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434 12TH PL N.PDFiiiiiiiiii 660 434 12TH PL N RECEIVED CITY OF EDMONDS * CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS 7- 0 MAILING ADDRESS CITY ZIP TELEPHONE NAME ADDRESS CITY ZIP ITELEPHONE NAME ICBL# CITY ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PERMITEXPIRES SE U PERMIT ZONE NUMBERA JOB LANDRESS 44, PROPERTY TAX ACCOUNT PARCEL NO. ZWK5 0 j!!2V50724 NEW RESIDENTIAL PLUMBING/ MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL 0 MULTIFAMILY SIGN REPAIR GRADING . CYDS o FENCE FT) DEMOLISH TANK GARAGE o RETAINING WALL F RE SPRINKLER CARPORT ROCKERY _] FIRE ALARM (TYP E 0 F U.6 F. B U S I S;Sq 7 R rA,;r 7 r AtMe 14 14;4411 V NUMBER OF NUMBER OF DWELLING CRITICAL AREAS Do STORI S UNITS NUMBER IY4 DESCRIBE WOqK TO BE DONE_ A f HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: VESTED DATE THIS PERMIT AUTHORIZES 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 APPLICATION: 180DAYS PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMA71ON . . 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE Crr1rS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION 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- TION; AND IN DOING THE WORK.AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. DATE SIGNED PLAT NAMEISUBDIVISION NO. T NO. LID NO. f LID FEE III PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Reqjlrod Street Use Permit Roo EXISTING — PROPOSED bulO"don RDqWrad Sidewalk Required REQUIRED DEDICATION— FT Underground wiring required 93 METER SIZE LINE SIZE OF I'DITURES PRV REQUIRED 7. YES 13 NO E3 3 REMARKS z z OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE 1 1011 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REOD I POSTED I DYES ONO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP , , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 21 z PARKING LOT AREA I PLANTG REVIEWED BY DATE REO'D I PROVIDED I REMARKS , li­ft�.' CHECKED BY I TYPE OF CONSTRUCTION I I cft GROUP SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [] YES IOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG VALUATION Description FEE Deq�rlptlon FEE Plan Check 9�te Surcharge Building.Permft City Surcharge Plumbing Base Fee Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscapeinsp. Total Arnt Due _11649-50 Recording Fee Receipt # j -4 CALL :OR INSPECTION (4251 - APPLICATION APPROVAL 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 prcrAded. OFFICIALS SIGNATURE DATE 771-0220 -RE BY DATE ATTENTION M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL-FILE YELA-INSeCTOR S" CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASS SSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES Liceming Authority NOTE: The de' rt 0 preclude the depa ent fro ment renewal of a license does n* t. taking,any action un er WAC 388-76-705, based on inspection. This' license is noftrafi�ferable, and is valid only for use by the c6r;poira�tlot'i:"; pa"t­me ��n onor ill Individual(s) to whom it is isiuedand'at the location above described, Issued by Authority of Chapter RCW 70.12 FF ' 7 * FINAL PROJECLUPEOVAL FORM ry r- %.. t� I Y 1-_w- 0 J U N 0 7 2004 TO: DEVELOPMEN'r SERVICES CTFL DATE: CITY OF EDMONDS MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: ����..FIRE DEPARTMENT DATE PLEASE SIGN ENGINEERING DIVISION DATE PLEASE SkGN PLANNING DIVISION DATE PLEASE SIGN PROJEC Aed SITE ADDRESS PERMIT ADB# DATE INSPECTED (S --L -7 DESCRIPTION OF WORK TO BE INSPECTED A-F-1-4 C QA,,P A field inspection was conducted to determine compliance with -approved plans. Final approval.' denotes that there are no objections from the above signed Department to the release of PERFORMANCE BONDS -and the granting of: GRANT FINAL PROJECT APPROVAL GRANT PROJECT. APPROVAL WITH CONDITIONS NOTED - 0 Copy of CONDITIONS given to owner/contractor by inspector FAILED FINAL INSPECTION - OUTSTANDING ISSUES 0 Copy of CORRECTION NOTICE given to owner/contractor by inpector 2. 3. RE -INSPECTED OUTSTANDING ISSUES - GRANTEINAL PROJECT APPROVAL Date. Signature 1:temp:b1dg:fbnns:ocaprv1 3/25/04 CL IR _j �L DI =r — i I 7tli f alp* rft Life 0. eumm!"Wr Mom FORMAL Vir*4Nfp BREAKrANOOK E L-' ON a 5 P_ C3 LL Le,,r-- M'T "ANE cl --AN RECEIVED LL RAO 6 2004 CITY COPY PERMIT COUNTER -0-TQ %�,J[Ly U U111U11 5 ET. F1 hFG1TF-W*WV CONSTRUCTION OCT 2 2 MRMIT '5�01L;T 11-13-cil Permit Numben ENGINEEHING Issue Date: A. Address or Vicinity of Construction: 434 12 Place North B. Type of Work (be specific): Install New. Service 9 0 1 o'� C 0 rn P I'L- C5 - C') C. Contractor: -Washing6n Natural Gas Company 'Contact: Gary Swanson, Mailing A . diress: 815 Mercer Street, Phone:. 224-2080 State License #: Seattle, WA 9".'rl Liability Insurance: Bond: $ D. BuildingPermit # (if applicable): Side Sewer Permit # (if applicable): E. :C] Commercial Subdivision City Project EX Utility (PUD, GTE, WNG, CA�BLE, WATER) Mul.ti-Family El Single Family Other INSPECTOR: INSPECTOR: y F. Pavement or Concrete Cut [9 Yes E]No U b. Size of Cut: —7-' - x 4 Ho Charge$ 0 Cl%.rT APPLICANTTO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this applicati6n,agrees to hold the Chy ofEdmonds harmlessftom injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeen, that mp� _be nad f EL�monds, or any of its departments or employ- �'against the City � ees, including. or not limited to the defense of any legal proceedings includi,djAfe&e costs, and attorneyfees by reason of granting this permit. R FOLLOWING THE FINAL INSPEC 7TON 7HE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MA 6z4FoRiAQJL�woc%EL AND ACCEPTANCE OF THE WORK'ES77MAYED RESTORA77ON FEES WILL BE HELD UN77L THEF7NAL STREET PATCH IS COMPLETED BY CIT� FORCES, AT WHICH 17ME A DEBIT OR CREDIT WILL BE PROCESSkDtFOR ISSUANCE" TO' THE'APPLICANT Construction drawing of proposed work required with permit application. A 24 hour notice'is required for inspection; Please call'the Engineering Department- 771-3202. Work is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches sha 11 be patched with asphalt or City approved material prior to the end of the working day;. NO EXCEPTIONS. I have Tead the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all timesfor inspection purposes. Signature: MCAAAAA4.1 Date: October 5, 1991 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY . .................. I ....... .............. ......... ....... . ..... NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION NOTES (Fund I I I Route copy to Street DeAt Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION 0 YES 11 NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. July 1985 Washington NaturalGat'-.� AWWvxjtcn Energy Gmparyy +��4 12- PL t,,J LIMr- tn winrinw Addendum.to: City of Edmonds Permit Application Engineering Aide: Kerry Walsh Washington Natural Gas 622-6767 x2761 HVIA gas main proposed Key: -s- squitary sewer w- water -g- gas water valve hydrant 815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767 A "7 :. S __.4NTE'R' -0'FFIiCE!'-'C MMUf 7A_ TO N' � TT. 7, DAT A Q U St., i c3. TO hitcutt N, FROM NIT 'BU vi c d n- Offi 'Tal. neerf Eng'f Depar r� S', u E3 J; E C T, Rockerv: Nsta'11al'oh BU-J-1dinq I..,kAtIdn' . ­4 4 12th. Pl. -�N. - P'ermit App 3 -Af ter a f VeId- i nspectib-n. of the, subjett' S 11 te 'the" -F-61 1 6%ri s::'h d" a o te, . .. . .... . .1. Contractor to -instal 1". 6- tach ..pe".rforated dra4'n,'.J'n, ai t ial free.'dr �ntn ��er behfnd-rbcker�.'at base. LIL 2. Mi ni mum slope of roc'ken�,J ::':'4 uj 10 Base sectfon to be- lbi" rock mthi Ir t was also: that -the oh;�� --c noted pmpert to the�,east� has' a drai*6': At -charges at the top of the''_'propose 'd -rorkery, this"'060d,'Wrebca ed�.-Itq_ t P. 0 h r tedt t P rocke�ry, 7- t� Call 7715�2525 'for side sewer inspections BEFORE covering any portion of the . constructi bi6-Sat., Sun., or holiday Inspec (Inspection will be provided within 24 hours"after 'requat, 002 S. ADDRE:? ]T_OCAn6N' OF CONSTRU .......... 5JL .. ....................... PROPE4T&XkGAL DESCRIPTION.:. ........................... ..................................................................... ................ . . ................ ...................................................................................................... ........................................................................ ........................... I ....................... f................................................................ OWNER .&KA , Z ­5 '.. ­1 ........................................... D/OR BUILDER ..... .. . .... p CONTRACTOR'S NAME DRES . ......... .... V A Pennission Is granted.. ......... —1p, ............... 1 i9l�=�, for repair and/or connection of a side sewer to the city -sanitary sewer systerri in accordance m riit;'o"dinondi; ordinances. ATTENTION is CALI�ED TO THE FOLiOWING: NOTE No. I�The owners of the property. -may obtain a p�ermit to construct -sewer inside property line. A licensed Side Sewer Contractor must be empl , oyed to construct side sewer'in street area.. -Do not cover arty portion of sewer before It has beem inspected.. NOTE No'. 2—All work performed in city right7of-way requires, an -Invasion of- Rlght-of�Way, Permit obtainable from the City Engineer's office. NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and'Regulations governlng�slde sewers when you get permit. hav e at least 30 inches coverage at property line and 12 Inches inside property fine; minimum grade of 2%. No b NOTE No. 4—Top of side. sewer must sharper.'than 'A will be . permitted. en ds in grade NOTE No. %---�Trenches in street must be water settled and surface of street restored to' original condition. - Contractors shall be responsible for failure due I to improper work which may develop within one year of completion. .. NOTE No. 6--It is unlawful to alter or do any other work than Is provided for In the permit,, or to doany work on, the madn sewer or its ap purteriances eicept to in- sert the.pipe into the wye. DISAPPROVEDn Date ... ................ ....... ........... By ................. Date ..................................... By ................ Date .......................... 7: ........ �By ................ APPAOVEP' C] Date ............................................................... By ........................................... ........................................................................................ Remarks: ...... ..................................................................................................... ...................................................... I ............................................. ...... BOTH Permit Copies MUST 'Be Signed By Owner of Firm Perforrning'Con�truction PRIOR To Request For Inspection 1 ................... t ................................................................... .. :, hereby, certify that- the side sewer installation* Constructed under this. permit �(Owner of'Contracting Firm Performing Construction) _�....was installed in accordance with all governing ordinances* of the City of:Edmonds. Datedthis ............................ day of .................................................. ..... ......... 1 19 ......... V V Check BEFORE you dig for: Water - _],. Telephone E], Power E], Sewer E), Other Ej -� V APPLICATION A0 City of Edmonds for EASEMENT NO - -- ------------- .......... .... SIDE SEWER PERMIT NEW CONSTRUCTION REPAIRS LID NO. ASMT NO -- --------- E=— L�-Mi�'RALL2 OW-NER ___F*Nl- e�p 13T7 CONTRACTOR RMIT NO . .. ................. ................ ....... ------------------------------ --------------------------------- .............................. ------ ---------- - .. ..... ........... JOB ADDRESS LEGAL DESCRIPTION: LOT NO. ..... ........... BLOCK NO - -------------- ------------ ------------------------------- --------------------- I ------------- ------- I .......... 0 0 0 0 --------------------- I ....... .................................................................................................. ....................... ",/ I I I Lzc=P-- NAME OF ADDITION --- tAt�2--P>1 ...... ....... ............................... - .................. d: ---------------------- By Al** ------------- ------------------- RCN� WIP r'"'ICIPPYAWAlt I !.�r EWW -DEPVRTMIENTt EWS ER.. 52M PETUFT i�el �cons!r�ctiow j��F6RF ;rjf tonsl 2i�bt' ior. inspections; -11 call, �715' I " , , - "; " C., our r46. Sat uri, '-or h6liddy- 6 It' w Kin,,!iIi h, a -after requst.,.* ... .10napectionwil!, 9, proyl e it ........... . .......... �-J 'IC MON X.TIONNOY. ON$TRUC is OC ................ ............. FSb�RIPTION�_ .... ....... -Jpjrwq� xid iDl PER 'A . ......... .............. ................ ........... . ............. ....................... .... ... ........ ........... ...................... 0. BUI R:... W-N, R ALN-D/OR'. -LDE .................. E ............... ................................. "!� . ........ ......... DRESS... ............. . ......... & ide;seweiAo' qanjt'alr_y�,,�ewer Y", j)i1;conn&t1on'-'o '21, for- repair and"// 'of, q: -&,dAn��Aylth!, c4y,, --EdTO& ordihan�ccs'.. aef oyed�:to,construct� -x LLOWINGt, er, cbn'tiactor: must�- bepempl S�GktOR�!To -0 � .1 1— . d k'kA�f- E-"N'tcT-TONI?��i - ajrj�4a, peimit to�Icbnstruct :sewer inal e�,properfy�,i trie ...A -iicenied', Side, sew chi WR�jbTEI�4461 inspected, re �� � - , - - " or an�y:,Portton of 'sewer -before it, hasv beew slde�,,sewi�lit!jkstreet area.,' Do�,iiot,coVI Pirrhit obtainable from. the� cjtyi.iqiijinoier'a.qfficei�, way, requires! an, invasion of Rlgbt-of--Wa� 11 in.,dity,,right-of- cie,�14%116.0301,andI Y�egulatlolns, goverRlnk�sldi',sewers, when, you gqiPeT7nit. gride�- of"2 %�;'Nd �bendsv n., riches inside property'' I -,�3=0 ine;_,minimum. ;;X.,. roperty 'line B�h(f 12.j K . .- , " -, '4 - - inches :coverage ;ELt P must,have',atJeast,30: proppr, Ccontrakloig sbalP be, resl>.onsibld. fo -restored% -to, orlgtna1�condjtton. wat�r iettled:�ain& surface of str�et� st'r�,must'lbi . ­ I � , I . - . - :1 . . . � I , rte t- to;. in- I velopj�wlthin one, -matM sewerVorAta,'EL year 6f.cdmpl . etion.. th �pe��n�t,l -or* to,do 4any work on.thel vided, for.In. e F, work, than 'Is pro 0-�N,OTP )I L t�ig4uhlb"�,fw,�totialti�"Ibilldo,,.*a'ny -�ther. w ?N e I, ye.,. tilto Alt -v B Vafe: .................. ....... BY. By .... .......... . Dat . .......... i'AbjSAW,PRO,V,1i0 ..................... . ......... ......................... 'BY .... .. �PPRO, ... .. ........ P V �F ............... I ........................... ............... ........................ ..... ............................... 7- ....... ........ ........ ...... ....... ........... ................ ....... Z�...... .... ....... ............ ...... ...... ........... .......... ..................... edtioni-­:­,�,, 7�711 _-_ in nSP Pil.n, P�erform' truction :,Owner of.. Firm, n Yni oples-MUST'Be..'S t'�C ign6d �,.BOTH�.Pei h tructed;riir�der�It isj;p, erm t, staa;itfon, cons 'that �t n -e lie sid&sew6r'i b�, certify. ......................... ............ . .... ..... . _-Y -,�ofodontractlng','Fl rm Perfrrming,..Construction City. :of�Edmonds. -Wi '. -alll"gov.erning;*.ordiriaiic.es.-.Of'.the. ordande� th� ............. .............. .. Oat d this ..... . x �Ch APPUCATION la The City of Edmonds I for - EASEMENT NO. � ------------------------------------------- SIDE SEWER PERMff NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT- NO - ------------------ D OWNER ------ t ---- -------------- CONTRACTOR --j 0-,e� ------ PERMIT NO. ------- --- JOB ADDRESS --- --------- ............................ LEGAL DESCRIPTION: LOT NO - ------- ----------------- ... BLOCK NO - --------- �/ --------------------- ................................................................................. — ------------------- ---------------------------------------------------------- NAME OF ADDITION ------------------------------- Approved: DATE............................................ By --------------------------------------------- DEC 17 2004 RETURN ADDRESS: ()OUNTER PERMIT City of Edmonds, City Clerk .121 5th Avenue North Edmonds, WA 98020 010 3 PGS, 200409161 - 07F .00 09-16-2004 04 Jm $21 SNOHOMISH Cou�TY[. WASHINGTON NOTICE Of LBUTATION AND COVENANT ADULT FANULYHOME Reference #: .Grantor(s): (1)IMd444 U9(2) Additional on pg._ Grantee(s): Cit y of Edmonds Legal Description (abbreviated): Sec__j��Twn Rng Qtr .5j6--- OR , Lot Block 'Plat Assessor's Tax Parcel ID#(s): (1) 405-0 7Z"491SQ 2., (2) Assessor's Tax Parcel lD# not yet assigned AUTHORIZED FOR RECORDING ity of Edmonds By: ej Date: Page of 5' WHEREAS, the undersigned'owners of property located at in Edmonds, Washingion 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 lof occupants of a i structure trigger certain requirements. relating to the fire suppression and exiting requirements; and WHEREAS, the City has notified the ap licant that the per mit 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 �'roviding notice to p 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 h�me 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 (a permitted. in the current occupancy classirication,j 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 promistz shall ap ly to and run w9h the land withespect to a residential structure located at' _.Edmonds, Washington and legally described as: .3. Notification to Future Purchasers and Assignees.1 This notification and covenant has been recorded. in the records of Snohomish Colunty, 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 andIstipulates 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 Y. . gity of Edmonds B Date: �&zl DATED this day of Ally 2004 ACCEPTED BY: APPLICANT/PROPERTY OWNER: Applicant Jeannine L. Graf Building Official Owner COVENANT AND NOTIFICATION AC,KNOWLEDGED: Mortgagor NOTARY FOR OWNER SIGNATURES State of Washington County of6u.4 6W (�h I certify that I know or have satisfactory evidence that at .,/ 1j, signed this instrument, on oath stated that he/she was authorized to execute the mstru ent nd acknowledged it as the 61IJ W (title) of &&W- ame of party on behalf on whom inst in nt w* executed) to be the free and voluntary act of such party for the uses.and�uposes mentions. in this instrument Subscribed and swo to before me this �ayoif XQV '(�ELJINS ANCE M. CURTIS (� X, iT, Notary Public in and for the State of LM%J I QRY PUBLIC W W#ff,8F WASHINGTON My commission expires 414le rnmmiqq1nN EXPIRES APRIL9,20.� I certify that I know or have satisfactory evidence that I 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 I 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 919-. Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING By:�oity of Edmonds Date: q/,'36/q Page '-L of L-%TEMPiBUELDING\FOPJAS\ADF�-COV.DOC2/10/04 *e. I - . -: RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 CONFORMED COPY ,200409161010 3 PGS 09-16-2004 04:07pm $21.00 SNOHOMISH COUNTY, WASHINGTON NOTICE, OF LEWITATION AND COVENANT . ADULT FAN11LY HOME' Reference #: Grantor(s): (1):&89 (2) Additional on pg. Grantee(s): City of Edmonds Legal Description (abbreviatedi: Sec__I�J( Twn Rng Qtr�S OR , Lot Block Plat Assessor's Tax Parcel IOD#(s): (1) 405-0 �W%WQ 2, (2) Assessor's Tax Parcel ED# not yet assigned AUTHORIZED FOR RECORDING ity of Edmonds By: ej Date: Page--/ of a� WHEREAS, the undersigned owners of property located at in Edmonds, Washington legally described below or on the attache ' d 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 Unifonin Building Code the number of o . ccupants 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 or fewer residents. and their caretakers; and WHEREAS, the City has issued a permit based upon such representations; NOW, THEREFORE, the' undersign . ed property, owners (hereinafter "Owner") in. consideration of the issuance of a,' building permit and in order to confirm the promises upon which such issui ance 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 1 6 - - — or fewer adults and their caretakers as allowed by applicable provisi o*ns of state Faw.* The owner acknowledges that in the event that the applicant seeks revision of the applicant's state license to operate an. adult fa My home with. nu an occupancy of greater than residents or attempts to rent, lease or otherwise provide residence for additional residents above the — 4 perm ' itted in the current occupancy classification, the structure shall' be vac;ted and all residential use ceased until such time'as the'property is brought into compliance with the provis ' ions 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. Suhlect Tract. The above stipulation and promises. shall apjply to and run w9h the land -wit;hCespect to a residential structure located at, 4.34 Edmonds, Washington and legally described as: -1407 .5 4A01eiWA1( @ 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 own ers 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 ity of Edmonds By: -5 Date: W-1,04 Page,,;_7- of DATED this day of Infly 2004 ACCEPTED BY:. OWNER: Jeannine L. Graf Building Official 1"1-16W Mo. 67149P NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington County of&h6h(�6 APPLICANT/PROPERTY Applicant Owner COVENANT AND ACKNOWLEDGED: Mortgagor I certify that I know or have satisfactory evidence that -r11A lud 4� A 6N signed this instrument, on oath stated that hetshe was authorized to execute the lnstruin�enMtnd acknowledged It as the 611jur of AL14- I N — (title) ame of, party on behalf on 'whom instrument wasexecuted) to be the free and voluntary act of such party for the uses and Toses mention,� in this instrument. Subscribed and swo to before me this day of slau Notary Public in and for,the My commission expires_4� ,,,,-�NSTANCE M. CURTIS I r%1QTAQV e of W I , PUBLIC 6 WASHINGTON II.-LAIQ SION EXPIRES �f4 APRIL 9. 2007 I certify that I know or have satisfactory evidence that signed this instrument, on oath sta ted that hetshe 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 dmonds By: Date: Page I? of 3' L-NTEMPMU"ING\FORMS\ADF�_COV.DoC7jlo/o4 RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 200409161010 3 PGS 09-16-2004 04:07pl-n $21-00 SNOHOMISH COUNTY. WASHINGTON NOTICE OF LIMITATION AND COVEN A�NT ADULT FANULY HOME' Reference #: Grantor(s): (2) Additional on pg._ Grantee(s) Legal Description (abbreviated): Sec--414—Twn_�?—Rng.-. __Qtr OR . Lot Block Plat Assessor's Tax Parcel ED#(s): (1) 405-0 �6091SO 2., (2) Assessor's Tax Parcel 1D# not yet assigned AUTHORIZED FOR RECORDING ity of Edmonds By: —,/—of L3' WHEREAS, the undersigned'owners of property located at in . Edmonds, Washingim, �Iegally 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; andl WHEREAS, the applicant has notified the City of applicant's int6ntion to utilize the improvements and/or to convert an existing single family strtlicture to an adult family home; and WHEREAS, under the Uniform Building Code the number :!of occupants of. a structure trigger certain re4uirements, relating to the fire suppr�ession and exiting requirements; and WHEREAS, the'City has notified the a licant that the per�mit will be issued conditioned on limitation of residents to or fewer res.61dents and their caretakers; and WHEREAS, the City has'issued a permit based upon such representations; i NOW9 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 �tipulate, covenant and agree as follows: 1. Covenant: Limitation on Residence. The owne� hereby stipulates and agrees that occupancy of the structure as an adult family hQ,'me shall be limited to 6 or fewer adults and their caretakers as all6wed by applicable provisions of state law. The owner acknowledges that in the evert i t 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,;i the structure shall be vacited and all residential use ceased until such time as the property is brought into compliance with the provis ' 16ns 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. Suh'ect Tract The above stipulation and promises shall ap ly to and t run with the land with pect to a residential structure located a! �jes Edmond Washington and legally described as: 3. Notification to Future Purchasers and Assignees., This notification and covenant has been recordedin the records of Snohomish C unty, 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 sir 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 andIstipulates 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 gity of Edmonds BY' Date: Page of 1. . y DATED this day of A111 Y 2004 ACCEPTED BY: APPLICANT/PROPERTY OWNER: Applicant Jeannine L. Graf Building'Official Owner COVENANT AND NOTIFICATION ACKNOWLEDGED: Mortgagor NOTARY FOR OWNER SIGNATURES State of Washington )ss County of6uh I certify that I know or have satisfactory evidence that -fzll aill Z ,6k s igned this instrument, on oath stated that he/she was authorized! to execute the . rStrui =ent nda acknowledged it as the 61ji "r (title) of a U/ I ame of party on behalf on whom instrument was executed) to be the free and voluntary act of such party for the uses and es me flo this �urposd n i ij� in instrument. Subscribed and sworn to before me this ay of SIQ NS 1ANCE M. CURTIS KIATA Notary Public in and for the State o W RY PUBLIC F WASHINGTON SION EXPIRES CIMA My commission expires 4el APRIL 9, 2007 1 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 wa� 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' &y of 19 Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING By:�gty of Edmonds,/ Date: Page -'3 of L-\TENMBUILDING\FOP,I'M\ADF�-COV.DOC2/10/04