6917 176TH ST SW.PDF11111111111111
15636
6917 176TH ST SW
0
0
ADDRESS: � A 1:7 - 17 (a tjn- S. F. 'cS. W ,
TAX ACCOUNT/PARCEL NUMBER: r2 o 6 1 & I 0()r,) 14 -c; 3 S�
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR: AE H 0-1+6
CRITICAL AREAS: DETERMINATION: F-1 Conditional Waiver El Study Required E] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (C
I lq4—
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
B1
OOM
SEWER LID FEE $: LID #: -,e4 ) 7
SHORT PLAT FILE: LOT: j 45 BLOCK:
SIDE SEWER AS BUILT DATED: .3-9-
SIDE SEWER PERMIT(S) #: 3�593
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DSTs\Fonns\Street File Checklist.doc
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
APPLICATION
for
ifie City of Edmonds STREET FILE., SEDE SEWER PERMT
EW CONSTRUCTION P--' REPAIRS
EASEMENT No . ..........................
OWNER ..... 10.4weld .......
/ . .......
... .. r ..................
CONTRACTOR a.)eS' /0 ...... .................... PERMIT No.
ADDRESS ..........
... .......................
LEGAL DESCRIPTION: LOT No.. -1/4/ ---- e. � ........................
BLOCK No . ............................................
0
APPROVED
MAR 6 1970
0
NAME OF ADDITION .....
,cae. 7;e, / t/,,5�- 7-0 7�v c ov r- ,vl- e,
L-Al ld5" I-H A� 170--U.), -/—/1/ 540 7-,e 16�� 1 &� iv47- S L V SO 7X 1,05r
5
Ll
,V zRi- 14) f-57-
Approved:
4 .......................
DATE ............................... ..... By.
CITY OF -EDMONDS
Call PRaspect 6-1107 when work
CIVIC- CENTER WATER -SEWER DEPARTMENT Is ready for inspection. (No laspec-
ti... Saturday, Sunday or holidays.) N2 UQ593
SIDE SEWER PERMIT
S 6917 176th Street S.W.
ADDRES, ............... 7 ...................... .................... ...... ................................... m ...........................................................................
Owen L. Williams. Western Sewer
OWNER._ ........................................................................................... CONTRACTOR ................................................................................
Perinission is granted . ....... M.A.r.,q, _Q
.......... 19 ... 7Q, for ........................ days to REPAYR or CONNECT a side sewer
with City Sewers in accordance, with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NO--. No. I —The owners of the property may obtain a permit to construct sewer Inside property 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.
NG-__�No. 2—Obtpin full Information regarding Ordinance 11.16.030 and Regulations governing. side sewers when you get permit.
NOTE 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 grade sharper than 1/s 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 wWch may develop within one year of completion.
NOTE No. S—It is unlawful to ELIter 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.
-7-
CITY CLERK 200410190005 2 PGS
CiTY OF EDMONDS 10-19-2004 09:03am $20.00-
121 5TH AVENUE NO. SNOHOMISH COUNTY. WASHINGTON
EDMONDS, WA 98020
CO VENANT
ForAdult Family Home's Second Kitchen
Whereas, the Grantor(s) A661W,1 /)I- MC,010D14
hereafter referred to as "Grantor(s)", have received a Building
Permit # Z00+052—A --for-p roperty- which is zoned single family residential, and is
located at-69-1 7�7 t�avv"V\ cU WA- qa() 1-(,
tax account parcel number C05-1310001-A�06 and legally
d escribed as follows: 13 '0
F-A 4 &OC�4 000 D --06 - -MA-r
pblZnOvl-� OP -TR 1445 b&F - (3E61 �>W 0-og -5 j> TP- 1L) 5-
-TZ 175 F T -rP13 —t 44 (!O?�Sl- Aik? 5 D '5 1, I,,� I C6 FT �i H- f'�
L)"3 IR 133 F-F Tit W PL-T -5 L-t\-� --- D '-)-Q I 051'T -Tf� -5
Lt-� '-.?t> -T'IZ FT TM -1X 0- 75 10 Fr J+C)p�
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 accommodation by issuance of a building permit, the Grantors
agree as follows:
JAN 0 4 2005
EDMONDS CITY CLERK
1. 1 This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
and successors in interest, and shall be deemed to run with the land and bind all
future owners to the real properties described above.
2. This covenant shall be recorded with the Snohomish County Auditor and
.Grantors shall pay for all recording fees.
3. Grantors hereby covenant that the kitchen on the lower, basement floor of the
.subject residence can be used only in conjunction with the Adult Family Home
and that the said kitchen shall be removed immediately upon termination of the
Adult Family Home State License # for the subject facility
or cessation of use of the property as an Adult Family Home, unless, or until,
zoning laws allow otherwise.
4. The provisions of paragraph 3 above shall be specifically enforceable in the
Superior Court of Snohomish County. The prevailing part shall be entitled to its
attorneys' fees in such a proceeding.
5. Grantors acknowledge and agree that approval of the second kitchen for the
Adult Family Home use and the creation of this Covenant are a reasonable
accommodation'of Grantors' rights as a care provider to the disabled and of its
clients' foreseeable needs. The Grantors, therefore, on behalf of themselves, their
successors and assigns do hereby waive any and all claims of the Americans With
Disabilities Act or the Washington Law Against Discrimination which they may
have as of the date of the execution of this Covenant and promise to hold
harmless and indemnify the City, its officers, agents and employees from any
cost, claim or liability which may be incurred in defense of such a claim.
By signing and execution of this Covenant, the parties hereto agree that Grantors are in
compliance with existing zoning regulations.
Signed
Subscribed and sworn to before me this 2V9 day of
C
(P PUBL%r- iat
r§p.- C5
OF WJk
tington.
J
MiURN ADDRESS: 200410190004 3 PGS
10-19-2004 09:03am $21.00
,.,...6ty,o1-Edmonds, City Clerk SNOHOMISH COUNTY. WASHINGTON
IZI-5�h Avenue Nordi
9dw6q -WA*08020
0 OF LMTATION AND COVENANT
ADMT FAAHLY HOME
Reference #:
Grantor(s): Additional on pg._
Grantee(s): city Of Edni�nds
1,egal Description (abbrevia Sec..- Rnc tr,24-2
OR '%' `Lpt' Block Plat
60A (2)
Assessor's Tax Paml WN(s): (1j, j� �51?4097q
___.Asses4oA Tar?arL*l ID# not yet assigned
AUTHOR MP.F.O1kPC0RD;N_G
City of Edinon ' ds-
By: �_-M : Doti -
Page I of —.---
WHEREAS, the undersigned owners of property
, in Edmonds, Vashlogt6n..1*11y described
below or on the attached Exhibit A, have applied f4ji a--'166J1di4g permit for
compliance and/or to remodel a structure located on the ii�!, 'an'd
WHEREAS, the applicant has notified the City of applicant9s Jnteqt1dq-..to utilize the
Improvements andfor to convert an existing single family 4nf r-'e, wjii'--adult
family home; and
WHEREAS, under the Uniform Building Code the number of
structure trigger certain requirements relating to the fire suppression And'Wdtlne..-'
requirements; and
WHEREAS, the City has notified the applicant that the permit will be
conditioned on limitation of residents to - 5 or fewer residents and thef�
caretakers; and
WHEREAS, the City has issued a permit based upon such representations;
NOW, THEREFORE, the undersigned property owners (hereinatter
"Owner'l 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
'a..bgrees that occupancy of the structure as an adult family home shall be limited
or fewer adults and their caretakers as allowed by applicable
state law. IMe owner acknowledges that In the event that the applicant
spaqAvijiQn.of-the applicant's state ficense to operate an adult family home with
---, ; 7 ." terthan 6 residents or attempts to rent, lean or
olix:11vi . bcy of.grea
�th . pro4il �esldence for additional residents above the
: -` 5 .. �` permltled In the current occupancy classification, the structure shall
be vicided-grnd jot ie;lil�iqtial use ceased until such time as the property is brought
Into C001;11=6� 4kt6.provIsIons of the State Building Code, under the edition of
the UnitofmBuIldift Code then In effecL The owner further stipulates that this
covenant t'j*�c' iidi&hcerns the land so long as the present structure and use
continues an-i rdioviib the land to all future purchasers and assigns.
2. S61��... t6eabove stipulation and promises shall apply to and
ran with the Innd'*If�'-r6p.ect`to.s residential structure located at
... 11 .
L0qj1-1-Z[P*4 C?T-6W.. � Edm6hd& Washington and legally described as:
3. Notification to Future Purchasers and AsManees.,*. Tlkb p6tiftgation
and covenant has been recorded in the records of Snohondsh Codnty,"W'.886
kigton
In order to provide notice to any and all future owners of the Orpp" of--th�--..
limitation at the current level of Improvement to single families and 9�ujtj�mily..,
home residents fewer than U In number.
4. Enforcement. In addition to any and other remedies civil or cdn9W---:
which the City may have, the property owner hereby agrees and stipulates that-" >
Is
grant of covenant shall entitle the City to enforce by Injunction the provisions of thi
code and, In so doing, to recover Its reasonable attorney's fees and costs.
AUMORIZED FOR RECORDING
of !d
By: ;gI44�46ML
e or ,�5 1
0
.5
-VATED this day of
0C+0 6,
....A1QGEM D BY:
je"ntne
Buildinj
J
20 0�
APPLICANTIPROPERTY
K&MA �kn [(sT)4
Applicant
Applicant
K& V,* wn lc� 0 t-�
Owner
Owner -
COVENANTAND
NOTIFICATION
ACKNOWLEDGED:
..,...,N�orlgagor
NOTARY FOR OWNER SIGr4kTURES...,,--`
State of Washington
7 )ss
County ofl�
I certify that I know or have satisfactory eMe**-s"ft*"&t'*-----Aj,^1a-
signed this instrument, on oath stated that heisbe4'seauLhorlied to execute the
Instrument and acknowledged It as the i (title) of
(name of party on behalf on whemingniment 'was executed) to be
the free and voluntary act of such party for the usesan#'6'q'rpq&es mentions In this
Instrument. Subscribed and sworn to before me thks Of -r QnA C..,,%%,
C61UqA,,., ..............
X
.$�
-0 NO rA4k
Notary Public In and for the giate of W &bIngt.Q&**,.---
My commission expires� - 2d:,� 7,
I certify that I know or have satisfactory evidence that
signed this Instrument, on oath stated that helshe was authorized 1�.Pxkv& tbi
Instrument and acknowledged It as the oide)4
(name of party on behalf on whom Instrument was exeWted) to bir--
the free and voluntary act of such party for the uses and purposes mentl�nsfii-.
instrument. Subscribed and sworn to before me this dav of
Notary Public In and for the State of Washington.
My commission expires
AUFHORIZED FOR RECORDING
City of Edmonds
By: -TIK Date: 4
Page '6 of '3,
1.%TEM�BURDINGWORMS�ADF�-CDVAOMO/04
0
CITY CLERK
CITY OF EDMONDS
iZi 5TH AVENUE NO.
.-ED#AONDS,, WA 98020
200410190005 2 PGS
10-19-2004 09:03am $20.00
SNOHOMISH COUNTY. WASHINGTON
COVENANT
)F*K Adult Family Home's Second Kitchen
Whereas, the Grilitot(s), M. M6,010,014
to as "Grantor(s)", have received a Building
Permit # 0OZ4052A fgZ*prqVerty.which is zoned single fhniil�residential, and is
located at 69 11- �W. t�-&VVL&V-\CU UO _ cfe 0 2,(-
tax account parcel numberi and legally
described as follows: &DCY- 000 1) -06 - -MA-r
R100T,3 Of- -TIZ 1445 bP�F >W' POP- 0 TP 114T -rlf F, AL�q
5W '5D -TZ 175FT 60 NST AIX-? ik,> 5 1 C6 PT
PL,-r VJ L,"3 -TIR tWr Tif W PLT.....51" L1-0'*-..151>-:-TQ 106
FT -rw
VL.r V3 LX4 --,D -'rp- 133 �-r TM(`
I C, Pr T Rop
Whereas, the City of Edmonds has receive�*i*b'u"ild*i"np,.per-'zpit application for an Adult
Family Home with a second kitchen to be located iw*in ixisting single family residenc e*
in a single family residential zone. .... ..
.............
Whereas, pursuant to WAC 388-76-190 an adult family' ho'm*eJs; c4nsidered a residential
use of property for zoning purposes, and are permittdd ifi--area�-ioned for single family
dwellings.
Whereas, the City desires to approve utilization of a second-.kitche-n'** in
Ohi�.Adult Family
Home as a reasonable accommodation to the facility as care "p*i.�.'.ov�Oe�..t6'.t'he.�lisab led for
so long as the second kitchen is utilized, and only utilized, in colflun*Cition-with . the Adult
Family Home use.
Therefore, in consideration of the City of Edmonds, Washington app'M-v`in-g tke-gccon4
kitchen as a reasonable accommodation by issuance of a building perink 0�,dr-a"�xto.rs-%.
agree as follows:
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
..Aiture owners to the real properties described above.
This c4venant shall be recorded with the Snohomish County Auditor and
GAnt,6 09fl-1pay for all recording fees.
3.""Or-aiitor&4�t#W'ife.venant that the kitchen on the lower, basement floor of the
�ubjed re�iidenqe.cait be used only in conjunction with the Adult Family Home
alid thaf the.-said.ldi
I chen shall be removed immediately upon termination of the
Addli Fadi'ily4l'o' M"�'�tate License #
for the subject facility.
or cegi�tW of.tiie..af.fhe property as an Adult Family Home, unless, or until,
zoning lawe-�.116w oth6wise.
4. The provisi q*.ns'of-par'h-g* rapf'O. above shall be specifically enforceable in the
I I ... . .
Superior Court-,454ofiommislh County. The prevailing part shall be entitled to its
attorneys' fees in..s , uch.-a'prgcee -ding.
5. Grantors acknowled: e gfitkaireq.--th41-lipproval of the second kitchen for the
Adult Family Home tM**cr6`tkodo'f this Covenant are a reasonable
accommodation of Gra�tqri.,.ri*ghtsias a care provider to the disabled and of its
clients' foreseeable needs. ---The.Grantors, t
kallo�re, on behalf of themselves, their
successors and assigns do biteby waive.ati* and'hIl claims of the Americans With
. y ...
Disabilities Act or the Washington Lg W` Again'st Discrimination which they may
have as of the date of the executiefi of * thi's Cav�enant and promise to hold
harmless and indemnit, the City, I�s oifiari's*, .1 ". nts and employees from any
ge
cost, claim or liability which may be`-iqcurre�.IhfdJefense of such a claim.
By signing and execution of this Covenant, the pirtlis.hi6iretb' agree that Grantors are in
compliance with existing zoning regulations.
...........
Signed
............
Subscribed and sworn to before me this day of
C
lab
( 1,41 A
A
_'O Ar
ary Pu ic in the Sta W-JtWngtod:
r
0 of
PUBLIC
ft:
% 'up nesi ing at -sf
eOF W J RV
;_0
c-ty`t'VEdmon*
I o
RIGHT-OF_V4Y CONSTRUCTION
PERMIT Permit Number.
Issue Date: - --7-(,- 94
A. Address or Vicinity of Construction: 6917 176 ST,.SW ( 9421769
890 B. Type of Work (be specific): Install New Serv&ce
C)
C. Contractor: Wa shiagtoa Natural Gas Company
MailingAddress: 815 mercer Street,Seattle.
State License #: WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: —
Bond: $
Side Sewer Permit # (if applicable):
E. E] Commercial F I
] Subdivision El . City Project 0 Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family [] Single Family El Other 4i
INSPECTOR: INSPECTOR: k_"JkJC_.H-
F. Pavement or Concrete Cut: El Yes []No � G. Size of cut: — 2 x 4 _ H. Chargq�_$
APPLICANT TO READ AND S�PN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold,t�&y ofEdmonds harmless #76m injuries, Homages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made, against the City of Edmands, or any -,of its departments or
le-,
employees, including or not limited to the defense ofany legalproceedings including defense,6ostsJn4d attorney fees by reason ?fgra7tia�jjhifpermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALSFOR A�PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RFSTORATIONAW—EN, T111, BE HEID UNTIL Tfi?YINAL�ZUEET PATCH
IS COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BEPROCESS& FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of prop&*or'k r'equirled I with(perm'it applicatiofi.
A 24 hour notice is required for inspection; Pleas� call the EpginC ng i siox 77J-00Q.
k It 4V
Work and material is to be inspected during progressand at com letio
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 shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the aboue statements and understand thepermit requirements and thepink copy of thepermit will be
auailable on site at all p5eR-f6r—ige�ctiourposes.
Signature: Date: June 29 1994
CWntractor or Agent),,
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR eITY USE ONLY
APPROVED BY: t&A; fe_.f i- RIGHT OF WAY DEPOSIT
TIME AUTHORI I ZED I :VOIDAFTER SiSPT
DAYS DISRUPTION FEE/FUND: Ill:
SPECIALCONDITIONS: CA,')t4TAQT C(T c4z a VJ RESTORATION FEE:
-TO �-SlSr 'It) 'bl(SLL"40"' PERMITFEE:'.
COMMENTS:
YOTAL FEE:
RECEIPT FEE:
DATE: ISSUED BY:
4?
NO WORK SHALL BEGIN PRIOR TO PERMIT
UANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
I Comments:
I Diagram -:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
El NO
A
AT
Addendum to Citx of Edmonds
-light of Wa
Permit Appifcaiion
Subm
itted by: MITCHELL So-LANKFORD
Engineering Aide
17 Co"D Washington Natural'Gas
7 #.'-521-'5246
f F
- i I c, "XI
Qx "r.,
Key:
Water itain depth .-w- water
M_ -g- gas
gas nain -ss- sewer
9-- watex hyclran't
C) . vat(;.-.- valve
?15 "4crccr St' (1 -')' "A 18')9), Scgttl'�, WA S 1111 "1206) 6_22-767
'A*7Washi� fo. S fe
DEPART ENT OF
S)�
V"�Tll'
..
M H "..--.-L1c
Adult Fa 11 Y, ome, ense
License Number: 697600
Pursuant to the laws of the. State of Washington and the Minimum Licensing� Requirements
of the, Department of Social and Health Services, a license. is hereby grain' ted to
REGINA MEDIODIA
to conduct and maintain at 6917 176TH ST SW
city of EDMONDS, Zip Code 98026 County of SNOHOMISH State of.washingt9n
S.
an Adult Family Home for the care and supervision of adults as�fbllow'.
24-hour care for no more than 6 adults
This license shall be in force from the 27th of April, 2005.subject to suspension or revocation for due, cause.
Conditions on License, if any':'
Licensing Authority
NOTE: The department renewal of a license does not preclude the d paii� a any act ion undier' WAC 388-76-705, based on inspection.
t
e
This license is not transferable, and is valid only for use bv the corporation, partn o ind iidual(s) to whom it is issued and at the location above described.
Issued by Authority of Chapter RCW 70.12
CITY CLERK
CITY OF EDMONDS
121 5TH AVENUE NO.
EDMONDS, WA 98020
200410190005 2 PGS
10-19-2004 09:03am $20.00
SNOHOMISH COUNTY. WASHINGTON
COVENANT
For Adult Family Home's Second Kitchen
Whereas, the Grantor(s) A66IW4 A- 1776,010DI4
hereafter referred to as '.'Grantor(s)", have received a Building
Permit '052-1 for property which is zoned single family residential, and is
located at 691 -�-- I -+IQ +VN �it - JW 1��d-Vv"nC4�,[ WN qxr)-)-I.
tax account parcel number C0573100014,5*06
described as follows: j3jeAo , and legally
r__ j4- &Locjt� 000 -MA-r
PNZIIOTI� OP -T1Z 105 b&F - t3E&I -'5W 0-og 15 �> -rjZ IL4T -nf E, "
,5L-N� " -TZ 175FT --TPI-5 —144 CONY-C AU1 5D -D 0,3 IC6F-r�j ff t,,S
PL,-r VJ L"3 —1 R 133 Fr Tit UU Pa '5 L-0 '-- �> 7 Q 165PT --Ni- '5
pUr- U3 UA 1-?D 1-(Z 13-3 F-r TM -1X 0- 5 1() Pr
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 ho m*e 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 accommodat , ion by issuance of a building permit, the Grantors
agree as follows:
JAN 0 4 2005
EDMONDS CITY CLERK
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 kitch en 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 Grantorsi 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 ex * ecution of this Covenant, the parties hereto agree that Grantors are in
compliance with existing zoning regulations.
Signed
Subscribed and sworn to before me this 5-'9 day of .2A
C - 7,4,
IA EW�
QT.
J"UBLIC
3 OA'-
OF WX
rary Pu ic in t�*' the Stao of Washington.
u
67
esidingat_ 'Ial Iqb 1,SfAIV--
LIKI�Wlq7c A)A-
4
200410190004 3 PGS
R16URN ADDR
- -of 10-19-2004 09-03am $21.00
tity -Edmonds, City Clerk
I Z I -51h Avenue North SNOHOMISH COUhTY. WASHINGTON
Edni6q(#�-WA'08020
OF LEMTATION AND COVENANT
ADIULT FANIILY HOME
Reference #:
Additional on pg._
Grantee(s): ' City of Edni�nds
Legal Description j1,,n Z, R,,,� CW Qtr,2�)
OR [At Block Plat
Assessor's Tax Pared ZW(s): (1 (2)
—Assessats; Tarfar6el ]nD# not yet assigned
AUTHORIUDY.OlkWEMRPING
City of EdIno 45._&W
By: g_-M : ZZ
Page F of --.--
WHEREAS, the undersigned owners of property 11�cal4at*_(A.1--� 11(tM 5�
in Edmonds, Vask�pg&u�.A"'y described
below or on the attached Exhibit A have applied f6i a-buildiiig permit for
compliance andfor to remodel a structure located on the
WHEREAS, the applicant has notified the City of applicantl%i . lnf�n!IKWto q6llze the
Improvements and/or to convert an existing single family Arif riie' to.j�i'-.#dult
family home; and
WHEREAS, under the Uniform Building Code the number of
structure trigger certain requirements relating to the fire suppression And'bat6C.
requimments; and
WHEREAS, the City has notified the applicant that the penult will be Issued"'
conditioned on limitation of residents to 5 or fewer residents and iher�
camtakers; and
WHEREAS, the City has issued a peftnit based upon such representations;
NOW, THEREFORE, the undersigned property owners (hereinafter
"Ownee,) in consideration of the Issuance of a building permit and in order to
confirm the promises upon which such Issuance 6 based while providing notice to
any future owners or mortgagors of the property does hereby stipulate, covenant
and agree as follows:
0
0
-4 . Md.:
agrees
be v
Into
the
Covenant: Limitation on Residence. Ile owner hereby stipulat
pt occupancy of the structure as an adult family home shall be limited
or fewer adults and their. caretakers as allowed by applicable
state law. The owner acknowledges that In the event that the applicant
�jof-the applicant's state license to operate an adult family home with
of. ter than IT residents or attempts to rent, lease or
...:;esidence for additional residents above the
P; In the current occupancy classification, the structure shall
id �htlal use ceasW until such time as the property b brought
ice th provisions of the State Building Code, under the edition of
Bill . _. e then In effect. The owner further stipulates that this
covenant u�bd �fia;;�ftcerns the land so long as the present structure and use
continues shall.rdii'yvith the land to all future purchasers and assigns.
2. Silbleit'Tra,pt -above stipulation and promises shall apply to and
ran with the land'*- H4.11-iipectlo.mi residential structure located at
I .
Loql I- J-71pt" gd'nuilkds, Washington and legally described as:
W
3. Notification to Future Purchasers and Ass1xim*s.-*, TW p6tiackdon
and covenant has been recorded in the records of Snohomish Co6$y:,`WasfiWgtoip
In order to provide notice to any and all future owners of the Ovorty of-Ahe-,
limitation at the current level of Improvement to single families and VAukf"T�
home residents fewer than in number.
4. Enforcement. In addition to any and other remedies civil or cdddW--'-':
which the City may have, the property owner hereby agrees and stipulates
grant of covenant shall entitle the City to enforce by Injunction the provisions of",,.
code and, In so doing, to recover Its reasonable attorney's fees and costs.
AUTHORIZED FOR RECORDING
m M
By: r 7Da — L4 6L
of�4e Of 6
0CA-0 b 't-
-PATED this day of 200�
Al� CEFTEDBY: APPLICANTIPROPERTY
Applicant
Applicant
jeanfilneUiGrV
Building
Owner
Owner
COVENANTAND
NOTINCATION
ACKNOWLEDGED:
..,.A!ortgagor
NOTARY FOR OWNER SIGi4A*_TURES.."
State of Washington
)ss
County of4L9�0�
I certify that I know or have satisfactory .RIC
signed this instrument, on oath stated that halihe'Qauibot
4, *va- / f le 41,c
A to execute the
Instrument and acknowledged It as the i .:* — (title) of
(name of party on behalf on wfiemlns0u�&eni'was executed) to be
the free and voluntary act of such party for the usciind"i— ' mentions In this
py
V&T
Instrument. Subscribed and sworn to before me this 4ayof A
...........
H07A4
Notary'Pufilic In and for the State of wsigbj 5kmL_,.
My commission expires . .. . ...... . -06
J ........
%
I certify that I know or have satisfactory evidence that
signed this Instrument, on oath stated that he/she was authorized 19,;;;; P! th'i
instrument and acknowledged it as the
(name of party on behalf on whom Instrument was exec
the free and voluntary act of such party for the uses and purposes men
Instrument. Subscribed and sworn to before me this day of
120--
Notary Public In and for the State of Washington.
My commission expires
AUMORIZED FOR RECORDING
City of Edniands
ny: —r1k Date: *4
Page '6 of 13, ,
1-%IlDONBURDINGWOPJAS"i�-COVJ)OCVIO/04
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C
ATE RE E
AFAM�4
USE PERMIT
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CITY OF EDMONDS CS
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDR
NER NAME/NAME OF BUSINESS V I 6_10
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PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
cc M)ULING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RVSCPar:1PF'�Z8Ud11.d
Street Use Pennit Req'd
CITY ZIP
TELEPHONE
41 r
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
Inspection Required
Sidewalk Required 13
Underground
9
wring required Ell
NAME
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
7"
YES 13 NO 13
9
1 6
t ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
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ZIP I TELEPHONE
TAX ACCOUNT PARCEL NO.
CEIL III
ENGINEERING REVIEIMWE n0iiijillir �ffia 1111 W,11111DATE
FIRE REVIEWED BY DATE WW
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. VARIANCE OR Cu SHORELINE OR ADB# NSPECTION BOND
CHECKED BY
.0 NEW
RESIDENTIAL
PLUMBING / MEC]I
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
FENCE
CYDS
X
13 DEMOLISH
El TANK
THER
GARAGE
CARPORT
RETAINING WALL
13
F RE PRINKLER
ROCKERY
FIRE ASLARM
(TYPE OF USE, BUSINESS
OR ACTIVITY) EX"N:
NUMBER
NUMBER OF
CRITICAL
OF,
/,,
DWELLING
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AREAS
�:,STORIES
UNITS
NUMBER
DESCRIBE WORK TO
BE DONE
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEM T ALLOWED , PROPOSED ALLOWED PROPOSED
on
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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PARKING LOT AREA I PJW DATE
REO'D I PROVIDED
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tFr)REMARKS e2�4, J 01 --1- -
.4C 14- .016ism"I u44,e w..4+ le
CHECKED bY
TYPE OF C NSTR CT71,N
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OCCUPANT 'e—,
GR )
SPECIAL INSPECTION
REQUIRED
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
VALUATION
lecavr maw -
Description
FEE
Description
FEE
Plan Check
State Surcharge
HM
GLAZING %
/YKI
LOT _%OPE %
A�
Building Permit
City Surcharge
PLAN 614ECK NO: VESTED DATE
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUPCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE. CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERM[T. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee
Receipt #
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
APPLICATION APPROVAL —
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
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ! ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO.
WORKMEN ION INSURANCE AND RCW 18.27.
FOR INSPECTION
receipt is acknowledged in space provided.
SIGNATUR, NE�R,& AGENT) DATE SIG ED p�u�
fM111%__1___�'
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OFFICIALS SIGNATURE DATE
?I 9
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771-0220
D
RELE—AS D E
ATTENTION
IT IS UNLAVfULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
EXT 1333
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110.
ORIGINAL F ILE YE1 nU .1—,
09/03 n0000 U A nr% %1^1 1 A OC
RA A Wilkle—% A ^^n100
PW"NER GOLD - ASSESSOR
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USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB �Cl- 11
ADDRESS
OrNER ( NAME/NAME OF BUSIN�SIS
MAILING ADDRESS
CITY ZIP TELEP�ONE
Fd.
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k"'FA IWO LAj,
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
F7 x f-
CITY
STATE LICENSE NUMBER
IROPERTY TAX ACCOUNT PARCEL
aj
ZIP I TELEPHONE
r7 NEW
I RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
13 MULTIFAMILY
REPAIR
[3 GRADING CYDS
ri DEMOLISH
13. TANK
GARAGE
CARPORT
RETAINING WALL
11 ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF
OF, DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
0A—V 0,
CBL #
"'I PERMIT EXPIRES I I I
PERMIT y q
NUMBER A
3W SUITE/APT#
A (YO
PLAT NAME/SUBDIVISION NO,
LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Rw Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
wiring required
METER SIZE
LINE SIZE I
I
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
DATE I CHECKED BY I VARIANCE OR CU
SEPA REVIEW
COMPLETE I E7T
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
41f
DATE
z
z
0
DATE 111
SHORELINE OR ADS#
I INSPECTION
BOND
REqD /
POSTED
10YES P(NO
1$
SIGN AREA
HEIGHT
ALLOWED PR
ALLOWED PROPOSED
,OPOSED
.REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
FRONT SIDE REAR
FRONT UR SIDE REAR
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)T AREA
I P(W Rj!�� DATE
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tN CODE_ OCCUPANT
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CRITICAL I Is f /_ /_ox
AREAS SPECIAL INSPECTION REA OCCUPANT
NUMBER REQUIRED [3 LOAD
YES 1:50
REMARKS
1PROGRESS INSPECTIONS PER UBC 108/ ISC109 / IRC109 FINAL INSPECTION REO'D
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
X FT)
THER
FIRE SPRINKLER
F RE ALARM
I M If-)W4-4f /;
'I CHECKED bY I TYPE 7F
VALUATION
%J K
0 19.9.
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Description
FEE,
Description
FEE
Plan Check
State Surcharge
HEATISWP�CE
GLAZING %
LOT S OPE %
Building Permit
Do
City Surcharge
PLAN 64ECK NO: r L
VESTED DATE
Plumbing
Base Fee
Mechanical
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,
Grading
Engr, Review
PERMIT APPLICATION: ISODAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUPCESO I RS
N 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 $HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN! ION INSURANCE AND RCW 18.27.
Fire Review
Plan Chk, Deposit
4�
Fire Inspection
Receipt #
Landscapelnsp,
Total Amt. Due
Recording Fee
'Receipt #
CALL
FOR INSPECTION
(425)
. 771-0220 (:?M
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,
OFFICIALS SIGNATURE DATE
— Z
�? ' 1z
SIGNATUR NE�RXR AGENT)
A —A
Em
DATE SIGIED
9 1 %1
—
RELETS11DAY DATE
ATTENTION EXT 1333
IT IS UNLAVqFULTO USE 08 OCCU PYA BU I WING OR STRUCTUR E U NTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
FANCY HAS BEEN GRANTED, UBC109/IBC110/IRC110. ORI i GINAL,FILE YELLOW- 4SPECTOR
P
IN*-�IJWNER GOLD -ASSESSOR
09/03 n0000 U A nr% %1^1 1 A II Ii A Wlki^- A f%f%n1C0
- — --- — ---------
6917 176th St SW
Edmonds WA 98026
FIRE SAFETY EVA CUA TION PLAN
EXIT
BEDROOM
3
� 6f."
3�'l j/1-1 I
EXIT
BA TH
3
20'-5"
N�S
BEDROOM 4
a,u�+o*c,r
2- 6- t�,
Lw
'lz 7�
4�- 1
LEGENDS:
Fire Extinguisher
Carbon Monoxide Detector
A, Smoke Detector
BACK
EXIT
6---sD
4-
KI TCHEN I
�i DIN
1
41
1
1 -
Z-41
LIVING
6�-7"
i
2- -'W
21
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RECEIVING
FRONT
EXIT
OD > 0 >
M 70
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�IR R_jI ;I ORS REM,
_j. I A N �DR �
1.2 SMOKE DETECT
THE ISSUANCE OF THIS TERMrr REQUIRES
WITH. ;BATTERY
�INNEOCONNECTED SN10KE 13ETECTORS
BACKUP IN THE FOLLOWING LOCATIONS:
1� �IN EACH SLEEPING ROOM.
41 OUTSIDE 'EACH SEPARATE SLEEPING AREA IN THE
IMMEDIATE VICINITY OF THE BEDROOMS.
ON EACH ADDITIONAL STORY OF THE DWELLING,
INCLUDING BASEMENTS BUT NOT INCLUDING CRAWL
SPACES AND UNINHABITABLE ATTICS. IN DWELLINGS OR
DWELLING UNITS WITH' SPLIT LEVELS AND WITHOUT AN
INTERVENING DOOR BETWEEN THE ADJACENT LEVELS, A
SMOKE ALARM INSTALLED ON� THE UPPER LEVEL SHALL
SUFFICE FOR THE ADJACENT LOWER, LEVEL PROVIDED
THAT THE LOWER, LEVEL IS LESS THAN ONE FULL STORY
BELOW THE UPPER LEVEL.
Provide one openable escape window in
basement and in each sleeping room""
meeting all of the following requirements:,
1. Am openable area of not less than 5-7
sq. ft. (5 sq. ft. for gr2ide. floor opening)
2. A minimum clear height bf 24"
3. A minimum clear width of 2011
4. Finished sill height of not more than
44" above the finished floor.
SEP 2 B 2004
PERMIT COUNTER
Z-/
(,?ql 7 - 7(1/
An y request for modification, variance or other
administrative deviation (hereinafter "variance")
must be specifically called out and identified.
Approval of any plat or plan containing provisions
which do not comply with city code and for which a
variance has not been specifically identified,
requested and considered by the appropriate city
official in accordance with the appropriate provision
of city code or state law does n ot approve any items
not to code specification. : .
19 7'
CIT I copy
U,405
RECEIVED
SEP 14'2004
PERMIT COUNTER