537 PARADISE LN11111111111111
14341
537 PARADISE LN
0
STREET FILE
CITY of EDMONDS --- PUBLIC WORXS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application:
537 - Paradise Lane
.00
DEPARTMENT
'COMMENTS
DATE
W A T E R
S T R E E T
S E W E R
N 0 T E S
BUILDING
DEPARTMENT COMMENTS
USE PERMIT
Z . ONE NUMBER
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BUILDING DEPARTMENJ� Applicant Fill 11
. PERMIT APPLICATION Inside Heavy Lines
JOB Oef 14 197
ADDRESS �-,3 7 PwIflo, JS;�:- A.410�
NAME (OR NAME OF BUSINESS)
VARIANCE OR COND. USE NO.
ADB NO.
MAILING -ADDRESS
PROPOSED YARDS
FRONT SIDE REAR
ILOT COVERAGE
CITY
TELEPHONE NUMBER
SIGN AREA
ALLOWED PROPOSED
rNVIRONN.IMENTAL REVIEW
COMPLETE [3EXEmP
13
Z
Z
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NAME
REMAR KS
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ADDRESS
PLANNING DEPT. APPROVAL DATE .
EPHONE NUMBER
LEGA I L LOT
. . [-] YES 0 i4 0
ILOT AR�EA ISUBDIVISION
NO.
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NAME,
STREET R/W
EXISTING STREET R/W FT� DEFICIENCY THIS PROPERTY
COMP. PLAN -ST. R/W FT. FT.
ADDRESS
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ff 4),
REMARKS,
CITY
TELEPHONE NUMBER
.7 1.14 -4
CHECKED By
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STATE LICEN
E NUMBER
14 N - EL -A 7 7".'
CITY LICENSE NUMBER
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91.
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ow or qc our Copies)
Lelgal Descripti n of Property (Show Bel Att h F
AOU b 11y.11
S R UTILITY WO
T REET AND/O
R E Q'D.. 0 YES No
PERMIT REQUIRED
YES El NO
UNDERGROUND
IWIRING REQ'D. El YES ONO
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TYPE CONNECTION YESIVERIFIED
I.SANITA RY SEWER El NO
B
SEPTIC SYSTEM El YES
APPVD BY CITY ENG.
NO
ERMIT NUMBER
1P
I
REMARKS
MFrYFP q17r !SERVICE
SIZE CLEARANCE
CHECKED BY
It
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2
F0 RESIDENTIAL GAS.
NEW I/N LINE
F 'ADD NON-RESID ENTIAL El SIGN
RETAINING
DEMOLISH WALL
- ALTER EXCAVATE FE . N
F .1 ' CE'
r OR FILL I— X —FT)
EJ- REPAIR PRE -MOVE swim
EJINSP. POOL
FIRE ZONE
TYPE OF CONSTR . UCTION ICODE
SPECIAL INSPECTOR
REQUIRED
N
11 YES El 0
JAREA
OCCUPANCY.
GROUP .10
CCUPANT
LO AD
PLAN CHECKED 93Y THIS SITE IS LOCATED IN. THE CITY
OF EDMONDS. LOCAL SALES TAX
SHouLD'BE CODED 31,04,
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a
REMARKS
NUMBER OF STORI*ES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PLAN -CHECK
NO.
VALUATION
FEE.'
PROPOSED USE
it
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In
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PLOT PLAN (INDICATE BUILDING SETBACKS.
ABUTTING STREETS)
—S
BUILDING
PLUMBING
HEAT GAS LINE
FENCE
-SIGN.
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
f--ti—
I hereby acknowledge that I have read this application; that the in-
m,uPn ic onrrt- —ri th�t I ,m the owner- or the. rhilv voitimr-1
STREFT FILE
DATF: Octob*er 13,' 1076
NE110 TO: llarry ll.hitcutt
Ruildinn nfficial
FROM: Richard P. Allpn
Assistant NtY Fnnine(,r
BUILDING PERMIT APPLICATInIll FOP. PHIL TLY 537 PARADISF 1,.ANE
SUBJ.ECT Z:F 37 PAR DI.- F I ANF
Af te-r revi(-.,v! of tho suhinct huilding-nermit anpli'cation, vie have t h+, fol-'
lov,,inq comments:
1) Coordi,nation of location.of bui 1 ding wi th utilities is
the responsibility of the. contractor.
'2) Connec"tion to.sanitary se.wer r eau ired.
3) Lot.drainage to be contalnedon. site or.dirpcted. to
'City Storm sYstem.
4.) nri vp'v!a,v s. Tones not to exceed .14 nercent..
5) Underground wi ri nq* -required.
-V -A
,--DATF,._ 44 76 PERMIT ADDRE&E
LEGAL DESCR4W nN
BUILDING PERMIT RFVIE14 - ENSINEERING DEPARTMENT CHECK LIST
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map for Leoal Subdivision -
Does it.conform to City Approved Su6division?
Reviewer's
Initials.
L-t;-,p 1. This lot included in Subdivision/Plat No.
t r- . Site Inspection made on: I lr_
3. Uhat are groundwater and soil conditions?
W
4. Site Orainage Checked? 110 11 410, 1 , to
5. Storm Sevier Avai 1 abi I i tv:_ jf3Eg ht. -2 f N(l. No. I-4—we-Wroject
Roadside Ditch A ) ^-k 114
6. Srading & Final Contours: nh-: i�_ aIlk I
7. Septic Tank . System Desinn Approved: AJAm
8. Sanitary Sevier Availability Sht. of 9. No.1jef6l Project 7t�Mj jjtR
Side sewer availability:___
9. Sanitary Sewer Connection Fees? tj p KM-
10. 111ater Mains A Fire Hydrants (Indicate Size flain)4 1 a mm ki 1weD,,co,
Check Fire Dept.'s Comments
11. Side s: (Site inspection shows conditions of sidewalks as follows)
WIA - - . � - O-V-& --l"4L AW-1� �
12. Curbs: T'g-j'LjgV Cuts/Priveways (Check driveways for safety, Incation,
grade and width'
- M_V
13. Underground Uiring:
Rift'" Street Lights:
14. Street Right-of-way Bldg. setbacks:,NWS!�nSht. of nfficial Street Map.
15. Existing Utility Easements?
16. Access Easements: M7
17. Site Plan checked for accuracy? Jp
18. Special Requirements listed in Memo to Bldg. Dept.
19. Commercial &-Apt. Requirements form completed?
20. Drawings stamped & notations made?
21. All Items fil.led in on Bldg. Permit Application?
22. Bonds posted for site work?
23. Right-of-way Invasion Permit required?
COMMENTS:
Rev. 7/1/76
I SREET F I LE, Da te Octoher 18',
T
'no to: Director of Maintenance & 0
pe.�ra tion
FuDlic Works
From: City Engineer
Subject:, Sewer Connec.tion Charges
Legal. Des6ription: Lot 4, Plat of Rodine.'s Addition,
Commonly known as 537 Paradise Lane
537 Paradise Lane owner: Phil Bly
Z.F.F. Calculation:
x $ Connection Fee
Lat.eral X Lateral Charge
Unit x $25 $ 25.00 Trunk Charge
This property included in P..odine Latp 10.00 Permit
Comer Agreement and will not he charged
as it %qas-part of installer's devplor.')mpnt. 35.00 TOTAL
CC:
2108
4
Date
—October 18*, 1976
Memo to: Director of Maintenance & Operation RECEIV'7r"
Public Works
From: City Engineer ...00T. 1 W176,
Public wor
Subject:- Sewer Connection Charges
Legal -Description: Lot 4, Pl-at of Bodine's Addition
Commonly known as'. . 537 Paradise Lane
Z..F.F. Calculation:
Z.F.F. x
L . ateral X
Unit x $25
This property included in Bodine Late
Comer Agreement 'and will not be charged
as it was part of installer's development.
CC:
owner: Phil Bly
Connection Fee
$ Lateral Charge
$ 25.00- Trunk Charg e
$ 10.00 Permit
$ 35.00 TOTAL
2108
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO - -------------------------------------------
NEW CONSTRUCTION F� REPAIRS n LID NO - ---------------- .-.ASMT. NO - ------------------
OWNER FI.J ------ a--t CONTRACTOR ---- PERMIT NO.
Y --------------------------------------------------------------
I - 1-4^,r x ----------------------------------------------
__) ..... f -� LEGAL DESCRIPTION: LOT NO - ------- ------------------------- BLOCK NO. - ------
.p�r
JOB ADDRESS -------------------------------------
. .....................................................................................................................................
E
9
NAME OF ADDITION ................................................................ --------------------------
e-
np e-
Approved:
DATE................................. .......... By ..
......................................... YUY6
�Wl
4101TA3U,".
s
4 JEW lald�
nn q —n
Y
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CIT" OF EDMONDS SIDE -EWER PERMIT
WATER-SEWFX DEPARTMENT
PERMIT N? 5668
(C.11 III-111ri bot side sewer inspections BFFORE covering any portion of the con tru tion.
I �w -
t�6;� be hours
.S will provided within 24 0
after requst. NO Sat., Sun., or holiday tn:peccti ns.)
ADDRE' ON ........ S_—_.> ... I .. .......... ...........................................
SS LOCA`TION OF CONSTRUCTI ................
PR3PERTY LEGAL DESCRIPTION ........ L=Q? . . ........ ............... .................................................
...................... . .......................... . ...................... . .................... ............................... r . ..... ...... ....... ........... ......................... ........ . ..................................................
................................................................ OIVNERANDIOR BUILDER ........ I .................... .......................... . .......................................................
... .......
CONTRACTOR'S NAME & ADDRESS ............ ......................... . .................................. . .......................................................
Permission Is granted ....... ....... . ............ 19'7.',',�for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A TION IS CALI D TO THE FOLLOWING:
ON
N o. I —The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area, Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No, 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line: minimum grade of 2%. No bends in grade
sharper than 1/,� will be permitted.
NOTE No. .5—Trenches in street must be water settled and surface of street restured to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6-1t is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye. -
DISAPPROVED[:] Date ... . .................................... By ................ Date ..... �OBY ................ Date ................ ................... By ................
APPROVED. Cr Date ... Ia..,_76 ....................... B ----- ---------------------------------------------------------------------------------------
Remarks: ............................................................................... .............. - -------------------------------------- . ...................................................................
..................................................................... . ................................ ....................................................... . .................................. . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
...... *'*'*"*'* -------------------------------------- ** ....... * ..................... .... hereby certify that the Side sewer installation constructed under this permit
Owner of Contracting Firm. Performing Construction)
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stalled in a cordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
W
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Check BEFORE you dig for: Water 0, Ga,,; rL-J. Telephone E3, Power 0, Sewer [j, Other El
A V�1�
.7
ADULT FAMILY HOME-& LICENSE-&
License Number: 478800
Pursuant to the laws of the State of Washington and the Minimum Liensing Requirements
ofthe Department of Social and Health Services, a license is heeby granted to
JEAN 0 BULACLAC
to conduct and maintain at 537 PARADISE LANE
9t
City of EDMONDS, Zip Code 98020 County of SNOHOMISH Site of Washin on
an Adult Family Home for the care and supervision of adults as follcus:
24-hour care for no more than 6 adults
This license shall be in force from the 31st day of December, 1998 subject to suspension or revocationfor due cause.
Conditions on License, if any:
Licensing Authority
NOTE: The department renewal of a license does not preclude the department from talcing any action uder WAC 388-76-705, based on inspection.
This license is not transferable, and is valid only for use by the corporation, partnership or individual(s) to whin it is issued and at the location above desenibed.
Issued -by Authority of Cbapter RC`W 70-128
Rubm" Jq" AGING AND ADULT SERVICES ADMINISTRATICN
C oErAirTME14T OF
X TH FIRE SAFEW -EVACUATION PLAN
CIAL
9VII& *AC 388-76-200(lli
4.
An Aouit -Family Hot le Snall have a poste,3 ' clan !0, evacuation to afe areas in event of fire. Draw a ciagram,ot the fioor c
of your home in the space pMveaed bsiow.' Inaicate escape routes and designate where staff anc residents should me�:
outside the residence. Indicate the locabon of fire extinguisher(s) andsmoke detector($).
INST qUCTIONS: Provider/Resident Manaaer comoletes, and Dosts in a consoicuous location
SM ok
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�a#M,-Y71 (�)
4 :� ----> ---It :P
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W-) 5 f" Ott
t--:� _4 -4
Ff
OATE
vampw" JON" AG114G AND ACULT SERVICES ADMINISTRATION
(xr*"MG4T OF FIRE SAFET� EVACUATION PLAN
SOCIAL&MEALTH
SEAVIM
WAC 388-76-200(lli
An Adult Family Hot rie snail have a postei plan to, evacuation to safe areas in event of fire. Draw a ciagram of the floor c,7
ot your home in the space provecied below. indicate escape ro6tes and designate where staff and residents ShouldmeE
outside the residence. Indicate the location of fire extingUisher(s) and smo'ke detector(s).
INST RUCTIONS: Provicer/Resident Manaaer COMOletes and oosts in a consalcuous location
CI-) S avae
(1) aato,
ala"
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cle-t-v,
PERMIT EXPIRES
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CITY OF EDMONDS
USE PERMIT
ZONE NUMBER -9:90-16Z
CONSTRUCTION PERMIT APPLICATION
JOB SIITEIAIT#
ADDRESS �' 4
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OWNER NAME/NAME OF BUSINESS
/,9
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
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MAILING ADMESS
0
9V
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
CITY ZIP
TELEPHONE
EXISTING — REQUIRED DEDICATION
S treet Use Permit Req'd C1
IVO)W)
7J-,209
Inspection Required 0
...... 0
qTi-V ,20
PROPOSED
NAME
METERSIZE
LINE SIZE
OF'FIXTURES
PRV REQUIRED
0
1
[—NO.
YES 0 NO 0
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ADDRESS
RE RKS
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CITY ZIP
TELEPHONE
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NAME
�NGINEERirsrb MEMO DATED REVIEWED BY
m
ADDRESS
FIRE MEMO DATED REVIEWED BY
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X
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CITY ZIP
I ONE
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VARIAN7E OR CU
ADB#
SHQREjVNE #
0
0
ITELEP)H
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STATE LICENS '�XPIRAT ION DATE
CHECKED By
SE9A RiVIEW
SIGN AREA
/��BER
COMPLETE
Er
ALLOWE PROPOSED
ALLOWED PROPOSED
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LEGAL DESCRIPTION.0 F PROPERTY - INCLUDE ALL EASEMENTS
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VA
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2
EXP
zz) .!5- Andlwe
LOT COVER,
"REL, SE;13ACKS
ETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PROPERTY TAX ACCOUNT PARCEL NO.
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LOT AREA
NI DATE
I I 3,Y
LEW
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0 NEW RESIDENTIAL PLUMBING MECH
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o COMPLIANCE OR
ADDITION COMMERCIAL
A01 -AAA,
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-A, -A.
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CHANGE OF USE
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REMODEL APARTMENT 0 SIGN,
A11411 AA;A4 bb"
IF
L--:.:
16 _f),Mrt*A OA fl iMA
REPAIR GRADING - FENCE,
El
CYDS. ( X FT)
Y OF CONISTRUCTION
APANT
CODE OC&
DEMOLISH TANK OTHER
0`11.01110111 A& IA.
GRODP2�
SPECIAL INSPECTOR AREA
o GARAGE RETAININGWALL RENEWAL
REQUIRED
LOAD
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CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:/
REMARKS
L)
0
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PROGRESS INSPECTIONS PER UBC 108
_j
in
uj
NUMBER
NUMBER OF
CRITICAL
D
to
OF
DWELLING
&VOrC
AREAS
haVVW1V
o
STORIES
NUMBER Atli
DESCRIBE WORK TO BE 90NE
Aj iZdjdt�� AZW "f, tV
A A 11JI A. -I,&
FINAL INSPECTION
REQUIRED
VALUATION
FEE
Ile
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
=T SLOPE %
BUILDIN!�,,,
PLAN CHECK N.0-*
VESTED DATE
PLU+NG .
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T�il`S-PERMIT COVERS WORK TO
2
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRU&IQt4 ON THE PUBLIC
:3
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ETC'.j WILL REQUIRE
GRADING/FILL
SEPARATE PERMISSION.
M
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STATE SURCHARGE
iawncr=
PERMIT APPLICATION: 180 DAYS
W
11A.
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
inLLI
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a: 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
_j PLAN CHECK DEPOSIT
0 DEEMEDTOMODIFY, WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMITIN ANYWAYTHE CITY'SABILITYTO ENFORCE ANYORDINANCE PROVISION."
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THEOWNER. 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 Official 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 providecl+
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATUR!( NE R AGENT DATE S17G OF I SIGINATURE
D (425) ICIALS D TE
2
771 zz
-0220
ELEASEDk�/ DATE
ATTI�NTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL XIE
A FINXL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- -�123 ORIGINA . L - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS 13EEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
5/98
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 ........................
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
'.�ATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNndE/AME N 4SS"
ABUS�a 6 6 C_�'
MAILING ADDRESS /x
CITY ZIP EL�Khl E
NAME
ADDRESS
CITY
ZIP I TELEPHONE
. —.1
1 b4100d1'0Vd (GK57- t"O"
ADDRESS
21bog, /0'/4.5r WAI
CITY , ZIP I TELEPHONE
III (Alftl I*W&t-
STATE LICENSE NUMBER EXPIR T N DATE CHECKED BY
14/04/ i(IC 0 b 3 Z 6-
V7.
;ROPERTY TAX ACCOUNT PARCEL NO.
NEW
O'O'RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
C] APARTMENT
0 SIGN
REPAIR 0 GRADING
CYDS
FENCE
X
DEMOLISH 0 TANK
OTHER
o GARAGE E] ROETAINING WALL
R CKERY
f RENEWAL
(TYPEOFUSE PUSINESS OR ACTIVITY EXPLAIN:
NUMBER
NOMBER OF
CRITICAL
OF -7,
DWELLING
I
AREAS
STORIES
UNITS
NUMBER /01
DESCRIBE WORK TO BE DONE
X_
FT)
FEM
HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: IVESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION .
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N 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
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAYTHE CITY'SABILITYTO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 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 STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA60R CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMWNSAYION INSURANCE AND RCW 18.27.
_SIGNAT �,IOW ORAGENT) - DAT:71ED
A17ENTION /
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PERMIT EXPIRES
USE PERMIT Z
ZONE �oa
NUMBER
JOB j §UITE/APT#
ADDRESS A-19/ve-
PLAT NAME/SUBDIVI SION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
c
Street Use Permit Req'd 0
EXISTING - PROPOSED inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION- FT Underground
Wiring required 0
METER SIZE LINE SIZE I NO. OF FIXTURES PPIV REQUIRED
YES 0 NO 0 9
W
REMARKS z
9
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE I a
ig
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
M
LWL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I PBOND
REO'D OSTED
YES (:] NO
SEPA REVIEW SIGN AREA I HEIGHT
COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
CHECKEDBY ITYPE FCONSTRUCTION IC E OCCUPA
0^4 Jov "110va GROUPW&_1
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED C] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 10&FINAL INSPECTION nEQ�D a
VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
DUE
TOTAL AMOUNT
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided.
OFFIPIIALS SIGYATU RE DATE
(425)
I
V
771-0220
6RELEASEDky,/
DATE
EXT 333
771-0221
ORIGINAL -FILE YELLOW- INSPECTOR
FAX
PINK - OWNER GOLD - ASSESSOR
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 ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
019990803wlso 199908030618
08/03/1999 03:06 PM Snohomish
P.0003 RECORDED County
NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
Reference #: 01270-V6 Z.-
Grantor(s): (1)JE" 6"14tiAt (2) f4e- A&k At 114C 14 6 Additional on pg,--
Grantee(s): Cijy of Edmonds -
Legal Description (abbreviated): Sec Twn 0
Rng P Qtr
OR Lot--5111ock Plat 6aoAe,-,4ddinow
Assessor's Tax Parcel ID#(s): J2
—Assessor's Tax Parcel ID# not yet assigned
Ask was
'm AUTHORIZED FOR RECORDING
151 BEET City of Edmonds
By: !7W--i D ate:,. -712 71,
Page / of
WHEREA5,,,the und ersigned owners of property located at
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
"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:
1. Covenant: Limitation on Residence, The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to 5zx_ 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 - -51X residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
5-/X 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. Subject Tract, The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at
-43-jVA14iu-%du Z-.�we- , Edmonds, Washington and legally described as:
I -Or -T A0V*Y6 44&11741,V
3. Notifleation 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 -SCL�eN 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
City of Edmonds
BY: J'Z-6� Date: Wz?/-Yg,
Page 2 of -3
199908030618
DATED this day of iq-42
ACCEPTED BY:
OWNER:
- 1-�k* 11-1�rv'A iq��09'
JWn'nine L. Graf6/
Building Official
131111VW47 AW Ir 7f nO f 4� Z
'40141f 1'5�111dy ka-.41a #4 70 ow
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
Owner
Owner
LOW 4=1 F.V
ACKNOWLEDGED:
Mortgagor
State of Washington )
)ss
County of 51to komoki
I certify that I know or have satisfactory evidence that Sf'ehul
signed this instrument, on oath stated that he/she was authorized to execute the
Minstr) ment and acknowledged it as the OW 0 CV' (title) of Qd 04-
L J!j W (name of party on behalf on whom instrument was executed) to be the,
free and voluntary act of such party for the uses and purpose
.kmention * th'
instrumenL Subscribed and sworn to before me this—aA day of S1 . r.4
. 19 'q'3 y I
" ��w —);//, (-,ILI - ,
Notary Public in and for the §t4te of W'Ishm2ton.
My commission expires_01fZ-6qZ03 -
I certify that I know or have satisfactory evidence that . !Ed sA aodo
signed this instrument, on oath stated that he/she was authorized to execute �he
instrument and acknowledged it as the 6tAJ�Ibk) (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 purris
t
-i mentions in-th*
instrument. Subscribed a V worn to before me this day of I
'19 1
0'pto -&'w LYX4�- ,
Notary Public in and for the State of Washingto
My commission expires -041A /0. � I �
AUTHORIZED FOR RECORDING
City of Edmonds
By: -776 Date:
Page -3 Of
L:ITEMPXBUILDINGVFORMS\ADF-COV.DOC
CONSTANCE M. CURTIS
NOTARY PUBLIC
STATE OF WASHINGTON
130MMISSION EXPIRES
APRIL 9, 2003
199908030618
Win
o-
PERMIT EXPIRES IZZ RILM
USE PERMIT
CITY OF EDMONDS
ZONE NUMBER 990,46?,
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADD
Alf /<
OWNER NAMEINAME OF BUSINESS
_ _.V
4��L
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
f/C
A A 1.41' 1161L(A'
cc
W
z
3:
119"tf—
MAILING ADDRESS
0
0
If,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprmed
0
EXISTING — REQUIRED DEDICATION
RW Permit Required
Street Use Permit Req'd 0
CITY ZIP
TELEPHONE
0;
Inspection Required 0
Side�alk Required 0
PROPOSED
NAME
METER SIZE
LINE SIZE
NO. OF
PRV REQUIRED
YES 0 NO 0
z
cc
ADDRESS
RE RKS
z
z
0
/V
1zW(&AWL'1zd jA/ tnqrA
5z
cc
uj
CITY ZIP
TELEPHONE
NAME
jNGINEERIWG MEMO Ddib REVIEWED BY
cr
ADDRESS
FIRE MEMO DATED REVIEWED BY
W
0
cc
LL
CITY ZIP
1. ONE
z
RIAN
VAYV�E OR CU
ADB#
SHPRFj_INE #
0
JTELEP�H
A
A/
STATE LICENS;,,NABER EXPIRATION DATE
CHECKED BY
R�Vl
SIGN AREA
H9IGHT
.
COM LETE E
ALLOEWE PROPOSED
ALLOWED PROPOSED
z
LEGAL DESCRIPTION 0 F PROPERTY - INCLUDE ALL EASEMENTS
I
,
0
EXP
t-
L.
I—I)r "!5r zh1ve M.,JzZwj!�
LOT COVERAGE
REQUIREL SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
Fj
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
00
W
z
PROPERTY TAX ACCOUNT PARCEL NO.
z
<
DATE
Lu
4
LOT AREA
NI
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0.
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44 /15:�
-7
NEW RESIDENTIAL 0 PLUMBING MECH
x
A
Lim#
COMPL ANCE OR
M ADDITION E3 COMMERCIAL
keu 4-4 i4 60hd 14A QAA Q < -
I - .. . — 4� —
. CHANGIE OF USE
o"
.
REMODEL E] APARTMENT SIGN
f
OA illlA
REPAIR GRADING FENCE.
1:1
6 —nAAArtA I 47,1
CYDS X FT)
C ECKED BY
jCaDE OCqPANT
OTHER
DEMOLISH TANK
9
lk--nFCONISTRUCTION
0
^,01111011 A& I GRO W7
SPECIAL INSPECTOR
OCCUPANT
o GARAGE RETAININGWALL [:1 RENEWAL
JAREA
REOk
ED
LOAD
z
CARPORT 'OCKERY
4
P
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
4d u I f Ai,�i d6t Hntie .1 F11-
PROGRESS INSPECTIONS PER UBC 108
w
NUMBER
OF
I
NUMBER OF
DWELLING
I
CRITICAL
AREAS
C A'fr '1_0 Z
h'0"Vj&&Q'a
o
STORIES
,.Ole
UNITS
NUMBER
DESCRIBE WORK TO BE 9ONE
A-W "A
A.4 A4JJ �1. 1'/ 10 .4,0.0-4J
FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
LOT SLOPE %
BUILDIN2
PLUM�ING
PLAN CHECK N.O"
VESTED DATE
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. T!41`S�PERMIT COVERS WORK TO
'
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRU&IOn ON THE PUBLIC
D
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ET&.Y WILL REQUIRE
G RADING/FILL
SEPARATE PERMISSION.
Cc
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
W
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
W *APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
%
Cc EDMONDS. WASHINGTON. 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 A PLAN CHECK DEPOSIT
0 NY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
- TOTAL AMOUNT DUE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT,'AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 13E EMPLOYED
Building Official 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.
OF ICIALS S17ATU E
SIGNATUR NE R AGENT) DATE SIG D RE T
(425)
7 771-0220 A 4A24
REL'EASEDW DATE
ATTENTION
I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINX L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- -�123 ORIGINA . L - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
5/98
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
199908030618
08/03/1999 03:06 PM Snohomish
P.0003 RECORDED County
NOTICE OF LEWTATION AND COVENANT
ADULT FAMILY HOME
Reference #: i0qqO-V6 2,
Grantor(s): (I) 6"i-4eiAt (2) E4,9Ak, IWACIAI, Additional on pg.—
Grantee(s): City of Edmonds
Legal Description (abbreviated): See-0 5—Twn Rng. f)
OR Lot--5 Block Plat 1-3oo1qe Addinow
Assessor's Tax Parcel ID#(s): (2)
Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
By: 4 Date: 712 7y,
Page / of
- Q0
WHEREAS, the undersigned owners of property located at 337 j a4,a dr',fZ
/-0 tj— , 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
"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:
1. Covenant: Limitation on Residence, The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to .5/X 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 — 5,4 residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
5-)X 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. Subject Tract, The above stipulation and promises shall apply . to and
run with the land with respect to a residential structure located at
ZA-ve— , Edmonds, Washington and legally described as:
3 Am m d u '
I -Or S /60,0/1-ve 44MMI.-V
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 16�,eN 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
City of Edmonds
By: 7ZA� Date:
Page ?. of 3
1999o8030618
DATED this �b day of 19
ACC PT D BY:
OWNER:
JWnnine L. GraV
Building Official
A-W Ir #' ?70 116 Z
19cltiffl'5�Al� ka"Va #4.700cv
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
State of Washington )
)ss
County of 54
I certify that I know or have satisfactory evidence that ',steAul
signed this instrument, on oath stated that he/she was authorized to execute the
instru-m nt and acknowledged it as the OW V1 6,0 —(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 purpose i
s th*
kmenti n4:4
instrument. Subscribed and sworn to before me this,. a&�L day of
, 19 qq
. '0
&Ulo ��w
t
Notary Public in and for the �t te o IV shing on.
My commission expires If , q1
I certify that I know or have satisfactory evidence that 6_d!�OCtAdq AUJa<AC
signed this instrument, on oath stated that he/she was authorized to execute he
instrument and acknowledged it as the 6WI4bk) (title) o.f.=!( LL
A"41600_ (name of party on behalf on whom instrument was executed) to be Ihe
free and voluntary act of such party for the uses and pur o M mentions in -this
instrument. Subscribed and orn to before me this day of
Cr
Notary Public in and for the.State of Washington.
My commission
AUTHORIZED FOR -RECORDING
City of Edmonds
By: �E6 Date:
1 Page 3 Of 3
L:\TEMP\BUILDING\FORMSXADF-COV.DOC
CONSTANCE M. CURTIS
NOTARY PUBLIC
STATE OF WASHINGTON
DOMMISSION EXPIRES
APRIL 9, 2003.
C99908'030618