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C-Al'Y_CLERK \ro% BUILDING
OF. EDMONDS
505 BELL STREET NOTICE OF LIMITATION AND COVENANT OCT .l 1 1996
EDMONDS, WA 98020 6 ADULT FAMILY HOME
WHEREAS, the undersigned owners of property located at otg j (-_� - " PL 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 the 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
C� trigger certain requirements relating to the fire suppression and exiting requirements; and
C7 WHEREAS, the City ha$ notified the applicant that the permit will be issued conditioned
0 on limitation of residents to Sp or fewer residents and their caretakers; and
Ct�
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 G7 or
fewer adults and their caretakers as allowed by applicable provisions of state law. f he owner
acknowledges that in the event that the applicant seeks revision of th applicant's state license
to operate an adult family home with an occupancy of greater than residents or attempts
to r nt, lease or otherwise provide residence for additional residents above
the 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 app4 to and run with
the land with respect to a residential structure located at ZN`1111:� S
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.
Aevwlrq _
LlTemplFormsILMT Cov.Doc
2/6/9b
vci..3 214 P46E le 70
• 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.
DATED this �t �` day of 4p A-
ACCEPTED BY: PLICANT/PROPERTY OWN :
(IkW Ph h,-i_
Appflcan,1,t___t
6 At
eannine L. GraK App,11cant
Building Official .Vval l
owner
Owner V,'�,1Nif1, M fJb/9P'
COVENANT AND NOTIFICATION
ACKNOWLEDGED:
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington )
)ss
County of Kkv. )
certify that I know or have satisfactory evidence that Vt r�kY\ Akyje-h�1av- signed this
o
instrument, on oath stated that he was authorized execute the instrument and
.acknowledged it as the Y'o p n� h (title) of VN 1 a (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 instument.Subscribed and sworn to before me
this i 1+'^ day of Si,4a, 19 9 G
(J�t O7.trry
Notary Public in and for the State of Washington.
My commission expires 51 W 19cl
I certify that I know or have satisfactory evidence that _ SA16 h t f a AkW.- do .,, signed this
instrument, on oath stated that he/she 'was authorized to ex cute the instrument and
acknowledged it as the 0 W h -e ' (title) of VN 1 q (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 meptions in this instument. Subscribed and sworn to before me
this day of 19 eA b
Notary Public in and for the State f Washington.
My commission expires 3l 20 q 9
L1Temp1FomulLMT Cov.Doc ,,:.•.- 21"5 f�vM
V �� - VOL. 3214 PAGE 1 l 71
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T"Y-CLERK \ro/ BUILDINGTY OF EDMONDSTREET STREET NOTICE OF LIMITATION AND COVENANT 505 BELL 0 C T 1996
EDMONDS, WA 98020 ADULT FAMILY HOME
WHEREAS, the undersigned owners of property located at � (�" PL 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 the 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
Cs� trigger certain requirements relating to the fire suppression and exiting requirements; and
WHEREAS, the City hag notified the applicant that the permit will be issued conditioned
on limitation of residents to 0or fewer residents and their caretakers; and
C�
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 G7 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 th applicant's state license
to operate an adult family home with an occupancy of greater than residents or attempts
to r nt, lease or otherwise provide residence for additional residents above
the 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 nun with the land to all future purchasers
and assigns.
2. Subiect Tract. The above stipulation and promises shall app�l r to and run with
the land with respect to a residential structure located at L-
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.
I
%���r 963q IbclLl Ir4W.�c Sz
L1Temp1Forms9_MT Cov.Doc
ys�sb VGL. 3 214 PAGE 1 17 o
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.
DATED this day of
ACCEPTED BY:
�!/ 1/�96
eannine L. Gra
Building Official
NOTARY FOR OWNER SIGNATURES
State of Washington )
)ss
County of Kkv,z ^)
LICANT/PROP
�1
Owner
Owner V �4I N' A
OWN
� pn
COVENANT AND NOTIFICATION
ACKNOWLEDGED: "
Mortgagor
I certify that I know or have satisfactory evidence that kviernkav- signed this
instrument, on oath stated that he R was authorized o execute the instrument and
acknowledged it as the Aq -Pic4S6 (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 instument.Subscribed and sworn to `before me
this l l+'^ day of 5�, , 19 q ('0
1� i�t c37,tnr�
Notary Public in.and for the State of Washington.
My commission expires31 20 199
I certify that I know or have satisfactory evidence that S-- h I e 4i AAWeKdnv signed this
instrument, on oath stated that he/she was authorized to ex cute the instrument and
acknowledged it as the QLU)n k,,v" (title) of ►N I A . (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 m tions in this instument.Subscribed and sworn to before me
this \ \ "—day of -P-t , 19 CA b
Notary Public in and for the State 51)
Washington.
My commission expires �, 2.f) 9
L1Temp1For7ns1LMT Cov.Doc
voL. 0214PAGEl r71
RECORULL
95 SEP 26 AM 9. 35
AUDITOR
i SNOHOMISH COUNTY, WASH.;
DEPUTY --
The land referred to herein is situated in the County of Snohomish,.
State of Washington, and is described"'as follows:
That portion of Lot 4,,Block 2, Lake Ballinger Land Company's Plat Subdivision Nc
1., as per plat recorded in Vol;une 9 of Plats, Pages 57 and 58, records.of
Snohomish County, described as follows:
Commencing at the Northwest corner of said Lot 4 and running,
THENCE Southerly along the arc of a curve to the right with a radius of 350.00
feet and following the Easterly margin of Bradley road,,a distance of 146.2 feet
to a point of tangency;
THENCE continuing along said road margin South 1302213011 East, :17.30 feet;
THENCE North 8901110211 East, 104.22 feet to the point of Beginning of the tract
herein described;
THENCE North 004815811 West, 72.71 feet;
THENCE North 89025121.11 East, 122.54 feet, more or less, to the I,13sterly margin
of old Interurban right of way;
THENCE Southerly along said right of way margin, 75.00 feet, mere or less, to a
point from which the point of beginning lies South 89011'02" West;
THENCE South 8901110211 West, 102.20 feet, more or less, to the point of
beginning;
TOGETHER WITH an easement for ingress and egress over the following described
strip of land:
The South 10 feet of the following described property:
That portion of Lot 4,block 2,Lake Ballinger Land company's Plat subdivision No.
1, described as follows:
Commencing at the Northwest corner of said Lot 4 and running,
THENCE Southerly along the arc of a curve to the right with a radius,of 350.00
feet and following the Easterly margin of Bradley road, a distance of 146.2 feet
to a point of tangency;
THENCE.continuing along said road margin South 13022.13011 East, 172.30 feet to
the point of beginning of the Tract herein described;
THENCE continuing south 1302213011 East, 75.00 feet;
THENCE North 8901110211 East, 104.22 feet;
THENCE North 004815811 West, 72.71 feet;
THENCE South 8902512111 West, 130.52 feet to the point of beginning;
Situate in the County of Snohomish, State of Washington.
VGL. PG t 2
n
� STREET FILE �
DATE: - Z..-1
ME1,10 TO: Building Division
Community Development Department
FROH; Engineering Division
Public Norks Department
SUBJECT:, z.- J 1 "1 STM` (��- , .
After review of the subject building; permit application, .:c- have
the following comments:
'
B U I L D I N G D I V I S 10•
Applirant Fill.
ZON,E,�
PERMIT APPLICATIO
Inside Heavy Lines
° 1•�
JOB
ADD'R E55 °-y _ `'�� ••
Y
NAME )OR NAME OF.BUSINESS)
LEGAL'DESCRI PTION
-SUBDIVISION
SUB NO.
MA LING ADDRESS
]SHORT
,
,
G
i
CITY
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
�
TELEPHONE NUMBER
'
° •�
EXISTING
!!\
F
NAME
-
PROPOSED -
DEFICIENCY OF RIGHT•OF WAY
I
U
F
ADDRESS °
PUBL•IC IMPROVEMENTS REQUIRED ❑
UDRAINAGE
IMPROVEMENTS REQUIRED ❑
3
It
Q
CITY
TELEPHONE NUMBER
DRAINAGE PLAN REQUIRED ❑
U
l
.UNDERGROUND. WIRING REQUIRED ❑
J
m
NAME
CONNECTION• TO SANITARY SEWER U �..�, �
d
SEPTIC TANK PERMIT REO'D ❑ NO.
ADDRESS
ELEVATION OF PROPERTY CORNERS ❑
- 7 •�
& FOOTINGS REO'D °
CITV
TELEPHONE NUMBER
SEE ENGINEERING MEMO DATED
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BV�-�
Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
:J
cr
REMARKS
F
Q
_
/
IL
SIGN AREA
ENV. REVIEW
ADB NO.
`
M
U
``"_/ :, �/, yI �- /
ALLOWED
PROPOSED
COMPLETE
EXEMPT
W
SHORELINE
0
� A
REMARKS
O
W
J
'
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS 11
LOT COVERAGE
FRONT• I SIDEI
E REAR
NEW
RESIDENTIAL
❑ S
LCODE
FIN
T
a NON-RESIDENTIAL
SIGN
OF CONSTRUCTION
HEIGHT
❑ ADD ❑ DEMOLISH RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY OCCUPANT
a. ALTER ElORFILL EXCAVATE FENCE
( X FT)
ID YES ❑ NO
GROUP LOAD
El
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EMNS. LOCL SA TAX
REPAIR D INSPMOVE LnPOOOL
SSHOUDLDOBEDCODEDA31.04.LES
Z
NUMBER OF STORIES
NUMBER OF
REMARKS
Q
DWELLING
H
Z
F
UNITS
W
6.
NATURE OF WORK TO BE DONE
-
f
�
F
U
0
W
Q
0
a
m
0
W
Q
PLAN CHECK FEE
VALUATION
FEE
-
PLOT PLAN
BUILDING
PLUMBING
MECHANICAL
FENCE
"Applicant, on behalf ofhis or her spoilsc, heirs, assigns and SIGN
successors in interest, a rees to indemnify,
€ y, defend and hold harmless
the City of Edmonds, Washington, its officials, employees, and RETAINING WALL
agents from any and all claims for damages of whatever nature,
arising directly or indirectly from the issuance of this permit. IS$II- SWIMMING POOL
a11ce c,f Ihis permit shall n,n Lc deemed to nlc.difv. waive or reduce
IL
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—_ --
PUBLIC WORKS DEPART= CHECKLIST
pA4F! C Pod L5 JMC.
133eo— SE 3o DU
.7yt7-777p
•1 BUILDING PERMIT REVIEW
r) <:� PL - (-Ll
(address) Wt-e
Street Right -of -Way Existing
REQD
z
Access Easements Existing
REQD
H
a
Utility Easement Existing
REQD
w
Lot Per Subdivision plat--,-
Assessor Map
w
Site Plan Checked for Accuracy
z
Underground Wiring Regd.
H
0
Check Accuracy of Le Description
z
Review by
Date
w'
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
114.
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Regd.
euT �f—T' T6k.htM& 6r7, Abat- a Frc R7'D
Cross Connection Inspecti RL
6"ALTOUE =Loot/ jet" of 2ec�P7'A��. vgLuurj
a
H
Fire Department Conments
APPR..ovsb TYPE .
3
Water Meter Charge Reqd.
Review by e �,�� _ ce-S
- 78'-3 Date G -
Septic Tank Design Approved
Date
Septic Tank Permit Regd.
Pe No.
Sanitary Sewer Availability
oj.
Drawing No.
File
Side Sewer Availability
w
Sanitary Sewer Connection Fee Reqd.
3
Review by
Date
w
Open Ditch Existing
Reqd.
Culvert Regd.
Size
c4
Catch Basin Reqd. X
Indicate on Site Plan
Shoulder drainage intain collection on swale open runoff
H
Manhole regd.
Indicate on Site Plan
Soil Conddii ons and Ground Water Field Checked
Revi 7 y
Date
3S.
Revised: lv10-1977
Page 2 ..
Revised: lv 10-1977
4b
�_eor—ram rat ., -
r�Rs 3
uOE PERMIT 960639
60 3Q
CITY OF EDMONDS � ZONE NUMBER tJ{C•�J
.CONSTRUCTION.' PERMIT APPLICATION JOB 1L SUITErAPT0
OWf4CFVAAWEr NAME OF BUSINESS ADDRESS z3i' ( ,. rl`PL
1 ja L A DESCRIPTION CHECK SUBDIVISION" 0 LID NO
yj W
W¢ MAILING. ADDRESS
1
'� L
�+
Y
..
�j
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
TESCP Approved D
RW Permit Required D
Street Use Permit Req'd D
Inspection Regyi(pd 0.
Sidewalk Required D
SSSS IT ZIP
TELEPHONE NU BER
ME
METER SIZE
LINE SIZE
NO.OF FIXTUREB
PRV REQUIRED
YES O NO
Z
w ADDRESS �..
ti
REMARKS
CITY
TELEPHONE NUMBER
•ZIP
b
NAME
19
^ ADDRESS
ENGINEERING MEMO DATED REVIEWED BY
.
rII1C MCMV VAICV
rICYICwCV Oi W
G
STATE LICENSE NUMBER EXPIRATION DATE
-
SIGN AREA
Allows° PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
EXP
ADS NO.
Legal Description of Property :'Include all easements
.
SHORELINE e
VARIANCE OR CU
PLANNING REVIEW BY
DATE
'
SETBACKS — FEET
FRONT SIDE
REAR
HEIGHT
cT
LOT COVERAGE ?
Z
frof�nY w�k �P /%
/Aar/L k® _/\ '�REMARKS
LJ NEW pf RESIDENTIAL LJ PLUMBING
ADDITION O COMMERCIAL O MECHANICAL
Rihl00El APT. SL Ii. - r 810N
• REPAIR O GRADING O FENCE
CYOS. L—r_FT)
DEMOLISH WOODSTOVE �'MPOOL
INSERT T TUB/SPA
,jj L ter'I7
.' RETAINING WALV MiGMMY I^`
CARPORT ROOKERY F
q ACT V Y) AIR:
Gq (TYP�m
�4� /CRITICAL
f ��NUMBER
.�
CHECKED BY
TYP OF CONSTRUCTION
�OM/r1�vLtt
CODE
OCCUP/
Gjft
SPECIAL INSPECTOR
REQUIRED
YEOAMOE
AREA
-
OCCU A
LOAD
A KS ,
PROGRESS INSPECTIONSPERUBC.305
NU
C SOF TORIES
F
SLING IOWe
NUM ER e4
D,RIBE WO9� TO BE, DONE (ATTACH PLOT PLAN(
VALUATION
FEE
.. - .'
PUN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
'
PLUMBING
Plan Check No.
E H NICAL
_
GRADINOIFILL
J
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, aidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Perrnl� Application:18G Days .. _
Permlt Limit: l Y�ai _ OnA4ded WOTk Is Sferteb Within 180 [lays ' . '
STORM ORAINAGG FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
S successors In interest, agrees to Indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
s employees, and agents from any and all claims for damages of
i whatever nature, arising directly or Indirectly from the Issuance
I of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0
imodify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I;hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given.is correct; and that I am the owner, or tho duly
authorlied_ agent -of the owner;'I agree to comply with city and
staildfawe regulating.constructlon; and.in doing the work authoriz•
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed.thereoy; no; person wlll:be employed In violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt Is.
tion Insurance and RCW 18.27.
INSPECTION .
acknowledged In space provided.,
-III ATURE (OWNER OR:A ENTI OATS III NED
DEPARTMENT
CITY OF
OFFI to ATURE
EDMONDS
TION
CALL FOR
LEASED DATE
ATT
T INSPEC 10N
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
- -
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
Owwo
11
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
PINK — Owner GOLD — Assessor
R/fs
—3
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
Q�O/ �A
J {�_•/
RUCTION PERMIT APPLICATION
'AooREss?�311 _ -ih
su1TEiA
• 1
' K
/NAME
OF BUSINESS
r `
ll 1 I
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO,
Ir
ESS L
`
FME
PUBLIC RIGHT OF WAY PER OFFICIAL STREETMAP.
REQUIRED DEDICATIONStreet
PROPOSED
TESCP Approved
RW Permit Required
Use Permit Rep'd
Inspection RegVilPd
Sidewalk Required
❑
❑ExISTINO
❑
❑
❑
ZIP .,
b6
TELEPHONE NUMBER
— 9 l
METER SIZE
LINE SIZE
NO.OFFIXTURES
PRV REQUIRED
YER ❑ NO ❑
ODRESS
TY ZIP ITELEPHONE NUMBER
' I STATE LICENSE NUMBER EXPIRATION DATE '
i I t Anal nescrintion of Prooertv - include all easements
ENGINEERING
SIGN AREA SEPA REVIEW ADS NO.
ALLOWED I PROPOSED COMPLETE JEXEMPT
SHORELINI
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS — FEET I HEIGHT LOT COVERAGE
BY
x Tax Account .46450.0oz
cc
REMARKS
Parcel No.
RESIDENTIAL
PLUMBING
El
ADDITION
COMMERCIAL
MECHANICAL
DRd1lOOEL
• -APT. BLgO. r
�1 810N • '
`OCCUPA
O GRADING FENCE
DYOS. L_X_FT)
REPAIR a
CHECKED BY TYP OF CON�SjTRUCTIO�N CODE
�OM/(.I�/�YL
G
�I
DEMOLISH ❑ OODTSTOVE ❑ SHOT WIM POOL
SPA
SPE
REQCIL UIRED 8PECTOR
AREA
OOAD T
GARAGE RETAINING WALL/ Ai4v*,
D
13 YES
CARPORT RCN ROCKERY,
MARKS '
'
4 (TYPE jLSE eusl E O ACT V TY) AIN:
o"
dul�MFNuMaER
PROGRESS INSPECTIONS PER USC 305
� • �/ // /
NUMBER
OF
NUMBER OF
DWELLING O�G
AREAS A
AM
f Lf/
C STORIES
UNITS
0 RISEWO K TO BE DONE (ATTACH PLOT PLAN)
/j y
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
NEAT SOURCE: GLAZING
%
PLUMBING
Plan Check No.
� Er,H NICAL .
4.1•
r/1
This Permit covers work to be done on private property ONLY.
GRADINGIFILL `
—�
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) WIII require separate permission.
STATE SURCHARGE
Permit Appllcatlon:180 Days
_
Pewit Limit: 1 Year'- Provided Work Is Sterted Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
successors in Interest, agrees to Indemnify, defend and hold
u harmless the City of Edmonds, Washington, Its officials,
a employees, and agents from any and all claims for damages of
z whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PUN CHECK DEPOSIT
c
c modify, waive or reduce any requirement of any city ordinance
0
z nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
' I.hereby acknowledge that 1 have read this application; that the
ATTENTION
APPLICATION APPROVAL
inloirnation given Is correct; and that I am the owner, or the duly
authorized agent, of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz•
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby; no person will, be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
(OWNER OR A ENT) DATE SIGNED
DEPARTMENT
LVATURE
CITY OF
OFF( L• SIG ATURE
EDMONDS
CALL FOR
LEASED DATE
ATT TION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 -Owwo
11 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
�+InaT
RECORD OF INSPECTIONS
�
INSPECTOR � DATE APPROVED
usroxono------. -_-----___'
� FowwoAnow �
poonng------' _---_-----
Wall.......................
Pier/Porch ................
nommmuWall---- -------__.
� Slab Insulation ............ ----------
� rLwmowa
Underground ----. ' ---------'
nuugx-In------ --_--------
o"mm"rci"pmm........ ----------
HEATING:
mmmu-----'
j
cas p*mo-----.
cqu*m"m-----.
ovmm.rciopmu---
EXTERIOR SHEATHING
wmuwo----.....—. -
----------
rnxMIwo------' __----___--
� /wouuT/ma
� pwv/"sumnon ........... _-_-_----__
Wmmsumnon---'
-
Ceiling Insulation --'
^ ooscTnocuNAILING ......
_ upso^L INopEcnom--
RADON MONITOR AT SITE.
^
�
�
,�606S(7 OW
STREET FILE
CITY OF EDMONDS
NAME . ADDRESS
ADDRESS OF PROPOSED,BUILDING
LEGAL DESCRIPTION: 'a LOT •�- ADDITION
TYPE*OF USE NO..OF BEDROOMS 3 SIZE OF LOT IY5-* Y/
SOURCE OF DRINKING WATER: Public -Supply Private Well
a. SURFACE D NAGE.
1. Is disposal field site well drained?. ""Yr�_v
2. Any water- courseF ('stream, drainage ditch, etc, through site?
-.b.. TOPOGRAPHY
1. Any heavy slopes in field area?
2.. Will present topsoil in fiel
are installed? d area be removed or graded before field tiles-
3. Will any fill mate be used in the disposal field site?
If yes., how much?. .,
c. SOIL CONDITIONS
1. Has.a hole at least 4 feet deep been dug in the disposal field area to deter-
mine the type of soil present?
2. After hole is dug record the soil conditions at the following depths. (Re-
cord as sand, gravel, clay, packed sand, loam, etc.)
--- 12 inches' 30 inches
1-8 inches _36 inches
24 inches 48 inches
3. AY ground water encountered before reaching a depth of 4 feet?
If so at what depth?
d. WATER TEST
A simple water test will show how well this.soil will drain or percolate water.
To perforn this test:
1. Dig hole at least 36 inches deep. Use a'shovel or post hole digger --
size of hole makes no difference --only depth..
2. Fill hole with water. Now let all water ran out` of hole. This soaks
the ground and will givea more accurate reading.*
3. Again pour water in hole'to a height of 12 inches from the bottom.
Let water run out until there is just 6 inches from bottom left.in hole.
4. Note how many minutes it takes for this last.6 inches to seep away.
Record -this time below,
Number of minutes for last 6-inches to seep away
5. Divide this time by 6'to obtain the -rate per inch
6. Date water test was performed
I hereby certify the above information to be correct and the above tests were
performed by me as prescribed. �f
Signed e-7, A 6&7�
Address
NOTE: A septic tank permit is issued on the basis of the above information. If
there are any changes or alterations in the above stated soil conditions it may
result in the'installation being rejected at the time of inspection.
Percolation Rate and Required Absorption Area. For'single Family Dwellings.
Percolation Rate ( Time in Lineal feet of 4 inch tile
minutes for water. to fall using trench with width of
one inch)two feet
150 minimum
4
.5 . 190
7 225 n
TO -250
12 265 rr
15 285
30 375" ►,
Over 30 Soil Unsuitable
•
PUBLIC WORKS DEPAR'LMENT CHECKLIST
�33�0— SE 3o sFi��w�
7Y•7-777p •
STREET FILE
BUILDING PERMIT REVIEW`
Street Right -of -Way Existing
REQD
z
Access Easements Existing
� READ
H
1:4
Utility Easement Existing
READ
w
Lot Per Subdivision
Plat. Assessor Map
w
Site Plan'Checked for Accuracy
z
Underground Wiring Reqd.
H
Check Accuracy of Legal Description
z
Review by
Date
w=
Existing Water Main Size
Water Main Required
Service Line Required -
Hydrant Size Exist'
1:4
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Reqd.
'D)SCHAQ6C- ou71-FT' TEQhIWAL. FfronRic Ta F-,l j�&QRMID
Cross Connection Inspecti RL
Cam" AeouE � OOD RMOF 2.ec�PT9«E • vA-Cuulj
s a
H
Fire Department Gonments
APPR-ovF'D 7-yP,6
3
�4ater Meter Charge Reqd.
Review by i� (�.�C
cc S - 703 Date G. -
Septic Tank Design Approved
Date
Septic Tai-& Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No.
File No.
Side Sewer Availability
w
Sanitary Sewer Connection Fee
Reqd.
3
Review by
Date
w
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
r�
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection
on swale open runoff
H
Abrd-role reqd.
Indicate on Site Plan
Soil Conditions and Ground Water
Field Checked
Review, by
Date
6S.
Revis,Cd: ).v10-1977
m
0