner, or the duly A17ENTION APPLICATION APPROVAL a U ho riz authorized agent of ' the owner. I agree to comply With city and THIS PERMIT state la, state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until ed I her( ed thereby, no person will be employed -in violation of the Labor ONLY THE by the Building Official or his/her Code of the State of Washington relating to Workmen's Compensa- WORK.NOTED Deputy; and fees are paid,,and receipt is ign.�ns,�rance arta—R-CW 18.27. t tio I s, INSPECTION acknowledged in space provided. I T'R S T SIGNA , FIETOWNER OR AGENT) DATE SIGNED 'r DEPARTMENT 't., OF I I L' S GNATURE DATE CITY OF EDIVIONDS"-.,. ATTENTION CALL FOR �RELFASED DATE INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771:7,0220 ORIGINAL — Fit's "."YELLOW inspector .A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK — Owner GOLD — Assessor 102-87 �0 w RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 Reference # Grantor(s): Grantee( 9803110566 03/11/98 16:27 P,00o3 Recorded s ohomish countY NOTICE OF LIMITATION AND COVENANT ADULT FAMILY HOME Legal Description (abbreviated): Sec� �Twn 2- Rn OR Lot ____Block Plat Assessor's Tax Parcel ID#(s): (1) (2) ....... Assessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING Ci.ty of Edmonds By: DateQ6&9- Page / of -3 -Z.4-2 WHEREAS, the undersigned owners of property located atc.�-7.-2, 09 in Edmonds, Washington legally described below or on the attached Exhibit A, have applied for a building permit for compliance andior 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 WHEREA:S, 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 ow ners (hereinafter "Owner") in consideration of the issuance of a building permit and in order to confirm the �p:'romises 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 -3 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 ----? residents' or attempts to rent, lease or otherwise provide residence for additional residents above the 3 permitted in the current occupancy classification, the structure shall be vacated and all residential use ceased until such time as the property is brought into compliance with the provisions of the State Building Code, under the edition of the Uniform Building Code then in effect. The owner further stipulates that this covenant touches and concerns the land so long as the present structure and use continues and shall run with the land to all future purchasers and assigns. 2. Subject Tract The above stipulation and promises shall apply to and run with the land with respect to a residential structure located ata-?�� - 4L)a-194 - —, Edmonds, Washington and legally described as: The west 122 FeCA of the east 377.27 Feet of Block 5, Fourtner's Homestead Plat, according to the plat thereof recorded in Volume 1 of Plats, page 97, in Snohomish county, Washington; EXCEPT the north 220 feet thereof. Together with easement for ingress, aqrpqg- and utilitips nypr and across the west 30 fe t of the east 255.27 feet of said block 5 as established of record by agreement recorded under Recording Number 1289921. 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 . 4 in number. 4. Enforcement, In addition to any and other remedies civil or criminal which the City may have, the property owner hereby agrees and stipulates that this grant of covena:nt shall entitle the City to enforce by injunction the provisions of this code and, in so doing, to recover its reasonable attorney's fees and costs. AUTHORIZED FOR RECORDING City of Edmonds By: —26 Date: Page 2— of 0. 90311056"`4 I I If DATED this ACCEPTED BY: OWNER: Jeannine L. Graf Building Official 4t A54-11 _112-53611 0 ,& # o�331' NOTIFICATION day of 1114rMl NOTARY FOR OWNER SIGNATURES State of Washington ) )ss County. of �� j APPLICANT/PROPERTY Applicant Owner COVENANT AND ACKNOWLEDGED: Mortgagor 1919- - ­7 1 certify t�hat I know or have satisfactory evidence that -jo 1/0-F- 1r'0ta_r',-)jy"F_RV signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the (title) of A2)vj_r ,CAI,-,, t-, V Atjin!�_ .(narne 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 191- 'j M ts r�'�r Notary Public in and for the 94te of Washington.� My commission expires 40 in-0 I certify that I know or have satisfactory evidence that ' signed this instrument, on oath stated that he/she was authorized to exec e he 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 i 19 .Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING City of Edmonds B y: /7- t7 Date: 310 Page 3 of -3 L:\TEMP�BUILDING\FORMSUDF-COV.DOC 980311^566 V iiiiiiii iiiiii 15572 22432 99TH AVE W C> 00 0 RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 1��74 w3110566 03/11/98 16:27 p,0003 Recorded s ohomish county NOTICE OF LEWITATION AND COVENANT ADULT FAMILY HOME Reference M Grantor(s): . Z-1 - - 9-- f,—, , Additional on pg.— Legal Description (abbreviated): Sec�_ �2Twn-2jL--_Rn Qt OR Lot JBlock-------Plat Assessor's Tax Parcel ID#(s): (1) 407-CO-T-tW -t4-1Z- —(2 ---Assessor's Tax Parcel EM not yet assigned AUTHORIZED FOR RECORDING City of Edmonds By: -72-6 Date: Page / of 3 WHEREAS, the undersigned owners of property located atc,-? --2- 41&,;� ""4V4, . iL)zw ! in Edmonds, Washing —ton legally below or on the attached Exhibit A, have applied for a building compliance and/or to remodel a structure located on the site; and described permit for 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 notifiled 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: 00, 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 __9 —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.--? residents or attempts to rent, lease or otherwise provide residence for additional residents above the 3 permitted in the current occupancy classification, the structure shall be vacated and all residential use ceased until such time as the property is brought into compliance with the provisions of the State Building Code, under the edition of the Uniform Building Code then in effect. The owner further stipulates that this covenant touches and concerns the land so long as the present structure and use continues and shall run with the land to all future purchasers and assigns. 2. Subject Tract. The above stipulation and promises shall apply to and ru ith the land with respect to a residential structure located ataa?l�� wi Edmonds, Washington and legally described as: The west 122-FeiA of the east 377.27 Feet of Block 5, Fourtner's Homestead Plat, according to the plat thereof recorded in Volume 1 of Plats, page 97, in Snohomish county, Washington; EXCEPT the north 220 feet thereof. Together with easement for ingress. Parpem, and tjtilitiwq� nypr and across the west 30-feet oi the east 255.27 feet of said block 5 as established of record by agreement recorded under Recording Number 1289921. 3. Notifleation 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 - 4 in number. 4. - Enforcement, In addition to any and other remedies civil or criminal which the City may have, the property owner hereby agrees and stipulates that this grant of covenant shall entitle the City to enforce by injunction the provisions of this code and, in so doing, to recover its reasonable attorney's fees and costs. AUTHORIZED FOR RECORDING City of Edmonds By: JM Date: Page 2— of -3 9803110566 DATED this SeloNIal ae — day of Alle-M, ACCEPTED BY: OWNER: Jeannine L. Graf L/ Building Official df A�#W-6-300 /& # S-33/ NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington ) County of )ss APPLICANT/PROPERTY Applicant Owner COVENANT AND ACKNOWLEDGED: Mortgagor I certify t�hat I know or have satisfactory evidence that jo llr-,F- signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the - 0a)r,/,E (title) of A2),vi-r AA&LLj , _.(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 —.A day of 4 19109 -7- C. � .'# ' . I i * *^If '.. �A% Notary Public in and for the Wte of Washington - My commission expires 11-i - C20 tit', n 04% I certify that I know or have satisfactory evidence that signed this instrument, on oath stated that he/she was authorized to exec 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 1-- 919- .Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING Cit of Edmonds B '..'7 y:— 1-6y Date: Page 3 of S L:\TEMP\IBUILDING\FORMS\ADF-COV..t)OC 9803110566