20000780.pdfI
VARIANCE OR CU
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SERA REVIEW
COMPLETE I EXEMPT
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SIGN
ALLOWED
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� ALLOW& ADF- As A 215-1*1111UH) UOF- IN A-
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SPECIAL INSPECTOR
AREA
OCCUR&
AEOUIRED 0 YES
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LOAD
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PROGRESS INSPECTIONS PER UBC 108
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FINAL INSPECTION REQUIRED
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ATTENTION INSPECTION I —
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR 'T 'E ORIGINAL — Fde YELLOW — Inspector
I' R-,,ATLu-,, 771-0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APP
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC — PINK — Ow,.e, GOLD — Assessor
SECTION 109 -S
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ADULLT FAMILLY ROME 1ACENar,
License Nui;7ber*.532000
pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services, a . license is hereby granted to
TATIANA CAffAN and NICU VASEIE CIMPAN
to conduct and maintain at 17915 73RD AVE W
City of EDMONDS, Zip Code 98026 count)r of SNOHOMISH Slate of Washington
an Adult Family Home for the care and supervision of adults as follows:
24-hour care for no more than 6 adults
Thislicensc, shall be in f0me from the 31st of July, 2090 subject to 9a`Pc"s'0rL or revocation for due cause.
This home has a special designation to provide service to persons with: Dementia Mental Ulness
Conditions on License, if aUY:
Licensing Authority
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NOTE: The department renewal of a License does not preclude the department trom taking any action under WAC 388-76-705, based on inspection.
Thigliteasch not tranwferAbless6d IS Valid ordy Fer'use by the corporation, partneryhip me individual($) to wtum It izI.Syned and at th-I—fi-a above descnbed.
ISSUCU UY AULU.9 ILY
FINAL PROJECT APP Al, FQRM
TO:—
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
'2- clde�,
FROM: �FIRE DEPARTMENT DATE —ALL—
'E. GINEERING DIVISION DATE —
_PLANNING DIVISION DATE—
PROJTCT--41L4,'--1
SITE ADDRESS DILI -73
PERmrr#____________ADB#_______-DATEINSPECTEI)
SPECTEDLLe
DESCRIPTION OF WORK TO BE IN
A field inspection was conducted to determine compliance with approved plans. Final approvi'=.tes that
there are no objections from the above signed Department to the granting of
'PC Final approval of the described work
____-----Performance Bonds associated with the project may be released
?S,_GRANT FINAL PROJECT APPROVAL
GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
AILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:tcmp.bldg:fOMIS6/98
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FINAL PROJECI APP VAT, FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: --FIRE DEPARTMENT D 2- -Z.
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DESCRIPTION OF WORK TO BE INSPECTED—,ZJ�1�---�.
A field inspection was conducted to determine compliance with approved plans. Final approval. denotes that
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there are no objections from the above signed Department to the granting of:
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approval ofthe described work
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Bonds asso ciated, with the project may be released
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-GRANT FINAL PROJECT APPROVAL
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FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
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FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvl.doc.l:temp:bldg:form96/98
RE TURN ADDRESS: CONFORMED COPY
City of Edmonds, City Clerk 200010020237
10/02/2000 jj-.41 AM Snohomish
121 5 th Avenue North p.o003 RECORDED CountY
Edmonds, WA 98020
NOTICE OF LIMTATION AND COVENANT
ADULT FAMILY HOME
Reference #: 2WO M30
Grantor(s): (2) Additional an pg—
Grantee(s): City of EdmQnds
Legal Description (abbreviated):
OR Lot--------J]lock Plat
Assessor's Tax Parcel ID#(s): (2)
_--__Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
By: Date: 90a Y-A 01
Page of3�:
WHE%A1, lbee�ndersigned owners of property located at /'276 -7?)gb
A V �� -- . , 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 app licant 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 or fewer residents and their
caretakers; and
WHERE AS, 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
my future owners or mortgagors of the property does hereby stipulate, covenant
and agree as follows:
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1. Covenant. Limitatign gn Rgsidence, 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 sta I te license to operate an adult family home with
an occupancy of greater than 1� residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
.(; — 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. SubiectTrag The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at Llej!5- �-1 �1)
AUt;-! - uo Edmonds, Washington and legally described as:
1�,\'K ooz) 00 L-0-r L42,
3. Notificalim- o Future Purgh3sff-&,1RLA&dg-nee& This notification
and covenant has been recorded in the records of Snohomish County, Washington
in order to provide notice to any and all future owners of the property of the
limitation at the current level of improvement to single families and adult family
home residents fewer than ?� in number.
4. EnforcpMg 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 ofcovenant shall entitle the City to enforce by injunction the provisions ofthis
code and, in so doing, to recover its reasonable attorney's fees and costs.
AUTHOIUZED FOR RECORDING
City of Edmonds
By:S�� Date-9-12AL--
Page Q of %3,— 1
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DATED this A� —day of
ACCEPTED BY: APPLICANT/PROPERTY
OWNER:
Jeannine L. Graf
Building Official
19,-If 1-14evie #53 7-000
NOTIFICATION
Applicant
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington )
County of. ShOYOM . t5h )ss
I certify that I know or have satisfactory evidence that -rO+Im . &AoaAn�
signed this instrument, on oath stated that he/4R)was authorized to execute the
instroment and acknowledged it as the 0 . (title) of MALY,
fb��-ame 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 1,15 day of
2-040
9 NOTARYPUBLIC
STATE OF WASHI
COMK41SSIONEXVBV&.y ublicin and fortheStateof ashington.
W. W
APR - IL 9. 200 ission expires—A-_-CLI—i -3
I certify that I know or have satisfactory evidence that L;4_11 C�MOA -
he he was authorized to execute the
signed this instrument, on oath stated thajs�
Minstrum t and acknowledged it as the QUA4UA, —(title) Of Ada L-,
=-me 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
inst ent Subscribed and sworn to before me this e6 day of
=, "1,9-=—.
AN ryj -). &&(,�
Notary Public in and for the St te of Washington.
mmission expires
DEBRA L. KARBER
NOTARY PUBLIC
STATE OF WASHINGTON AIJTHORIZED FOR RE CORDING
COMMISSION EX INES City of Edmonds
L 9' POOPIRES By.
IEJ 'Page :i. of-2;-_
APRIL 9, 200 By: Q, P, Date;fL4_01)
L'.\TEMP\BUILDIN4nFORMS\ADI�--COV.DOC
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RECORD OF INSPECTIONS
INSPECTOR DATEAPPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall ..................
Pier/Porch ................
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MISCELLANEOLIS
FINAL APPROVAL
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CITY OF EDMONDS -2011
CONSTRUCTION PERMIT APP C ALT 11 0— N WEIAPT I
IPWNERNANlE/NAMEOF-u�'���'-1,47-i,4A//)
lill DESCRIPTION CHECKI SUBDIVISION NO ILI. No I
AILI A 0 EBB
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PUBLIC RIGHT OF WAY PER OFFICIAL STRSET MAP.
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LINE SIZE
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NO. OF FIXTURES
PAV REQUIRED
YES D NO 0
ADDRESS
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zip o NUM81P
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ENGINEERING MEMO DATED REVIEVEOSY
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TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR CU ADBI —INE
77
Legal Description of Property - incl= all easements
E A
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SIGN
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ALLOWED
AREA
P ROPOSED
HE IG14T
ALLOWED
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ALLOWED IPROPOS D
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FRONT So
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PRDPOSEUSETBACKS(i
P,
FRONT UP
,
SIDE, REA
NEW RESIDENTIAL PLUMBINGIMECH
AW�s AS Pff"IT=
COMPLIANCE OR
ADDITION OM.ERCIAL CHANGE OF USE
REMODEL ART. BLDG. SIGN
GRADING FENCE
REPAIR DITIS L_.—FT)
CHECKED BY TYPE OF Go
I 'A%F1vi
IMI
10 DIE POOL
DEMOLISH "BOOST SWIM
ERT HOTTUB/SPA
GARAGE 0 RETAININGWALL/ 0
El CAPPORT Li ROCKERY
FO-FA—CTIVITY) EXPLAIN:
SPECIAL INSPECTOR
B
-E
R QUIRED 0
E
YES
rREMARKS
AREA
P
P C R UBC 108
PROGRESS INSPECTIONS PE
577�� /A WK # 5- 3
NUM9E.
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STORIES 1 4— UNITS . — - I .... —
6 6 a ymnu
DESCRIBE WORK TO BE DONE IATTAC. PLOT PLANII
- a
FINAL INSPECTION
REOUIRED
VALUATION
FEE
PUN CHECK FEE
BUILDING
HEAT SOURCE:
`/B
PLUMBING
j
rplen Check No. 22=!921
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the pubIll=l.n= sidewelks,
driveways, marquees, etc.) wil rmission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE �1
Pennit Limit: 1 Year - Provided Work Is Started Within 180 Days
'App11c,,j,o,n be I Or her Spouse, heirs, assigns and
of h 5
ENO. INSPECTION FEE
SU n a. agrees to indemriI,,,fGJ.olend an
C .... re B, Z! 'd hDIS1,
harmless the Cl 'Y Of Edmond' We I n ,a
cl-Im-
emp eye 5, n giants from an, �nd .11 I., damages .1
h.f.V.,erNaf`Urde,`arI.ing directly or Indirectly from the Issuance
am to
of this permit. Issuance of this perrmlf sihg�l nnoyl be d1l.er, ad
PLAN CHECK DEPOSIT
modify, waive or reduce r.,. am n 'y dInarce
Carly,
nor limit In any way the Ity s ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
i I hereby acknowledge that I nave read this application; that the
ATTENTION
APPLICATION APPROVAL
information given I a correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is net a,
:ta a laws regulating construction; and In doing the work aulhortz.
in of the Labor
ALT. V
ONLY T E
1perml��ntil
h"ll'
signed ha.%.1d;I
bynd
d thereby. no person will be employed violation
Code Of the state Of Washington relallng to Workman's Compansa.
WORK NOTED
pt I
Deputy.,,
acknow dgedjrj04C,*proVIdd.
tion Insurance afic RCW 18.27.
INSPECTION
DEPARTMENT
I NATURE( N R N I DATE SIGNED
_5F_FlClALS SIGNATURE DATE
ITY OF
ECDMONDS
CALL FOR
ATTEUTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OF;
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
PINK GOLD A-IISS.,
SECTION 109
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