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23326 97TH PL W.PDF. iiiiii iiiiii 9609 23326 97TH PL W ADDRESS: elf 1z,7 TAX ACCOUNT/PARCEL NUMBER. BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver 0 Study Required F] Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED P-71 \*�.OjGq� PERMITS (OTHER): IV /,,. it - - PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT FILE: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DA LID #: LOT: BLOCK: ��,O �) 51c;?4:� L\TEMP\DSrs\Fbmis\Sfi,eet File Checklist.doc 0 0 APPLICATION AND INSPECTION CHECKLIST - Adult Family Home Code References: 2003 IBC 310 (WAC 51-50) and 2003 IRC 110 (WAC 51-51) APPLicATioN NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION 1 - PROPERTY INFORMATION SMADDRESS:-2-3a2& 01-0 P"AC'e 0) -fDM0�1051 ASSESSOR'STAX/PARCEL#: - - - - - - --- - - - . PROPERTY OWNER NAME: PQPC 114r) MefCAQ0 DAYTIME PHONE. LICENSEE NAME (ii, DIR:ERENY): MIOW-W DAYTIMEPHONE: SECTION 3 - FLOOR PLAN A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components 7or exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) ff" " 7--- C E I I f E D APR - 6 21)06 SUILDNIG DEPT. SECTION 4 - DISCLAIM ER/SIGNATURE BLOCK I certify under penalty of perjury that the information fumished by me is true and correct to the best of my knowledge, and that I am requesting or I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further certify that I am in the process of making an application to the Department of Social and Health Services for an adult family home license and that I have also made application to the applicable 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/TrTLE: _.J'D 40 D - M00JO DATE: 0 PROPERTYOWNER 0 APPL1CANT,;3--L1cENSEE 0 0 I r N R - TNSPIECTIC Note: Checklist to be completed by building department in the jurisdiction home will be located. YES NO Home licensed (or applying for license) on or after July 1, 2001 SLEEPING ROOMS Sleeping Room #1 0 S ANSI 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside El 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 roorn window has a maximum sill height of 44" Sleeping Room #2 0 S NSI 0 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 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20"wide) ci Sleeping room window has a maximum sill height of 44" 0 Sleeping Room #3 0 S NSI 0 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" k)�Sleeping Room #4 0 S 0 NSI 0 NS2 B room 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 El 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) [:1 11 �leeping room window has a maximum sill height of 44" El 11 Sleeping Room #5 0 S 0 NSI 0 NS2 It, -"'A'.room 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 roorn window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 0 11 :iong room window has a maximum sill height of 44" 0 0 Sleeping Room #6 0 S 0 NSI 0 NS2 ro rn door is openable from the outside when locked 0 11 Closet doors are readily openable from the inside 0 0 Smoke alarm is installed in the bedroom 0 11 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 0 0 Sleeping room window has a maximum sill height of 44" 0 0 GENERAL Bathroom doors are openable from the outside when locked 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 1:1 Access road and water supply approved by Fire Department 0 PASSED 0 CORRECTIONS REQUIRED PERMIT REQUIRED n K'L� INSPECTO DATE: Ll_� epAzd-ezvs Application kandnspection Checidist developed by Washington Association of Building Officials (WABO), in cooperation with Department of Social and Health Services (DSHS) for use by both departments and licensors. EINAOLITROVAL FORM 0 T 0 /'� %k, I;W TO: FROM PERMIT COORDINATOR, BUILDING DIVISION 11J11q 5A417;P1 FIRE DEPARTMENT ENGINEERING DIVISION PLANNING DIVISION DATE DATE DATE DATE__3=/2--P8 OWNER O/ZeIT dKI)DRESS 2_3 3 4? -;7?VL hl PERMIT #_0/ e0l!�4 ADB# -INSPECTED ON__S:__.,:'16 _��e 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 -Landscaping is approved -Other inspected ___�Perfbrrnance Bonds may be released -PASSED FIRST INSPECTION - CONDITIONS NOTED 1. -FAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR INSPECTION L. 2. 3. I's OCCUPANCY OR FINAL APPROVAL DATE BY -RE-INSPECTED - APPROVED RE INSPECTED - FAILED I . 701 — — RE -INSPECTED APPROVED /OCCAPRVL12/96 DATE_BY�__ DATE -BY DATE__BY R, 9 IC 0 rn 00 :0 rn 0 M Z rn a RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATIOk' OWNER NAME/N�ME 0, 11SIN11S. '�-A kff L PLEA AWLI MIL, MAILING ADDRESS 233�6 q 14 � PL W CITY "P TELEPHONE f"r_)MW,D,S 900go 00 - 601 - -Iol� NAME 1= ADDRESS CITY NAM ADDRESS Z CITY 0 STATE LICENSE NUMBER :fl PROPERTY9AX ACCOIJN 11 ]TELEPHONE ZIP I TELEPHONE CBL# CHECKED BY PERMIT EXPIRES ill1l"l-) F'PE RMIT 7 P NUMBER L JJ OB OB APT# ADDRESS Z33?-6 9771-1-oz- WS PL � PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. NEW _E�KRESIDENTIAL PLUMBING I MECH ADDITION COMMERCIAL COMPLIANCE OR MIXED USE CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING FENCE CYDS ( X FT.) DEMOLISH TANK �. 1 11 OTHER [].PARAGE RETA�NING WALL F�RE.SPRINKLER. j: CARPORT ROCKERY F IRE ALARM ,(TYPE OF USE, BUSINESS 08 6eTIVITY) EXPLAIN: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING -_ PROPOSED. - REQUIRED DEDICATI FT ,",QN METERSIZE ffIREMBEEMIZO REMARKS NW IWV N ff W 9 E OWNER/CONTRACTOR RESPONSIBLE FOR EWED BY LID FEE $ TESCP Al)pro�ecl RW Permit Required street use Permit Required Inspection Required Sidewalk Required Underground winno required PRV REQUIRED ES 13 NO 13 DATE BY DATE VARIANCE OR CU SHORELINE OR ADB# I INSPECTIONO SEPA ,3 YREQ'D ICOMPLETED, EXEMPT I ES )(N CA# ZONE SIGN AREA HEIGHT [3 WAIVER a I ALLOVED , PROPOSED ALLOWED PROPOSED 13 STUDY Atr LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSfDE REAR :26 7a 1 qc- t4a 0"�cll t46 C_1vv__,ne_ z z z PARKING LOTAREA PLANNING REVIEWED BY DATE REO'D i PROVIDED Pico t4r. REMARKS i;�' 1 1 4x'-< r 'y 0" . 11 & �— r� �' C- ;�v V%e�egs, Am. %,a-- cps��Aired -.A6z&7 1,ii J.C' NUMBER OF STORIES NUMBER OF DWELLING UNITS -&I —2-C —Z X) P-1 TYPE OF Colh'LrRUCTION CODE 03 OCCUPANT GROUP DESCRIBE WORK TO BE DONE SPECIAL INSPECTION REQUIRED [3 CONSULTANT OCCUPANT LOAD REMARKS z GEOTECH REPORT BY: STRUCTURAL DESIGN BY: VALUATION Description FEE Description FEE HEAT SOURCE LOT SLOPE% VESTED DATE- Plan Check State Surcharge City Surcharge IS' PLAN CHECK NO: Building Permit Rp Plumbing Base Fee THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Grading., - w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review Recording Fee PERMIT LIMIT., SEE ECDC 19.00.005(A)(6) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit (n APPIL CANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Receipt # 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 Fire Inspection Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Receipt # 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL 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 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 FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. (425) AL I A& DATE SIGNATUR(jOWNE99 OR AGENT): DATE SIGNED 771-0220C �R a , g -060 EITBY j DATE ATTENT16N EXT. 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE YELLOW - INSPECTOR PINK -OWNER GOLD - ASSESSOR 6/05 PRESS..HARD - YOU ARE MAKING 4 COPIES c90 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS D PAte Tt_�-' MAILING ADDRESS CITY Z I P TELEPHONE NUMBER ADDRESS NAME ADDRESS USE ZONE PERMIT 19 8 (2) NUMBER JOB ADDRESS LEGAL DESCRIPTION CHECKI SUBDIVISION NO. _rLIO 7NO I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP APPrZ:� 0 EXISTING —REQUIRED DEDICATION RW Permit R ad 0 Sir I Use Permit Req'd 0 PROPOSED Inspection Required 11 Sidewalk Required 0 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED I YES 13 NO 0 NUMBER 9,e- lab 0� /r( & ( /n u 9 lktIO�V11Y 0/ Ifinaws =aw- S U-bier 0 ENGINEERING MEMO DATED REVIEWED BY CITY ZIP TELEPHONE NUMBER R STATE LICENSE NUMBER EXPIRATION DATE of Property - include all easements Property x Ta Account L Parcel No. NEW L.5j RESIDENTIAL E] PLUMBINGfMECH R El COMPLIANCE OR ADDITION COMMERCIAL CHAf4GE OF USE All — El REMODEL APT. BLDG. SIGN GRADING EJ FENCE REPAIR CYDS. I x _FT) DEMOLISH WOODSTOVE INSERT SWIM POOL HOT TUB/SPA r7 RETAINING WALL/ FGARAGE JCARPORT ROCKERY RENEWAL (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER NUMBER OF. CRITICAL OF DWELLING 0*61 AREAS 11114 STORIES �we I UNITS INUMBER DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) VARIANCE OR CU ADB # SHORELINE It SEPA REVIEW SIGN AREA HEIGHT COMPLETE I EXEMPT ALLOWED PROPOSED A LOWED I PROPOSED LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (F1 ALLOWED I PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR BY ,A A44- k.~. t ( o A 1-o— L. - W""TUTZ/2 rAM" NOR REQUIRED 13 YES PROGRESS INSPECTIONS PER UBC 108 *R0400, X&I-4-,5Z /YO� FINAL INSPECTION REQUIRED �e--3 -T-n VALUATION FEE PLAN CHECK FEE BUILDING HEAT SOURCE: PLUMBING Plan Check No. 96-6- 4f MECHANICAL Tttis Permit covers work to be done on private property ONLY. GRADINGIFILL Any construction on the public domain (curbs, sidewolks, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Permit Application: 180 Days Permit Limit: 1 Year - Provided Work Is S tarted 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 PLAN CHECK DEPOSIT 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 nor limit in any way the City's ability to enforce any ordinance provision." ITOTAL AMOUNT DUE I H-r-b acknowledne that I have read this application- that the y information given is correct; and that I am the owner, or th - e duly ATTENTION APPLICATION APPROVAL authorized agent of the owner. I agree to comply with city and THIS PERMIT state laws regulating construction; and in doing the work authoriz- I AUTHORIZES T his 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 Wash I ngtorrr6lat i ng to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is tion InsuraAce-ojig RCW 18.�� . INSPECTION acknowledged in space p . rovided. (OWNEROR AGENT)/ SIGNED DEPARTMENT :ATE CITY OF OFfICIAL ATE 'S SIGNATURE EDMONDS lmuh CALL FOR RELEASEDW DATE ATTENTION INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL File YELLOW Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC — SECTION 109 PINK — Owner GOLD — Assessor rA APPLICATION AND INSPECTION CHECkLIST - Adult Family Home Code References: 2003 IBC 310 (WAC 51-50) and 2003 IRC 110 (WAC 51-51) APPLICATION NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION 1 - PROPERTY INFORMATION SUE ADDRESS: Oa2& _TM W -�OM'0"DSI ASSESSOR'STAXIPARCEL#: - - - - - - --- - - - PROPERTY OWNER NAME: 'POPC (A W WeCA 00 DAYTIME PHONE: LICENSEE NAME (IF DIFFERUM: 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 for exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) RECEIVED APR - 6 2006 BUILDING DEPT. SECTION 4 — DISCLAIMER/ SIG NATURE BLOCK i I certify under penalty of pedury that the information furnished by me is true and correct to the best of my knowledge, and that I am requesting or I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further certify that I am in the process of making an application to the Department of Social and Health Services for an adult family home license and that I have also made application to the applicable 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. InAll . — —06 NAME/TITLE: MN RJO DATE: q 13 0 PROPERTY OWNER 0 APPLICANT,P--,UCENSEE It, - 17 N -9; - TISISPECTIC Note: Checklist to be completed by building department in the jurisdiction home will be located. YES NO Home licensed (or applying for license) on or after July 1, 2001 XJ 11 SLEEPING ROOMS R, 11 Sleeping Room #1 11 S 'A NS 1 0 NS2 Bedroom door is openable from the outside when locked 0 Closet doors are readily openable from the inside 0 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) 11 Sleeping room window has a maximum sill height of 44" 'i, 0 Sleeping Room #2 0 S NSI 0 NS2 Bedroom door is openable from the outside when locked 0 Closet doors are readily openable from the inside 11 Smoke alarm is installed in the bedroom 1A 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20"wide) 11 Sleeping room window has a maximum sill height of 44" 0 Sleeping Room #3 0 S XNSI 0 NS2 Bedroom door is openable from the outside when locked 11 Closet doors are readily openable from the inside 0 Smoke alarm is installed in the bedroom 11 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 11 Sleeping room window has a maximum sill height of 44" 0 Sleeping Room #4 0 S 0 NSI 0 NS2 �k%B room door is openable from the outside when locked 0 0 Closet doors are readily openable from the inside El 0 Smoke alarm is installed in the bedroom [3 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) 11 0 geeping room window has a maximum sill height of 44" 11 Sleeping Room #5 0 S 0 NSI 0 NS2 0�.roorn door is openable from the outside when locked 11 Closet doors are readily openable from the inside 11 Smoke alarm is installed in the bedroom 0 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) C1 0 kZrpiong room window has a maximum sill height of 44" C1 11 Sleeping Room #6 0 S 0 NSI 0 NS2 0 m door is openable from the outside when locked 0 11 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. (minimum dimensions- 24" high; 20"wide) 0 0 Sleeping room window has a maximum sill height of 44" 0 0 GENERAL Bathroom doors are openable from the outside when locked E] Smoke alarms are installed on all levels of the dwelling \Z;pr 0- All smoke alarms are audible in all parts of the dwelling upon activation of a single device Z 0 Access road and water supply approved by Fire Department YL 0 PASSED 0 CORRECTIONS REQUIRED 0 PERMIT REQUIRED ,_� I INSPEcrolot: DATE UJQ 4). Application arid Inspection Checidist developed by Washington Association of Building Offlicials (WASO), in cooperation with Department of Social and Health Services (DSHS) for use by both departments and licensors. RECEIVED CITY OF EDMONDS rRUCTION PERMIT APPLICATIO)IN'* ME OR BUSINES A U T 14 D,S ZIP TELEPHONE 90090 Mo - 001 - _19/& ZIP TELEPHONE ZIP I TELEPHONE CHECKED BY �7. . '1!7 7� PERMIT EXPIRES PERMIT NUMBER JOB ADDRESS 2_334 t?� PLI NAME/SUBDIVI SION NO. LOT N7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED — REQUIRED DEDIC N FT METERSIZE ffMMMkMA%NNOM REMARKS — WV In WEI 0 -[ OWNER/CONTRACTOR RESPONSIBLE FOR BY ED BY BY I UITFJAPT# W 7- s LID NO. LID FEE $ TESCP Approved AW Permit Required Street use Permit Required inspection Roqu red SldeWalk Required Uncle,grou d mrigireg.ved MIVPRV REQUIRED ESCI NO13 DATE DATE UJI LU z PO NIT PARCEL NO, �/�&o VA R I A CE VARIANCE OR CU N SHORELINEORADB# I I INSPECTION REO'D 113 YES KNO SEPA COMPLETED I EXEMPT I X_ XESIDENTIAL —A COMMERCIAL 0 PLUMBING / MECH c R COMPLIANCE OR CA# C A# W A I V WAIVER 0 E R ST Y [3 STUDY I 0 U D ZONE —0 R&— 0 - SIGN AREA ALLOWED , PROPOSED I HEIGHT ALLOWED PROPOSED a6l I Wr L C OT 0 LOT COVERAGE A 0 ED LL � ALLOWED PROPOSED :267c mc. REQUIRED SETBACKS (FT.) FRONT SIDE REAR ill PROPOSED SETBACKS (FT.) FRONT LIRSIDE REAR C�tm,,,Ae_ z MIXED USE MULTIFAMILY GRADING CYDS TANK CHANGE OF USE 31E SIGN FENCE X FT.) OTHER PARKING REO'D PROVIDED J_ LOTAREA I NC, z PLANNING REVIEWED BY DATE RETAINING WALL ROCKERY: .R F:RE SPRINKLER F RE ALARM I REMA.RKS ANESS OR 6eTIVITY) EXPLAIN: I NUMBER OF DWELLING UNITS 0 BE DONE NMUAwd ILA sflwa�e_-"44AV (-esz:% TYPE OF coft-rRUCTION CODE OCCUPANT GROUP SPECIAL INSPECTION CONSULTANT OCCUPANT LOAD REQUIRED 0 YES I I REMARKS _j BY: STRUCTURAL DESIGN BY* VALUATION Description FEE Description FEE LOT SLOPE%6 VESTED DATE Plan Check State Surcharge 40: Building Permit City Surcharge Plumbing Base Fee 1ORLZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO IVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Mechanical SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading' SsION. PERMIT APPLICATION: SEE ECDC 10.00.005(A)(5) PERMIT LIMIT., SEE ECDC 19.00.005(A)(6) Engr. Review Recording Fee :E BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection Plan Chk. Deposit 1EHALF OF HIS OR HER SPOUS E, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Receipt # REES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF INGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND )AMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY .NCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amt, Due FY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Landscapeinsp. Receipt # !DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL A,ND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- tHE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED I E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO CALL FOR INSPECTION This application is not a permit until signed by the Building Official or his/her Deputy� and Fees are paid, and receipt is acknowledged in space provided. ISATION INSURANCE AND RCW 18:27. (425) 771-0220 VFFIALSSIGNAT DATE J, a q, 16 jOR AGENT): DATE SIGNED --Rd E Y13NY DATE A-0 EXT. 1333 IF '0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL rION HAS BEEN MADE AND APPROVAL OR A CERTI- PANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. ORIGINAL - FILE - YELLOW - INSPECTC PINK -OWNER - GOLD - ASSESSOR PRESS. HARD - YOU ARE MAKING 4 COPIES -A J RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab Insulation ......... PLUMBING: Underground ............. Rough -In ............... I Commercial Final HEATING: Gas Test ........ ........... )ping .... ........ gas P Equipment ................. Commercial Final ....... EXTERIOR SHEATHING . NAILING ................... I ...... FRAMING ........................ FIRST FLOOR FRAMING ... INSULATION ................... Floor Insulation ......... Wall Insulation ........... Ceiling Insulation ....... SHEETROCK NAILING ... SPECIAL INSPECTION MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. 2c*6�0373 6avmms ,SCALE: 114" = V-0" Addless'2332r, cJlth Place N. Edmonds, P4A 'Ba02O p'— ` JOHN MONZON 1(20ro) 801-'101ro Bill REVISION: 02 DOOR SIZES 5R HEIGHT WIDTH (01-111 21(oll (01,111 2 1(o 11 WINDOW SIZE (5A5Et-1ENT) 5EDROOr HEIGHT WINDOW HEIGHT WINDOW WIDTH 4 2'1011 5'cJ-3/4" 5 3'3 -1/4 3'3 -1/411 5'c3 - -1 /0 11 L FLEASANT LIVING AIDULT FA�11L"� HO�IE PLAN: JOHN MONZON PLAN DATE: 411410ro ApR 2,4 200B 'rj�Fkr ,p-v3jmr= oh- - 0 eo� F &.0mcs Sheet: Of & She 4 . .1 . 9 . . I 2 3 4-T H --5 T F�E E T-- 5 W uj I> M a m 1E z -4 A rn m z U m zu -xi a r Eu —E (k 5< STAIR s ILI G', mi C6 m r r (IQ ------------ ------------ - - -------- -4 06) L------------------ ----- jL ----------------- Ow F- -_I CS OSE; cm CI)M ess; 2332ro c3lth Place N. Edmonds, PqA 'Ba02O Pho�e 7 ](20f'o) 801-101(o CADocumcnts and SettinasWandyTocal Settings\Tcmi)orary Internet Filcs\Cont PLEASANT LIVING AIDULT FAMIL*'� HOME FLAN: JOHN MONZON FLAN DATE: 411410(o IRC P.313.1,1 SMOKE DETECTORS REQUIRE THROUGHOUT EXISTING RESIDENCE THE ISSUANCE OF THIS PERMIT REQUIRES UPGRADE OF INNERCONNECTING SMOKE DETECTORS IN THE FOLLOWING LOCATIONS: 0 IN EACH SLEEPING ROOM. OUTSIDE EACH SEPARATE SLEEPING AREA IN THE IMMEDIATE VICINITY OF THE BEDROOMS. ON EACH ADDITIONAL STORY OF THE DWELLING, INCLUDING BASEMENTS BUT NOT INCLUDING CRAWL SPACES *ND UNINHABITABLE ATTICS. IN DWELLINGS OR DWELLING UNITS WITH SPLIT LEVELS AND WITHOUT AN INTERVENING DOOR BETWEEN THE ADJACENT LEVELS, A SMOKE ALARM INSTALLED ON THE UPPER LEVEL SHALL SUFFICE FOR THE ADJACENT LOWER LEVEL PROVIDED THAT THE LOWER LEVEL IS LESS THAN ONE FULL STORY BELOW THE UPPER LEVEL. Provide one openable escape window in basement and in each sleeping room meeting all of the following requirements: I - An openable area of not less than 5.7 sq. fl. (5 sq. ft. for grade floor opening) 2. A minimum clear height of 24" I A minimum clear width of 20" a-Igg, -f-,,OV:-:D DATE, -j_r-.0F1--1GlAL: - 14 pERVAIT INUMBER Any i request -for modification, - variance or other administrative deviation (hereinafter "variance") must be specifically called out and identified. Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the aPpropnate provision Of city code or state law does not approve any items not to code specification. 0 r% RESU13 APR 2 4 2006 BUILDING DEPARTMENr CI-TY OF EDMONDS 4. Finished sill height of not more than 44" above the fifflished floor. 01-N CON OV EQAj _0 STATUS: ISSUED 6/14/2010 Expiration Date: 6/14/2011 Parcel No: 00446900000100 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS,WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 PROPERTYOWNER APPLICANT CO11Tz'RCTOA LIBERTY ADULT FAMILY HOME EUGENIA MICLEA N/A 23326 97TH PL W 23326 97TH PL W EDMONDS, WA 98020- EDMONDS, WA 98020- (206) 250-1941 Ext. (206) 250-1941 Ext. Ext. LICENSE #: EXP: ADDING BEDROOM #4, LOCATED IN BASEMENT, FOR ADULT FAMIL CONSTRUCTION INVOLVED. VALUATION: $0 NO. PERMIT TYPE: Residential PERMIT GROUP: 19 - Compliance Inspection GRADING: N CYDS: 0 T YP E OF CONST RUCT ION: VB RETAINING WALL ROCKERY: N OCCUPANT GROUP: R3 OCCUPANT LOAD: FENCE: N ( 0 X 0 FT.) CODE: 06 OTHER: N ------- OTHER DESC: IZONE: NUMBER OF STORIES: 0 VEST ED DATE: NUMBER OF DWELLING UNITS: 0 EXISTING ARL-k LOT 4: PROPOSED ARFA IBASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0 —y—BASEMENT: 0 1 ST FLOOR: 0 2Nr—FLOOR: 0 13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 FRONTSETBACK SIDESETBACK RE.-kR S ETBACK REQUIRED: PROPOSED: IREQUIRED: PROPOSED: IRETU'IRED: PROP-=D-. HEIGHT ALLOWED:O PROPOSED:O JRFQUIRED: PROPOSED: SETBACK NOTES: I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCT ION AND IN DOINGTHE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATTNGTO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. THIS APPLIQ-ATION-I-"OT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR Hl"ER DEPUTY AND ALL FEESARE PAID. Z o,0 Y / 2 0/ L-) OL-j !?I I L? / M Signature Print Narne Date LVeasQ6 By Date ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTTL A FINAL INSPEC-nON HAS BEEN MADE AND APPROVAL ORA CER-nFICATE OF OCCUPANCY HAS BEEN GPANrED.UBCI09/ IBCI 10/ IRCI 10. norm pma a I MEET NLE ONLINE APPLICANT ASSESSOR �4 OTHER _eeA912 STATUS: ISSUED BLD20100385 CONDITIONS • Final approval on a project or final occupancy approval must be granted by the Budding Official prior to use or occupancy of the building or structure. Check the job card for all required City inspections including final project approval and final occupancyinspections. • Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable. Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. • Sound/Noise originating fromtemporary construction sites as a result of construction activity are exempt fromthe noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays, At all other times the nois e originating from construction s ites/activities must comply with the noise firnits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. • Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold harrrdess the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of whatever nature, aris ing directly or indirectly fromthe issuance for this permit. Issuance ofthis permit shall not be deemed to modify, waive or reduce any requirements of any City ordinance nor link in any way the City's ability to enforce any ordinance provision. INSPECTIONS THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCT10N ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6) F--BUMDING (425) 771-0220 EXF. 1333 1 ENGINEEMG (425) 771-0220 EXT. 1326 1 FIRE (425) 771-0215 I PUBLIC WORKS (425) 1-0235 1 PRFTRFATMENT (425) 672-5755 1 RECYCUNG (425) 275-4801 :] When calling for an inspection please leave the folloWng information: Permit Number, Job Site Address, Type of Inspection being reauested. Contact Name and Phone Number. Date Prefereed. and whether you prefer morning or afternoon. • B-Building Final • F-Fire Final 14, Permit Inspection Details Permit: BLD20100385 PE:RMITTFZAX 06/15/2010 steinike 20 y 11 985'n� F-:Fire Final. ...... 06/16/2010 SMITHM 15 APPROVED Total Inspections: Total Time: 20 omplete?,'-t y Total Time: 15 Total Time: 35 6/16/2010 10:08:08 AM Page 1 of 1 APPLICATION AND INSPECTION CHECKUST - Adult Family Home Code References: 2006 IRC Section R325 (WAC SI-51) APPLICATION NUMBER: SECTIONS 1, 2, 3, AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED SITE ADDRESS: 2 ; 3 2 6 9 7 TH PL \X/ C bm olvoS 5;?02- ASSESSOR'STAXIPARCEL#: 004q_�LOO 00 0 10 0 SECTION 2 -APPLICANT INFORMATION PROPERTY OWNER NAME: IEUC115flV14 M 1 C Z YTIME PHONE: 2 o 6 2 Xo �Nl UCENSEE NAME (IF DIFFERENT): DAYTIME PHONE: i SECTION 3 — FLOOR PLAN APPLICANT MUST DRAW A COMPLETE FLOOR PLAN ON THIS FORM. PLEASE INCLUDE ALL SLEEPING ROOMS (BEDROOMS). **ON THis DRAwiw, THE BUILDING INSPECTOR MUST THEN IDENTIFY WHICH ROOM IS SLEEPING ROOM #1, 2, 3, 4, 5, AND 6 AN LABEL ALL COMPONENTS FOR EXITING i.e. STAIRS, RAMPS, PLATFORM LIFrS & ELEVATORS. (USE BACK OF THIS PAPER IF YOU NEED MORE ROOM) RECEIVED Cyyy COPY iUN 0 8 2010 DEVELOPMENT SERVICES CTR. CITY OF EDMONDS SECTION 4 — DISCLAIMER/ SIG NATURE 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 requesting or I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further certify that I have made application to the Department of Social and Health Services for an adult family home license and that I have also made application to the applicable 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 cl 'm ( In I di sts, expenses, and attorneys' fees incurred in the investigation of such claim), which may be made by any person, including the underegnedcandlil d against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, including s officers and employees, up+ he accur y of the information supplied to the jurisdiction as a part of this application. "N iEp NAME/TITLE: DATE: 0 6 16?120 10 S4 PROPERTY OWNER APPLICANT LICENSEE 811109 xfvlp P - X% I . 7 .�,'�.NAMEOF SECTION 5 MUST BE COMPLETED BY THE BuILDING DEPARTMENT IN THE JURISDICTION THE HOME W ILL 13E LOCATED. PLEASE CHECK ALL APPLICABLE BOXES. PLEASE ALSO INDICATE ON THE FLOOR PLAN DRAWN BY APPLICANr WHICH BEDROOM IS #1, 2, 3,4,5, OR 6 AND THE CLASSIFICATION CODE: S, NS1, OR NS2 (TO MATCH THE LIST BELOW.) R325.3 SLEEPING Room CLASSIFICATION. Each sleeping room in an adult family home shall be classified as: Type S - where the only means of egress contains stairs to evacuate. Type NS1 -where one means of egress does not have stairs to evacuate. Type NS2 -where two means of egress do not have stairs to evacuate. SLEEPING ROOMS Sleeping Room #1 Type ype NS1 Type NS2 YES NO Closet door/s are readily openable from the insid nS7 NO 0 Smoke alarm i� installedin the':bed(oom..: : 0. 'El. Bedroom door is easily and quickly openable from the outside when locked 11 0 Sleeping room window has minimum dimensions at least 24" high; at least20" wide -(NET OPEN-ABLEAREA OF5.7SF **) **EXCEPT PER R31 0. 1. 1: AT -GRADE ESCAPE WNDOWS -(MAY HAVE NETCLEAROPENING5SF) 11 E] Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted I 01 11 42.�_ El -NS1 Sleeping Room pe S: Type. Tyo.e.NS2 .'YES NO Clo.sefdo.o0s:are read ilyopen.O.ble..' from YES Smoke alarm is installed in the bedroom 0 Bedroom door':iS:easily.;and quickly op9nable-from 4he.outside:when locked Sleepin'g:.r'oo'm.winddW::hbs��ninit'nu'm:dimOhsions.,ai least 24" high;,at least 20" wide -(NET OPEN-AkE AREA OF 51SF:�*)' �!ExCEPTPE R R31 0.1.1: AT -GRADE ESCAPE WINDOWS -(MAY HAVE NETCLEAR OPENING 5. SF)", 0-j Sleeping. room window has: a m aximum sill.hpigh tot' 4 4". a bove floor;.no, steps: under window permitted Sleeping Room #3 Type NS1 Type NS2 YES NO Closet door/s are readily openable from the inside YES Smoke alarm is installed.in the bedroom NO DI 0: Bedroom door is easily and quickly openable from the outside when locked 0 Sleeping room window has minimum dimensions atleast 24" high; at least20" wide -(NET OOEN-ABLE AREA OF 5.7 SF **ExCEPTPER R310.11 AT -GRADE ESCAPE WNDOWS -(MAY HAVE NET a -EAR OPENING 5 SF) 11 Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted Sleeping �Roorn #4 El Type.S Type NSI 11 Type�NS2 YES- NO.. Closet door/s are readily open able. from,be insidp] Smoke alarm is installed in the bedroom 11 El Bedroom door is easily and -quickly openable from the -outside when lb.cked El El. S I e e p i n g room wi n d ow: h a s m i n i m LIT d i m e n s i on s. at least. 24' 6 igh; at least 2 0" wi d e - (NET OPEN -ABLE AREA- OF 5.7 SF **EXCEP.TPER`R310.1.1: AT -GRADE ESCAPE WINDOWS -(MAY HAVE NET CLEAR OPENING 5 SF) Sleeoing,t6orn.window ha - s7a. maximum Sill. heightibf'44"::'ab, ove: floor; no steps under window permitted: Sleeping Room #5 Type S Type NS1 [ 0 Type NS2 YES NO, Closet door/s are readily openable from the insi( o El Smoke alarm is idstalled.in'thote&oornp Bedroom door is easily and quickly openable from the outside when locked Sleeping room window has minimum dimensionsat least 24" high; at least 20" wide -(NET OPEN -ABLE AREA OF 5.7 SF . "EXCEPT PER R3 10. 1. 1: AT -GRADE ESCAPE WINDOWS - (MAY HAVE NET a -EAR OPENING 5 SF Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted -S1ee0ing:_Room46:: Type-S Type NS1- T.ypel.NS2.. YES. :':N&. ClbsetdooOs are readily o0enable4rom,theInsk 6, .. El S�ndl(e alarm is installed in the bedroom El 0 Bedroorn'door is�easily and quickly bpen.abl.q..from1he outsidel'..When locked Sleeping room window: -has mi nj mUmAimen'sioh'S.,at: least 24":hj; ;:at least20" wide -(NETOPEN-ABLEAR I EA oF:5.7 S'F.**): �gh **EXCEPT. PER R310.1.1: AT -GRADE ESCAPE WNDOWS -(MAY HAVE NET CLEAR OPENING 5 SF) ax m,um.sill:height,,of+44�.:aboV.e.. floor; no steps under window permitted� Sleeping room windowbas a m i GENERAL YES NO Bathroom doors are easily and quickly openable from the outside when locked Smoke alarms are installed on all levels of the dwelling, in each bedroom and common areas Any smoke alarm must be audible throughout the home when activated. Access road and water supply meet local fire jurisdictional requirements 811/09 1 49 R311.6 RamDs Inside Ramn YES NO ......... ... . __ R311.6.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope). 11 El R311.6.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto and where ramp changes directions. -ramps, R311.6.3 Handrails required (on both sides of ramp: per state licensing requiLement WAC 388-76-10730). Outside, Ra MP YES, R311.6.1 Maximum Slope one unit,vertical ifilwelve�units horizontal (8.3% slope). 11311.6�2 Landing Requirerrients'. �min. 3.X3 fbot(landlingat top/bottom, where doors open onto R311.6.3 Hanclrails.re�quirecl '(on both:sidiis -6f;ramv:,.-6er state licensing requirement WAC 388776710730) ,Y::rl 11 ex *Guards below;.are depicted.::veitita a ample only. Less than 4" Guard 36" min ADULT FAMILY HONE RAMP per 2006 IRC with 'NA. ST AMEKD�,IVJS "ALL RAMPS REQUIE A 8RJ11_DN?G PiE,1014 R311 Means pf Egress YES NO R311.4.2 Door Type and Size: Side -hinged not less than 3 feet in width and 6 feet 8 inches in height. 0 11 R311.4.4 Type of lock or latch: readily openable from the side from which egress is to be made without the use of a key or special knowledge or effort. 0 El R111vS,,'StAiilrways.: YES� N01- ..Riser Hei - a '. ht. Max riser'be* ight: 'inches .(8 inches in structures built prior to.Jul 1,2004) shall.�lielj/4 - y 113,11.5-3.2 Tread Depth:,.-.,Mip..::te.e�d,.'depth shall,.be:A0jncfi6.; �(9 inches in structures built prior. to July 1, 2004) R11 - liS.&�abdrails.�rpqUir0cl-on botKsid6s.of.o6eriser,or more (r)er state ficensirwrequirement WAC 388-76-10730) J] EV Bars in Bathrooms YES NO -Grab WAC 388-76-10730 The AFH must install and securely fasten grab bars (not suction cup style) to meet the needs of residents in: facilities such as tubs and showers; and -Bathing On both sides of the toilet (if structurally not feasible use type that affi� to toilet seat) A6id-l�Swimming��Pool�-,SRA,Uot�-Tub�, YES;: VO, high, May have: doors and or:gates th .AG105-Must be surebdhd6d'bv:,.j��,barrier.:that..is:.4EI:.inches� at must haVe audibIe;::alarm*s:when1, d'. _AG105. 1 5 EXCEPTION.: Spas or,, h6t�:ibbs�with,�a:safef��cdv�e� Which complies with ASTK IF 1346 E] PASSED INSPECTOR'S ADDRESS: 13 CORRECTIONS REQUIRED 1:1 PERMIT REQUIRED Application and Inspection Checklist developed by Washington Association of Building Officials (WABO), in cooperation with Department of Social and Health Services (DSHS) for use by both departments and licensors. 811109 BEDROOM 2 10'-1/2"X 9'-1" BEDROOM 3 a.-Tlk C31-111 _r " LIVING I 24'-51-:5::-'1 DINNING C14 CLOSET IT-0 CL05ET 4W T CLOSET A� CLOSET C4 C, SUPPLY FROOM/6WICE 0 BATH (n FOCI BEDROOM I N KITCHE V-1 1/2"X IV-& 1/211 BATH Q11 10 EXIT.." EXIT WIN[)oW'&j;iEt- (-M,4-IN LE�/EL BPI DOOR 151ZE5 E5EDF SILL WINDOW "61NDOL HEIGHT HEIGHT WIDTH f5EbROCMHEIGHr WIDTH -Y4'- �3-3/-W- -1-S-3/4' MAIN LEVEL FLOOR FLAN I V-1-112": V-0" 2 3'5-3/4" 3'3-1/2— 5!'5-3/4' 2 roll.. 2--rV`Z-1 35-3/4" 3'3-3/4" V13-3/4' SCALE: 1/4" 1'-&' 3 roll" 2'-O,,� BRI BATH 3'4-3/4" 33-1/4" 310" DULT FAMILY HOME e 2332ro 91th Place H. LIVING A Edmonds, WA W020 PLAN: I 5,45EMEN-"' FLOOiR FLA -5CALE: 114" = V-O" t MEN �? H1 A 977r: is, E R ]-.s ADULT FAMILY HOME LICENSE License Number: 751224 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.to EUGENIA MICLEA.. to conduct and maintain an Adult Family ljorne at 23316.91TH PLW te of Washington Cit y of EDMONDS, 98020 Snohomish County, Sta f6r the cAre and supervision of Adults' as follows:: .24-hour care for no more than 6 adults Thi . s license shall be in force from the 13th , of February, 2009 subjqct to suspension or revocation for due cause Dementia 8pecialty,.Mental Health Specialty Licensing Authority RECEIVE-D JUN "0 8 2010 LU .j LL. F_ Uj Uj C13 DEVELOPMENT sERVICES CTR taking -an 'on under WAC 388-76, based o n in�o NOTE: The department renewal of a license does not preclude the. department from, y acti This -license is not transferable, and is valid only for use by the corporation, partnership or individual(s) to whom it is issued and at the location above described. Issued by Authority of Chapter RCW 70-128 ..'-kETURN ADDRESS: Cfty of Edmonds, City Clerk 1-21 5"' Avenue North Edmonds, WA 98020 Ill Ila I 3 PGS 2 12:17 L Ml R Wfly NOTOI�E OF LIMITATION AND COVENANT ADULT FAMILY HOME Referei�et*#*- Grantor(s�..(l ' 4-0� (2) Additional on pg._ C�rantee(s)- .' City of i4knon�ds Legal Descriptitn (6kki-eViat . edX Twn AZVRng.�Qtr NIE OR' Lot —Block —Plat Assessor's Tax Parceulb#(s)�:fIL0Jl 6 9 00000 100 (2) Assessor's Tax Parcel ID# not yet assigned AUT11ORIZED FOR RECORDING it of Edmonds By: 7— page_/_ of _4:7 WHEREAS, the undersigned owner9*4 pmlpertylloc4led at 2?32,!� 977�4PZW &OM offo , WA , YJ'OZ 0 -in itiptinds...4ashington legally described below or on the attached Exhibit �, have a#pjjjgd for a building permit for compliance and/or to remodel a structu�e-lecgf�dlo*n' tl��--jite; and WHEREAS, the applicant has notified the City 6f ap�liciuitls intention to utilize the � "i"' f: - improvements and/or to convert an existing Single. kluily..�Iructure to an adult family bome; and WHEREAS, under the Uniform Building Codeithd�'n * unibet: of occupants of a N structure trigger certain requirements relating to -the ir't su'pp'ies'sion and exiting requirements; and ........... .. WHEREAS, the City has notified the applicant that -1he'pe'rrnij--Wijl. be issued conditioned on limitation of residents to 6 or few�e.-.--- residei t' .1"n d their caretakers; and WHEREAS, the City has issued a permit based upon such repre s6t.aejon§;---. NOW, THEREFORE, the undersigned property own6s.-Jiterziiiafter "Owner") in consideration of the issuance of a building permit and in. qr�er to confirm the promises upon which such issuance is based while prov14i0,,g---iotic-e--t,-0 any future owners or mortgagors of the property does hereby stipulate��'cqv*`ein'a'n* t and agree as follows: I Covenant- Limitation on Residence. The owner hereby stipulates a nil ' agrees that occupancy of the structure as an adult family home shall be limited to '6 LiX) —or fewer adults and their caretakers as allowed by applicable pybvisions of state law. The owner acknowledges that in the event that the applicant -'�.4tff 'V-eyision of the applicant's state license to operate an adult family home with an oiccup#ncy of greater than residents or attempts to rent, lease or ot6rvkserprovide residence for additional residents above the pemitted in the current occupancy classification, the structure shall -..,be v;kcdtcd and-.all.residential use ceased until such time as the property is brought R6 coi�plianc�i,�ith-the provisions of the State Building Code, under the edition of tho.'bnifpf-'*ni-.'��iiding*"l�7ode then in effect. The owner further stipulates that this covendi�t todilies &d'�oncerns the land so long as the present structure and use coniinues*�nd stkaljx4q v;ith the land to all future purchasers and assigns. ..S*ubjedi Tract. The above stipulation and promises shall apply to and run with thi'land"witifftspect to a residential structure located at 2 3 3 26 9 1 r# P1 Edmonds, Washington and legally described as: IT 3. Notification to Future Purchase . &-inii . d` Assizne6. This notification and covenant has been recorded in the records of 9nolioJIMI-A County, Washington in order to provide notice to any and all future:: o,4 n e * rs'-o ' f Ahe - property of the limitation at the current level of improvement to single "famijit-i*'ind adult family home residents fewer then 6 in number. 4. Enforcement. In addition to any and other : rei4�di6i ciyil or criminal which the City way have, the property owner hereby 9gr'4'*.S.P;d str- piiigits that this grant of covenant shall entitle the City to enforce by injunctign.0re pt . ovi4fts of this code and, in so doing, to recover its reasonable attorney's fcei��nd' costs....: AUTHORIZED FOR RECORDING C*t f Edmonds By: Page of RATED this day of iQLeafAd--;1 2 aor SIGNATURES Owner ceple'd Properol A Hw Property Owner BuildixWOfficial License Holder BuiW[ng Pehnit No License Holder AFH COVENANT XNV NO hFICATION ACKNOWLEDGED: NOTARY FOMIQWNIERSiGNATURES State of Washington . ......... )s County of VVA I certify that I know or6vCkati4ac�ory..,6�idence that WoffnAo— signed this instrument, on,' �if� st ' alid-tiathiishe was authorded to execute the instrument and acknowledged if ag *t'he --J�wrLRA (title) of ( j6tr Adut F&4�a`m behid on whom instrument was executed) to be Te of par6 qn' the free and voluntary act of iivch-li'arty for the..ff�e�..and purposes mentions in this instrument. Subscribed and s"m to befo.17.eme this�-. da f QQWSt . . . . . . 12 QQ�< 0 INIOMPUIDDe In fi.i"n-n 5k3t8Q?WdftVM JIM= TAWA MARIE OLLMER Notary Mublic in an(l.!orthle $taq,of Washington. �1VAPPNMft*fflEX0QsJW 12,2010 My commission expiri�s (TU 12 I certify that I know or have satisfactory evidenco-tli�i signed this instrument, on oath stated that he�sht waig"au-1horized to execute the instrument and acknowledged it as the .. . ....... .... (title) of (name of party on behalf on wh�m-ins&iimient Was executed) to he the free and voluntary act of such party for the uscs:im4.-O��posts mentions in this instrument. Subscribed and sworn to before me this of 2_. Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING Edmonds BY: Date: Page of L:kTE?klP�BtJ[LDINGWORNMCOVENANTS"FH-COV.DOC9/07 .ADULT FAMILYHOME LICENSE License Number: 750.126 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 to LU > mm co John D Monzon.. UJ C-*4 'a"9 in to conduct and maintain an Adult Family Home at 23326 97TH PLACE W Ui 1 UU City of EDMONDS, 98020 Snohomish County, State of Washington cc ca for the care and supervision of adults as follows: 24-hour care for no more than 4 adults This license shall be in force, from the 16th of October, 2006 subject to suspension or revocation for due cause. Dementia Specialty, Mental Health Specialty ing Authori OF CL NOTE: The department renewal of a license does not preclude the department from taking any action under WAC 388-76-705, based on inspection. This license Is not transferable, and is valld only for use by the corporati . on, partnership or individual(s) to whom It is issued and at the location above described. to Issued by Authority of Chapter RCW 70.128 N In compliance withand pu -dmum Licensing Requirements ,puant to the laws of the State of Washington and the Mh of the Department of Social and Health Services a license is hereby granted to AN=NIA P . ORATE License Number to conduct and maintain at 23326 .- 97TH PLACE W 320400 city of 4ONDS Zip Code 9 8 0 2 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 zi-x (6) adults This license shall be in force from the 3 OTH day of 14AY 19 977 to and including or due cause. the 30TH day of MAY 10 9 8—,) subject to revocation f Special Term 4� ZVft�A�Wkw. ft Thcmson L6. Ja= JOAMe Pullen- aboVe NM: This Beense is not timaerable, and is rifid only for use by the bbRviduial(s) to whom it is L%sued and at the location. dmribedL-L-med by Authority of Chapter 172, Laws of 1967, and RCW 70-M., A, A' L .V" "R m firl -ul 'A 'e"Y D('Flar�rllvllt ol 320400 ANTONIA P_ ORAT R v.k conmuct and - 2 3 2 G - 9717 PLACE W UM i SNOH 9802C trwou n t� of suopel-v or gum' �tn AduM F�11.,,'Jy lJolyie fo?, t w c�tr(t nstci I c fat n i ly care f ()T n u Jr. or(! f h; I I six- '4 7 Ing to alld inclad 'llis :;�!all hk-� ini forev tr(q t.'�- 340T71- dav 01 foi- doc cauv� se Ole D TH Y' subje TH T�U IN T� 'Fs� 3 Isan ��nd �Y and is, V�did or0 HmWiCl iS Dot b-All lss'�td by Authurio., ';taptor 1172, 1AV-0— RE TURN ADDRE SS: City of Edmon ds, City Clerk 121 5th Avenue North Edmonds, WA 98020 9804301197 04/30/98 16:40 p.0003 Recorded Snohomish County OA4 NOTICE OF LEWITATION AND COVENANT ADULT FAMILY HOME Reference #: 177-15-f- Grantor(s): (1 '445 R CX-19�_ (2 1 40/fe/F— —Additional on pg___ Grantee(s): City of Ednionds Legal Description (abbreviated): Sec—Twn —Rng—Qtr OR Lot t lock --!----Plat 7 Assessor's Tax Parcel ID#(s): (1 Ad — All — Oe) OR2) FT4 M rjqDo a IS Ala, 7 —Assessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING City of Edmonds B 026 3//2-/90 y: Date: I"age � of WHEREAS, the undersigned owners of property located at in Edmonds, Washington legally described below or on the attached Exhibit A, have applied for a building permit for compliance and/or to remodel a structure located on the site; and WHEREAS, the applicant has notified the City of 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 WHE REAS, the City has notified the applivant that the permit . will be issued conditioned on limitation of residents to or fewer residents and their caretakers; and WHEREAS, the City has issued a permit based upon such representations; NOW, THEREFORE, the undersigned property owners (hereinafter "Owner") in consideration of the issuance of a building permit and in order to confirm the promises upon which such issuance is based while providing notice to any future owners or mortgagors of the property does hereby stipulate, covenant and agree as follows: . 1. Covenant:- . itati n n Ppeirlani, The owner hereby stipulates and agrees that occupancy of the structure as an adult family home shall be limited to --or fewer adults and their caretakers as allowed by applicable provisions of state law. The owner acknowledges that in the event that the applicant seeks. revision of the applicant's state license to operate an adult family home'with an occupancy of greater than residents or attempts to rent, lease or otherwise provide residence for additional residents above the permitted in the current occupancy classiflcation, 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 at 2 337-7,K 1?7_`-�� pl ku 7 , Edmonds, Washington and legally described as: 11,2 J1,4Z4(A,1,e fve .7, 7 ",74A, 3. Notifleation-lo—Future PurchaLem_ 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 7— 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 Date: 3/1z/ft? Page 7— of 3 DATED this day of 191-A ACCEPTED BY: APPLICANT/PROPERTY OWNER: Ifaw, �� - .veannin—e L. Graf k�' Building Official 19?`H7 # 3Z0400 13L. -#-6-z9q AAAwr -# W/J;� COVENANT AND NOTIFICATION ACKNOWLEDGED: Mortgagor NOTARY FOR OWNER SIGNATURES State of Washington ) )ss County of I certify that I know or have satisfactory evidence that A signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the WN I rs, 9 - (title) of API--',--7- AJWL!� (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 3 day of 19 �2 ci Notary Public in and for t9e ate ofWashington. ON My commission expires I certify that I know or have satisfactory evidence that A.m To Pq tf% "OX-, signed this instrument, on oath stated that he/she was authorized to execute*'th?.", instrument and acknowledged it as the , ?Rj VIVA 10 W IV /A (title) of ft-47, kVo 7 fkft-�(l b�AQ (name of party on behalf " n whoni instrument was executed) to be the 0 free an tary act of such party for the uses and purposes mentions in this instrument Subscribed and sworn to before me this -7 day of /144. C - Notary Pu'blic in �and for hq1=tate of Washington. My commission expires -1 - (DO AUTHORIZED FOR RECORDING _V�y of Edmonds Page 3 of 3 L'XTEMPXBUILDING'%FORMSkADF-COV.DOC 04,301197 GY3 REi TURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 9804301197 04/30/98 16:40 p.0003 Recorded Snohomish County NOTICE OF LIMITATION AND COVENANT ADULT FAMILY HOME Reference #: 1?71 Z5-y- Grantor(s): (Iy2L40'q4J ? V4^1Z- (20,41-0AI119 1011'Le/25: — Additional on pg.-- Grantee(s): City of Edmonds Legal Description (abbreviated): See Two 9 Qtr OR Lot Block--Z---Plat V-1 f Assessor's Tax Parcel ID#(s): (1) 7 ---Assessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING City of Edmonds , By: �&4 Date: 3112,190 Page / of WHEREAS, the undersigned owners of property located at -21 24 q7 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 appl ME that the permit will be issued conditioned on limitation of residents to or fewer residents and their caretakers; and WHEREAS, the City has issued a permit based upon such representations; NOW, THEREFORE, the undersigned property owners (hereinafter "Owner") in consideration of the issuance of a building permit and in order to confirm the promises upon which such issuance is based while providing notice to any future owners or mortgagors of the property does hereby stipulate, covenant and agree as follows: 1. Covenant: Limitation on Residence. The owner hereby stipulates and agrees that occupancy of the structure as an adult family home shall be limited to or fewer adults and their caretakers as allowed by applicable provisions of state law. The owner acknowledges that in the event that the applicant seeks revision of the applicant's state license to operate an adult family home with an occupancy of greater than. residents or attempts to rent, 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. Subject Tract. The above stipulation and promises shall apply to and run with the land with respect to a residential structure located at �2 -3 ;' I?- 7-"'� Let( Edmonds, Washington and legally described as: ml 4et/f tv -7 a Zt4 M 7 �-O- a-f- A rP a ".1et- " P<' 01, , " 72, /"/, C-�, 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 7 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: -94 Date: 311 2-1!�6 Page ?— of 3 DATED this day of 9 X-1 ACCEPTED BY: OWNER: Ifaw, �� .Veannine L. Graf �-' Building Official 1��H # 3 Z0 -100 13L #-5-Z99 NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington ) )ss C 0 u n ty 0 f 5vo f4 01n, �,-i ) APPLICANT/PROPERTY COVENANT AND ACKNOWLEDGED: Mortgagor I certify that I know or have satisfactory evidence that 1140MI.A_.) signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the 0 6),-) m 6- 9 (title) of A k-7j,v 4�- (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 3 day of Aw-, .19 Notary Public in and for the ate! of Washington. My commission expires I certify that I know or have satisfactory evidence that A NTO ty it, signed this instrument, on oath stated that he/she was authorized to execute' the , instrument and acknowledged it as the, ! P V/ A (title) of &�!� b�Al I (name of party on behalf on whoni instrument was executed) to be the free anil voluntary act of such party for the uses and purposes mentions in this instrument. Subscribed and sworn to before me this day of 19 C 24=2=d Notary Public in and for ihqState of Washington. My commission expires 0 'AUTHORIZED FOR RECORDING Citv of Edmonds By:— j-4� Date: 3117-1 Page 3 of 3 L:\TEMP\BUILDING\FORMS\ADF-COV.DOC gf�& - h I s-, �Mv/ 430 1197