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431 12TH PL N.PDF1111111111 669 431 12TH PL N 0 0 ADDRESS:, '/X?)/ — /,;—, A /V TAX ACCOUNTAPARCEL NUMBER- 0,!�) 5 t1,2 U // a 6) BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: El Conditional Waiver E] Study Required F1 Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: LID #: LOT: BLOCK: L\TEMP\DSrs\Fomis\Street File Checklist.doc APPLICATION for The City of Edmonds STRW FU SME SEVV= PERMT NEW CONSTRTj4MON [] REPAIRS 0 c)wN-Ep t ...... ........... I ....... +L.4 ... 44-1 ................... ADDRESS ......... M ... 3-1 ................. 11 ........... N ....... T%&-K ............... I I 59 A�* EASEWMT No. 0 6) A ep J, (104 CONTRACTOR............ J.�A ... Wk ... % ........................................................ PE LEGAL DESCRIPTION: LOT No . ......... // ............................... BLOCK No. NAME OF ADDMON .... /TA(01 ........ A* / � 6) -� Ar, , AP.Pi , ' ' , _J MAR 14 Approved: AJ f44w--;wm5— ............................ DATE ...... ............... By .......... g 0174 jp. _. � : : : - ­6TY 00­ EDMONDS' Cali PROSPect, 6-1107 when. -work �CIVIC -CENTER WATER -SEWER DEPARTMENT is rewly for Inspection., (No Ifispec- 'WO tions Saturday, Sunday or holidays.) A N 2 8 0'8 ...SIDE SEWER PERMIT th AbDRESS .............. 4� . ..... Nqr ................................................................................... OWNER ............ Frank I* Laush ................ ........................................................ ........ CONTRACTOR ..... PH"r March 12 Perinission4s granted .................................... ..... ..................... days t REPAIR or CONNECT aside sewer. for._. With City Sewers in accordance with application on file and governifig ordinances. ATTENTION IS CALLED TO THE FOLLOWING: 'NOTE No. 1—The owners of the property may obtain a permit to construct sewer pioperty line. A licensed Side Sewer Contractor must be employed to construct side sewer In street area. Do not cover any portion of sewer before It has been Inspected. No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulatio s governing side sewers when you get permit. N,.__,.No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends In gra.de sharper than 2/fi will be permitted. NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper work wh1ch may de ' velop within one year of completion. N70TE No. 5—It is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or its appur- tenances except to Insert the pipe Into the wye. STREET FILE M IP-7 T com ED CITY OF EDMONDS 121 STH AVINUE NORTH - EDMONDS,WA 98020 PHONE� (425) 771-0220 - FAX� (425) 771-0221 -111,7 roll STATUS: ISSUED 'erW'i( i4*6'*�;'- p1ra. 111�W- 12 S: 4 h I 2TH,fL.Ni!EI)M0NDS* ro Parce I No: 00507200001100 PROPERT1'ONVISTR APPLICANT COINTRACTOR JENICA VARTOLOMIEU JENICA VARTOLOMIEU N/A - COMPLIANCE PERMIT 431 12THPLN 431 12T H I'L N EDMONDS, WA 98020 EDMONDS. WA 98020 425-775-0381 425-775-0381 LICENSE # EXP. JOB DESC1?,IPTI,*N - AFH COMPLIANCE (5 BEDROOMS ON MA IN FLOORNSI BA SEM ENT TO BE USED FOR PRIVATE RESIDENCE AND NOT PART OF A FH)L VALUATION: $0 PERMIT TYPE: Residential PERMIT GROUP� 19 - Compliance Inspection GRADING� N CYD& 0 TYPE OF CONSTRUCTION: VB. RETAINING WALL ROCKERY: N OCCUPANT GROUP R3 OCCUPANT LOAD: FENCE: N ( 0 X 0 FT-) CODE: 2003 OTHER: N ------- OTHER DESC� Z NE:RS-12 NUMBER OF STORIES: 0 vE sT 1: D DATF. NUMBER OF DWELLING UNITS 0 EXISM,G AREA iBASEMENT: 0 1 ST FLOOR: 0 2ND FLOW 0 PROPOSED AREA 0 1 ST FLOOR 0 2ND FLOOR- 0 TBASEMENT: 13R,D FLOOR: 0 GARAGE: 0 DECK: 0 OTHER. 0 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 FRONT S MACK SIDESETBACK PFA R S ETB AC K REQUIRED: 25 PROPOSED- IPEQUIRED: 10 PROPOSED IREQUIRED 25 PROPOSED HEIGHT ALLOWEDiO PROPOSED:O JREQUIRED� 10 PROPOSED. I SETBACK NOTES: State law preempts local landuse regulations andallo%%s adult famil% homesasapermittedusc in a single-family residential zone. Ramp is less than 3 feet and is permitted in setbacks for access. I AGREE TO COMPLY WIT It CITY AMD sTAT E LAWS REGULAT INC, CONI-,F RUCT ION AND IN DOING T HE WORK AUT HORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLAT ION OF I FIE I-AI30R CODF OFT HE 5TAT E OF WASHINGTON' RELATING TO WORK MEN*S CONIPENSAT ION INSURANCE AND RC\k; IS.27. T HIS,\PPLICAT ION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFIcIAL OR HIS11-WR DEPUTYAND ALL FEES ARE PAID. VGAAAkv o7-2�,e6 711- Vlp 0 Signature Rint Name Date Reldased By Date I --1,jC7 tv H I CCI U— ATTENTION IT IS UNLA\VFULTO USE OR OCCUPY A BUILDING OR STRUCT12RE UNTIL A FI11:AL INSPECI-ION 14AS Bl--E.,\.\IADE..X',,\D.APPROVAL OR A CER11FICA FE OF OCCUPANCYHAS BEEN(iF ANTED tlfi('100 IRCI 10 IPCI 10 E-1ARCHIVE ED APPLICANT ASSL—SSOR THLR 90 STATUS: ISSUED BLD20060782 Any request forth e modificat ion. variance or other ad min is trative deviat ion (herein a fter"variance") must be specifically called out and identified. Approval of any plat or plan containing provisions which do not compl�y with City code and for which a variance has not been specificalk, identified, request 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. SoundfNoise originating from temporary construction sites as a result of construction activity are exempt from the 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 noise originating from construction sites/activites must comply� with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to FCC 5-30-120. THIS PERMITAUTHORIZES ONLY THE WORK NOTED- THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TINE LIMIT: SEE ECDC 1900005(A)(6) CALL FOR LNSPECTIONS BUHDFNG (4 25) 771-0220 EXT. 1333 ENGINEERING (425) 771-0220 ENT. 1326 FIRE (425) 771-0215 PURLIC WORKS (425 � 771-0235 PR&TREAlAIENT (425) 672-5755 RECYCLING (425) 275-4801 • 13-Buildine Final J�\j • F-Fire Fin,[ QW6- olla voo� REQUEST FOR INSPECTION- Adult Family Home APPLICATION NUMBER: Z61:K--O 782— Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SFrE ADDRESS: 143 1 1?— PI-N- &IMM49,0-1?02�9 ASSESSOR'S TAX/PARCEL #: -- — — — — — --- — — — -7- PROPERTY OWNER NAME: DAYTIME PHONE: V LICENSEE NAME (IF DIFFERENT): I SECTION 3 — FLOOR PLAN DAYTIME PHONE: 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) REC.-FRIVED Mrl 2 7 2G.m CITY CULD VJL U0 -WiLOANG cITY OF EDMONDS SECTION 4 — DISCLAIM ER/SIGNATU RE BLOCK i I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am authorized by the owner of the above premises to request inspection for and operate an Adult Family Home at this location. I further certify that I have made application to the Department of Social and Health Services and the jurisdiction for the appropriate license(s) to conduct such business at this location. I further agree to hold harmless the jurisdiction conducting such inspections at my request as to any daim (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 suppfied to the jurisdiction as a part o�thi I- ation. �1� 1 VO4 NAME/TITLE: _ 6a— , �= DATE: lo4ROPERTY OLNER APPLICANT L LICENSEE SECTION 5 - INSPECTION CHECKLIST YES NO Home licensed (or applying for license) on or� after July 1, 2001 SLEEPING ROOMS Sleeping Room #1 �j S —ZN S I 01tN S 2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside : --Jl Smoke alarm is installed in the bedroom �j Sleeping room window has a minimum net openable area of 5.7 Sf. (minimum dimensions- 24" high; 20" wide) :1 Sleeping room window has a maximum sill height of 44" -1 Sleeping Room #2 S /NS I -OtiqS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #3 -D S - AS I S 2 Bedroom door is openable from the outside when locked F., Closet doors are readily openable from the inside 7 Smoke alarm is installed in the bedroom 1.0- Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) le Sleeping room window has a maximum sill height of 44" Sleeping Room #4 �j S AS I ^S2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside F/- --I Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #5 S S I ONS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom j Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Le Sleeping room window has a maximum sill height of 44" Sleeping Room #6 -] S NS1 -1 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) L Sleeping room window has a maximum sill height of 44" L -j GENERAL Bathroom doors are openable from the outside when locked r-7�1 —i Smoke alarms are installed on all levels of the dwelling -1 All smoke alarms are audible in all parts of the dwelling upon activation of a single device Access road and water supply approved by Fire Department -1 PERMIT REQUIRED -jj PASSED CORRECTIONS REQUIRED INSPECTOR: VAAA &�4n& DATE: -7 L----1 t'�--aLd- JD'etv�-. so= mm� S IT FILE TRE CITY CLERK MY OF EDMONDS CONFORMED COPY 121 5TH AVENUE NO. 2007JI080093 2 PGS EDMONDS, WA 98020 11/0812007 9:42am WOO SNOHOMISH COUNTY, 1ASHINGTON COVENANT For Adult Family Home's Second Kitchen Whereas, the Grantor(s) -, )e -J`VJd+ MA-frO hereafter referred to as "Grantor(s)", have recei Permit # for property which is zoned single family residential, and is located at I Z-141 PC /V tax account parcel number_ODLGA2�0�0�00�.- , and legally described as follows: Z Li ) TWN Z -71 [&"F, :3 1 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 Family Rome use. Therefore, in consideration of the City of Edmonds, Washington approving the second kitchen as a reasonable accommodation by issuance of a building permit, the Grantors agree as follows: L' 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. I 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 Grantor's are in compliance with existing zoning regulations. ..................... . Signed qt""— OLIC IVA a Vi, 8U:bscR%'M'a`nd sworn to before me this ci�Y da of y Mfiary Public in and for tbe State of Washington. MMM&MAMMI I STREET FILE RETURN ADDRESS: City of� Edmonds, City Clerk CONFORMED COPY 121.5th Avenue North 20�7�108009J 3 PGS 110 /2007 :42am 42,00 Edmonds, WA 98020 SNOHOMISH COUNTY, NSHINGTON NOTICE OF. LINHTATION AND COVENANT ADULT FAWLY HOME Reference #: (1�_�,N I �,A VWN kXk Additional on pg. 0 an r tee(s): Qtv*of Eftonds ated): 9ec_2,g Tw Qtr U,pl.pescription (abbrevi n 9 OR Lot —Block Plat Assessor's Tax Parcel ED#(s): (1) -00 51)_7;�Ao/) 0)100(2) Assessor 9 s Tax Parcel 1D# not yet. assigned AUTHORIZED FOR RECORDING City of Edmonds -7 BY: Date: Page of WHEREAS, the undersigned o winers of -property located at L13) - I Z101 PL IQ 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 WHEREA.S, 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 f2imilybome; and WHEREAS, under the Uniform Building Code the number of occupants of a st reture trigger certain requirements relating to the fire suppression and exiting requirements; and WHEREAS, the City has notified the a plicant 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 und ed property' owners (her�elnafter ersigp "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: Cov,epant: Limitation on Residence. The owner hereby stipulates and'agr6es that occupancy of the structure as an adult family home shall be limited to —Or fewer aduW. 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 tate license to operate an -adult family home with an occupancy of greater than residents or attempts to rent, lease or othe'711se provide residence for additional residents above the permitted. In the current occupancy 'classification, the structure shall be;,vac4ted andall 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. Sublect Tract. The above stipulation and promisesshall appW to and run with the land with respect to a residential structure located at 01 1 �,k PL �4 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. 4. Enforcement. In addition to any a fid other remedies civil o r* criminal Which the City may have, the property owner hereby, agrees and stipulates that -this grant of covenant shall endtle'the City to.enfotce by Injunction the provisions of this code and, in so doing, to recover Its reasonable attorney's fees and costs. AUTHORIZED FOR RECORDING Edmonds !ty of By'_4 Date: /)//0/01 Pav of Mortgagor NOTARY FOR OWNER SIGNATURES Stste'of Washington )ss .County of i.cer-tify that I know or have satisfactory evidence that :YawcA VbzTnLn&AEU Ahis Instrumen4 on oath stated that he/she was authorized to execute the signed instrument and acknowledged It as the 0 nm-sn (title) of cyj n w` (name of party on behalf on whom instrument was.executed) to be th610ee- and voluntary act. of such party for the uses and purposes mentions In this ment. Subscribed and sworn to before me this dayo'*f 'Myl 4V, Notary Public In and for the State of Washington. 107 s .1,0i My comml sion expires .,know'or have satisfactory evidence that .4 to,execute the 16tiutnen4 on oath stated that he/she was authorized cknowledgeditasthe (title) of nt and. a (name of party on behalf on whom instrument was executed) to be the and voluntary act of such party for the uses and purposes mentions In this n 't'lmpnt Subscribed and sworn to before me this day of n 19. Notary Public in and for the State of Washington. My commission expires E AVTHORIZED FOR RECORI)ING Cjty of Edmonds By:�::� Date: 16 11PIO 7 Page Z- Of 42 L:\TEMMMDING\FORMS\ADF-CQVJ)OC2110/04 mom CITY CLERK CITY OF EDMONDS 121 5TH AVENUE NO. EDMONDS. WA 98020 CONFORMED COPY 200711080093 2 PGS 11/0812007 9:42am 41.00 SNOHOMISH COUNTY,' NSHINGTON COVENANT For Adult Family Home's Second Kitchen Whereas, the Grantor(s) , )9,�v Jd& �J&ei-OLOM Z�A hereafter referred to as "Grantor(s)", have received a Building Permit # 11XQ-dM2 for property which is zoned single family residential, and is located at. Z_ial I Z-1-h 10C IV tax account parcel number 0() GQ 7,)-00 0// 0 0 and legally described as follows: 0-r,� Z T(AJN 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 Family Home use. Therefore, in consideration of the City of Edmonds, Washington approving the second kitchen as a reasonable acc , ommodation by issuance of a building permit, the Grantors agree as follows: I 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. I 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 Grantor's are in compliance with existing zoning regulations. Signed -i 401 Lie s ed and sworn to before me this day of �04—,te— e State of Wa—shington. N tary, Public in and for th' y Pub P RETURN ADDRESS: .City of- Edmonds, City Clerk .121.5th Avenue North Edmonds, WA 98020 CONFORMED COPY 200711 092 3 PGS 11/08/ 00 9:42am �42,00 SNOHOM�SH COUNTY, ASHINGTON NOTICE OF LMTATION AND COVENANT ADULT FANULY HONE' 0 Reference #:—oWl - 7 ON -.Grantor(s): (1>_� Additional on pg. Or�i n*tee(s): Cliv of Edmonds Le 0-scription (abbreviated): 9ec_L!J_Twn_2:j_Rng Qtr 5 gal D OR Lot Block Plat Am ssbrfs Tax Parcel ID#(s): (1) 'Q050-7.'�Wl) 01100(2.) Assessor's Tax Parcel 1D# not yet. assigned AUTHORIZED FOR RECORDING City of Edmonds BY: J Date: �1)114117'7 Page _L_ of WHEREAS, the undersigned o winers of property located at Z�31 - I Zr" PL f\J 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 a plicant has. notified the City of applicant's intention to utilize the p 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 trieeer certain requirements relating to the fire suppression and exiting requirement�-,­and WHEREAS, the City has notified the a plicant 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; NOWP . THEREFORE, the undersigned pro erty owners (hereinafter p ."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 mortgagor's of the property does hereby stipulate, covenant and agree as follows: 1. Covegant: Limitation on liesidence. 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 4 s ks revision of the applicant's tate license to operate an -adult family home with, ee an occupancy of greater thar residents or attempts to rent, lease or ot& Ise provide residence for additional residents above the L Oermitted in the current occupancy classification, the structure shall be vacated and.all residential use ceased until such time'as the property is brought lntq�';ompllance with the provisions of the State Bui Ming 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. Sublect Tract. The above stipulation and promisesshall apply to and run with the land with respect to a residential structure located at 01 1 PL �J 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. 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 dity of Edmonds By. Date: //)//0/01 Pap Of DATED* this day of 20 ACCEPTED BY: OWNER: L L. Graf Building Official Lie - woe 0 75 0 06Z NOTIFICATION APPLICANUPROPERTY Applicant Applicant � ( ) e�l �J" Own�� Owner COVENANT AND - ACKNOWLEDGED: Mortgagor NOTARY FOR OWNER SIGNATURES State,61! Washington )ss County of 1cert-ify that I know or have satisfactory evidence that '3awcp, LQMEU signed this Instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged It as the 0, Ny-y- (title)of ownev-N., (name of party on behalf on whom instrument wasexecuted) to be the,, fkee- and voluntary act of such party for the uses and puKposes mentions In this instrument. Subscribed and sworn to before me this dayo'f Notary Public in and for the Stat on. 4N e of Washingt .4 0 TA 0, :,0: - �1- My commission expires U *1 know or have satisfactory evidencethat trument, on oath stated that he/she was authorized to.execute the nt 'and acknowledged It as the (tide) 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 119 Notary Public in and for the State of Washington. My commission expires E AUTHO RIZED FOR RECORDING CRY of Edmonds By.: Date: 16 11PIO 7, Page '�—of-�— ��TEM"UELDING\FORMS\ADF-COVMOC2/10/04