20050868.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
WIN NAH _J7\\/jER-FA Tf\ f�!LLO IZI-\ KINP HL-AU
MAILING ADDRESS
19-3Cj V6*Tlk AVE- W
CITY ZIP TELEPHONE
Epmcjl�ps �0216
NAME
ADDRESS
NAME
ADDRESS
4 ,
CITY ZIP TELEPH ONE
NUMBER
PROPERTY TAX AC
2-7041800.3
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
NO.
70c)
COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN
CBL#
PERMIT EXPIRES �4�fl
P6WT
NUMBER Cits
JOB AVE SUITE/APT$t
ADDRESS
PLAT NAMEIS UBDIVI SION NO.
LOT NO.
LID NO
I
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Requited
Street ist, Permit Requited
EXISTING ___ PROPOSED
Inmroction Requited
Sidewalk Required
REQUIRED DEDICATION FT_
Underground
Wifing required
METER SIZE
NO OF FIXTURES
PRV REQUIRED
YES 13 NOE3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
RE REVIEWED BY
BY
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DATE
DATE Uj
TION DATE CHECKED BY VARIANCE OR CU SHORELINEORADBI i INSPECTION I SEPA
RECiD COMPLETED I EXEMPT
E3YES 03'NC I &__�
CAft ZONE, SIGN AREA HEIGHT
KED BY
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WAIVER 13 ALLOWED , PROPOSED ALLOWED , PROPOSED
STUDY 13 0 1 N6
PLUMBING ir MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR LD
COMPLIANCE.eR* z
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PARKIN2 LOTAREA PLANNING REVIEWED BY DATE
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SIGN
REQ D
PRi VIDED
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FENCE
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FT.)
REMARKS
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OTHER
FIRE SPRINKLER
FIREALARM
TYPE OF
NUMBER NUMBER OF 3h li� �K_
OF DWELLING SPECIAL INS 1431ECTIO
STORIES UNITS REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
CODE OCCUPANT
I n3 I GROUP K�
CONSULTANT OCCUPANT
I LOAD
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Build Ing Permit
City . Surcharge
PLAN CHECK NO:
Y. 6 2_2
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY . CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 119�00.01115(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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'
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapellisp.
Total Amt. Due
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Recording Fee
r
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN 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-
P Y
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.
CALL
FFOR INSPECTION
(4-25)
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FF S SIGNfjRE DATE
SIGN UR (0 NEIR OR AGECIll'
._QA!F.,SIGNED
- `*_ \
09- 117s- 0_1�
771-0220 RE
4ATENTIOW, EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 if IBC110 If IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPLUIL
PINK -OWNER GOLD - ASSESSOR
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SECTION 5 - INSPECTION CHECKLfST
YES
NO
Home licensed (or applying for license) on or after July 1, 2001
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SLEEPING ROOMS
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Sleeping Room #1 L S NS1 e"NS2
Bedroom door is openable from the outsidewhen locked
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Closet doors are readily openable from the inside
Smoke alarm is installed in the bedroom
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
Sleeping room window has a maximum sill height of 44"
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Sleeping Room #2 E S NSI ff-"N S 2
Bedroom door is openable from the outside when locked
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Closet doors are. readily openable from the inside
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Smoke alarm is installed in the bedroom
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
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Sleeping room window has a maximum sill height of 44"
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Sleeping Room #3 E S NS I 91"NS2
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Be droom door is openable from the outside when locked
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Closet doors are readily openable from the inside
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Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24'. . gh; 20 wi( Je)
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Sleeping room window has a maximum sill height of 44"
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Sleeping Room #4 F S NS1 FKNS2
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Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
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Smoke alarm is installed in the bedroom
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Sleeping room window has. a minimum net openable area of 5.7 Sf..(minimum dimensions- 24" high; 20 . w1i de)
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Sleeping room window has a maximum sill height of 44"
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Sleeping Room #5 E S NS 1 0 NS2
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Bedroom door is openable from the outside when locked
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Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
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Sleeping room window has a maximum sill height of 44"
Sleeping Room #6 F S NS1 F-I NS2
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Bedroom door is openable from the outside when locked
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Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
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Sleeping room window has a maximum sill height of 44"
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GENERAL
Bathroom doors are openab le from the outside when locked
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Smoke alarms are installed on all levels of the dwelling
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All smoke alarms are audible in all parts of the dwelling upon activationof a single device
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Access road and water supply approved by Fire Department
PASSED n CORRECnONS REQUIRED n PERMIT
REQUIRED
31-0 0 -
INSPECrOR: DATE:
..............
7
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA'98020 (425) 771-0220 FAX (425) 771-0221
Website: wwadedmondsm&us
D ELOPMENT SERVICES DEPARTMENT
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Planning 'Building Engineering
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October 31, 2005
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Winnah Javier-Fajarillo
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19301 86"' Avenue West
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Edmonds, Washington 98026,1
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RE: A Kind Heart Adult Family Home.@ 19301 86t"Avenue West, Edmonds
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Dear Ms. Fajarillo:
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Before the City can grant final approval on your Adult Family Home You Must SUbmit the
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following documents:
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Copy of the issued State Adult Family Home License
If there are extenuating circumstances which would prevent You from fully complying by
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Novernbe'r 30, 2005 please immediately contact me at 425-771-0220 extension 1226.
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Sincerely,
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Jeannine L-Graf
Building Official
Incorporated August 11, 1890
Sister Citv - Hekinan,
RETURN ADDRESS:
City of.Edmonds, City Clerk
.121 5th Avenue North PGS
Edmonds, WA 98020 14A
RVINGION
NOTICE OF LIMITATION AND COVENANT
ADULT FANHLY HOME
Reference #:
Grantor(s): (1 (2) Additional on pg.
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Grantee(s): Cill o Edmonds
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Legal Description (abbreviated): S c T Rn
OR Lot Block_...,.�lat
Assessor's Tax Parcel ED#(s): (1), 2 -70q 1% 0 0301 (2)
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Assessor's Tax Parcel 1D# notyet assigned
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AUTHORIZED FOR RECORDING
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City of Edm ds
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By: Date: u
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of 2
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WHEREAS, the undersigned owners of pro�erty located at 19SOi 86TH
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1601 i�, WEST in Edmonds,. Washington legally described
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below. or on the attached Exhibit A, have applied for a building permit for
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compliance and/or to remodel a structure located on the site; and
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WHEREAS,the applicant has., notified the City of applicant's Intention to utilize the
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improvements and/or to convert an existing single family structure to an adult
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family home; and
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WHEREAS, under the Uniform Building Code the number of occupants of a
structure trigger certain requirements relating to the fire suppression and exiting
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requirements; and
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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
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
confirmilie, promises upon which such Issuance is based while providing notice to
a 'future owners or mortgagors of the property does her y stipulate, covenant
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iind agree as follows:
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1. Covenant: Limitation on Residence. The owner hereby stipulates
and ag that occupancy of the structure as an adult family home shall be limited
to rT 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 fandly home with
an occupancy of greater than _CD residents or attempts to rent4 lease or
otherj�e 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.'
20 Subiect Tract. The above stipulation and gromises.shall apply to and
run with the land with respect to.a residential structure located, at 405018671+ AVE
W E,'�T Edmonds, Washington and legally desiribed as:
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SEC is JIL), P ZI C, F_ G4 LT-20A) LOT I Or CATy Dim ED SP S-15_028
01F S W V4 WE A/4 Sr-- i A W 1/4
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3. Notification to Future Purchasers and Assionees. This notification'. >
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and covenant has been recorded in the records of Snohomish County, Washington.
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in. order to provide notice to any and all future owners of the'Property 0
limitation at the current level of improvement to single families and -adult family. z
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'home resid ients fewer than in number.
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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 Edmon
6y: -17K 'Dat
Pap J- of —.?L.
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DATED this day of
ACCEPTED BY: APPLICANT/PROPERTY
OWNER:
Applicant
Jeannine L. 4Grr9-" Applicant
Building Official
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Owner
COVENANT AND
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NOTIFICATION
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ACKNOWLEDGED:
Mortgagor
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NOTARY FOR OWNER SIGNATURES
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State of Washington
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'County (of
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I certify that I know or have satisfactory evidence that
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signedthis Instrumentp on oath stated that he/she was authorized to execute the
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Instrument and acknowledged it as the .(title) of
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(name of party on behalf on whom instrument was.executed) to be
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nd voluntary act of such party for the uses and
the free a pur I poses mentipnsin t
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instrument. Subscribed and sworn to before 'me this
Notay Publid
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StMe ofWashington
ANA MARY, ANN A. ENGUS
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hi ON EXPIRES
Notary Mile in and fai the State of Was WQ0MMISSI
Marchl 0. 2M
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My commission expires
I certify,that I kn6' or have satisfactory evidence that
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-Inst nt, on oath stated that he/she was authorized to. execute the
signed this rume
instrument and acknowledged It as the, (title) of
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(name of party on behalf on whom* instrument was executed) to be
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the free and voluntary act of such party for the uses and purpos6smentions in this
Instrument. Subscribed and sworn to before me this. day of
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Notary Public in and for the State.of Washington.
My commission expires
AUTHORIZED FOR RECORDING'
C OfEdmon
ity
By:- Date: 6 Q
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Page of —22
-\TEMMUELDING\FORMS%ADF-COVJ)OC2/10/04
6:
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall............... 7******
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Pier/Porc.h .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final
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'HEATING:
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Gas Test .....................
Gas Piping � ..................
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Equipment
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.................
Commercial Final .......
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EXTERIOR SHEATHING
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NAILING . ...........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation ........
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Wall Insulation ........... .
*Ceiling Insulation ........
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SHEETROCK 14AILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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