20060280.pdf4671�t 5 (Y1 Q 'A,46�-G-a
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OCT, 0 6.2006
�POMONDS CIMOLEPIK
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'ADULT FAMMY HOME UCENSE
02
License Number: 7501
pursuant.t� the laws'of the State of Washington an&the MinimuntLicensing Requ rements
U hdreby granted to
of the Department of Social and Health Services, a, icense,is
CEDAR, VIEW, AM INC
to conduct and maintain.an Adult Family litune at 013 MADRONA LANE
NDS, 98026snobomish'County, State of Washington
City of EDMO
for the care and. supervision of adults as follows:
adu
-24-hour care for no more than 5 Its
2006 iubjecit jo.suspensioh or revocation for due cause.
This license shall be in force from the 23rd of September,
alty, Dementia Specialt7y
DevelopmentelDisabilities; Speci
Licensing Authority
e,,f OL
from taking oily action under WAC 388-76-705; based on inspection.
NOTt: The department renewal of a.licens6 does not preclude,the departnicnt
a d is val d only for use by the corporatl* Partnershili or Indiviclual(s) to whoin it Is Issucci and at the location above described.
This license is not transferable.. n
RCW 70 128
If 7 7 L4 I.
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
1V'1�11'0169:09am �3410 PGS
NON MISH COUNTY, ASHINGTON
RECTEIVItb
APR 2 7 20id
EDMONDS CITY CLERK
NOTICE OF LMIITATION AND COVENANT
ADULT FANHLY HOME
Reference 40,1(1 -114eO
Grantor(s)- (1) AW&Yyy Additional on Pg--
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec� T.._La_R. tr
OR Lot_Block Plat
Assessor's Tax Parcel M#(s): (1) 0050117 77
__-Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
i of Edmonds
By: Dn��
page f
WHEREAS, the undersigned owners of property located at '96 1?, MQAfVnq
L4(40 ' 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 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
IlOwner") 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:
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1. Covenant: Limitation on Residence. The owner hereby stipulates
and agrees that occ I upancy of the structure as an adult family home shall be limited
to (i - 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 61 residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
(0 - ---- 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. Subiect Tract. The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at Z,65/ '3 Mad(nw'
V1 9 Edmonds, Washington and legally described as:
QW N(4 t A I ii:0 ro M (2.
3. Notification to Future Purchasers 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 (, 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
Ci Mftno ds
MD'.44&
Pge of
DATED this _dylf D"701rCt4 — .
ACCEPTED BY: APPLICANT/PROPERTY
OWNER:
Applicant
Jeanniine L. Graf
Building Official
NOTMICATION
Applicant
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington
)ss
County ofS&a&Qm&j)
I certify that I know or have satisfactory evidence that /NM o--r //. 6&,eo
signed this Instrument, on oath stated that helshe was authorized to execute the
instrument and acknowledged it as the , —(title) of
p722ULjaa_ (name of party on behalf on whom instrument was executed) to be
the free and voluntary act of such party for the uses and pur
. poses mentions In this
instrument. Subscribed and sworn to before me this—,-)� day of
t-o-er".
17
Notary Public in and for the State of Washington.
My commission expires� C/!-/ 9- 6 7
0)s
I certify that I know or have satisfactory evidence that
signed this instrument, on oath stated that helshe 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
Notary Public in and for the State of Washington.
My commission expires_
[AUTHORIZED FOR RECORDING
Ity Edmonds
By: Date -
age of
LATEMMUILDINGWORM"DF-COV noCV10/04
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Permit Inspection Details
Permit: BLD20060280
PERMITTrAX
04/0712006 Smok 0 APPROVED y
Total Time: 0
04/07/2006 SMITHM 0 APPROVEDIJ, WESTFALL y
Total Time: 0
2 Total Time; 0
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6/5/2009 9:08:23 AM Page I of I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
.
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:.
Underground ... ..........
Rough -in — ..............
Commercial Final
HEATING:
Gas Test ..........
Gas Piping .................
Equipment .............
Commercial Final
EXTERIOR SHEATHING
NAILING ......................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Cal ing Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
--7-fiko
OCCUPANCY ..................
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