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20031005.pdfDATE CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 1 101 4M liaMEINAME OF BUSINESS :ArE� PliPLEVMV MAUT VAMIL1.1 WAF MAILING ADDRESS 100)1 22* Pic - W CITY TELEPHOVE 013 M(v �� 00 -49 ZIP NAME ADDRESS CITY NAME AD9q1ESS CITY STATE LICENSE NUMBER ZIP I TELEPHONE ZIP L Act NEW RESIDENTIAL ADDITION COMMERCIAL REMODEL 1:1 MULTIFAMILY REPAIR 0 GRADING CYDS DEMOLISH 1:1 TANK GARAGE RETAINING WALL 0 CARPORT ROCKERY (TYPE OF US BUSINESS OR ACTIVITY) EXPLAIN: I NUMBER OF fl. STOMES 44, NUMSER'0V DWELLING U We �1�14 DE6131111189WORK TO BE DONE'�)j CBL # LPERMIT EXPIRES L sees USE PERMIT ZONER'5 / NUMBER JOB SUITE/APT# ADDRESS 679mrnf")s 9A PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE 3 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TFSCP Appl=,ad Aw "." , Street Use Permit ReWd EXISTING — PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION— FT Underground Whingrequired METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES E3 NO 13 REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE I I'M", VARIANCE OR CU V A R 'A $HORELINEORADBN INSPECTION BOND IONDATE CHECKEDBY I REQ'D I POSTED I 13YES 01�0 $ — SEPA REVIEW 8 SIGN AREA HEIGHT COMPLETE EXEMPT C 0 M P' ALLOWED PROPOSED ALLOWED PROPOSED 1 62— L�� --A— EXP X P LOT COVERAGE LO REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) 13 PLUMBI NGIMECH A LL OW ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR C2 [3 COMPLIANCE OR r z CHANGE OF USE - - -_ PARKING P LOT AREA PLANNING REVIEWED BY D AT SIGN REO'D VIDED 14 a �Ruagt I I FENCE _I FT) REMARKS OTHER FIRE SPRINKLER FIRE ALARM CHECKED BY jTYPEjOF_CON TRUCTION COQE OCCUPANT 1, —T—CRITICAL 1/7 1 GROU�� AREAS SPECIAL INSPECTION JAREA OCCUOANT f NUMBER REQUIRED [] YES LOAD tREMARKS 2 P OGt R SS SP =0 SP USCI PROGRESS INSP!ECTIONS PER UBC 108/FINAL INSPECTION REG'D $ Description FEE Description FEE Plan Check zzo State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % T Building Permit city surcharge PLAN CHECK NO: VESTED DATE Plumbing Mechanical L THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPEM ONLX ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPILICATION: 180 DAYS 916 PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT; ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 MATURE, ARISING DIRECTLY OR INDIRECTLY CAP FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due 2-- DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..' Recording Fee Receipt N I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPR0VAL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CrTY AND STATE LAWS REGULATING CONSTRUC. CALL This applicallion Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THERESY, NO PERSON WILL BE EMPLOYED Building Offlcial 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 e,ee,ses, - EA AGENT TE IGNLa (425) d 771-0220 DATE ATTENTION Off 1333 AA A -- MZ64W�zal IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 40 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YE6 I PECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING a z 0 j 0 M =i:% 5i � 0 M C M _1 §' 0 C 3� r. M M o"n n 3� MM 0 0 0 Cc 0 z 0 9. 0 M 6 &A/z I P 1, Al Is A ENISE "V� 'M I 1 2 �NA 7 395404 .:'Litense Number: 44 4C, Pursuant toithe 1aW8 0ftA'f,SWd'6UW'sh6 le.. licensing, Requirements a i.ngton afid'llh 44-hertt anted to ep f* 4�tme* f So Hdalth Sd&ice_§,' h iffhnd gr rV IL RPOR CL 3 'R.7 , . .. % At A fiffli n� f6ditfd by *iVLX;X,'ij C'LGMTE if P`Aftfieh C*06 o rep. H-0 4 'Ain at 204 8 Jh0a niaitit L,N-f ik- g U jAn --St#te of Washifij#6n C, of"91DU91 M. fis I! I v. . I Ows aftA IVIF e. &'a's" r611 e This lianse: Aall be'i fdr�e the'16 I OeU forque .. ii , Cohditions,on Lio.use, i any: Ai 7 E Licensing-Authonty:. NOTI�: Th'6..dOartrnent'rcnd'wa1bf a license. S de b depa 'me 8-76-705, based'on ins' tion pe.q 0 0 .. M d viduil(s) to whom It IsIssued and at the 16catl6d above described. - This license Is n t transferable, and Is valid only use by th"' Issued M Authority of Chapter RCW 70.12. y DU . ... . ..... . RETURN ADDRESS: City of Edmonds, City, Clerk CONFORMED copy 121 5th Avenue North 200401050536 3 PGS Edmonds, WA 98020 01-05-2004 04:16pm $21.00 SNOHOMISH COUNTY WASHINGTON NOTICE OF LIAHTATION AND COVENANT ADULT FAMILY HOME Reference #: Grantor(s): (I)V OR.* (2 Additional on pg._ Grantee(s): City of Edinglids Legal Description (abbreviated): Sec—J—q--TwnA7AL—Rn OR Assessor's Tax Parcel ED#(s): (1_ ------Assessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING C1 Edmonds By: — Page -L- of%az NMEREAS, the undersigned owners of property located at AVPL 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 WHERE AS, the applicant has notified the City of applicant's intention to utilize the improvements and/or to convert sin 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 ap, I.cant 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; NOW9 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: C.- Z — (A' S, :2. 4 1. Covenants Lemitation on Resedence, The owner hereb y* stipulates and agrees t 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 state license to operate an adult family home with an occupancy of greater than -- 6 ---- residents or attempts to rent� lease or otherwi provide residence for additional residents above the r 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. SlibJect Tract. The above stipulation and promises shall ly to and run. with the land with respect to a residential structure located at r YsIql Av� . LO Edmonds, Washington and legally described as: 3. Notification to Future Purchasers—aad_Afflftnees. 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 -- - 0 In number. 4. Enfacement, 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 �f Edmonds By: 61-W DMA! ing-C,4,- Of —,q DATED this day of ACCEPTED BY: OWNER: 6 A �!! i� �- - Jeannine L. Graf Building Official /, �e�l, r w4a,90�- A V- j � 5 - NOTIFICATION NOTARY FOR OWNER SIGNATURES State of Washington ) APPLICANT/PROPERTY Applicant Applicant -AAAA M 'owner Owner COVENANT AND ACKNOWLEDGED: Mortgagor )ss County Of 52391h=4,h� I certify that I know or have satisfactory evidence that A"I�N &LA9--E-T-F- signed this instrument; on oath stated that he/she was authorized to execute the instrument and acknowledged it as the 9&&2n6Aff/ Ar Mo~ . (title) of M96"Ayoname 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 -1a d6 dp hi Notary Public in and fWthe State of Wa ngW s My commission expires--f---Zg -,0 �7 t, I O�k 00..* I certify that 11 ow or have satisfactory evidence that signed this Instru nt� on oath stated that he/she rized to-a`xe"iCt�the [Ist 9 on Instrument and ac ledged it as the (title) of _ (name of on behalf on om Instrument was executedl. to be the free and voluntary act of suc instrument. Subscribed and - -9 lg---., irtlCe uses and purposes mentions in this before me this - day of Notary Public In and for the Sta&vkwashington. M y commission expires AUTHORIZED FOR RECORDING City of Edmonds By: ate: Page _,5 Of L-.NTEMPXBUILDINMFORMS%ADF�COV.DOC A". ij- 0 S I M:. - V; -)k5 PA SIX,101 0 Ve MU OAlli*3 , 0;10 In sap v el ILE- ou '5'5'e WN-aw's h 7 Sill b� , 0;00 YES NO Home licensed (or applying fbr licerm) on or after July 1, 2001 0 0 SL1ERjNgjLQM 0 0 Sleeping Room *1 0 S 0 NSI 0 NS2 Bedroom door is openable ftom the outside when kdmd 0 0 Closet doors are readily openable 1rom the Inside 0 0 Smoke aim is Irmialled In the bedroom 0 0 Sleeping room window has a rnInlrnum net openable area of 5.7 A (nimmm dhimom 24& Ngh,. 2w wMe) [1 0 Sleeping room window has a maximum sill height of 440 0 0 Sleeping Roorn #2 0 S 0 NSI 0 NS2 Bedroom door is openable fiom the outside when locked 0 0 Clo-A doors are readily openable fmm the Inside 0 0 Smoke alarm is installed In the bedroom 0 0 Sleeping mom window has a minimum net openable area of 5.7 sf. (rw*ium dnwaws- 2,r ho; 2w wwe) C] 0 Sleeping room window has a maximum sill height of 4,r 0 0 Sleeping Room #3 0 S 0 NS1 0 NS2 Bedroorn door is openable from the outside when locked 0 0 Ckwet doors are readily openable ftm the Inside 0 0 Smoke alarm is installed In the bedroom .0 0 Sleeping room window has a minimum net openable area of 5.7 sf. (rfvnkmm dmmww 24N high; 2V wide) [I Sleeping rom window has a mvdmum sill height of 4,r 0 0 Sleeping Room *4 .0 S 0 NSI 0 NS2 Bedroom door IS OWk*e from the outside when locked 0 0 Closet doom am readily oPenable from the Inside 0 0 Smoke alarm is Installed In the bedroom 0 0 sleeping room window has a minimum net openable area of 5.7 sf. (mwmm &mwwww- 2,r high; 2V We) C) 0 Sleeping room window has a maximum sill height of 44" 0 0 Sleeping Room *5 0 S 0 NSI 0 NS2 Bedroom door is openable ftm the outside when locked 0 0 Clowt doors are readily openable from the Inside 0 0 smoke aim is installed In the bedroom 0 0 sleeping room window has a minimum net openable area of 5.7 sf. (rrdnkmirn dmwukxw 2,r tfth, 2V wWo) 0 0 Sleeping mom window has a ffodmum sill height of 4,r 0 0 Sleeping Room #6 0 S 0 NSI 0 NS2. Bedroom door is openable ftm the outside Men locked 0 0 closet doors am readily oPenable from the Inside 0 0 Smoke aWm is installed In the bedroom 0 0 sleeping roorn window has a minimum net openable area of 5.7 sf. (rWMnwn dWwWow 2,r high; 2V wide) 0 0 sleeping room window has a miudmum sill height of 4,r 0 0 Bathroom doors are openable from the outside when lockW 0 0 Smoke alarms are installed on all lev& of the dwelling 0 0 All smoke alarms are audible In all parts of the dwelling upon acdvatlon of a single device 0 0 Access; road and water sWply approved by Fire Department 0 0 0 PASSED INSPECTOM 0 CORREC71ONS REQUIRED 0 PERM REQUIRED DATE: 0 C Z; C X. q, FINAL PROJECLA.-PPROVAL FORM TO: 0 2. RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL Date Si ocaprvl.doc.l:temp:bldg:formsIO/OI z 9 0 M 'q :R c Ma 0 -40 oc -4 C X M M Z 10-1 CE cl) 0 -n - n m M a 0 0 M C (n 9 co) M 0 Z z z 0 m 4199 J. I "V, 4 0. �06P fjl,�R 7 11 "', "!FjIfl�ix `s�� r � P tl 1 '0 t � I , . , I I � i. %it" 4'41)szol rvvjj3R'% It I 4 9 CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION 0 IE OF BUSINESS Arcmgmv MAUT f"I L111-1 M"f MAILING ADDRESS 104.),71 "* #8* - W. CITY ZIP TELEPH0j4E "�n NAME ADDRESS CITY ZIP NAME ADDRESS CITY STATE LICENSE NUMBER Cal. N -J'V PERMIT EXPIRES PERMIT USEEk9'5 %V/ ZON / NUMBEBAV - JOB SUITE/APT# ADDRESS201t� 22jbAW PLAT NAME/SUBDIVISION No. LOT No. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCF Approved RW Perrrit Required Street Use Partnit Raq'd EXISTING - PROPOSED Inspection Required Sid&*alk Required REQUIRED DEDICATION- FT UndwWMM Ming required 13 METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED YES 1:1 NO 13 z REMARKS I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE I DATE FIRE REVIEWED BY DATE us ZIP TELEPHONE 01 0I NEW RESIDENTIAL ADDITION [j COMMERCIAL REMODEL MULTIFAMILY 13 REPAIR 0 GRADING CYDS 0 DEMOLISH TANK [3 GARAGE CARPORT RETAININGWALL ROCKERY (TYPE OF BUSINESS OR ACTIVVM EXPLAIN: NUMBER OF NUMBER'01F DWELLING STORIES UNITS DESCRIBE WORK TO BE DONE RON DATE NHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION REO'D 113YEs &No $ BOND STED SEPA REVIEW SIGN AREA COMPLETE EXEMPT ALLOWE BED ALLOWED PROPOSED 0,/ EXP — , __ I —F PLUMBING/MECH COMPLIANCE OR CHANGE OF USE LOT COVERAGE ALLOWED PROPOSED 1 REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) FRONT SIDE REAR FRONT LJRSIDE REAR 2 0 SIGN FENCE X Fr) PARKNG LOT AREA I PL�NNING REVIEWED BY REOD I PROVIDED I 6E9Lu-2&= REMARKS DAT I z f OTHER 4vtALr, RM 9of FIRE SPRINKLER FIRE ALARM CHECKED BY ITYPE OF CON RUC71ON ITE7 I OCCUPANT I —1 GROUP CRITICAL 1 AREAS SPECIAL INSPECTION JAREA OCCUPANT NUMBER ��'/ LOAD //f I REQUIRED [3YES I I REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D V111 M M imam �OMEntm rVIRA01- VALUATION V I law $ Description FEE Description FEE Plan Check ZZO State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit 1 0 City Surcharge PLAN CHECK NO: VESTED DAT . E Plumbing Me&inkaf THIS PERMIT AtrrHORRIES ONLY THE WORK 14OTM iillfll PlEnmrr COVERS WORK TO BE DOME ON PRWATE PROPER7Y ONLX ANY CONSTRUCTION ON THE PUBLIC 21 3 DOMAIN (CUPM. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review PERMrr APPILICATIOW 180 DAYS PERMTT LIMM. I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. Inspedlon SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, Oil BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 C-0 Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, 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 Landscapelnsp. Total Amt. Due NOR LIMIT IN ANY WAY THE CM ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRE17R 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 Officiall 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. - WORKMEWS COUPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGt4ATURE DATE 4D i IA05) edif 0 SIG E R AGEj ATE IGN /Z 12 11.16 Z RJUZ�l 771-0220 1 L DATE NL '�5 1 ATTENTION EXT 1333 M11IM-A A A . � - IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -_FILI� ' 'YEEW lf�PECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING