20020886.pdfOW DATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF DUSINE
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THIS PERMIT AUTHORINS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
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DOMIRIN (CURBS, SIDEWALKS, DRIVEWAYS UEEI, ETC.) WILL REQUIRE
SEPARATE PERMIS's "lov.
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City Surcharge
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IN INTEREST, 'AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAM ES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
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FROM THE I SUANCE F THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
DEEMED TO MCIDIF� WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Fire Inspection
Total Amount Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Receipt at
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
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APPROVAL
GIVEN IS COIFIECr, 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.
CALL
This plicadon Is not a Panne ontit signed by and
TI.N; AND IN GOING THE WORK ALITI-1.1111E. THEREBY . NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSATION INSURANCE AND Row 18.27,
FOR INSPECTION
6.110.0 0"Ptaial or hairs, Depty: and Fees are paid, and
non1pt 1, dakno.i.dgad Itt.psist. p—Id.d.
DATE SIGNED
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OF DATE
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ATTENTION
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
YELLOW -INSPECT A
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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SITE LEASE WITH OPTION
THIS SITE LEASE WITH OPTION ("Lease") is by and between Walter-L & Dianne M Berschaue ("Landlord") and
Voicestream PCS III Corporation, a Delaware corporation ("Tenant").
1. Option to Leas
(a) In consideration of the payment of and No/100 Dollars (the "Option Fee) by Tenant to
Landlord, Landlord hereby grants to Tenant an option to lease the use of a portion of the real property described in the attached
Exhibit A (the 'Property"), on the terms and conditions set forth herein (the "Option"). The Option shall be for an initial term of
twelve (12) months, commencing on the Effective Date (as defined below) (the "Option Period"). The Option Period may be
extended by Tenant for an additional twelve (12) months upon written notice to Landlord and payment of thesurn of
and No/100 Dollars ('Additional Option Fee") at any time prior to the end ofthe Option Period.
(b) During the Option Period and any extension thereof, and during the term of this Lease, Landlord agrees to
cooperate with Tenant in obtaining, at Tenards expense, all licenses and permits or authorizations. required for Tenam's use of
the Premises from all applicable government and/or regulatory entities (including, without limitation, zoning and land use
authorities, and the Federal Communication Commission ("FCC") (the 'Governmental Approvals"), including appointing Tenant
as agent for all land use and zoning permit applications, and Landlord agrees to cooperate with and to allow Tenam, at no cost to
Landlord, to obtain a title report, zoning approvals and variances, land -use permits, and Landlord expressly grants to Tenant a
right of seem to the Property to perform surveys, soils tests, and other engineering procedures or environmental investigations
on the Property, necessary to determine that Tenant's use of the Premises will be compatible with Tenard's engineering
specifications, system design, operations and Governmental Approvals. During the Option Period and any extension thereof,
Tenant may exercise the Option by so notifying Landlord in writing, at Landlord's address in accordance with Section 12 hereof.
(c) if Tenant exercises the Option, then, subject to the following terms and condition s, Landlord hereby leases to
Tenant the use of that portion of the Property sufficient for placement of Antenna Facilities (as defined below), together with all
necessary space and easements for access and utilities, as generally described and depicted in the attached Exhibit B (collectively
referred to hereinafter as the "Premises"). The Promises, located at 9710 Edmonds Way, Edmonds, WA 98020, comprise
approximately 300 sq/ft. square feet.
2. Term. The initial term of the Lease shall be five (5) years commencing on the date of the exercise of the Option
(the 'Commencement Date"), and terminating at midnight on the last day ofthe initial term (the "Initial Term").
3. Permitted Use. The Premises may be used by Tenant for, among other things, the transmission and reception of
radio communication signals and for the consouction, installation, operation, maintenance, repair, removal or replacement of
related facilities, tower and base, antennas, microwave dishes, equipment shchers andfor cabinets and related activities.
4. Rent. Tenant shall pay Landlord, as rent. and No/100 Dollars per month ("Rear). Rent
shall be payable in advance beginning on the Commencement Date prorated for the remainder of the month in which the
Commencement Date falls and thereafter Rent will be payable monthly in advance by the fifth day ofcach month to Walter L &
Dianne M Bcmebau at Landlord's address specified in Section 12 below. Ifthis Lease is terminated at a Came other than on the
last &y of a month, Rent shall be prorated as of the date of termination for any reason other than a default by Tenant, and all
prepaid Rent shall be immediately refunded to Tenant.
5. Renewal. Tenant shall have the right to extend this Lease for five (5) additional, five-year ternis ("Renewal Term").
Each P�qewal Term shall be on the same terms and conditions as set forth herein, except that Rent shall be increased by
A the Rent paid over the preceding term. This Lease shall automatically renew for each successive Renewal Term
unless Tenant notifics Landlord, in writing, of Tenant's intention not to renew this Lcasc, at least sixty (60) days prior to the
expiration ofthe Initial Term or any Renewal Tenn. IfTenant shall remain in possession ofthe Premises at the expiration ofthis
Lease or any Renewal Term without a written agreement, such tenancy shall be deemed a mouth-to-mouth tenancy under the
same terms and conditions ofthis Lease.
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6. Interference. Tenant shall not use the Premises in any way which interferes with the use of the property by
Landlord, or lessees or licensees of Landlord, with rights in the Property prior in time to Ternmes (subject to Tcrmfs right,
under this Lease, including without limitation, non-interfercnce). Similarly, Landlord shall not use, nor shall Landlord permit its
lessees, licensees, employees, invitces or agents to use, any portion of the Property in any way which intcrlorcs with the
operations of Tenant. Such intcrferen" shall be deemed a material breach by the interfering party, who shall, upon written
notice from the other, be responsible for terminating said interference. In the event any such interference does not coast,
promptly, the parties acknowledge that continuing interferon" may cause irreparable injury and, therefore, the injured party
shall have the right, in addition to any other rights that it may have at law or in equity, to bring a court action to enjoin such
interference or to terminate this Lease immediately upon written notice.
7. IMP-r-ovements; Utilities: Access.
(a) Tenant shall have the right, at its expense, to erect and maintain on the Premises improvements, personal property
and facilities necessary to operate its communications systern, including, without limitation, radio titinsmitting and receiving
antennas, microwave dishes, tower and base, equipment shelters and/or cabinets and related cables and utility lines (collectively
the "Antenna Facilities"). Tenant shall have the tight to replace or upgrade the Antenna Facilities at any time during the term of
this Lease. Tenant shall cause all construction to occur lien -free and in compliance with all applicable laws and ordinances. The
Antenna Facilities shall remain the exclusive property ofTenant. Tenant shall have the right to remove the Antenna Facilities at
any time during and upon termination ofthis Lease.
(b) Tenam, at its expense, may use any and all appropriate means of restricting access to the Antenna Facilities,
including, without limitation, the construction ofa fence.
(c) Tenant shall, at TenanCs expense, keep and maintain the Antenna Facilities now or hereafter located on the
Property in commercially reasonable condition and repair during the term of this Lease, no
mial wear and tear and casualty
excepted. Upon termination or expiration of this Lease, the Premises shall be returned to Landlord in good, usable condition,
normal wear and tear and casualty excepted.
(d) Tenant shall have the right to install utilities, at TenanVs expense, and to improve the present utilities on the
Property lincluding, but no, limited to, the installation of emergency power generators). Landlord agrees to use reasonable
offorts in assisting Tenant to acquire necessary utility service. Tenant shall, wherever practicable, install separate meters for
utilities used on the Property. In the event separate meters are not installed, Tenant shall pay the periodic charges for all utilities
attributable to Tenant's use. Tenant shall have the right to install necessary conduit and sleeving from the roof to the point of
connection within the Building. Landlord shall diligently correct my variation, interruption or failure ofutility service.
(c) As partial consideration for Rent paid under this Lease, Landlord hereby grants Tenant an casement in, under and
across the Property for ingress, egress, utilities and access (including access for the purposes described in Section 1) to the
Premises adequate to install and maintain utilities, which include, but are not limited to, the installation of power and telephone
service cable, and to service the Premises and the Antenna Facilities at all times during the Initial Tom of this Lease or any
Renewal Tem (collectively, "Basemene'). The Easement provided hereunder shal have t e in t s
I h sa c erm as thi Lease
(I) Tenant shall have 24-houm-a-day, 7-days-a-week access to the Premises at all times during the Initial Tenn of this
Lease and any Renewal Tem.
8. Termination. Except as otherwise provided herein, this Lease may be terminated, without any penalty or further
liability as follows:
(a) upon thir.ty (39),days written notice by Landlord ifTenant fails to cure a default for payment ofamounts due under
this Lease within that thirty (30) day period;
(b) upon thirty (30) days written notice by either party if the other party commits a non-monctaty default and fails to
cure or commence curing such default within that thirty (30)-day period, or such longer period as may be required to diligently
complete a cure commenced within that thirty (30)-day period;
(c) immediately if Tenant notifies Landlord of unacceptable results ofany title report, environmental or sail tests prior
to Tcnant*s installation of the Antenna Facilities on the Premises, or ifTermut is unable to obtain, maintain, or otherwise forfeits
or Meals any license (including, without limitation, an FCC license), permit or Governmental Approval necessary to the
installation and/or operation of the Antenna Facilities or Tenant's business;
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(d) upon ninety (90) days written notice by Tenant if the Property, or the Antenna Facilities we or become
unacceptable under Tenant's design or engineering sliccifications for its Antenna Facilities or the communications system to
which the Antenna Facilities belong;
(c) immediately upon written notice by Tenant ifthe Premises or the Antenna Facilities are destroyed or damaged so as
in TenanVs reasonable judgment to substantially and adversely affect the effective use of the Antenna Facilities. lnsuchcvcnt,
all rights and obligations of the parties shall cease as ofthc date of the damage or destruction, and Tenant shall be entitled to the
reimbursement of any Rent prepaid by Tenant, If Tenant elects to continue this Lease, (lien all Rent shall abate until the
Premises and/or Antenna Facilities are restored to the condition existing immediately prior to such damage or destruction; or
(f) at the time title to the Property transfers to a condemning authority, pursuant to a taking of all or a portion of the
Property sufficient in Tenant's determination to render the Premises unsuitable for Tenant's use. Landlord and Tenant shall each
be entitled to pursue their own separate awards with respect to such taking. Sale of all or part ofthe Property to a purchaser with
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the power ofeminent domain in the face of the exercise of the power shall be treated as a taking by condemnation.
9. Ines. Tenant shall pay any personal property taxes assessed on, or any portion of such taxes directly attributable
to, the Antenna Facilities. Landlord shall pay any real property taxes or other fees and assessments attributable to the Property.
In the event that Landlord fails to pay my such real property taxes or other fees and assessments, Tenant shall have the righ4 but
not the obligation, to pay such owed amounts and deduct them from Rent amounts due under this Lease.
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10. Insurance and Subrogation.
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(a) Tenant shall provide Commercial General Liability Insurance in an aggregate amount of One Million and No/100
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Dollars ($1,000,000.00). Tenant may satisfy this requirement by obtaining the appropriate endorsement to any master policy of
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liability insurance Tenant may maintain.
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(b) Landlord and Tenant hereby mutually release each other (and their successom or assigns) from liability and waive
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all right of recovery against the other for my loss or damage covered by their respective first party property insurance policies
for all perils insured thereunder. In the event of such insured loss, neither partys insurance company shall have a subrogated
claim against the other.
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11. Hold Harmless Tenant agrees to hold Landlord harmless from claims arising from the installation, use,
maintenance, repair or removal of the Antenna Facilities, except for claims arising from the negligence or intentional acts of
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Landlord, its employees, agents or independent contractors.
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12. Notices. All notices, requests, demands and other communications hereunder shall be in writing and shall be
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deemed given if personally delivered or mailed, certified mail, return receipt requested, or sent by for next-busincss-day delivery
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by a nationally recognized overnight carrier to the following addresses:
Ifto Tenant, to: With a copy to: Ifto Landlord, to�
Voicestream Ks Seattle Walter L. & Dianne M. Berschatier
t2920 SE 38* St. Attn: Lease Administrator 19934 NW Hood Point Road
Bellevue, WA 98006 19807 North Creek Parkway North Seabeck, WA 98380
Attn: PCS Leasing Administrator Bothell, WA 98011
With a copy tw. Attn: Legal
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13. Quiet Enjoyment, Title and Authority Landlord covenants and warrants to Tenant that (i) Landlord has full right,
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power and authority to execute this Lease; (ii) it has good and unencumbered title to the Property free and clear of my liens or
mortgages, except those disclosed to Tenant and which will not interfere with Tenant's rights to or use of the Premises; and (iii)
execution and performance of this Lease will not violate my laws, ordinances, covenants, or the provisions of any mortgage,
lease, or other agreement binding on Landlord. Landlord covenants that at all times during the term ofthis Lease, Tcnmfs quiet
enjoyment of the Premises or any part thereof shall not be disturbed as long as Tenant is not in default beyond my applicable
grace or cure period,
Si� Number. SE1632A R— 2100
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14. Environmental Laws. Landlord represents that it has no knowMge of any substance, chemical or waste
(collectively "Hazardous Substance') on the Property that is identified as hazardous, toxic or dangerous in any applicable
federal, state or local law or regulation. Landlord and Tenant shall not introduce or use any Hazardous Substance on the Property
in violation of any applicable law. Landlord shall be responsible for, and shall promptly conduct any investigation and
mmudiation as required by any applicable environmental laws, all spills or other releases ofany Hazardous Substance not caused
solely by Tenant, that have occurred or which may occur on the Property. Each party agrees to defend, indemnify and hold
harmless the other from and against any and 211 administrative andjudicial actions and rulings, claims, causes ofaction, demands
and liability (collectively, "Claims") including, but not limited to, damages, costs, expenses, assessments, penalties, fines, losses,
judgments and reasonable attorney fees that the indcranitec may suffer or incur due to the existence or discovery of my
Hazardous Substances on the Property or the migration of any Hazardous Substance to other properties or the release of any
Hazardous Substance into the environment (collectively, "Actione), that relate to or arise from the indemnitor's activities on the
Property. Landlord agrees to defend, indemnify and hold Tenant harmless from Claims resulting from Actions on the Property
not by Landlord or Tenant prior to and during the Term and any Renewal Term of this Lease. 'Me indemnifications in this
section specifically include, without limitation, costs incurred in connection with my investigation of site conditions or my
cleanup, remedial, removal or restoration work required by my governmental authority. This Section 14 shall survive the
termination or expiration ofthis Lease.
15. Assignment and Subleasing. Tenant shall have the right to assign or otherwise transfer this Lease and the
Easement to any person or business entity which is authorized pursuant to and FCC licensed to, operate a wireless
communications business, is a parent, subsidiary or affiliate ofTenant, is merged or consolidated with Tenant or purchases more
than fifty (50) percent of either an ownership interest in Tenant or the assets of Tenant in the "Metropolitan Trading Aree' or
"Basic Trading AmC (as those terms we defined by the FCC) in which the Property is located. Upon such assignment, Tenant
shalt be relieved of all liabilities and obligations hereunder and Landlord shall took solely to the assignee for performance under
this Lease and all obligations hereunder. Tenant may sublease the Premises, upon written notice to Landlord. Tenant may
otherwise assign this Lease upon written approval of Landlord, which approval shall not be unreasonably delayed, withheld,
conditioned or denied.
Additionally, Tenant may, upon notice to Landlord, mortgage or grant a security interest in this Lease and the Antenna
Facilities, and may assign this Lease and the Antenna Facilities to any mortgagoes or holders ofsecutity interests, including their
successors or assigns (collectively "Mortgagees"), provided such Mortgagges agree to be bound by the terms and provisions of
this Lease. In such event, Landlord shall execute such consent to leaschold financing as may reasonably be required by
Mortgagees. Landlord agrees to notify Tenant and Tenant's Mortgagm simultaneously of any default by Tenant and to give
Mortgagees the same tight to cure any default as Tenant or to remove my property of Tenant or Mortgagees located on the
Premises, except that the cure period for any Morgagees shall not be less than thirty (30) days after receipt of the default notice,
as provided in Section 8 of this Lease. All such notices to Mortgagees shall be sent to Mortgagees at the address specified by
Tenant Failure by Landlord to give Mortgagees such notice shall not diminish Landlord% rights against Tenant, but shall
preserve all rights of Mortgagees to cum my default and to remove my property of Tenant or Mortgagecs located on the
Premises as provided in Section 17 of this Lease.
16. Successors and Assiggs, This Lease and the Easement grantod herein shall run with the land, and shall be binding
upon and inu the benefit ofthe parties, their respective successors, personal representatives and assigns.
17. Waiver of Landlord's Lien. Landlord hereby waives my and all lion rights it may have, statutory or otherwise
concerning the Antenna Facilities or my portion thcreafwhich shall be deemed personal property for the purposes ofthis Lem,
whether or not the same is deemed real or personal property under applicable, laws, and Landlord gives Tenant and Mortgagocs
the right to remove all or any portion of the same from time to time, whether before or after a default under this Lease, in
Tenant's and/or Mortgagee'g*sole discretion and Without Landlord's consent.
19. Miscellaneous.
(a) The substantially prevailing party in any litigation arising hereunder shall be entitled to its reasonable attomeys'
fees and court costs, including appeals, if any.
(b) Each party agrees to furnish to the other, within twenty (20) days after request, such truthful estoppel intormation
as the other may reasonably request.
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(c) Ibis Leasc constitutes the entire agreement and understanding ofthe parties, and supersedes all offers, negotiations
and other agreements, There are no representations or understandings of any kind not set forth herein. Any amendments to this
Lease must be in writing and executed by both patties.
(d) Each party agrees to cooperate with the other in executing any documents (including a Memorandum of Lease in
substantially the to= attached as Exhibit C necessary to protect its rights or use of the Premises. no Memorandum of Lease
may be recorded in place of this Lease by either party. In the event the Property is encumbered by a mortgage or deed of trust,
Landlord agrees, upon request of Tenant, to obtain and furnish to Tenant a nonAisturbance and attornment agreement for each
such mortgage or deed oftrust, in a form reasonably acceptable to Tenant. Tenant may obtain title insurance on its interest in the
Premises. Landlord agrees to execute such documents as the title company may require in connection therewith.
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(e) This Lease shall be construed in accordance with the laws of the state in which the Property is located.
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(f) If any to= of this Lease is found to be void or invalid, such finding shall not affect the remaining terms of this
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Lease, which shall continue in full force and effect. The parties agree that if my provisions are deemed not enforceable, they
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shall be deemed modified to the extent necessary to make them enforceable. Any questions ofparticullar interpretation shall not
be interpreted against the draftsman, but rather in accordance with the fair meaning thereof.
(g) The persons who have executed this Lease represent and wan -ant that they are duly authorized to execute this Lease
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in their individual or representative capacity as indicated.
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(h) This Lease may be executed in any number of counterpart copies, zaclit of which shall be deemed an original, but
all ofwhich together shall constitute a single instrument.
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(i) All Exhibits referred herein and any Addenda are incorporated herein for all purposes. Ile parties understand and
acknowledge that Exhibit A (the legal description of the Property) and Exhibit B (the Premises location within the Property),
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may be attached tc�this Lease and the Memorandum of Lease, in prclimit�ary form. Accordingly, the parties agree that upon the
preparation of final, more complete exhibits, Exhibits A, and/or B, as the me may be, which may have been attached hereto in
preliminary form, may be replaced by Tenant with such final, more complete exhibit(s), The terms of all Exhibits are
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incorporated herein for all purposes.
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0) If Landlord is represented by any broker or any other leasing agent, Landlord is responsible for all commission fee
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or other payment to such agent, and agrees to indemnify and hold Tenant harmless from all claims by such broker or anyone
claiming through such broker. If Tenant is represented by any broker or any other leasing agent, Tenant is responsible for all
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commission fee or other payment to such agent, and agrees to indemnify and hold Landlord harmless from all claims by such
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broker or anyone claiming through such broker.
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The effective date ofthis Lease is the date of"ccution bythe lastpartyto sign C'Effective DaW').
LANDLORD: Walter L. Berschauer
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LANDLORD:
Dianne M. Berschauer
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I certify that I know or have satisfactory evidence that Dianne M. Berschauer is the person who
appeared before me, and said person acknowledged that he/she signed this instrument and acknowledged it
to be his/her free and voluntary act for the uses and purposes mentioned in the instrument.
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STATE OF WASHINGTON
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I certify that I know or have satisfactory cvid ence that U is
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the person who appeared before me, and said person acknowledged that heshe signed this instrumem, on
oath stated that he/she,was authorized to execute the instrument and acknowledged it as the
or tion
E-Ae-CLICil,.e� 't>MCAOf of VoiceStream PCS III Corporation, a Delaware Corp a
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to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument.
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Notary Public
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My commission expires Ao- 12-
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EXHIBIT A
lAgal Description
Tbe Property Is legaity described as follows:
PARCEL A:
Lot 1, EDMONDS HI -WAY TRACT s, accordinS to the Plat thereof recorded in
volume 13 of Plats, Page 82, records of Snohomish County, Washington,
F IEPT that portion thereof conveyed to the state of Washington by deed
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recorded under Recording No, 2237962,
Situate in the County of Snohomish, State of Washington.
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PARCEL B-
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2, EDMONDS Ill-WAy TRACTS, according to the Plat thereof recorded in
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volume 13 of Plate, page 82, records of Snohomish County, Washington:
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EXCEPT the South 65 feet thereof;
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AND EXCEPT that portion thereof conveyed to the state of Washington by
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deed recorded under Recording No. 21?6693.
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Situate in the County of Snohomish, State of Washington.
to
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Lot 3, EDMONDS HI -WAY TRACTS, according to the Plat thereof recorded in
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volume 13 of Plats, Page 82, records of Snohomish County, Washington;
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EXCEPT the South GS feet thereof;
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AND EXCEPT that portion thereof conveye d to the State of Washington by
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deed recorded January 12. 1�71 under Recording Mo. ;�1602 02.
Situate in the County of Snohomish, -State, of'Washington.
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SiteNumber. SE1632A Rev. 2100
Site No= Edmonds Way Snow/Pud
Market: Seattle A4
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EXHIBIT'B'
Premises Location within the Property
SE1632.A Edmonds Way/SnoPud/Berseltauer
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- FINAL PROJECT APPR.0VAL -FORM
DATE:
MEMO TO: PERWr COORDINATOR, BUILDING DIVISION
FROM: DEPARTNIENT DATE —
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
PROJECT A10V 447
sr—rEEADDRESS
PERMIT 06 7 DATE INSPECTED 9�0
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DESCRIPTION OF WORK TO BE INSPECTED.-AF��,'
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROXECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED C (-tP —0,'- -32-,
a Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
o Copy of CORRECTION NOTICE given to owner/contractorby inspector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
ocaprvl.doc.l:ten4):bldg:forimIO/OI
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: F DEPARTMENT DATE-
DIVISION DATE
--3NGINEERING
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PROJECT ni(e,
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PERmrr IWZ-6 ffgB#---------PATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the a have signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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u Copy of CORRECTION NOTICE given to owner/contractor by inspector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprvl.doc.l:tenq).bldg:fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in ...................
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Commercial Final
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HEATING:
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Gas Test ....................
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Gas Piping .................
..Equipment .................
Commercial Final
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ............
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FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........