20000781.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAN CHECK FEE
BUILDING
HEATSOURCE: GLAZING
ab
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done an private property ONLY.
GRADINGIFILL
Any construction on the public domain (c sldewPiks,
driveways, marduees, BID) will require sep= permission.
STATE SURCHARGE
permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: I Year - Provided Woe. Is Started Within 180 Days
"Applicant, on behalf of his or her spouse 'ITS, assigns and
lndemnjj�Ird.f�nd and held
ENG. INSPECTION FEE
S in interest, agrees to
uccessors Ed d !IS .111cial
harmless the City of 'me' a IT
ClInglon,
employees, and agent. from any �niWaf aims for damages of
whatever nature Brising directly or indirectly from the I ssuance
of this permit. I�suance of this permit sha�l not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement o any city ordinance
nor limit In any way the City's abi Ity to enforce any ordinance
TOTAL AMOUNT DUE
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provision.-
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I hereby acknowledge that I have read this application: that the
ATTENTION
APPLICATION APPROVAL
information given is orreCt*,:nd,that I am the owner, or the duly
authorized agent of the ow I, gree to comply with 'Ity and
THIS PERMIT
This application is not a permit until
statelaws regulating construction; and theworkauthoriz
Labor
AUTHORIZES
oM T
LY �E
signed by the Building Official or his/her
d1r,doing
ad thereby am P ,a T violation .1 the
WORK NOTED
Oeputy: and fees are paid, and receipt is
Code of h� Eo�,,Pee.rslonaw�h'Lbg-
at ing o W rkmen's Com pensa.
ton rello o
acknowledged in space provided.
tion Insigg=o RCW 18.27,
INSPECTION
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CITY OF
EDMONDS
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CALL FOR
'RELEASED
TTENTION
INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
BEEN MADE AND APPROVAL OR 771-0220
ORIGINAL — File YELLOW — Inspector
UN& A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109
10247
PINK — Owner GOLD Assessor
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MAL PROJECT APPROVAL FORM
TO:
-DATE-
wmo To: PERmrr COORDINATOR, BUILDING DIVISION
FROM: FIR DEPARTNIENT D
NGINEERING DIVISION DATE—
LANNING DIVISION DATE,
.PROJECT &,�,2c-!� A—Fr4
SrTEADDRES 9106 LILLA- 4212-
PERMIT --ADB#------DATE INSPECTED-�1--7—L-00 0
DESCRIPTION OF WORK TO BE INSPEC
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
inal 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
___---FAILED FINAL INSPECTION - OUTSTANDING ISSUES
2.
3.
OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
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"TURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
CONFORMED Copy
200010020239
10/02/2000 11:41 AM Snohomish
P-0003 RECORDED County
NOTICE OF MUTATION AND COVENANT
ADULTFAMILYHOME
Reference #
Grantor(s): (2) Additional on pg.—
Grantee(s): CifyofEdmonds
Legal Descrilition (abbreviated):
OR Lot_ '5iery-n- Ulg"
Assessor's Tax Parcel ID#(s): (1)
_____Assessor's Tax Parcel 1D# not yet assigned
EFORRECORDING
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By. ,L AEdmonds
:7—
of
Page-�-01`25—
WHEREAS, the undersigned owners of property located at 800G sterup,
DRiUk6 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 .5 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. Covynant -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 residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
,6' 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 effecL 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. Subiect Tract, The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at A60G -SLC!YZA
e, Edmonds, Washington and legally described as:
I . - I - -
3. Notification to Future Purchasers and Assigagg& 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
Imitation at the current level of improvement to*single families and adult family
home residents fewer than 6' 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.thig
code I and, in so doing, to recover its reasonable attorney's fees and costs.
L AUTHORIZED Fop. RECORDING
City of Edmonds
"—Pge- - of S
DATED this 2--0 71 . .... —day of (�-,or , —x4La-,
ACCEPTED BY: APPLICANT/PROPERTY
OWNER:
. L3,
Applicant
Jeaiittine L. GraT-
Building Official
#
NOTIFICATION
Applicant
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington )
, )ss
County of 5=64a-
I certify that I know or have satisfactory evidence that
signed this instrument, on oath stated that e/she authorized to execute the
instrument and acknowledged it as the vl)= (title) of ,
22I&MA Af�k (name of party on behalf on whom instrument was executed) to be the
free Ad voluntary act of such party for the uses and purposes mentions in this
instrument. Subscribed and sworn to before me this zO 4-L day of 0
,�c ep
'qqary Public in and for the State fif Washington. —0—
ATy commission expires �5 91 PUSL10
I certify that I know or have satisfactor5
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 _ day of
-19—.
Notary Public in and for the State of Washington.
My commission expires
AUmoRIzED IroR RECORDING
City of Edmonds
BY: Ail� . Date:±��-rl
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