The URL can be used to link to this page

521 12TH AVE N (2).PDF1111111111 634 521 12TH AVE N OV EbAf A CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS,WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERMIT MUST BE POSTED ON JOBSITE* STATUS: APPLIED ENG20070411 SIDE SEWER PERMIT (I -Single Family) Permit Number: ENG20070411 Expiation Date: 1]/] 3/2007 Job Address: 521 12TH AVE N, EDMONDS SOUTHWEST PLUMBING SOUTH WEST PLUMBING 2401 SW ALASKA ST 2401 SW ALASKA ST EDMONDS, WA 98106 EDMONDS, WA 98106 206-932-1777 LICENSE #: SOUTHWP07 I C6 EXP: 4/1/2009 • =• REPAIR N PROPOSE TO REUSE LATERAL LID NUNIBER. CGRU N D EERR P U M P N I PROPOSE TO REUSE SIDE SEWER SIDE SEWER REPAIR _LJ N E,kS ENIENTINFORiNIATION PROJECT CROSSES OTHER PRIVATE PROPERTY I VERIFICATION OF RECORDED EASEMENTS COMPLErE I IADEMNITY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries, damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and anorneyfees by reason ofgranting this permit. CALL DIAL -A -DIG (1 -800-424-5555) BEFORE ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220 EXT. 1326 24 HO UR NOT10E REQ UIRED FOR ALL INSPEC-nON R�Q UESTS THISAPPLICATION IS NOT A PERMIT UNTIL SIGNED BY THECM ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN SPACE PROVIDED. F-] FILECOPY INSPECTORCOPY Printed: Monday. A [-� APPLICANT COPY STATUS: APPLIED ENG20070411 • Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements. • A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line. • Maintain 10'separation between the sanitary side sewer and the water service line. 0 B-Sanitary Side Sewer Inspection PARTIAL INSPECTION DATE: INITIAL: NOTES: PARTIAL INSPECTION DATE: INITIAL: NOTES: FINAL INSPECTION APPROVED DATE: INITIAL: City -of Edmonds Plumbing/Mechanical/Tank/Demolish Permit Application Form Site Address: . Suite#: Rtiqiness/Tenant Name (if atmlicable): Phone: (_) - CONTRACTOA: Mailing . Address:--IH6 FAX: 5n .,%� : Parcel M E-Mail: City: ge State:--O--4:-Zip: Phone: 9 3 FAX: (-) E-Mail: State License Number: Exp: Date:- City of Edmonds' License No: MECHANICAL PLUMBING Fixture Type Fixtures Total Fixture Type Fixtures Total Water closet Gas Furnace/Fireplace: BTUs Location Sink as logs/direct vent fireplace Lavatory BTUs Tub/Shower -Location Air Handler Location Dishwasher _BTU c3 Electric Hose Bib h,,t,, /, nansion tank Gas water heater w/expansion tank o Other Boilers BTUs Location BTUs Location Expansion Tank Hydronic Heating Vents, Single Duct # Floor Drain Other Pressure reduction valve Water Service Line ft Gas Piping ft Other: # of Outlets Gas Outlets Tank .,gallons o AC Unit o Furnace Fill Material o Water Heater o Boiler Pump, Rinse & Cap • Dryer o Stove/Range 0 Removal • Fireplace o BBQ Critical Area Chklst o Other G s Outlet o St udy.Req. [3 Waiver . L:\TEMP\BUILDING\WEBchecklists\MECH.PLUMB.APP.doc 8/31/06 1 STREET F:j APPLICATION 1 �4 for The City of Edmonds SIDE SEWER PERMT ONSTRUCTION REPAIRS OWNER...... 4> .............................................................. t'--2 ..... / _'e ..... Z,? 7 ADDRESS ............................................................ 0 0 0 EASEMENT No . .......................................... CONTRACTOR- ........ ..................... PERMIT LEGAL DESCRIPTION: LOT No . ....... ..................... BLOCK No . ............. ... NAME OF ADDITION ... --V-1-Vp.ZC ....... ......................................................... VED 1969 Approved: DATE ... ...... % ............. . By ....................... ........................... 7.0!-- --6.0 PORCH E CAST [RON TO PVC-SDR 35 W/FERNCO, 18" DEE X2.0 A) M/H B) SW CORNER OF THE HOUSE 9'N, 16.5'E OF A C) 7'N, 5'W of B - 18" DEEP CUSCHL 35 W/Fernco D) C/O 6'N, 6'W OF B E) 22.5- - 2-N, 7.5-W OF B F) 22.5' - 3.5-S, 18.5-W OF B G) C/O - 6-S, 20.5'W H) CONNECTION TO MAIN W/ROMAC SADDLE ON CAST IRON MAIN - 8.5'S, 20'W OF B 22.5* BEND 5.10'�6.�O' Y'51 1852 '0�51 .5' co 01 co 22.5- BEND 3.5.-7 G7 a) (D U) CONNECT TO MAIN W/ ROMAC SADDLE ON CAST IRON MAIN 6" MAIN 0 E.D CITY OF EDMONDS SIDE SEWER AS- BUILT ADDRESS: PERMIT 521 12th Ave N NO. ENG20070411 CONTRACTOR: HOMEOWNERi SCALE: Southwest Plumbing/Donato Stargill, Brad NTS DATE INSPECTED: INSPECTED BY, DATE DRAWN, DRAWN BY: -&t. 1890 08-16-2007 J. Hawkins 08/22/07 J.Collins BUI LDING J U L 16 1998 ADUL----,T, FA MILY HOME LICENSE License Number: 448600 Pursuant to the laws of the State of WasIbington and the Minimum Licensing Reqi&ements of the Department of Social and Health Services, a license is hereby granted to . EM-EltALD GARDENS LLC If Partnership/Corporation, represented by GORDON PXfR[CK GRANADE to conduct and maintain at 521 12TH AVE N City of EDMONDS, Zip Code 98D20 Cotinty of SNOHONHSH State ofWashimgton an Adult Fan-jily Horne for the care and supervision of adults as Bollows: 24-hour care for no moro than 6 adults This license shall be in broe frorn the 7th day of Jaly, 1998 subject to suspension or revocation for due cause. Conditions on Ucense, if any: Licensing Autbority NOTE: The department renewal of a license does nct preclude the department from taldng any actien under WAC 388-76-705, based on inspection. Wi 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 AuthDrity of Chapter RCW 70.128 - -dQI�TY OF EDMONDS Permit No. COMMUNITY SERVICES DEPARTMENT :RIG14T-OF-WAY CONSTRUCTION PERMIT STREET -FILE'. Issue Date o- t) A. e Owner: Q. A CA B. *Contractor. �ailing Address ailing Address '�> C� - 0 &A II.1r. City State Zip City State Zip State License Number Telephone Number C. 9 Address or Vicinity of Construction: p 2 �= Type of Work to be Done: \ - r,:)\,- Ac_�=_ \,7:),l ". . C D. G� Work in Connection With: D Sub or Plat 0 Single Family El City Projects El Commercial 0 Multifamily ',_�Utility E. 0 Pavement Cut: N F. * Size of Cut: x APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds ,harmless from any injuries, damages, or claims of any kin f 4 Vr,' s i tion_wh*eever2 forse' "s or unforseen, that may �y of its derar(M-17ce is ritployees�, inclui ri �i limited to the defense be made, against the City of Edmonds, or an ees by reason of granting this permit. any legal proceedings including defense costs, and ttorney ;of. 7o court THE CONTRACTOR IS RESPONSIBLE FOR WOR MANSHIP AND MATERIALS FOR A PERIOD OF ONE, YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. E . stimated restoration fees will be held until the final street patch is completed by City'forces, at which time a debit or cAit will be processed for issuance to the applicant.. • A 24 hour notice " is required for inspection; Please call Engineering: 771-3202 • Work is to be inspected during progress and at completion. • Restoration to be in accordance with* City Code. • Street to be kept clean at all times.. • Traffic Control to be'in accordance with City regulations. All street -cut ditches must be patched with asphalt or City approved material prior to end of working day; N,O_-EXCEPTIONS. I understand &,a6ove and that.this Perm - it must be Signature: LL�IL �4 Owner & Contractor at the job site for insp ection purposes at all times. Date: q - 2 %�� - q Permit Must be Posted at the Job Site For Inspection Purposes Call DIAL-A�-DIG Prior to Beginning Work APPROVED BY: RIA/ PERMIT FEEg Z Time Authorized: Void after 15—days- Restoration Fee: 0 Special Conditions: IYA Receipt No V) Fund 111 �Fe Street Cut Dimensio U W RELEASED BYAN,�_ Date 10—A-010 INSPECTED BY Date 0 NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. M�irch 1989 FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dep&),* Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION 0 YES Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: 0 NO Eng. Div. July 1985 1 .11 -71� W% A li STREET FILE fKwrlw5l eue6;r toLr-r-- ,7v"UE4� -LJ MA4wu5, AOPFZ" qtzl - IZ'?,L%k'A W. sow?'o.- LxpdAL oaQcp4rnow " OF L,7r I AWDIHAT ftFLTU)t4 -F WT 2, 49t.ympv, ft4wp To rwr "wlkpe4:, 10 6 213 PF NO& Q&, F-be-KA05 OF 5,tADWHK* C.U�M, WA- CIUOMITIM WWe5yMAJO) TM Aao-ACT FAFez,� te: ZIPWIkA . ; PI- rz LOT -m& I T".6-a- <.F LOT j�RVEFAap- Vr d2l�t tp pr�"' Mot umun,4 F461-rwzp OL�lv 6"ft 44" Wiw vec-#� IV* -WVI� 410,MvPk4 00%4 -F -1 01,C,-dv*f - U6, MN tor mftKAO 'Z7J-Z Of + *40M 4F - 244r. W OT M ACTL*L. pt�o wt4m .4, 1 t+. Od VA&INA40 V"WVO FEI�JOMV Cl. 14= CF) bv".4c. FF-P 67z " WITAI#�y w6p wv,L lmmR..b Apa. .*It V 1-517'a tvl'�Id v Pwm ftxwT ''PROJ T,, C REVIE W. CHECKLIST PROJECT NAME:`.";;mlq-6WCL ROJECT ADDRESS:, I j REVIEW -D BY: (I nitial/Date) PLAN- WATER 7 - - - - - - - - CQMMENTS FIRE BLDG. SEWER STREET., Legal Description Verification or Quit Claim/Street Dedications A(ov6- Easements - Public/Private 0 Engineering Storm Drain Review Fee 302e Engineering 2.2 Inspection Fee .13, Drainage Plan (On-Site)6�,� ?p 6V.Sr Setback - Top of Bank, Stream, Water Courses ......... . . . . . . . . . . . . . . . . . . . . . . . 6 Setback - Storm Drain Line . . . . . . . ......... .... . . ..... �17 Open Ditch - Existing .................. Culvert Required A�u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . ...... Culvert Size ... ......... ftAb 20. Shoulder Drainage/Shale Open Runoff ...... . ............ ... . . . ....... . ....... .... .. . . ...... ... ..... ... . ... Catch Basin Required .. . - -- - ------ ..... . .... Driveway Slope & Vehicle Access Sidewalk Required I ..... ... .. .. Curb.& Gutter Required Curb Cut For Driveway Required ........... lllz�hd -25 1 Street Paving Required . . . . . . . . . . . . . . . . . . . 129 26 A_)6 lVzal7. 27 Right -Of -Way Construction Permit Required 28* Street Name Sign Required Other Signing Required /1/16ho _29 30 Bond Required For Public Improvements o I(lZ6 FEMA Map Check/Water Table 32: Side Sewer Availability Calculate Sewer Connect —LID # ion Fee If No 33 Create Street File Alo 4 ..... ......... 34 Existing Water Main Size . . . .......... . 36:ij Water Meter Size Service Line Size -------- Water Meter Charge Required Hydrant Reguired A6190 Hydrant Size Existing 7� :j .1 Fire Line Charge Required - Sprinkler IIZ6& 4.11. Street Cut - --------- ....... 42 E-4 Alt) Mi,§cellaneous 43 Reviewed By: FIRE PLANNING ENGINEERING PUBLIC WORKS TO: Permit Coordinator, Building Division FROM: Lyle Chrisman, Engineering Inspector 8/90 ADDRESS: AVJa-" DATE: 11 1uV1qa STREET FILE OWNER: PLAN dK# Iff After review of the subject permit application the following is required: 1. Construction hours are: WEEKDAYS .......... 7:00 a.m. - 10:00 p.m. (ECC 5.30.110) WEEKENDS/HOLIDAYS..10:00 a.m. - 6:00 p.m. 2. A separate Right -of -Way Construction Permit is required for all work on City property. (ECDC 18.60) 3. Connection to City water system required. Separate charge for water meter. jECDC 7.30) 14. Connection to City sanitary sewer system required; obtain separate.permit. LID # !f4 (ECDC 18.10) ,�j Fees paid: Yes-- No — Charge $ — 5. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10) 6. Driveways must be paved a minimum of 20 feet back from City right-of-way; separate permit required. (ECDC 18.80.060C) ",47. Driveway slope not to exceed 14% without waiver. Waiver granted to- % (ECDC 18.80.060D) 8. Back water valve required if downstairs plumbing is below elevation of upstream manhole. (ECC 7.20) "'*4-9. Builder/Owner responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030D) 1-40. No burning of construction refuse without permit from Fire Department. 11. Truck haul route plan must be submitted and approved prior to permit issuance. --j12. Street shall be kept clean of debris, dirt, mud, and construction materials. Contractor responsible for dust control. (ECDC 18.30) %--j.13. Inspection required -on drainage system, catch basin installation, dri'Veways, and sidewalks. Contractor responsible to contact City for inspection. (ECDC 18.30) '*'�14. Repair or replace all defective existing curb, gutter, and sidewalk adjacent to property. If intersection is involved, installation of wheelchair access may be required. Permittee to meet with Engineering staff to determine extent of repair prior to issuance of permit. (ECDC 18.90) 15. Underground wiring required on all new construction; and for additions, alterations, and repairs that exceed 50% of the total assessed value of the structure.; (ECDC 18.05.010) "'J'16. No work shall be done within 15 feet of streams or 10 feet from any closed drainage facility. '-J 17. A final engineering inspection is required prior to the Building Division granting occupancy of the building or structure. (ECDC 18.80) 18. 0 ^60e AWf-V&V#V ---------- e. ___ 'rl ��` Z 0 W V) U C4 0 �Jo "A C-110V40F, EDMONDS COMMUNITY SERVICES DEPARTMENT RIGHT - OF - WAY CONSTRUCTION PERMIT A. 0 Owner: Permit No. Issue Date JUL 2 5 1991 B. Name Mailing Address City State Zip City State Zip STREETFILE State License Number Telephone Number C. * Address or Vicinity of Con Type of Work to be Done: D. 0 Work in Connection With: El Sub or Plat Single Family El City Projects El Commercial El Multifamily El Utility E. 0 Pavement Cut: El Y )t N F. 0 Size of Cut: — X APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages, or. claims of any kind or description whatsoever, forseen or unforseen, that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs, court costs, and. attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be processed for issuance to the applicant. • A 24 hour notice is required for inspection'? �Ie`ase ZalfEngineering: 771-3202 • Work is to be inspected during progress and at completion. • Restoration to be in accordance with C,it-j��C6de. • Street to be kept clean at all times. • Traffic Control to be in accordance with City regulations. • All street -cut ditches must be patched with asphalt or City approved material prior to end of working day; NO EXCEPTIONS. I understand the aboyCand/that Ais permit mus . e available at the job site f . or inspection purposes at all times. lf 150151,1�11, D A� Signature: ate: Ownef'-'o Co ractor Co r' - osted at. the Job Site For Inspection Purposes This Permit Must Weoste Call DIAL -A -DIG Prior to Beginning Work A Ar APPROVED BY - Time Authorized: Void after days Special Conditions: RELEASED BY: — 6t�� — Date SLIAVP Restoration Fee: Receipt No.: Fund I I I Fee: Street Cut Dimensions: x $ INSPECTED BY Date NO WORK TO BEGIN. PRIOR TO PERMIT ISSUANCE Vng. Div. marn 1989 FIELD INSPECTION NOTES Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION Partial Work Inspection by P. W.: Work Disapproved BY: FINAL APPROVAL BY: 0 YES Date: (Fund I I I - Route copy to Street De'p't:) - _ 0 NO =I Eng. Div. July 1985 0� 000.00 CITY OF EDMONDS LAURA M. HALL MAYOR 7110 - 210TH ST. SW - EDMONDS, WA 98026 - (206) 771-0235 FAX (206) 744-6047 COMMUNITY SERVICES DEPARTMENT — PUBLIC WORKS DIVISION 9 0 9 Ci March 27, 1995 James Magnus 521 - 12th Ave. N. Edmonds, WA 98020, SUBJECT: BLOCKAGE OF SANITARY SEWER MANHOLE Dear Mr. Magnus: Per city requirements, all utilities need to be accessible at all times to grade with no obstruction preventing immediate access by city personnel. Crews have tried to check the' manhole located in your yard and found that, a planter is on top of the manhole that prevents access to check the sewerline. Please move this obstruction off the manhole by April 7, 1995 at which,time the city crews will check the cover. If this cannot be done by this time, please.notify.me when it will be done. Thank you for your assistance in this matter and I look forward to your continued assistance and compliance in this matter. Sincerely, Ron Holland Water/Sewer Supervisor wordata\sewer\magnus e Incorporated August 11, 1890 0 Sister Cities International — Hekinan, Japan AQIJLT FAMILY HOME TE ARCHITECTS , n -"�l WJIIECI M , _Or GRANAM RES;DENCF W11 Al j EL STREET 57 12?h ANIENUENO EDVIONDS�WA 98020 Wr'�. WA 98= STEM" c. WNR ph— 4-- i4S533 1,STAIE OF wkW&Toml N 4* fvbf6 Ixt colt Ze "-m 2"oc. "Zt� -TIWA &AUEgr [Iot.6e- P;a*v S(WAWAC" I Is, Loll". tj T�—� -IJ I I UN& P4 CM* 400 v, cn v- 4W OCK- IIVA4449;5�,- 70 0#00t i P"WAY + Kq* �%o f-- FtW : FA-r q9^yCo IoLo -a4l 5,2-1 lzlq A-vo. W. SotvNp--,. LXAAL OEctArn0l,l A" oF LCrr i Wo -MAT Ft7f&TlOt4 'IF LOT 'Z, OWMPV- ftV4M PD. 1, PegOrOINA -ro 7140 iwwuwb two Now e4w4op- 9%- PL06-r WX0E-vW IN VOLUME, ?:3 IF FLA-f-S, px~y SIM W00, 06, Fe6plt� OF srbtmlsf� cou"m TANnime WA. OV44 LW4"mb . N 11 t TAA .4a4a.,,- -ool - a.::.a8 u) Uwe QEum&LhQm IWW 44PW,$fV AW ffWrYMP5orWjlr UU& i) This drawing shall not be construsd as *re=d* IER"qc% 4, , *as buff. Air Sam `r OF BUILDING J U L 1 6 1998 ADUL T FA M-ILY HOME L !C,ENfSE License Number: 448600 Pursuant to the laws of the State of Wasbi-ngton and the Minimum Licensing Reqdrements . of the Department of Social and Health Services, a-lic C'use is hereby granted to F-M]EIRALD GARDENS LLC If Partnership�Corporafion, repmen I ted by GORDON PAT RICK GRANADE to conduct and maintain at 521 12TJR AVE N City of EDMONDS, Zip Code 98020 County of SNOHONUSH State ofWashington -an Adult FaniilyHome for the care and supervision of adults asfollows: .24-bDur cam for no more than 6 adults This ficense shall be in fbrce from the 7tb day of Jmlyj 1998 subi ect to s uspemion or revocation for due causte Conditions on Ucense, if any: Licensing AuthDrity NOTE: The deparimcnt renewal of a license clues * n(A preclude the dePartment from taldng anY actim under WAC 338-76-7D5, based on inspection.' Tbh license is not transferable, and is valid only for tme by the corporation, partnership'ar individual(s) to whom it is issued and at the location above described. Issued by Authority of Chapter RCW 7&128 Fidelity National Title any of Washington ALTA Commitment, Page 2 Order No. 0156427 "Schedule A" (continued): 4. The land referred to in this Commitment is situated in the County of Snohomish, State of Washington, and is described as follows: All of Lot 1 and that portion of Lot 2, OLYMPIC HEIGHTS NO. 1, according to the plat thereof recorded in Volume 23 of Plats, Page 58, records of Snohomish County, Washington, lying Southerly of the following described line: , Commencing at the Northeast comer of said Lot 2; THENCE South OU 10'53" East along the East line of said Lot 2 a distance of 8 1.00 feet to the true point of beginning of the herein described line; THENCE North 89'42'41" West parallel with the North line of said Lot 2 a distance of 72.00 feet; THENCE North 00'17'19" East, 1.00 feet; THENCE North 89142'4 1 " West parallel with the North line of said Lot 2 a distance Of 45.00 feet; THENCE North 56'50'04" West, 35.00 feet; THENCE North 89'42' 4 1 " West parellel with the North line of said Lot 2 a distance of 72.80 feet to the West line of said Lot 2 and the terminus of the herein described line. TOGETHER WITH that portion of Lot 25, MAPLEWOOD VILLAGE NO. 4, according to the plat thereof recorded in Volume 25 of Plats, Page 45, records of Snohomish County, Washington, lying Northerly of the following described line: THENCE South OU 09'06" West 23.28 feet to the true point of beginning of the herein described line; THENCE South 8T3 I'l 4" East 191.3 8 feet to the Easterly boundary of said Lot 25, And the terminus of said line; (ALSO KNOWN AS Parcel B of City of Edmonds Short Plat No. S-4-88 as recorded under Recording No. 8804280285 and revised by instrument recorded under Recording No. 8811030263) Situate in the County of Snohomish, State of Washington. CITY OF. EDMONDS PUBIJC WCMM — EWSINEERI ACTION REPORT 1972 STREET FILE SUSPENSE DATE: Time: File # Date:. Attachments: SUBJECT: REQUESTOR: NAME. rn h ADDRESS �h PHONE - REQUEST RECEIVED BY: TELEPHONE r --- I CONTACT IN OFFICE r-1 OTHJ�R:_ M-1 A 1r\ ALAA1 L I Al� Action Completed/File - ----- -- - ----- - - - ----------------- ------------------------------------------------------ - --- --- -003-0009 -30-85 53 5 f�00 1 11 .144 OLIVER PARK 0225 9 0 T LAND FIREMANS FUND MTG bLK 001 0-00 - LOT 3 SLOG GONLALEZ ROSALIO 09828941 TOT 2 - __ __ '-- T - I I - RD- - 7555 FARM NGTON STREET FILE FARMINGTON HILLS MI 48OL8 I- 214429-86 144 OLIVER PARK FIRLMANS FUND MTG BLK 00.1 0-01 - RICHARD CHARLES A 971364-6 LOT 4 LESS ELY 1OFT OF SLY F_Z7_5_5_5_FA_RA_INGTON_RD__ - MIL PLUS VAC PTN OLIVER LANE ADJ SO FARMINGTON HILLS MI 48018 LOT 5351-001-005-0007 205281-87 OLIVER PARK K MART CORPORATION #4208 BLK 001 0-00 - i TAX DEPT LOTS 5 C 6 TGW WLY 112 VAC OLIVER LANE LY,ADJ $0 LOT_S__..TG BL.K 2 LOTS 5 F, 6 TGW 5356*000-001-0008 10-10-83 OLYMPIC HEIGHTS 1 7 1 1.� :MAGNUS.J,J BLK 000 0-00 ALL OF LOT I G el 521 12TH AVENUE-'Pidkf�V" TH PTN LOT 2 LY SLY OF FOL CUP AT NE COR DS WA E.OMON 9SC20 SO LOT 2 TH SOO*10 .53E ALG E LN SO LOT 2 . . i A DIST 81FT TO TPE OF SO np�;r IM TU 31 32 N89*42 41W Pi:W N LN SO LOT 2*FOR DIST OF 72FT TH N00*17 19E I.00FT TH N89*42 ....... 41W, P-L.W.--N LN.SD.LO.T 2 DIST 45FT TH N56*50 04W 35FT TH N89*42 41W PLW N LN SO LOT 2 DIST 72.80FT TO W LN SO LOT 2 &-TERM SO DESC LN TGW TH PTN LOT 25 MAPLE WOOD vILIA6E NO 4 PER PLATS VOL 25 PG 45 LY NLY OF FOL - COM AT NW -.-----COR- S.D LOT 25 . TH SOO*09 06W 23 28FT 'TO TP8OF SO . _. DESC LN TH S83431 14E 191*38FT TO ELY BOY SO LOT 25 TERM SO LN 5 35 6-700 -001-0107 29431-88 OLYMPIC HEIGHTS 1 RNO D.%.:.CLARENCE H BLK 000 0-01 8527 228TH S W A'L*-,-L--''T,*H-A,T-,--,""P-T-,N----"L-O"T"'S, 1 G OAF EDMONDS WA 98ozo BEG AT NE CCR OF SO LOT 2 TH N89*42 41W ALG N LN OF SO LOT 2 219903FT TO NW COR OF SO LOT 2 TH S00*10 53E ALG W LNS OF LOTS I G 2 187*62FT TO SW COR OF SO LCT I TH S89*50 54E ALG S LN OF SO LOT I 26*83FT TH N45*00.00 88FT TH P406*30 COE b1t.39FT Tm S89*�Z 41E PLW N LN OF SU LOT 2 122-28FT To E LN OF SC LOT 2 TH NOOO 10 53W ALG E LN OF SC LCT 2 1 F T To Pub 0225 90 T LAND' BLDG TOT 0225 90 T LAND T OT 0210 0 1 LAW OLU, TO T 0210 90 R TOT APPLICATION CARD No . ...................................... for The City of Edmonds EET FILE SEDE SEWER PERMT EASEMENT No . ...................................... OUTSIDE E] INSIDE REPAIRS 0 6a., - - --- ------------------------------------------------ PERMIT No. OWNER ............................................. .................. CONTRACTOR ............ ...... STREET HOUSE No. ........... ......... ....................... AVENUE LOT 'No . ................. - --------------------------- ...................... BLOCK No . ................ .............................. /�L4 7- -qcl A -'s NAMEADD . ..................................................... ........... .............................. ...................................................... 77 Date BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ..................... ............... SEWER WORK ORDER ISSUED .......................................... ��A— Ore APPROVED �QV2. 1963 Approv By ..... DATE . .. .... .......... ---------------- 7 �Y PERMIT CITY OF EDMONDS ZONE NUMBER nnNATA" TION PERMIT APPLMATInN OB AUITE/APT # ORR NAME/NAME OF BUSINESS ADDRESS 6-21 12 71- zl� /Vo cr f� 1 17. IT. H WS? t� Ue7 LEGAL DESCRIPTION CHECK LID NO. Zw :M�A�ILI G ADDRESS (31L PM,)ZiPre, C15 12 _711 V(E) �J. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP ZIP e2 99a2x) ADDRESS CITY NAME ADDRESS NUMBER EXISTING REQUIRED OEDICATION APPROVED BY R E' PROPOSED RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED)< STREET USE PERMIT REQUIRED El S REVIEW SEE ENGINEER G EMO DATED // 1Z 6 _NN M NUMBIAER RFMARK.5 W I OMEN, CITY ZIP TELEPHONE NUMBER STATE LICENSE NUMBER Legal Description of Property - inc (show below or attach two copies) M easements Tax Account Parcel No. 6-3660-0d0-001-o"" 1:1 NEW RESIDENTIAL E] PLUMBING CKIDD/ALTER -, COMMERCIAL MECHANICAL Ir— E] REPAIR 0. APT. BLDG. El SIGN DEMOLISH REM�DEL [] EXCAVATE, FILL OR GRADE ;;r CARPORT GARAGE FENCE FT) swim POOL WOOD STOVE/ E] RETAINING WALL/ INSERT ROCKERY RENEWAL ,%IiAou tuta" tr_� ki4, I a,4 AIQP MA9 - ;rA,1,V IZE IBUILDING SUPPLY SIZE IFIXTURE UNITS REMARKS SIGN AREA ENV. REVIEW ALLOWED I PROPOSED I C-OMPLETE I EXEMPT IVARIANCE OR CU I PLANNING REVIEW BY I DATE SETBACKS — FEET I LOT COVERAGE FRONT SIDE REAR NUMBER OF STORIES NUMBER OF DWELLING UNITS NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) Pe7M-r6 . 4F-,10 I CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT I — 1 0 83 A5 SPECIAL INSPECTOR AREA REQUIRED OCCUPANC GROUP OCCUPANT LOAD n YES — NO REMARKS PROGRESS INSPECTIONS PER UBC 305 FINAL INSPECTION REQUIRED V L I N PLAN CHECK FEE BUILDING PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on private property ONLY. GRADING/FILL Any construction on the public domain (curbs, sidewilks, STATE SURCHARGE driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days Permit Limit: 1 Year - Provided WorR is Started Within 180 Days "Applicant, on behalf of his or her spouse, heirs, assigns and cn successors in interest, agrees to Indemnify, defend and hold 'Wn harmless the City of Edmonds, Washington, its officials, .7 employees, and agents from any and all claims for damages of cr < whatever nature, arising directly or Indirectly from the Issuance of this permit. Issuance of. this permit shall not be deemed to PLAN CHECK DEPOSIT modify,, waive or reduce any requirement of any city ordinance TOTAL AMOUNT DUE 0 I nor I.Imit in any way the City's 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 ATTENTION authorized agent of the owner. I agree to comply with city and ,state laws regulating construction; and in doing the work authoriz- THIS PERMIT AUTHORIZES ed thereby, no person will be employed In violation of the Labor ONLY THE Code of the State of Washington relating to Workmen's Compensa- WORK NOTED fiQn IpsuranCe. INSPECTION SI P G URE e5PR AG E DATE SIGNED DEPARTMENT igh, A,0 CITY OF EDMONDS NTION/--- CALL FOR INSPECTION 6 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202 IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC PTER 3, APPLICATION APPROVAL . This application is not a permit until signed by the Building Official or his Deputy; and fees are paid, and receipt is acknowledged in space provided. OFFICIAL'S SIGNATURE DATE RELEASED BY: DATE ORIGINAL — File YELLOW — Inspector PINK — Owner GOLD — Assessor 0 Z 2 Z _j CL STREET FILE CITY OF EDMONDS USE PERMIT ZONE 95 -2 NUMBER CONSTRUCTION PERMIT APPLICATION !joB T ADDRFSS Ave NAME/NAME OF BUSINESS 7R '.7.T. /I k-� 11� Df�� LEGAL DESCRIPTIO UB -I... �ID NO. w .I 3 z 0 MAILING ADDRESS .45*�� 1 1 ') 7*1 A TESCP CITY ZIP T.ELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY )2z) 84 1� EXISTING -5�2 REQUIRED DEDICATION !7 NAME -44 PROPOSED -7 0 RIGHT OF WAY CONSTRUCTION PERMIT REOUIREDX W Ow ADDRESS STREET USE PERMIT REQUIRED 0 W Z cc CITY ZIP FHONE NUMBER REVIEW BY SEE ENGINEER NG MEMO DATED 1117r- Z W REMARKS7,�-, NAME 7 ADDRESS 0 0 METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS cc CITY ZIP E NUMBER Z REMARKS STATE LICENSE NUMBER SIGN AREA ENV. REVIEW ADB NO. Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT (show below or attach two copies) SHORELINE # Z LD CL cr U VARIANCE OR CU PLANNING REVIEW BY D�TE- W SETBACKS - FEET HEI�T,, C LOT, OVERAGE W FRONT SIDE ;EAR Z Z 5 Tax Account Parcel No. REMARKS CL F 9 NEW RESIDENTIAL PLUMBING -.- C -A A-ADDIALTER 0 COMMERCIAL MECHANICAL REPAIR 1:1 APT. BLDG. El SIGN EXCAVATE, FILL FENCE CHECKED BY TYPEOF CONSTRUCTION CODE HEIGHT DEMOLISH OR GRADE (- X FT) 45 CARPORT swim REMODEL GARAGE POOL -S PECIAL INSPECTOR REQUIRED AREA occ PANC GROUP OCCUPANT LOAD n YES No WOOD STOVE/ RETAINING WALL/ INSERT RENE� REMARKS ROCKERY L Z Q (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 cc D 0 (n W NUMBER OF STORIES NUMBER OF co C- DWELLING 0 (5) f\j UNITS NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) FINAL INSPECTION REQUIRED ELI Ld I (Ar 6A �kilI5 VALUATION FE E FEE PLAN CHECK FEE BUILDING 3 PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on private property ONLY. GRADING/FILL Any construction on the ptfbilc domain (curbs, sidewplks, driveways, marquees, etcj will require separate permission. STATE SURCHARGE Permit Application: 180 Days Permit Limit: 1 Year - Provided Work is Started Within 180 Days "Applicant, on behalf of his or her spouse, heirs, assigns and R)Ij successors in interest, agrees to indemnify, defend and hold w �armless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damaggs of < whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT modify,. waive or reduce any requirement of any city ordinance 01 nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE -7 provision." , 77j�, -v - I hereby acknowledge that I have read this application; that the information given is correct; and that I am the owner, or the 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- AUTHOR ZES This application is not a permit until ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is tion.Insuianqp. I NSPECTION acknowledged in space provided. SIGP TURE&OWUNE �OR AG.ENT) DATE SIGNED DEPARTMENT CITY OF 0 - FFICIAL-Sj§jGN�; DATE ...... .. 'JE EDMONDS N T 10 CALL FOFr-- RELEA-SED By: DATE L J ��TT:t INSPECTION . IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE 771-3202 UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — inspector Ir CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC ;HAPTER 3. PINK — Owner GOLD — Assess�r nM7 RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 9809000198 09/08/98 09:46 p.0004 Recorded Snohomish County NOTICE OF LEUITATION AND COVENANT ADULT FAMILY HOME Reference #: 67 �'05 & ? Grantor(s):'(lQQ,-1 ?6464A.1� (2)1/,,.� Additional on pg.—C Grantee(s): Cft of Edmonds Legal Description (abbreviated): Sec—ga(—Twn ng--j Qtr OR Lot Block Plat Assessor's Tax Parcel ED#(s): (1) -,T-3,64g DOR (2 I .4,,p ----Assessor's Tax Parcel rD# not yet assigned (01 ,14ove. WE(447-5 /VZ. I /4bd0",jj7,-P-7.-41C- 1&-097 3 ORIZED FOR RECORDING 4 City of Edmonds By: L77A Date: o-zo-90 Page I of AL WHEREAS, the undersigned owners of property located at C a I - 12, th &( , , 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 applicant that the permit will be issued conditioned on limitation of residents to (a 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 G —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 �4 , residents or attempts to rent, lease or otherwise provide residence for additional residents above the (a 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 la Z� P V,<_ - &I, , Edmonds, Washington and legally described as: R64-SA! _5kev /� ,:;- -4 , & 4 A-7T-V4-AL9-0_--n — ., ' ,rkia9_L_,r-r-L- Al,�--i,,1.4, -7-1 -r-L�-- A�� ,W� ,*7- 4V,�� 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: OZ6 Date: ""0 Page _I of_q_ DATED this W, ACCEPTED BY: OWNER: Jeannine L. Graf Building Official Ald,� le4-wr ,,* fSar62- Ism Nofty "k StatO Of Walhington MA SOCK Appofn**nt Empkes May 30.2001 NOTARYFOR State of Washington day of Alc9a5+ -lgff6 a APPLrANT/PR TY �PRO 9 0 _Or ,j 400j , Applic t C? 1 5 - Applicant 60ke - Owner _ALi4_t L_ C_7 Owner COVENANT AND ACKNOWLEDGED: Mortgagor )ss County of___Qy,. �__ L 00 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 00&4�- -(title) of Sa I - la-c-L A,1jZ1V Eq (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 - �2� . 19 '?P' CQ - )6 -41- C� C_ Notary Public in and for the State of Washington. My commission expires *"--/ -7 0 0 0 I certify that I know or have satisfactory evidence that P, 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 13 V-4 day of _Q=.� 19 .7 F, i- - - - - - --- C)C_ IL L-&*- /3 Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING City of Edmonds By: 0-24 Date: X-;W-ff Page 3— Of 4-- L:\TEMP\BUILDING\FORMSUDF-COV.DOC Not(" Pub0c SWO Of Vlashhgton DIA BOCK My AppcAntnent bvires May 30,2001 Five] I & A O-V 0 REQUEST FOR RECORDING aT pe of Document to be Recorded: WW (V ,(-hVe- CQVQ1+24t+'PW Reference Number (If Applicable): 4- C1 � D15(0 z Grantor: Grantee: 'C1 fy S Legal Description (Include at least Section, Assessor's Parcel Number Township, and Range): 3!5�0 00 0 co I co ce) Fees Colle t d: Rece ipt Number: . r�SWe OF BUILDING J U L 1 6.1998 ADUL.T, FAMILY HOME L . ICENSE License Number: 448600 PuTsuant to the laws of the State of Wasbington and tke Minimum Licensing Requirements of the DepaAmcnt of Social and Health Services, a hcense is hereby granted to EXERALD GARDENS LLC If PartnershiplCorporation, represented by CORD ON PALTRICK GRANADF, to conduct and mainWn at 521 12TH AVE N City of EDMONDS, ZJP'Code 98D20 County of SNOHOMSH state ofWashington an Adult Family Home for the cate and supervision of adults as follows: 24-bour cam for no i-nore than 6 adults Tlis. license shall be in force firont the 7th day of Jaly, 1998 subject to suspension orrevocafion for due causm Conditions on 14cense, if any: Licensing Autbority NOTE: The department renewal of a license does nct preclude the departinelit from taMng any actien under WAC 388-76-705, based on inspection - Ibis license Is not transferable, and is valid only for tise by the corporation, partnership or indivfdual(s) to Whom it h issued smd at the location abuve desnibed. Issued by Authority of Chapter RCW 7&128 CITY- OF EDmoNbs USE V, ZONE PERMIT CONSTRUCTION PERMIT APPLICATION NUMBER JOB SUITE/AP ADDRESS OWNER NAME�NAME OF BUSINESS IP117 6AWN"__6 LEGAL DESCRIPTION CHECKI SUBDIVISION NO. LID'NO, uj Z 3: 0 MAILING ADDRESS 12 - PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCIP Approved a CITY ZIP TELEPHONE NUMBER EXISTING REOUIRED DEDICATION RW Permit Required _B Street Use Permit Req'd a PROPOSED Inspection Required .0-- Sidewalk Required ET_ NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NOD w ADDRESS 0 III tF�AJA REMARKS A/c, oj,,, 4�? 0 1 S CITY ZIP [TELEPHONE NUMBER 9867-P 145 3�+.r,50 TO A -K, 1/1 0 L NAME eAl el. I I%/ S P e (�,7-7 1-01 ADDRE§IS cc 0 ENGINEERING MEMO DATED REVIEWED BY ..�7 6 CITY TELEPHONE NUMBER FIRE MEMO DATED REVIEWED BY Z A, 0 STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU ADB# SHORELINE # ------ Legal Description of Property - include all easements AW ,0 107' 072. SEPA REVIEW SIGN AREA HEIGHT o , -ro 5,,tv 6 r15 Y61*d7T AJ& COMPLETE EXEMPT ALLOWE PROPOSED ALLOWED 1PROPOSED 1. EX x P4,AT jec-e OAift�v IAJ PO4 -Of Pi-A7$ co 68, OaU45 Of SN610 01 I-V Uzi. LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) AP 4-3 MP ALLOWED JPROPOSED 00 FRONT SIDE REAR 4--- .4,A FRONT UR SIDI�. Property Tax Account LP-,2 Parcel No. FINEW RESIDENTIAL PLUMBINGIMECH OR 0. ElCOMPLIANCE ADDITION COMMERCIAL CHANGE OF USE ;KEMODEL APT. BLDG. SIGN GRADING FENCE REPAIR' — CYDS. 11 x —FT) E] DEMOLISH, WOODSTOVE INSERT SWIM POOL . -, El HOT-TUB/SPA RETAINING WALL/ FGARAGE ICARPOR ROCKERY RENEWAL (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN - NUMBER NUMBER OF CRITICAL OF I DWELLING. AREAS INUMBER STORIES UNITS DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) ONAMR1, DO M., ne.E -4 IREQUIRED YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108 FINAL INSPECTION REOUIRED VALUATION PLAN CHECK FEE BUILDING HEAT SOURCE: GLAZING :PLUMBING Plan Check No. A . -,. / V/ MECHANICAL GRADINGIFILL This Permit covers wnrk to 3 on privatb property ONLY. Any construction on ths) public domain (curbs, sidewpiks, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Permit Application: 180 Days . I Permit Limit: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE SMA PE NXIEE "Applicant, on behalf of his or her spouse, heirs, assigns and su ccessors in interestj 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 4&2e cr whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT modify, waive or reduce an requirement of any city, ordinance _y 1 1. 0 b. 1 11 nor limit in any wa�..,,�he"City's ability to enforce an inance _y ot; TOTAL AMOUNT DUE provision." I hereby acknowleqge thdVhave read this appllcatlon�; that the information given is correct,, and that I am the owner, or the duly ATTENTION authorized agent of the owner. I agree to comply with city and THIS PERMIT state laws regulating construction; and in doing the work authoriz- AUTHORIZES ed thereby, no person will be employed in violation of the Labor ONLY THE Code of the State of Washington relating to Workmen's Compensa- WORK NOTED tion Insurance aria RCW/18.27. INSPECTION (OWNER: OR AGENT) DATE S11 NED DEPARTMENT CITY OF EDMONDS CALL FOR 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 A CERTIFICATE OF OCCUPANCY HAS BEEN GR ANTED. UBC SECTION 109 .11q <1), FEE __;17= 17 . [q% to 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 provided. TE (GINAL — File 'YELLOW — Inspector PINK — Owner GOLD — Assessor 1� 11: W a: W W K 0 Z RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ................... FOUNDATION: Footing .................... Wall ......................... Pier/Porch ................ RetainingWall ............ 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 ..... FINAL PROJECT APPROVAL FORM TO: - DATE: (2 Q K MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION FROM: FIRE DEPARTMENT DATE PLEASE SIGN ENGINEERING DIVISION DATE PLEASE SIGN PLANNING DIVISION DATE PLEASE SIGN PROJECT SITE ADDRESS PERMIT # O'�—& ;�- ADB# DATE INSPECTED 6'— ( DESCRIPTION OF WORK TO BE INSPECTED F - iD- A- LEH 122- 6,- � U (' e-�� - r:3 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 granting of: Final approval of the described work Performance Bonds associated with the project may be released GRANT FINAL PROJECT APPROVAL GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED III ----FAILED FINAL INSPECTION - OUTSTANDING ISSUES 2. 3. ---�RE-INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL ocaprvl.doc.l:temp:bldg:fonm6/98 -R—ETURN ADDRESS: City of Edmonds, City, Clerk 121 5th Avenue North Edmonds, WA 98020 NOTICE OF LEWITATION AND COVENANT ADULT FAMILY HOME Reference #: (2) Additional on Pg--4— Grantor(s): Grantee(s): Cily of Edmonds Legal Description (abbreviated): SeC-2Y—T*n.--2�ng--J--Qtr—A&— OR Assessorss Tax Parcel ID#(s): (1) (2) ALL . Or L,07- I )4,,p � �ssessor's Tax Parcel 1131f 'lot Yel 22551WITZU 77*017 P,,1a:r1Vj 0jr-, i-or--W- 00 V15, 4- L 01.y'�WM4 4+0�- - 4 UTHORIZED FOR RECORDING City of Edmonds y: j7A Date:-O-]�-*--90 Page I of A_ WHEREAS, the undersigned owners of property located at -C 1-1 - '26 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 i . mprovements 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 applicant that the permit will be issued conditioned on limitation of residents to G or fewer residents and their caretakers; and WHEREAS, the City has issued a permit based upon such representations, NO . W ' 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: I/ 1. Covenant: Limitation- on Residence, The owner hereby stipulates and agrees that occnpancy of the structure as an adult family home shall be limited to G 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 (A ' residents or attempts to rent, lease or otherwise provide residence for additional residents above the U 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 I the edition of the Uniform Building Code then in effect. The owner further stipu ates 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 —azw- ta A vie- - tJ, - �, Edmonds, Washington and legally described as: V-1 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 4 � — 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: OZ& Date: "o-ye I Page I'L of A— A I I I DATED this ACCEPTED BY: OWNE R: Jeannine L. Graf Building Official * '790-l'6-2- Notaty Pubft state of WCW%hgton NABOCK Mv AppointrAnt EVIres May 30,2001 NOTARYFOR State of Washington I ) cy 4R day of 19-.Lu APPL IMP R:20 T'Y '9b Applic Applicant 0 X.Car-N.) qorz Owner k/ f4-VL� L Owner COVENANT AND ACKNOWLEDGED: Mortgagor )ss County of--Qa�,- 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 -rl -(title) of Sal - ia Avc. /V foo4agX(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 6�- 19 ?P, C-Q -�' '� CD C- Notary Public in and for the State of Washington. My commission expires ?k2t!y-O.- 4 0 0 0 — I certify that I know or have satisfactory evidence that 404 4 12, (21 signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the r .7 (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 /3 �c4 day of A3 Notary Public in and for the State of Washingtom My commission expires )IU- . a000 AUTHORIZED FOR RECORDING City of Edmonds By: c—)2-4 Date: I Page 5 Of L�— L:kTEMT\BUYLDYNGWORMS%,ADF-COV.DOC No" Public State of Washington DIA BOCK MV Appointment Dpires May 30. 2001 ,-Ar I r RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds) WA 98020 9009000198 09/08/98 09:46 p.0004 Recorded Snohomish County NOTICE OF LEWITATION AND COVENANT ADULT FANMY HOME Reference M 67 &)5 & 2 Grantor(s): (1QAja P j,4-s,.-- Additional on Pg.A— Grantee(s): CRY -of Edmonds Legal Description (abbreviated): Sec--RY—Twn Rng—�Qtr OR Lot Block Plat Assessor's Tax Parcel YD#(s): i3eiipoepR (2)' i .4,,p ----Assessor's Tax Parcel JD# not yet assigned do , 0V M 4 WE r 5 AID. I AUTHORIZED FOR RECORDING 4 4 City of Edmonds B Y: L-j U Date: 0-40-90 Page I of__q_ VVUEREAS, the under signed owners of property located at 46; a I - 1 Aj 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 flre 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 WHEREAJS, 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: a I 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 (0 . residents or attempts to rent, lease or otherwise provide residence for additional residents above the I (a 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. Sub - ject Tract, The above stipulation and promises shall apply to and run with the land with respect to a residential structure located at 5:)-t— ta Vie- 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 -I.-, 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: OZ& Date: 0"ZO-M Page q. of_q_ 1W I N0110V Pubk State ct Walihington MABOCx My Appointrnmt Expires MOV 30,2001 NOTARYFOR State of Washington Owner \� e_v__ k L Owner COVENANT AND KTIN�'Q I Mortgagor )ss County 00 I certify that I know or have satisfactory evidence that r_16A?'�00'j. ? signed this instrument, on oath stated that he/she was authorized to execute the instrument and acknowledged it as the Q6_YtJa-R_ —(title) of Sal - izll- Asliz A/ Eo (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 beforeme this day of . 19 '?P' CQ - , If- 48. C� C_ Notary Public in and for the State of Washington. My commission expires *ft!Z -ROOO I certify that I know or have satisfactory evidence that signed this instrument, on oath stated that he/she was authoriped to execute the instrument and acknowledged it as the OC4.�-j C — -7 r (title) of (name of party on behalf on whom instrument was executed) to be the free and voluntary �ct of such party for the uses and purposes mentions in this instrument. Subscribed and sworn to before me this day of Q::�� '19 01C Notary Public in and for the State of Washington, My commission expires R 0 AUTHORIZED FOR RECORDING City of Edmonds , By: CV4 Date: f7w-ff Page3__ of __4_ LATEMMUIMINGWORMMADF COV.DOC Notary Pubffc State of Washington . DIA BOCK My Appotntment Expires May 30.2001 MAYS] �4 lu CA -46V�. 77 "g LN". V�t Z3 7-77 . . . . . . . . . 10001 - r-12 , 44: ... 1544-6� m= r. j7 2C lo