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USE PERMIT pp''
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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Parcel No. rj 1 p1 ^ 0 Z �( ` (=•C7 "' C7nV U I L
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DEMOLISH ❑ WOODSTOVE IM PCUPANT
El OOL CINSERT SWHOT TUB/SPA SPECIAL INSPECTOR ARE
REQUIRED R 1�7! �X^ LOAD
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RETAINING WALL/ El YES (.•4 /J',Y 1E3
CST ROCKERY RENEWAL REMARKS
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STORIES UNIT$ !�`/ • %� NUMBER % l��r�\ .�S/+•%l�!yC%/�r� / Cr L7• :ZIWQW &V40- �E
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) S(!f0 rue ;) Y d;.V7-C ' ei>•qSL! tS M-CI a..; j/e
U 1 • " ' ' V- e' - FINAL INSPECTION REQUIRED
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PLAN CHECK FEE
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BUILDING
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Plan Check No. `7 Y Z MECHANICAL L
This Permit covers work to be drone on private property ONLY. GRADINGIFILL
Any construction on the public d0main (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days 30
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 ENO. INSPECTION FEE 514,.
m successors In interest, agrees to Indemnify, defend and hold _
harmless the City of Edmonds, Washington, Its ollicials, / ,f 'U' CC'
i employees, and agents from any and all claims for damages of�1•';%'
a whatever nature, arising directly or Indirectly from the issuance
x of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
omodify, waive or reduce any requirement of any city ordinance
x nor limit In any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE �' C!(
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL(
information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
slate laws regulating construction; and In doing the work authoriz• AUTHORIZES This application is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his/her
--
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy: and fees are paid, and receipt Is
lion Insurance and RCW 18.27. INSPECTION acknowledged In space provided.
SIGNATURE (OWNER OR AGENT( DATE SIGNED DEPARTMENT i
A,` �E 9 CITY OF ONATURE DATE j
EDMONDS
OWN CALL FOR C.
ELEA 11a CA
ATTENTION /--Sr✓ IN PECTIION '/t ' , ;.•J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 7�'� ®�o ORIGINAL — Fde YELLO:V — Ins
GERALD & SARAH BERNSTEIN
6653 N.E. WINDERMERE RD
SEATTLE, WA 98115
February 10, 1995
RECEIVED
FEB 1 3 1995
PERMIT COUNTER
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)
G�
Gerald Bernstein, February 10,,1995
Sarah` Bernstein, February 10, 1995
State of Washington
County of ra,�
Wined or atte t/e7d before me on
�c �7Lh, ✓ 49 YS by
Title
My appointment expires WP
COVENANT OF NOTIFICATION AND INDEMNIFICATION/BOLD.RMi,ESS...
Under the review procedures established.pursuant to the State
Building Code, incorporating amendments promulgated by the Cityqtq •
of Edmonds, and as a prerequisite to the issuance of a building
CQ per -,tit for the construction of a residential structure and
attendant facilities, the undersigned OWNERS of property do
hereby covenant', stipulate and promise as follows-
.� 1. Description of Subject P=o^arty. This covenant of
notification and indemnification/hold harmless rel'a"t�es.! to a tract
of land at the street address of /J �/� % .YUPSI ..•� (insert
street address), Edmonds, Snohomish County, Washington and
legally described as:
Lofs jand lc/ 131c;d•k �27 Plej. cf %�ie�u�c�o�lale Bcach�
TO 7-/�c, lal. Melii_ta� rrcnkdr�! ;h I ?/�rn�G S
d./��cu/n�ily /tJ�r.shM��i/CrJ>
06-e7-Hc:c 1N, i�-1 b�2cctTc�{ :j�cLS C�e /7i2'.1tu GiL U/i1�Jllcj ��y�rt Imo .
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
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VOL.3073PAGE 643
BUILDING
FEB 9 - 1"0
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- i..:..r..:'. - ��.--1 ., -:. .!-`:�...'--_•.._ .,... ....--.__. �. ..n' ✓�'..�=.. _ �:
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the risks associated with development are contained in building
permit file number /`5�� (insert number) on file with the
City Edmonds Building
5 Yj� r ,�''�•.
t
Uk,�;ctt
.
of Department. Conditions, limitations, or:
prohibitions on development may have been imposed in accordance
with the recommendations of the consultants in the course ofS�sM1.
permit issuance. The conditions, limitations, or prohibitions
may require
ongoing maintenance on the part of any owner or
ii rk,Me�f"i
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,
;+`..,�L'•�-t'..ya..
geologist, architect and/or structural engineer are hereby•t,��y�4�,.
incorporated by reference from the contents of the file as fully
as if herein set forth. Any future purchaser, lessee, lender or
Y
any other person acquiring or seeking .to acquire an interest.in'
i
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
tK
be reviewed during normal business hours or copies • obtained at.
the Planning Department, City of Edmonds, 505 Bell Street,
Edmonds, Washington 98020.hx,.
3. Indemnification and Hold •Harmless. The undersigned
r
OWNERS hereby waive any and all liability associated with -
development, stating that.they 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
rr{asT
against the City of Edmonds, its officers, agents and employees
WSS52079A 0006.040.034
WSS/klt 02/08/90
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.. VOL. J®'7JPAGE%fj44
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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 permit(s) 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-art (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•:
%/.tom 711 ci 3r1 Ci ics(% ti
[insert insurance..requirements.and time -period,
if ... any--if-no--insurance.-required, so state..]
WSS52079A/0006.040.034 -3-
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4 4G1.3073PAGE264
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 //('L'ad , 199_.
1'
OWNER(S)
7
By:
By:
By:
STATE OF WASHINGTON )
� -
COUNTY OF •</7 ss: 1 )
I}certify that I . know or have satisfactory evidence
that Cl�ll�il� �L�'//S/f/'1 signed this instrument and acknowledged'
WSS52079A/0006.040.034 -4-
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VOL. 30'73RGE264G
--7.- 77=:r
it to be (his/her) free and voluntary act for the purposes
mentioned in this instrument.
DATED this day of d 1ZL?;
'L71
NOTARY PUBLIC
My commission expires:
STATE OF WASHINGTON ) )
) ss:
COUNTY OF Z l "l )
I certify that I know or have satisfactory evidence
that 2'60141signed this instrument and acknowledged
it to be (his/her) free and voluntary act for the purposes
mentioned in this instrument.
DATED this ,2E� day of l�' 199 55
=Al4
NOTARY PUBLIC (.
My commission expires:
STATE OF WASH INGTON )
)ss:
COUNTY OF �� )
I' certify that I /know or have satisfactory evidence
thatsigned this instrument, on oath
stated that A& (he/she) was authorized to execute the
instrument and acknowledged it as the _�J/C•iIf/S (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 2Z day of /lea,"'t ,� t
— , 19�. t
i
NOTARY PD�LIC /
My commission expires:
WSS52079A/0006.040.034 -5-
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,,-01,vi, al 6L.f,•.b7 A VOL.3®r1 PAGE2b4`�
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS...................<S-
C
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch ................
Retaining Wall............
Slab Insulation ............
PLUMBING:
Underground .....
. ...... .
Rough -In ..... I ..........
4-
Commercial Final ...`...
HEATING:
Gas Test.............�.......5
l ° rr3 ` hGv
Gas Piping ................
Equipment ................
Commercial Final.........
--. — —�
EXTERIOR SHEATHING�C�
NAILING ................
FRAMING .................lam_!
INSULATION:
Floorinsulation......,,.�..--�--
Wall Insulation .......
l2, •r1G
Ceiling Insulation...
SHEETROCK NAILING
SPECIAL INSPECTION
RADON MONITOR AT SITE.
FINAL APPROVAL
FOR OCCUPANCY.
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