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20030941.pdfDATE RECEIVE CITY OF EDMONDS CMKM PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS PjQZ flNj;p,4Njj -MMqR# ZTBM14 Y 0 - Fs MAILING ADDRESS 9-40OLI 824 V1 CITY ZIP TELEPHONE EdInon J 99OU 1425-742-01463 NAME ADDRESS CITY ZIP ITELEPHONE NAME A - / . ICBLN ADDRESS CITY ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY NEW XRESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN 0 REPAIR 0 GRADING CYDS FENCE X_ FT) DEMOLISH [3 TANK OT -Amlu [CI -A [3 GARAGE CARPORT RETAININGWALL 0 ROCKERY FIRE SPRINKLER FIRE ALARM (TYPE Of.PSE, BUSINESS OR ACTIVny) EXPLAIN: NUMBER NUMBER OF OF DWELLING AREAS STORIES UNITS NUMBER _1 CRITICAL DESCRIBE WORK TO BE DONE HEAT SOURCE GLAZING % LOT SLOPE % PLAN CHECK NO: 2L a VESTED DATE THIS PERMIT AUTHORInS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBUC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, UARQUEES, ETC.) WILL REQUIRE 3 SEPARATE PERMISSION. PERMIT APPLICATION: 180DAYS PERMIT ILIMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- OEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION o,'UIVEN 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. DATE SIGNED _0 I PERMIT EXPIRES I r USE PERMIT ZONE NUMBERCO&3,—(V Joe sUVE/APJ# ADDRESS 2 100-4 82j� 104 JAI PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AP '=. RtW;bCF1s1.1PR Street Use Peffnit Req'd EXISTING - PROPOSED Inspectlon Required SIdewalkRequ�ed REQUIRED DEDICATION- FT nderground Widng isquired 13 METER SIZE LINE SIZETNO. OF FIXTURES PRV REQUIRED YESI3 NO C3 z REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE REVIEWED BY DATE FIRE REVIEWED BY DATE M VARIACE Oli CFJ SHORELINE ORADB# ]F IN&t6TION BOND REO'D 1[3YEs POSTED 1 4P S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR PARKING LOT AREA P N, rG REVIEWED BY D REQ'D I PROVIDED 91' IREMARKS CHECKED BY ITYPE OF CONSTRUCTION COIDE— UUL;UrA'!? -1117 I q7 GROUP I , —30 SPECIAL INSPECTION JAREA OCCUPANT REQUIRED [3 YES I LOAD & REMARKS M Of KPROGRES$ INSPECTI(IINS PER UBC 108/FINAL INSPECTION REQ'D —04 0 7 574 1' "? J 'r Z- � . 1. Z If - $ L - Description FEE Description FEE Plan Check State Surcharge Building Permit City Surcharge_ Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Plan Chk. Deposit Fire Inspection Receipt # Landscape Insp. Total Amt. Due Recording Fee Receipt # CALL FOR INSPECTION 42 ( 0) 771-0220 APPLICATION APPROVAL This application is not a permit until signed by the Building Official of histher Deputy: and Fees are paid, and receipt Is acknowledged In space provided. OFFICIALS SIGNATURE DATE 3 4AI DATE RE S E RJUK ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL MY I &A A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YEI I CAN - INSI(ECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING z 74 M C M -4 § 0 C 51 z M z 3� ' 0M t)o co 0 Fn C? C a MO z 0 1 0 M 6. RETURN ADDRESS: City of Edmonds, City Clerk CONFORMED COPY 121 5th Avenue North 200401050534 3 PGS 01-05-2004 04:16pm $21.00 Edmonds, WA 98020 SNOHOMISH COUNTY; WASHINGTON NOTICE OF LEWITATION AND COVENANT ADULT FAMILY HOME Reference #: 14 Additional on pg.— Grantor(s): Grantee(s): City of EdmUnds Legal Description (abbreviated): Sec_±9 Twn—jZ__—jKngy 04 t. OR & WOO 449 (2 Assessor's Tax Parcel ID#(s): (1) 19-06422,-( -----,4ssessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING Edmonds By: Date:hVq/" Page__/_of—,4�� WHEREAS, the undersigned owners of property located at24004 82nd .-PL - W in Edmondsq 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 notifled the applicant that the permit will be issued conditioned on limitation of residents to 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: At Cgvengnt: LoWtation on Relidence. The owner hereby stipulates and agrees that occupancy of the structure as an adult family home shall be limited to V 6' , 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 - IC - residents or attempts to ren4 lease or otherwise provide residence for additional residents above the A 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 effect. The owner fart ' her stipulates that this covenant touches and concerns the land so long as the present structure and use continues and shall run with the land to all future purchasers and assigns. 2. SubJect 1ract. The above stipulation and promises shall apply to and ran with the land with respect to a residential structure located at24004 L2qd.- Tk.Vj . Edmonds, Washington and legally described as: L,gk-E Mkk BLk Wo A-60 3. Notification to Enjure PMrchasers and Assignees, This notification and covenant has been recorded In the records of Snohomish County, Washington In order to provide notice to any and all future owners of the property of the limitation at the current level of improvement to single families and adult family home residents fewer than 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 this code and, in so doing, to recover its reasonable attorney's fees and costs. AUTHORIZED FOR RECORDING City of Edmonds By,, W — - — _A02 Z-a zAod Page of DATED this %24eh day of -*XLW ACCEPTED BY: OWNER: Jeannine L. Grn�. Building Official NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington ) County 04 )ss APPLICANT/PROPERTY Applicant Applicant Owner . �a_naa� &�� Owner N COVENANT AND ACKNOWLEDGED: Mortgagor #A A A A.0 / / I certify that I know or have satisfactory evidence that YK signed this instrument; on oath stated that helshe was authorized to execute A ipstrument and acknowledged it as the -(title) ofa. * �&Z NOW, - -_ — (imame 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 nstrument. Subscribed and sworn to before me this day of Notary Public In and for the S f as-ington. ,.,Mte o w h My commission, expires- 4 . Id-Z I certify that I know or have satisfactory evidence that il-ki'mmin signed this instrumen4 on oath stated that helske warthorl zed to execute t I t nt and acknowledged it as the _Qd(.16 (title) of --w 7 kb4ame of party on behalf on whom instrument was executed) to be the free and voluntary act of such party for the uses and pur mentions in this i=1 Subscribed and sworn to before me this 7W day of A/ .v P-1,40 --z7. aj'� W� 0 ) - Notary Public in and for My commission expires- L:%TEMP\BUILDING\FORMS\ADF-COV.DOC A ,of W shington. ,P) �-7 a L J. "A 14, REQUEST FOR INSPECTION- Adult Family Home APM=TM NUMBW Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. &V ZEL*: 99&44.0 MOO SrrE ADORESS:2,102 82- Ad P1- Vf- ASSSMSTWPAP — — — — — .2,15MI 11111W NUMBER! Mile]," TO 4 #9N 6 Ed N E MOPEM OWNElk NW: R .4 DAYnME BENiqAiJV PIUMCMA111 UCENSEE WM OF DOTBUNn: DAYnME PHONE: 12-f Y�t /a Y and all components for A complete fKW plan must Include all sleeping rooms, klerMed by number (*1, *2, *3 etr d� form Ift and devators. (Attach additional dvxft If necessary) exiting, Le. stairs, ramps, plad I'st .— 'TU R E: ,B LC -4-w� D - LAIM R/*SIGN*A I certify under penalty of PerJury that the Infionnation furnished by me is true and correct to the best of my WvMeft and that I am authorbmd by the owner of the above premises to request Inspection for and operate an Adult Family Home at this location. I further COW that I ham "VIde applicad n r to the Departnient of Socla[ and Health services and the Jurisdiction for the appropriate licertm(s) to conduct such business at this WmftL I fwtdw agree to hold harmless the Jurisdiction oorKlucting such Inspections. at my request as tx) any claim (including C061:56 VVenw-4 and aamwW fees incurred In the investigation of such claim), which may be made by arty person, Including the undersigned, rind filed against the Jurisdiction, but only where such claim arlses out of the reliance of the Jurisdiction, including its ofters and employees, upon the accuracy of the information supplied to the jurl9diction Nasa r�t of ;this awpplicai3tion. NAME/TIM: DATE: 0 pRopERTy OWNElt 00 APPUCANT D UCENSEE Sbq*q Rmn *1 P511's 0 NSI 0 NS2 Bedroom door Is openable from the outsIde when lo� Closd doors are madly openable from the Inside Smoke alarm Is Installed In the bedroom Sleeping room window has a m1r9mum net openable area of 5.7 sf. (mwmn amwdws- W tdgh; 2V We) Sleeping room wkWm has a rroftum sM height of 4,r Sbqft Rown *2 R"s 0 NSI 0 NS2 &Wroom door Is openable from the outside when locked Closet doors are readily openable fnxn the Inside Smoke alarm Is Installed In the bedroom Sleeping roorn v*odow has a n**nm net openable area of 5.7 sf. (mwmtmn onmftw 2v high, 2V vMe) Skqft mom window has a rrofturn sill height of 440 Skqft Rom *3 13 S 0 NSI 0 NS2 Bedroom door Is openable ftm the outside when locited Owsel: doors are readily openable from the Inside Smoke alarm Is InstaMd In the bedroom Sleeplr* morn wWm has a n**num net openablee area of 5.7 sf. (mwmm &mmims- 2,r ho; 2V We) Sleeping mom window has a noftum sill height of 4,r SbqphM Room *4 es 0 NS1 0 NS2 Bedroorn door Is operiable from the outside when lod(ed Closet doors are madly openable ftorn the Inside Smoke alarm Is Instaled In Me bedroom Sleeping mom wirmbw has a mk*num net openable area of 5.7 sf. (mwmum &nmftu- 2,r tigh, 2v wwo) Sleeping room window has a maAmurn sill height of W Sbapbs Rown #5 Os 0 NSI 0 NS2 Bedrom door Is openable ftorn the outside when lod(ed doors am readily openable Rom the Inside Smoke alarm Is Installed In the bedroorn Sleeping , w , window has a minimum net openable area of 5.7 sf. (mwmurn &nmftr,. 24,, wgN 2v voe) Sk*pIng ooi, window has a maximum sM height of 44N SMqp1ng RO=n *6 0 S 0 NSI 0 NS2 Be*oorn door Is openable from the outside when locked Closet doors am madly openable from the Inside Smoke alarm Is Installed In the bedroom Sleeping room window has a minimurn net openable area of 5.7 sf. (mwnwm d.mm*m- 24w tigh; 2ir wme) Sleephv mom whxbw has a nodmum sill height of 44ff GIs Bathroorn doors are opwvdk ftm the outskle, when Wced Srrooke alanw are kistalled on all levels of the dwelling All smake alarms are audible In ad parts of the dwelling upon activation of a single device Access road and water supply approved by Hre Department PASSED NS REQUIRED 0 PERMT REQUIRED 31b INSPECrOR: DATE: MV,.. FINAL PfflffL"T APP&O.VAL FORM a 2. 3. RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL Date Siga ocaprvl.doc.I:WM:bldg:formsIO/OI z 9 0 m =i 9 V5 -r-' OM c ma 0 80 c: --I m MM m Z co 0 m M 0 0 0 M C M 0 Z z co) z 9 0 m IL 0 E 0 C3 0i ADULT FAMIL-Y "Y'OMT'/ L1r1ENSSE---1-,, License Number: 665100 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 BENIAMIN PALANGEANU to conduct and maintain at 21004 82ND PL W City of EDMONDS, Zip Code 98026 County of SNOHOMISH State of Washington an Adult Family Home for the care and supervision of adults as follows: 24-hour care for no more than 6 adults RECEIVED This license shall be in force from the I Sth of April, 2004 subject to suspension or revocation for due cause. APR 2. .120 U") MRMIT COUMI I Conditions on License, if any: Licensing Authority NOTE: The department rcncwal of a license does not preclude the depa+nt o taking any 2�tion under. WAC 388-76-705, based on inspection. This license is not transferable, and is valid only for use by the corporation, partne 0 or I ndlvldual(s) to whom it is Issued and2t the 10C2tion above described. Issued by Authority of Chapter RCW 70.12 RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS� ..... . ........... . FOUNDATIOW'. Footing...................... 'Wall ........................... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... C PLUMBING: girw Underground ............. Rough -in . .................... 'Commercial Final ...... 10 Z� HEATING' GasTest ... ................ G s Piping a Equipment ............... C OMM arcial Final:....' EXTERIOR SHEATHING ,NAILING .................. ....... FRAMING ......... ..... T OL60R FRAMI 'FIRS NG. INSULATION ................... Floor Insulation ......... Z) :Wa I Insulation ...... ceiling Insulation ....... M'. SHEETROCK 14AILING� ... SPECIAL INSPECTION ... MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY ... .............. AftftAl coo7 �rl CITY OF EDMONDS I I ==M PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS P&NNIMANY-nim,go 7*flAMY fi-F,h MAILING ADDRESS 240014 82nd N - V1 CITY ZIP TELEP14ONE Edmond 5, W4 O&OU 14257-742-0/483 IATTIF:; CITY NAME ADDRESS CITY STATE LICENSE NUMBER I It ZIP I TELEPHONE CBL N PERMIT EXPIRES (44 �Elv:;f — USE PERMIT 0� ZONE NUMBER JOB ADDRESS 2 loo .4 8 2..,v.0 SUVE/APj# W PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Ap RW Penni, rPa_ff=%" Street Use EXISTING — PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRY REQUIRED I I YESE3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERING FIRE REVIEWED BY DATE _—ITELEPHONE ZIP ,O�,2 VARIA'NCE OR Cb % SHORELINE OR ADBN INdP9tTION BOND EXPIRATION DATE CHE CKED BY .mm� REQ%NO $ POSTED I 113YEs I SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED NEW RESIDENTIAL ADDITION,, COMMERCIAL 0 RE DEL MULTIFAMILY EPAIR z GRADING CYDS DEMOLISH TANK oGARAGE RETAININGWALL CARPORT ROCKERY. (TYPF;%P�E. !�SINESS OR ACTIV" EXPLAIN: A_— . A , NUMBER' NUMBER OF OF " DWELLING STOAES UNITS DgliICRIBE WORK TO BE DONE 00 EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) 0 PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR COMPIL ANCE OR z 0 CHANGIE OF USE I - PARKING LOT AREA P N NG REVIEWED BY DjTE U SIGN REQ`0 I PROVIDED A L� oFENCE ( X FT) REMARKS OTHER *-�-E ,,VTC L40 e FIRE SPRINKLER FIRE ALARM 0 CHECKED BY ITYPE OF CONSTRUCTION CODE 117 CRITICAL AREAS SPECIkLINSPECTION JAREA NUMBER 9/j± REOU;qED [3 YES PECTIONS PER UBC 108/FINAL ,09- A 94110 1 E OCCUPAk 43ROUP OCCUPANT LOAD 6 Ill ON REGVD I § C;; IN. � $ Descriptlon --I N FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit _TM City Surcharge PLM CHECK NO: z VESTED DATE Plumbing Mechanical '17 THIS PERMIT AUTHORIZES ONLY THEWORK NOTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPEMY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DONWN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMITAPPLICATIOW 180DAYS PERWT UUM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS trign. SEE BACK OF PINK PERMIT FOR MORE INFORMATION .Inspection "APPLICANT, ON BEHALF OF HIS OR . HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deprosit IN INTERESif. AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEK AND AGENTS FROM ANY AND Fire Inspection Receipt 0 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due I DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE ABILITY ENFORCE ANY ORDINANCE PROVISION.' - NOR LIMIT IN ANY WAY THE CITYS TO llw� Recording Fee Receipt 0 laq )-. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN 18 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- CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Oftlal or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN`S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE .- I i'l.".. L PATESIGNED SIGNATURE (OWNER I 1A10 ) P-125 - �43 /0 1-02 0 R SE DATE ATTENTION M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ?7/ =/ 1. z - A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YEI I nk INS(ECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING less