23931 76TH AVE W.PDFlill 11111111
6448
23931 76TH AVE W
-P -e-
CITY CLERK
CITY OF EDMONDS
121-5TH AVENUE NO.
EDMONDS, WA 98020
CONFORMED COPY
200711260811 2 PGS
11126/2007 4:09r N1.00
SNOHOMISH COUNT , ASHINGTON
COVENANT
For Adult Family Home's Second Kitchen
Whereas, the Grantor(s) DIMINA 0. ZABALA
hereafter referred to as "Grantor(s)", have received a Building
Permit # for property which is zoned single family residential, and is
located at 23931 76th Ave w. EDMONDS WA 98026
tax account parcel number 0 4888006008ol and legally
described as foflows:
S3.2, .2,7NI
Whereas, the City of Edmonds has received a building permit application for an Adult
Family Home with a second kitchen to be located in an existing single family residence
in a single family residential zone.
Whereas, pursuant to WAC 388-76-190 an adult family home is considered a residential
use of property for zoning purposes, and are permitted in areas zoned for single family
dwellings.
Whereas, the City desires to approve utilization of a second kitchen in the Adult Family
Home As a reasonable accommodation to the facility as care provider to the disabled for
so long as the second kitchen is. utilized, and only utilized, in conjunction with the Adult
Famfly Home use.
Therefore; in consideration of the City ofEdmonds, Washington approving the second
kitchen as a reasonable. accommodation by issuance of a building permit, the Grantors
agreeasfollows: LAKE BALLINGER LAND CO 8
08DIV 1 BLK 006D.
85 FT OF/-W* 170- FT:OF N 125 LOT.8 TGW 1/3 INT IN & TO T-Hir
S.25 FT OF W 170 FT SID Tim - a.
1. This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
and successors in interest, and shall be deemed to run with the land and bind all
future owners to the real properties described above.
2. This covenant shall be recorded with the Snohomish County Auditor and
Grantors shall pay for all recording fees.
3. Grantors hereby covenant that the kitchen on the lower, basement floor of the
subject residence can be used only in conjunction with the Adult Family Home
and that the said kitchen shall be removed immediately upon termination of the
Adult Family Home State License # for the subject facility
or cessation of use of the property as an Adult Family Home, unless, or until,
zoning laws allow otherwise.
4.. The provisions of paragraph 3 above shall be specifically enforceable in the
Superior Court of Snohomish County. The prevailing part shall be entitled to its
attorneys' fees in such a proceeding.
5. Grantors acknowledge and agree that approval of the second kitchen for the
Adult Family Home use and the creation of this Covenant are a reasonable
accommodation of Grantors' rights as a care provider to the disabled and of its
clients' foreseeable needs. The Grantors, therefore, on behalf of themselves, their
successors and assigns do hereby waive any and all claims of the Americans With
Disabilities Act or the Washington Law Against Discrimination which they may
have as of the date of the execution of this Covenant and promise to hold
harmless and indemnify the City, its officers, agents and employees from any
cost, claim or liability which may be incurred in defense of such a claim.
By signing and execution of this Covenant, the parties hereto agree that Grantors are in
compliance with existing zoning regulations.
Signed &e
Subscribed and sworn to before me this EhIn da of
y , .soo
oft IRAN Notary Public in and for. the State of Washington.
MXM
MVAPOoInftnw#EVw 2j.�010
Residingat
STREET ADDRESS FILE
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
'C's t . 18 9 \�)
February 28, 1996
Wilfredo Q. Zabala
23931 - 76th Ave. W.
Edmonds,- WA 98026
Dear Mr. Zabala'.
I have reviewed your account and will allow a credit from September 25, 1995 through
January 5, *1996 in accordance with our City policy. The policy states that the customer
will be billed at the retail rate based upon the average water consumption for the same
period during the previous year. In addition, the excess water lost from the leak will be
billed to customer at the City's wholesale rate with a 15% surcharge added for
administrative cost. Only one leak credit will be granted in any three year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Ron Holland . I
Water/Sewer Supervisor
. I
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit96\#510I75
Incorporated August 11, 1890 0
Sister Cities. International — Hekinan, Japan
�0' V C'e'o�-t-
-2s AV 1 - '�- - (�'
7R/- PDA 0 4:-- '
CITY OF EDMONDS COMBINED UTILITY
501 Bell Street
P.O. Box 2008
Edmonds, WA 98020
Dear Sir/Madam:
23931 76TH AV W
EDMONDS WA 98026
Feb. 26, 1996
I talked to your customer service representative perso-
nally on 1-29-96 about the reasons why a portion of our water
bill is being witheld. Our water bill jumped up to $,85.00 from
an average of $70.00. No leaks were found inside the house.With
the help of a professional plumber, several leaks were unco-
vered in the water Line between the house and the meter.
w3 i4w e-
In due time, this was fixed withletp'ense"s for the new
water line installation and repairs. WE just purchased this
house 8 monIffis ago finding ourselves with unexpected costly re-
pairs. Attached are copies of Mr. Rooter billing statement.
We are more than willing to pay our average actual con-
sumption. We appreciate your consideration.
?RE pect ul
i i la
4 4 10 f/_4
Mr. Rooter & Express Plumbing
P.O. Box 27187 STATEMENT
Seattle WA. 98125
To:
Willie Zabala
23931 76th Ave. W.
Edmonds WA. 98026
Statement #: MR17194
Date: February 8, 1996
Customer ID:
Date
Company
Invoice
Description
Amount
Payment
Balance
1/8/96
MR. Rooter
MR17194
Water Line Replacement
$3,933.04
$500.00
$3,433.04
2/8/96
MR. Rooter
MR17194
Finance Charge
$54.50
$000.00
$3,487.54
Total
$3,487.54
Payment Due By 2/12/96 $�00.00,
Thank you again for your patronage.
"'o HAMIERICA'SIROIJBLESHoOTE
PLUMBING
Name: (9t--,ec&- -:i�n
Address: 3 93 Z - Z6%Z4 6q.,
City: Z—r-14"O"all State: 40n 'zip:9,P0._Z6
e: (Work).(SCO Z363-,Y
Phon �ome)_&( )
VALUED CUSTOMER PIDU31TECTION PLAN
Periodic Analysis Adjustments Lubrication Cleanmig -,Testing
ProvidingYOU top plumbing Rellabihty, Efficiency, and Safety
Benefits to you., ourValued Customer
• PEACE OF MIND: Automatic inspecting, lubricating, adjusting and cleaning oi'your water heater and fixtures keeps them operating at peak
trouble -free efficiency. Potential problems are spotted before they cause trouble.
• COMPETENT EXPERTS AT YOUR SERVI4�13: A competent, trained, dependable staff of experts'looks after and "worries" about your
plumbing fixtures and its performance.We work with you to schedule your service calls when convenient.
• PREFERRED TREATMENT: Our Valued Customer Plan increases your plumbing reliability, but should you need emergency service, you will
receive preferential treatment.
• PRICE PROTECTION: Your agreement price cannot be raised during the effective dates. Prices will not be raised for following renewal periods
without first notifying you. (We charge by the job, not by the hour, so you save money.)
M SERVICE YOU CAN TRUST: Our skilled experts know their business, we are licensed and insured for your protection. Rely on us and our
reputation to give you fast, dependable and fair service.
• PERIODIC INSPECTIONS: We reduce the number of emergency calls by revealing potential problems 'that can be corrected inexpensively before
causing major plumbing repair bills.
• RECORDS: MR. ROOTER will maintain complete records of all maintenance and repairs preformed by us and wil I provide you with a written
report upon completion of any work.
M TRANSFERABLE AGRF M NT: This agreement is transferable to the new owner should the property exchange hands or you can take it with
you to provide you peace of mind in your new home. ( Subject to the availability of a MR. ROOTER fi-anchise.)
Name:
Address:
City: State: -Zip:
Ph6ne: ork) (Home)
Valued Customer Protection Time Plan: El 1 Year 0 2 Year Year
VALUE INVESTMENT $
Accepted: MR. FLOWER PLUMBING
by - 14�
Effective Date: -
Contract No:
Mdte - Custonjer Yellow - Franchise Pink - Mr. Rooter Corporate
CONTRAcT NP 17194 1
DATE
COu
nty
Mr. Rooter of S�nohomls
P.O. Box 27187
Seattle,*WA 98125
License #MRROOSC063Q9
PLUMBING T14ANK YOU for your valued patronage
AS
4D
4.
cident. it is always the result of high intention. sincere
-EXCELLENCE auality is never an ac . cution. Service EXCELLENCE is our commitment to you.
effort. intelligent direction, and skillful exe NAME
NAM I
AII 6�L,111 I
X t/__ ADDRESS,
Value AD ESS . . . . . . . . 00, STATE.
Rate'
STATE ZIP CITY
bESTIMATE
he Value R CITY on ORK PHONE.
I exclusively fo P. 0. NUMBER HOME PH ONE W I
e rMee H ME ONE WORK PHONE
;ustome
uD!4
11-11! MW
-)I -*E,
WINENTS/WARRAN Y
yl . &% .
0 RK AUTHORIZAII IU11111 I MENT OF THIS -INVOICE
CONTRACT DUE UPON' COMPLETION OF WORK
'Wff4 PROPOSED WORK. 1, the undersigned, am owner/authorized
RK
Co
A
IN
U
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R
T
A
H
C
OR
T
AUTHORIZATION TO PROCEED Wn
1 0 p m -4
represen=tive/tenant of the premises at which the work mentioned above is to be done. I hereby
L
ou 1
authorize you to perform said work�, and to use such labor and materials as you deem advisable. A
N 1 h% will be added after ten days. I agree to pay reasonable attorney's fees
monthly service charge of 1
nd 7 rt he event of
ree r C i d a
and court costs in the event of legal action,or reasonable bank costs if my check fails to clear. I have
t contract. Ali parts will be removed from premises and
read, agree to, and have received a copy of the
discarded unless otherwise specified herein..
I hereby authorize , you to proceed with the above . work at the. price of $
AUTHORIZED
QIGNATURE
0 C.C. 0 CHARGE APPRVD BY U0
0 CASH Pl�__UECK
CREDIT CARIJ
NO. E ACCOUNT NO.
AUTHORIZATION CODE DRIVER'S UC. NO. DAXTPE
307,(16
0
SERVICE
AGREEME T 001
SUB
TOTAL 17
N (3
TAX
ACCEPTANCE OF WORkIPERFORMED I find the service a
materials rendered and installed in connection with the above wc1*
mentioned, to have been completed in a satisfactory manner. I
agree that the amount set forth on -this contract in the space
labeled "TOTAU' to be the total and complete flat rate/minimum
charge. I agree to pay reasonabie attorney's fees and court costs
in the event of legal action. I acknowledge that I have read and
received a legible copy of this contract and have read the Notice
to owner and statement 7quired on contract on reverse side.
I
1P ,
EXCELLENCE. ouality... is never. an.. accident:�.'. it is always the result of high intention, sincere
effort, intelligent direcdom. and skillful execution. Service EXCELLENCE is our commitment to you.
Rate
NAME
NAME
0 Value
Rate
ADDRESS
jZ,
ADDRESS
O'ESTIMATE;
The Value Rate
is exclusively for
rTy
C u WE
CITY b7ATE Zip -
_��e
Service Agre6:.
_pmntCustorrie
I
HOME PHONE WORK PHONE P- 0. NUMBER
U0
JHOME PHONE WORK PHONE
A hTifflOwilki
IDA a %UOULOMMIt G I Mae] I 1161TITI ILI r�. t\�,
OJA
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Y_
_2
V&61.e 7/19
30-(0
'3/1/YS.?5Z
F
WORK AUTHORIZATION PAYMENT OF THIS INVOIPE,./
CONTRACT DUE UPON COMPLETION OF WORII�
..'AUTMORIZATION-TO PROCEED WITH PROP6SED WORK. I.. the undersigned,arrit owner/authorized.
representative/tenant of the premises it'*which the 'v�ork'mentionecUabo�e?isl�.toi;e.,done: I he!py
authorize you to perform said work. and to use such labor and materials as you. deem advisable. A
SERVIdE
monthly service charge of 1 1h% will be added after ten days. I agree to pay- reaionAle attor'6ey's fees
AGREEMENT
and court costs in the event of legal action or reasonable* bank c calls if my check fails to clear. I have
SUB
read, agree to,and have received a copy of the contract. All parts.�will belr�mo rpm. premises and
V
discarded unless oth6rwise specified herein.
TOTAL
TAX
I hereby authorize you to proceed with the above work at the price of $
AUTHORIZED
SIGNATURE X
ACCEPTANCE OF WORKill JIWORMED I find the service and
0 CASH CIC'HECK 0c.c. .',,E]CHARGE APPRVDBY
CREDIT CARD EXPIRATION DATE
r
aterialls rendered and instdW I 10nnection with the above work
mentioned, to have been c6m=-`1d in a satisfactory manner. I
NO.
agree that the amount set forth on;thie . contract in the space
labeled "TOTAL" to be the total and othiplete flat rate/minimum
AUTHORIZATION CODE
DRIVER'S UC. NO.
ACCOUNT NO.
7E—R--
P.
charge. I agree to Pay reasonable attorney's fees and court costs
in thp Pvpnt nf 1pnnl iptinn I #k- i h _
1?890- 1 9q
February 21,
CITY OF EDMONDS
501 BELL ST. * P.O. BOX 2008 * EDMONDS, WASHINGTON 98020
FINANCE DEPARTMENT (206) 771-0241
1996
ZABALA WILFREDO 0
23931 76TH AV W
EDMONDS WA 98026-8811
ACCOUNT NO. 5-10175
ZABALA WILFREDO 0
DUE DATE 2./26/96
BARBARAFAHEY
MAYOR
Your account for utility services provided to the property located at
23931 76TH AV W
is delinquent in the amount of $215.95, due on 2/26/96
If you disagree with the charges or if there is some other reason why
you are withholding payment, please contact our Utility Billing
Service Representative, either by telephone - 771-0241 - or by a
personal visit to our office located at 501 Bell St.
Failure to make payment or to contact this office by the due date
indicated above will give us no altervative but to shut off water
service to the above property address. This is the only notification
you will receive from this office. When a water division employee
is dispatched to turn the water off, additional charges will be as
follows:
A turn-off charge of $20.00
. To restore service
During normal working hours of 9 am to 5 pm - $20.00
After normal working hoursr weekends and holidays - $75.00
If you have already paid this billy originally due
disregard this notice.
Sincerely,
fa4.1
ILENE LARSON
Customer Service
��?4
1/29/96, please
APPLICATION CARD No . ................. ....................
The City of Edimonds for
U)E SEWER PER311T EASEMENT No . ......................................
VEETT INSIDE 0 REPAIRS 0
OWNER....................... .......................................................................... - ................. CONTRAC70R .-J .. ............. PERMIT No.
STREET
HOUSENo.,-% ............................. ........................................................... ................... AVENUE LOT No . .............. .............. ................. .................. BLOCK No . .............
-3� - Z'-- Z, -,: ( ..............
NAME ADD . ........................
2 7
-� 0
0-7
7/
Date
BACKFILL WORK ORDER ISSUED ................................ — DEPOSIT, $ .......... ..................................
SEWER WORK ORDER ISSUED ..........................................
Approved:
DATE By
..... ... ......... ................... ............. ....................
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
A*-PA4'iiNtun State
KrMENT OF
DE V
SOCIAL&HEALTIf
S S
ERVICE
E'l S
A u
d It Family Home License
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 Divinia 0. Zabala (Hyacinth Adult Homecare 1':) License Number
to conduct and maintain at 23931 78th Avenue West
Edmonds
453100
, zip code 98026. , county of King
State of Washington, an Adult Family Home for the care and supervision of adults as follows:
24-hour family care for no more than 2 adults
number
a
This license shall be in forc6 frofn the 12th day of June 19 98
to and including
the 12 th
- day of June 1 19 99 subject to revocation for due cause.
Special Tenns:
4"
Nathaniel E. Dotson ic�;&vor
Gregory J smi-�k mp
N(Y]'E:rhis license is not transferable, and is valid only for use by the indhidual(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.
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VISION NO
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NAME:
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A METE -No
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OF FIXTURES,
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YES 0 No 0
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-I TELEPHONE*, NUM13ER C�yC: Z� �_jo Wehv,
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ADDRESS.
'REVIEWED BY
ENGINEERING MEMO DATED ,
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0 REVIEWED BY
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SEPA REVIEW AREA HEIGHT'
EXEMPT ALLOWE�, jPROPOSED. ALLOWED
z OPOSED
�EXP -'r
7
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LU ERAGE ;REOUIR �PROPOSED SETBACK&(FT.)
Ea.SETBACKS.(Fr.).
��LOWER PROPOSED
U FRONT SIDE REAR FRONT UR,SIDE REAR
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Proorti.
--LOT-AREA _PVANNING�8EVUjWB
DATE,
�REMARKS�* _7
I" I NEW- RESIDENTIAL. PLUMBINGA�Eq�y
El
Ej COIMPLIA�6E OR�:LL
L CHANGE OF we as
ADDITION COMMERCIA' USE
;�SIGN
GRADING,:,. TYPE OF'CONSTRUQTION�, CODE
FENCE, - 0 Co'
M REPAIR El CYDS
qV
WO DSTOVEr
0 OR I -AREA -
El
vw _SWIMrPOOL- IALINSPECT OCCUPANT
INSERT TUB/SPA
DEMOLISH_ El LOAD
Or
'r Y S
E
QUIRE
L�j CARPORT ROCKtRY _L�j RENEWAL REMARKS
z
Y (TiVIDE�,017.1ySE., BLISIN�§�Pp �GTIVIT�) X PROGRESS �INSPEC-,,! NS,
E PLAIN- PERVIBIC.1 8-
�T
.�LIMBER IsiUMBFR- OF
1' , '. I� 404"l) /V
0
)WELLING
UNITS:-.---,_kWF_ NUMBER
0
.ST6RI
7%�DIESCRiEltMORK
E.66NE A!TACHPLOTPLAN)..
SPECTIO'N'9REQUIR0
VALUATION FEE
0a. A
FEE
B'U'LDING",
HEAT §Q&CE
%
PLUMBING
MECHANICAL
heck No
:.Plan &
N
016'rp rs: Work -to be done,on, private propert ONLY'
,a - rmit�cove GAADING/FILL.
:,.Any construction gn the publid.-domain�(curt:�,-.slddwplks---',
a P M;L q
a �seppr ��,p 11 t.
_q: ��L STATE. SURCHARGE-,
1peffniv
40011daition:1 I ays
STORM'DRAINAGE FEE
yt,
?,!6vlde�d. Work is Started Within,18.0. Da
:.11A PplicanL on'behalf, of- his or.h6r Spouse; heirs, asSignS�966`. ENG�1NSPECTION:FEE
U) - : SdCCBSSO�61. in - intleresti �6grees- to: Indemnify, dofendtand.hold.:
'W `hai*rnlm,'-.'.the _City of. Ed mondq7,-:Wash Ing ton . iaW�
Its7offl(
,Vw. r
m iemplbyeps,,and agents- I rdm4any..andiall claims fordamages-of.,.� :or_
-6 tul
��Wfiate*%;&.� rej,arisihb'dire6fly or,indirectly'from-'the"�i-ssua-Ince
1 . ) I PLAN CHECK
At; Issuance. of'thIs- p6rmit'iihall rnot. be deem6d'tb�,r DEPOSIT
-in'
ny city.,�Qfdln ce
m or'reduce any.Te4uIrem6kv6f;.a
0 6,dlilm in;
5 qj, 1�;o f&;io
n any way the City's ability to enforce any ordinance� TOTALr AMOUNT DUE t
prbvision:".
4�1
I �herebylacknow.lidge. that Lhave read thla:'application; thiftii�.�:
i*,..i n 16 : rmat, 'on gi I ven *is. correct; and that: I am the rOwner, or the du . ly ATTENTION APPLICATION, APPROVAL
er. Vabrie-.to comply with c ty:'and;
gent;�U*46'.-own
T'. Ul THIS PE MIT
S t 4 q Igul4ii66�6666iructioh;:arid-in doing the work aut6orlv P This application is not a permit - until.
AUTHORIZES
0 ONLY THE Sig
r Person will-be.employed.in violation.,.6f.th.e Labor- ned by the Building. Official. or his/her
Ut tate of Was6ing!on-relating,to�Workmen's Compensa-. WORK. NOTED :Deputy;:and: fees are;oaidj�and recelotAs
-I� %'r;a' :RIDW,18.27�r INSPECT16N acknowledged in space�*Ovlded.,
NERtj�M:AGENTV r,_. ]DATE SIGNED DEPARTMENT
46SIOG TURE
CITY OF A E*
EDMONDS
R 7 —%ATE
0 N. Ic
CALL FQ
ATT�
OR ;MPE od.
.!UNLAWFUVT0 OCCUPX.A -BUILDING, STAUCTURE,,
AL:k-FINAL- �G'IGINAI — File YELLOW — Insp*ec"tor
ul*�, IT INSPECT16N `:HAS �ZEEWWADE: AND APPAOV�L- OR":.
-777791- i-02-2
A" CERTIFICATe: --OP' 'OCCUPANCY, HAs. :BEEN GRANTED: UBC' -
SECTION.109.' Owner GOLD — Assessor
PINK —
f, - 1 0 -.!
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
Reference
Grantor(s): (1) Wo 7-44t4 (2) Olyl-1154 Z441.4 Additional on pg.
Grantee(s):- - City of Edmonds
Legal Description (abbreviated): Sec 3Z __:rwn__'?_:��ng 446 Qtr SW
OR Lot Block I' t 65- 2 2 -W/
a
Assessor's Tax Parcel ID#(s): (I 1"Afg-006-008-0/07—(2)
------- Assessor's Tax Parcel 1D# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
Ily: O?S Date:
Page I of 3
WHEREAS, the undersigned owners of property located at 2 3 131 74
, 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
familyhome; and
WHEREAS, under the Uniform Building Code the number of occupants of a
structure trigger certain requirements relating to the fire suppression and exiting
requirements; and
WHEREAS, the City -has notified the applicant that the permit will be issued
conditioned on limitation of residents to — 2- 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 oeder 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�
. L Covenant: Limitation on Residence, The owner hereby stipulates
and agrees that occupancy of the structure as anadult family home shall be limited
to 7-wO —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
I 7_1A10 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 slipulates 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
,23,731 F& Aw _Wes;� Edmonds, Washington and legally described as:
/Ah 15141111-11en, ".4411101 6o 144// wila-v / ISIP4 om, /-)- ol-
47145/ 957 76�1' 40?� 6A&-.Cr /-70 ?;�e-/ &A Mele� 1,25- 4o;r- 8
7-
6 k+� 4we Y3 llvr 1--v 7z) 7w,- So " 7�Y .2 6-,4e,,4 o,-e Wexl
1-70 Ireel- so 1-07-9
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 -3 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: -7Z6 D a t e:
Page of 3
DATED this 215r-
ACCEPTED BY:
OWNER:
Je'-'annine L. Graf
Building Official
AcIl #4,5-3100
A�Wlr #�;go
NOTIFICATION
day of. k,41 g4e� g
_19 9L
NOTARY FOR OWNER SIGNATURES
State of Washington
)ss
Countv of r)&
APPLICANT/PROPERTY
Applicant
Applic
eld
OwneW'
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
D
I certify that I know or have satisfactory evidence that L-� L) i k, , A 24
signed this instrument, on oath stated that he/she was authorized to execute the
instrument and acknowledged it as the (title) of
(name of party on behalf on whom instrument was ex the
free and voluntary act of such party for the uses and purposes me & N.
instrument. Subscribed and sworn to before me this --JIS7'-
V, TAfty
op
Noiary Pubfic in and for tpp State of Wash 9
My commission ex W A
.pires,
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 (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 Edmonds
By:—�-� Date:.--.g/.?4/9;6
Page 3 of 3
L:\TEMP\BUILDING\FORMS\ADF—COV.DOC
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch ................
Retaining Wall ............
Slab Insulation ............
PLUMBING:
Underground ..............
Rough -In .................
Commercial Final ........
HEATING:
Gas Test .................
Gas Piping ................
Equipment ................
Commercial Final .......
EXTERIOR SHEATHING
NAILING .....................
FRAMING ...... .............
INSULATION:
Floorinsulation ...........
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY ...........
Y"
I . or
RETURN ADDRESS:
C` of Edmonds, City Clerk
ity
'J 215 Avenue North
Edmonds, WA 98020
.-NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
&p. 2.00 7-11119
-0
DIVINA ZABALA
'an ir
Additional on pg.
to (s): (1) (2)
City of Edmonds
:1j e`gai ckiption (Abbreviated): Sk _�ng Qtr
CO. SUBDV"?
6R Lot, 8 B104_�_Plat
T ax Parcel ID#(s): (lf014.88800Z008-,01
Ass (2)
Assessor's Tax Parcel ID# not yet assigned
-.217 Af o4l E
AUTHORIZED FOR RECORDING
City of Edmonds
By: Date:
Page of
WHEREAS, the undersigned owners of property located at 23931 76th Ave W
in Edmonds, Washington legally described
below or on the attached Exhibit A,. have applied for a building permit for
compliance and/or to reniodel a structure located on the site; and
WHERE -AS, the applicant has notified the City of applicant's intention to utilize the
impr6ve#ients and/or to convert an existing single family structure to an adult
fAiiiiiyahoine; and
WHEREAS,. under the U . niform Building Code the number 'of occupants of a
structu,0' trigger certain requirements relating to the fire suppression and exiting
requirements; and
-WHER.-EAS, the City has notified the,applicant that the permit will be issued
conditioned on limitation of residents to or fewer residents and their.
caretakers; And
WHEREAS, the City has issued a permit based upon such representations;
Now,. THEREFORE, 'the undersigned property owners (hereinafter
91Own6r11) in consideration of th6'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:.
M
1. Covenant: Limitation on Residence. The owner hereby stipulates
axid.-a.giees that occupancy of th6structure as an adult family home shall be limited
40 5 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
: ,:aivoccupancy of greater than residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
permitted in the curr.e - at occupancy classification, the structure shall
e*�Aci*ted and all.residential use ceased until such time,as the property is brought
int-o-:0mpliance with.the provisions of the State Building Code, under the edition of
th,6-:Uniform Building Code then in effect. The owner further stipulates that this
covehant.totiches and concerns the land so long as the present structure and use
con . nues. a nd shall run with the land Wall future purchasers and assigns.
2. Subiect Tract. The above stipulation and promises shall apply to and
rtin ''with the land With respect to a residential structure. located at
230.11. 76th Ave W. Edmonds, Washington and legally described as:
....LAKE.BALLINGER LAND CO SUBDIV 1.BLK 006 D-01 — E.85 FT OF W
1'7V-:PT OF N 125 PT LOT 8 TGW UND 1/3�INT IN VTO THE S 2.5 �,7T
OP �4 7 0 Yt SD LOT.-8
'31. Notification to Future Purchasers and Assignees. This notification
and.:c&enant has.been recorded in the records of Snohomish County, Washington
'in order to' provide -notice to an'
y 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 6 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: Date:—
Pa.ge of
2007
DATED this day of
ACCEP.TERBY- APPI��CANT/PROPERTY
OWNER:
DiVINA 0 ZABA19
Applicant
A plican
p
DIVI ZAPjALA e�
Owner
Owner
COVENANT AND
NOTIFICATION
ACKNOWLEDGED.
COUNTRYWIDE HOME LOANS
Mortgagor
'NOT
TARYFOR OWNER SIGNATURES
State -of Washington
)ss
County f5kawn
I �ertify.that:I know orhave satisfactory evidence that wq, r,,,o,
SJO.od this instrument, on oath stated that he/she was authorized to execute the
ih,truipent and acknowledged it as the 0 L,�-) e*-� (title).of V\ t,
s
(name of party on behalf on whom instrument was *executed) to be
the free find voluntary act of such party for the uses and purpo.ses mentions in this
i4strumefit. Subscribed and sworn to before me this day of
TVILZ� .20 61
QAAA I.
Notary Public'in andfor the State of Washin
.,e-L _gton
My commission expires_
ow
or have satisfactory evidence that.
-IM-0 u ent, on oath stated that he/she was authorized to execute the
ffi�gtrii.ment and acknowledged.it as the (title) of'
.,'(name of party on behalf on whom instrumpt was executed) to be
volunta.ry act of such party for the uses and purposes mentions in this
tAstrulnent. Subscribed and sworn to before me this day of
Vdtary P liblic inand for the State of Washington.
My,c6mmission expires
AIUD FOR RECORDING
..City ofEdthonds.
ty: Date:
Page of
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