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USE PERMIT []�p� A s,-•�
CITY OF EDMONDS ZONE •, r,. NUMBER
CONSTRUCTION PERMIT APPLICATION /
t\wNf ItNAAIl. NAMF OF HUtiINCtis ADORE55
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'.ITV ZIP IEL HONE NUMBER _
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IFLICEN\FNUMBER EXPmAIION DA E
1. ♦ 1 1 ' �` 25I
Legal Oesc.lpllGn OI Property - include all easements
kko---s
Property
TR. Account 5 I -u (•7
Parcel No.
j4n NEW RESIDENTIAL ILL/-xJ�� PLUMBING
LJ AODIIION COMMERCIAL II1���I1 MECHANICAL
RE'h10DEL APT BLDG. LJ SIGN
ElIJF IIAIR ® G OI CYDs ❑ (ENCE K_F
�DENIOLISI. WOOOSIOVE El SWIMPOOL
INSFm FIOT TUBISPA
OARAGF RETAINING WALL/ RENEWAL
"A.Fo— ROCKERY
ITYPF OF USF. BUSINESS OR ACTIVITY) EXPLAIN-
�;l �yNsrc�P(ycL
NUhIRFR NLIMRER OF I1 NUIU[H •Z OW ELLING
-OnIES UNITS {rl,r
DESC/MBE WORK TO BE DONE (ATTACH PLOT PLAN)
c.., 1. L'
LEGAL DESCRIPTION CHECK
SUBDIVISION NO LID
NO
PUBLIC RIGHT F WAY PER OFFICIAL STREET MAP TESCPAIFI—I)
❑
L� RW
EIIISTING _ nEOUIREG DEDICATION C sr`.:
Permll Repotted
u'. Permll Rpa d
I.Ipecllon
RROPOSEO
R"I rod
Requeed
SltlewelY
METE SI �E
LINE SIZE
NO OF FIXTURES
PRVJIEOUIREO
'J/
VES NO ❑ '
TGNrNNE INSP W-410. 1.1-0. wl ING
Gown 5t WAleKwAY AWIJ4 FkoarA4,11117. 0" 12101
rINAL ►� INSp, iaQaYY�Lr i�MP a6¢IJ•
ENGINEERING MEMO DATED REVIEWED BY
�
f I�uc q6 Lf.
FIRE MEMO DATED REVIEWED BY
SIGN AREA
SEPA REVIEW
ADD
ALLOWED PROPOSED
COMPLETE EXEMPT
SHOR Ee
EKP
VARIANCE OR CU
P N EVIEW BY
TE
Jr —
SETBAC S—FEET
HEIGHT
LOT VE A
//(())
FRONT °n /�� SIDE /TlgEAR
f7
REMARKS
CHECKED 9Y
/./i/Y[.Va[L
TYPE OF CONSTRUCTION
CODE
OCCUPANT
Gg
1
LUY7l
7 )
SPECIAL INSPECTOR
REQUIRED
AREA
R3 !Z7/ e-'
OCCUPANT
LOAD
Ky..
S?e%
L'14' fi' -,Y 'D E
REMARKS
PROGRESS INSPECTIONS PER UBC 305
. ,SjTt[�r,pes(c HsyeJ�,Ni1+t/�F/('Q�+PE
a'a Fcic ECrC[ ca�tsu r5 AF`x.Ocnas P
FINAL INSPECTION REOUIRED
PLAN CHECK FEE
BUILDING
HLAI sCIURC(
/�5 T'C12 «EQ /At-\TZ.
GLAZING
a/a
PLUMBING
Plan Check No. '7- V/
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Pemllt Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"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 IhiS permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
ENG. INSPECTION FEE
/ 1i ,
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
iff�W.11 Ai Kim
given is correct: and that 1 am the owner, or the duty
ATTENTION
I
ed agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
s regulating construction; and in doing the work authorii-
by, no person will be employed in violation of the Labor
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
L,nion
ranceand RCW 18.27,
INSPECTION
acknowledged In space provided.
E IOWNFR OR AGENTI DALE SIGNED
DEPARTMENT
�f�/� r Qll
7--"
CITY OF7jL
ILSNATURE DATE
c'<
EDMONDS
_..
ATTENTION c��7,� (k.s c✓ %`�� >�st�. ,mac
INSPECTILvALL ON.
EA a1DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
-�
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL O
rR -oAwL10
ORIGINAL — File YELLOW — Inspector
A CFRTIFICATF. OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER J.
PINK — Owner GOLD — Assessor
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IN
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RECEIVED
FEB 1 3 1995
KFUT COUNTER
GERALD & SARAH BERNSTEIN
6653 N.E. WINDERMERE RD
SEATTLE, WA 98115
February 10, 1995
TO: CITY OF EDMONDS, WASHINGTON
BUILDING DEPARTMENT, PERMITS
RE: APPLICANT/OWNER LIABILITY & LANDSLIDE ACKNOWLEDGMENT
We the applicant/owners of the site (-15912 75th West) acknowledge the following:
a) That the accuracy of all permit submittal information is warranted by the applicant/owner in a
form which relieves the City and its staff from any liability associated with reliance on such
permit application submittals. While an application may reference the reports of prior public
consultants to the City, all conclusions shall be those of the applicant/owner her/his design
professionals (ECDC 19,05.030) and, b) That the applicant/owner understands and accepts the
risk of developing in an area with potential unstable soils and that they will advise, in writing, any
prospective purchasers of the site, or any prospective losses of the structures on the site, of the
slide potential of the area. (ECDC 19.05.040C)
Gerald Bernstein, February 10, 1995
Saralf Bemstein, February 10, 1995
State of Washington
County of k,n___r�
S.ned or attested before me on e /% 9s by
i
Title
My appointment expires
32 X I I
AI
FE
["I
U1 I Y CLERK RECORDED
CITY OF EDMONDS
505 BELL STREET
EDMONDS, WA 98020 '95 SEP 19 P 7 ;Q9
COVENANT OF NOTIFICATION AND INDEMNIFICATION/HOLD.�FiARM�LES.._
Under the review procedures established.pursuant to the State
Building Code, incorporating amendments promulgated by the City
of Edmonds, and as a prerequisite to the issuance of a building
permit for the construction of a residential structure and
attendant facilities, the undersigned OWNERS of property do
hereby covenant-, stipulate and promise as follows:
1. nest iotica of Subject Property. :his covenant of
notification and indemnification/hold harmless relates to a tract
of land at the street address of /Jr'7/`W %7 �--Wes%' (insert
street address), Edmonds, Snohomish County, Washington and
legally described as:
LGfs 9 Cernd /C', j3/c k �29� Plc�'f c,f /il�cl6�Gcod�dl' �c�tch�
Ci ccGF D,Nc: ; u Tl?,✓ Pla 1. jl2e,6 n � reccke%c! ;'n V' ILr n G 6
CJ �'lat5, f��iye ,35 ;,7 Stu/o,»,'s/i C�l.ul7y CLil.5i7/�7y%�JJ
I CJL'� lfic`L W r 1'�Cct7c�( J�cLSiCiP '/7CC'i)tt1 GCGi%U
2. Notification and. Covenant of Notification. The above
referenced site '(hereinafter "subject site") lies within an area
which has been identified by the City of Edmonds as having a
potential for earth subsidence or landslide' hazard. The risks
associated with development of the site have been'evaluated by
technical consultants and engineers engaged by the applicant as a
part of the:process to obtain a•building permit for the subject
site. The results of the consultant's reports and evaluations of
WSS52079A/0006.040.034 -1- BUILDING
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the risks associated with development are contained in building
permit file number �5C-4' (insert number) on file with the
City of Edmonds Building Department. Conditions, limitations, or
prohibitions on development may have been imposed in accordance
with the recommendations of the consultants in the course of
permit issuance. The conditions, limitations, or prohibitions
may require ongoing maintenance on the part of any owner or
lessee or may require modifications to the structures and earth
stabilization matters in order to address future or anticipated
changes in soil or other site conditions. The statements and
conditions proposed by the OWNERS' geotechnical engineer,
geologist, architect and/or structural engineer are hereby
incorporated by reference from the contents of the file as fully
as if herein set forth. Any future purchaser, lessee, lender or
any other person acquiring or seeking to acquire an interest.in
the property is put on notice of the existence of the content of
the file and the City urges review of its contents. The file may
be reviewed during normal business hours or copies obtained at.
the Planning Department, City of Edmonds, 505 Bell Street,
Edmonds, Washington 98020. '
3. Indemnification and Hold 'Harmless. The undersigned
OWNERS hereby waive any and all liability associated with -
development, stating thatthey have fully informed themselves of
all risks associated with development of the property and do'
therefore waive and relinquish any and all causes of action
against the City of Edmonds, its officers, agents and employees
WSS52079A/0006.040.034 _2_
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VOL. 3073PAGE%644
32 X E
arising from and out Of such development. In addition, the
OWNERS on behalf of themselves, their successors in interest,
heirs and assignees, do hereby promise to indemnify and hold
harmless the City of Edmonds, its officers, agents and employees
from any loss, claim, liability .or damage of any kind or nature
to persons or property either on or off the site resulting from
or out of earth subsidence or landslide hazard, arising from or
out of the issuance of any permits) authorizing development of
the site, or occurring or arising out of any false, misleading,
or inaccurate information provided by the OWNERS, their
employees, or professional consultants in the course of issuance
of the building permit.
4. Insurance Requirement., In addition to any bonding which
may be required during the course of development, the Community
services Director has/ham-nat (strike one) specifically required
the maintenance of an insurance policy -for public liability
coverage in the amount and for the time set forth below in -order
to provide for the financial responsibilities established through
the indemnification and hold harmless agreement above:
(insert insurance.requirements.and time -period,
if..any--if-no--insurance.-required, so state..]
V
WSS52079A/0006.040.034 -3-
WSS/klt 02/08/90
VOL. 3O73PAGE 2(i5
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32 X E
S. Covenant to' Touch and Concern the Land. This covenant
of notification and indemnification/hold harmless touches and
concerns the subject tract and shall run with the land, binding,
obligating and/or inuring to the.benefit of future owners, heirs,
successors and interests or any other person or entity acquiring
an interest in property, as their interest may appear. This
provision shall not be interpreted to require a mortgagor or
lender to indemnify the City except to the extent of their loss
nor to obligate such persons to maintain the insurance above
required.
DONE this 25- day of / " LQ
1'
OWNER(S)
i%
By:
By:
STATE OF WASHINGTON )
ss:
COUNTY OF
I ,certify that I know or have satisfactory evidence
that CLLiGf RILL signed this instrument and acknowledged'
WSS52079A/0006.040.034 -4-
WSS/klt 02y/08/�9p0 q
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it to be (his/her) free and voluntary act for the purposes
mentioned in this instrument.
DATED this ads day of MLZtie gg:_S
NOTARY PUBLIC
My commission expires:
STATE OF WASHINGTON ) J
) ss:
COUNTY OF )
I certify that I know or have satisfactory evidence
that �/J1i�i/� '.1 �LofYIJ signed this instrument and acknowledged
it to be (his/her) free and voluntary act for the purposes
mentioned in this instrument.
DATED this '?h day of'6-1zj 199
NOTARY PUBLIC
My commission expires:
STATE OF WASHINGTON )
)ss:
COUNTY OF ✓? )
I* certify that I know or have satisfactory evidence
that Gf/z ���SC1r�t� 3'j/ 5i //l signed this instrument, on oath
stated that 1�e-, (he/she) was authorized to execute the
instrument and acknowledged it as the /J�L%/f/5 (title)
of (name of party on behalf of whom instrument
was executed)• to be the free and voluntary act of such party -for';
the uses and purposes mentioned in this instrument.
DATED this Z�14 day ofl�r,u� , 1935
NOTARY P LIC
My commission expires:
WSS52079A/0006.040.034 -5-
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................,,.
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch ................
Retaining Wall............
Slab I nsulation ............
PLUMBING:
Underground .............
Rough -In ................y, —�
/
.4- `.r .3 -2
Commercial Final........
HEATING:
"ZZ
p
Gas Test.............j,
Gas Piping ................
Equipment ................
Commercial Final.........
EXTERIOR SHEATHING
r ��q�-• q
NAILING ................ �;..-.-.-----�/ .�-: �.
! b
'-
7 • (� TCJ
FRAMING ................. �__�
G —St
INSULATION:
Floorinsulalion.......
Wall Insulation......;,,...--
Ceiling Insulation. .......
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE.
FINAL APPROVAL
FOR OCCUPANCY.....`.,
O
32XIL