BLD2008-0376 LEGAL DOCSF le
�1
s. niiov, i /, md-i z : wimrik0000ve r r rem I e r momesi I T mauKAN4.�Pt: NO, 10401 2"12 0 0 8
1PROOvCER (SD9)325-3024 FAX -1)32S-1803
Moloney, O'Neill, Corkery & Jont Inc.
1206 N Lincoln, Suite #200
Spokane, WA 99201
Mark Roff
THIS CERTIFICATE IS` _'IED AS A MATTER OF INFORMATION
ONLY AND CONFERS UGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFi -,%TE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED RH Hoover Inc
9ZO9 E Mission
Suite F
Spokane Valley, WA 99206
INSURER& Berkley Regional Specialty Ins
INSURER B;
INSURER C�
INSURER D:
INSURER I!:
COVERAGES
THE POLICIES OF INSURANCE LISTEO BELOW KAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS CERTIFICATE hiAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SLIC)i
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I
WMSU
ryPE OF INSURANCE
POLICY NUM15ER
EFFECTIVE
POOkAY MMfDDfyyl
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
CCL0009040
04/01/2008
04/01/2009
EA0H 00CU11RENCE
S 1,000,000
DAMAGETC) RENTED
pAgUISIFS frA
S 100.000
7X COMNIErtcAL GENFAkL LIA61LITY
CLAIMS MADE F571 OCCUR
Mr D EXP (A#%y ome perfAml
S Excluded
A
PERSONAL 6 ACV INJURY
S 1,000,000
GENERAL AGCAEGATE
S 2,000,000
GS?I't AGGREG&7E LIMIT APPLIES PER:
PRODUCTS - COMPIOP AaG
5 2.000.000
7 POI.ICY FX7 J,,ECOT. F7 Loc
AUTOMCSILE
LIABILITY
A14Y ALTO
COIJBIN60 SINGLE LIMIT
JES ACC�denl)
S
SOCILY INJURY
(Per penon)
ALL OWNED AUTOS
SCIIIECULED AUTOS
HIRED AUTOS
ION,OWNID AUTOS
BODILYINJURY
(Per3cciden))
PROPERrYOAMACP
GARAUE LIABILITY
AUTO ONLY -CA ACCIDENT
S
'R TjiAN EA ACC
OTit.
AUTO ONLY: AGG
S
ANYAuTO
S
___S
EXCESSIUMEIRELLA LIABILITY
---
EACH OCCURRENCE
S
]OCCUR FICLAIMS MAX
AGGREGATE
S
DIECIUCTIRL11
WORKERS COMPENSATION AND
"C _STAIU
I TW -11-1I.H.
I', F
FIR
ANY PROP1RILTOrVPAfI`YNEkC-XECLMVI!-
E.IL. EAC44 ACCIDENT
$
El DISPASr-EAEMPLOYEd
S
OFfICERINIENIBER EXCLUDED?
Ifyc--, doscrLba unair
SPCCiAL PrICIVISIONS 1)�I&-
LIA 7
El. DISFASF - POLIc;Y Liwj
OTHER
F
DESCRIPTION OFOPERATIONS J LOCATIONS I VEMICI, 51 EXCLUSIONS ADDEO BY ENOOR3e1YIPN'T1SPfC1AL PROVISJONS
Is Respects: Operations of the named insured.
:ertificate holder is additional insured as their interest may appear, per policy form BR3130 9/06
3ttached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOV2 DSSCRIAeD POLICIESSE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER VIALLENOEAVORTC, MAIL
City of Edmonds
30 DAYS WRITTEN NOTICE TO YRE CrRTIrICA71E HOLDER NAMED TO THE LE;Y,
Attn: Permit Dept
BUT FAILURE TO MAIL SUCH NOTICE SRALL IMPOSE NO OBLIGATION OR LIABILITY
121 Sth Avenue North
OF ANY kiND UPONTWV INSUPER. ITS WIENTS OR REPaCSFIQTAYIVCS_
Edmonds, WA 99020
rAUTHORIZEO REPRESENTATIVE
M -I, b--FFYI A
M
ACORD 25 (20U1108)
AA1&&-C A OMJEA'&�l 986
Re c e i v e J 7 ]me k10 v. 17. 9: 23AM N 0 V 18 20OR
BUILDING DEPT,
Hoover Premier Homes No.1646 P. 3
Nov, 17. 2008 2 : 50PM
IMPORTANT
If the cerlOicate holder Is an ADDITIONAL INSURED, the policy(jeS) must be endorsed. A statement
on this certificate doesnotconfer rights to the certificate holder;n lieu of such endorsoment(s).
It SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, certain policies may
requIre an endorsement. A statement on this certificate dDes not confer rights to the cedificate
holder in lieu of such enclorsament(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a conlrW between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon,
AGORD 25 (Z0011DO)
Received Time Nov. 17, 9: 23AM
Nlov,11, 2008 2:50PM Hoover Premier Homes
No� 1646 P. 4
BR 31 30 09 06
THIS ENDORGE�WNT CHANGES THE POLICY. PLEASE RX�D IT CAREFULLY.
ADDITIONAL INSMD - PRIMARY COVERAGE - SCHEDULED PERSO'N OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILXTY COVERAGis FORM
SCHEDUL9
Name Of Additional Insured Person(s) or organization(s):
Any and All Person or Organization
when Recruired by Contract
Location(s) Of Covered Operations,
Washington
Informationt.required to complece this Schedule, if not shown above, will be shown in
the Declara, one.
A. Section 11 - WhO Is An Insured is amended to include as an additional insured the
Merson(s) or organization(s) showa in the Schedule, U
bility "b t only with respect to
for '(.bad! I inji��-- :[property damagen or personal and dvertiEing
iniurY4 caused, in whoTe or in p�rt by: a
1. Your acts or omissions; or
2. The acts Or Omissions of those acting on your behalfi in the performance of
�our ongoing operations for the adaitional ingured(s) at the locations(s)
esiqnated above.
B. With Fespect to the insurance afforded to these additional insureds, the
following additional exclusions apply:
This insurance does not apply to ,bodily injury,, or "property damage" occurring
after;
1. All work, incl-uding materials, parts or equipment furAi3hed in connectior, with
such work, on the project (other than service, maintenance or repairs) to be
performed by or on behalf of the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises -has been
Put to its intended use by any person or organization other than another
contractor or subcontractor engaged in performing operations for a principal
as a part of the same project.
C. With rempect to tho insurance afforded to these additional insureds, the
following applies;
1'he �nsurance Provided by this endorsement is prima insurance and we will not
seek contribution from any other insurance ava:'flable to the person or
organization shown in the Schedule unless the other insurance is provided by a
pawBon or organization other than you for only the sane,operation and location
designated above. Then we will share with that a her insurance by the method
described in subparagraph c. of para t
COMMERCXA6L OBNERAL LIABIL17Y CONDITIONS . . graph 4. Other insurance of szcTION IV
OR 31 30 09 D6 Inctudes copyrighted materiaL of insurance servicez
office, Inc., with its permission
Received Time Nov.17, 9:23AM
. I I Nov,17, 2008 2:48PM Hoover Premier Homes
No. 1646 P. 1
HOOVER PREMIER HOMES
A dIvIsIon of R.H. Hoover, Inc.
To: IZ41a r / (f-1
16300 Mill Creek Blvd., #108
Mill Creek, WA 98012
Phone: 425-745-1370
, Fax: 425-745-1466
"'M'A'
Fax: 7 71
Date: # of Pages -J4—
Note: �zo 0 F 0 �� -76
From:
RECOVED
Nov 18 2TAI
Scott Hoover, Executive Vice President
Cathy Patterson, Vice President
Heather Rogers, Office Assistant
MASTER BUILDERS
A S 1 0 C I A T 1 0 N
41 Counteec
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
200810090471 CONFORMED COPY
5 PGS
10/09/2008 4:05r 1,88 00
SNOHOMISH COUNT , ASHINGTON
COVENANT OF NOTIFICATION
AND INDEMNIFICATION/HOLD HARMLESS
Reference #: 20g46
Grantor(s): (1) P-4,11 (2) Additional on pg.
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec Twn Rng
YZ5- Qtr
OR Lot 2� edIrtfILI Block 0 Plat r1f-A- OOAC�
Assessor's Tax Parcel ED/I(s): (1) 0 0 10 0 oc> 2 q 0 2-
Assessor's Tax Parcel EN not yet assigned
CITY OF EDMONDS
APPROVED FOR RECORDING
BY: DATE: /d/44AGE L OF
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. Description of Subject Property.
I"P OVED FOR U COPG,
B - DATE'-� 4
P Y: 0
A E F
This covenant of notification and
indemnification/hold harmless relates to a tract of land at the street address of
lc�U2-1�7 I t� t� FL V,�, (insert street
address), Edmonds Snohomish County, Washington and legally described as:
I &-
1-tQAL—'-
MEADOWDALE BEACH BLK 000 D-02 TH PTN LOT 24 PLAT OF
MAEDOWDALE BEACH'& LOT 25 PLAT OF MAEDOWDALE BEACH
SUPPLEMENTAL PLAT DAF: COM AT CONC MON IN STEEL CASE AT INT
158TH ST SW & 75TH AVE W TH NO2*48 17E ALG C/L 75TH AVE W
389.15FT TH N87*48 41E 30.12FT TO E LN 1OFT STRIP OF LAND
DEEDED TO CITY OF EDM VOL 5 OF DEEDS PG 53 REC SD CO & POB
TH NO2*48 17E 10.256FT To S LN SD LOT 24 TH N88*09 43W ALG
SD S LN 1OFT TO SW COR SD LOT 24 TH NOO*39 53W ALG W LN SD
LOT 24 82FT TH S88*09 43E PLW S LN SD LOT 24 120FT TH
sOO*39 53E PLW W LN SD LOT 24 49.80FT TH N88*09 43w 18.38FT
TH SOO*39 53E 32.20FT To S LN SD LOT 24 TH N88*09 43W ALG
SD LN 20FT TH S76*23 13W 25.50FT TH S87*38 41W 47-34FT To
POB PER CITY OF EDM BLA NO S-3-91 REC AF NO 9105020156
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 the risks associated with development are contained in building
permit rile number 024P
.e26P
,� (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
EA0EtQ0R RECOMM;i.
"P 0
B DAT!�V
P :� OF
P Y-�
A6E
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 Building Department, City of Edmonds, 121 5th Avenue
North, Edmonds, Washington 98020.
3. Indemnification and Hold Harmless. The undersigned 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 against
the City of Edmonds, its officers, agents and employees 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,
Ci ty 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.e.arth subsidence or la ndslide hazard, arising.from or out of
the issuance of any permit(s) authorizing development of the site, or occurring or
[APP 0 FOR 0 6-
B - DAT - 64P
Y-A OF
PAGE 7
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/has not (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:
5. Covenant to Touch and Concern the Land. This covenant of
notification and indeninification/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.�i I nd . emnify the City except to
the exten.t.of .,their. loss.nor to obligatesue I h ersons to maintain the insurance above
p
required.
IikppROVED Fj)R RECORDJrKG:
13Y.- f)ATE:
P
AGE OF
DONE this day of
OWNER(S
By:
By:
By
STATE OF WASHINGTON
COUNT-YOF ss:
I certify that I know or have satisfactory evidence that K7 le—
q"..j signed this instrument and
acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in
this instrument. I�N— 'I- c� C., 6-
DATED this day of
J.-
..opslolv
NOTAdK PUU�:
N::� ssion exp, D
my commi ires: U
L:
k.- :
Message Page I of I
Harrison, Marie
From: Harrison, Marie
Sent: Thursday, November 13, 2008 12:26 PM
To: 'Kristin Hanson'
Subject: Ray bld2008O376
Hi Kirstin: We are about ready to issue the Ray permit. I will need a restoration
bond in the amount of $50,000.00. 1 have attached a bond form for 1) bonding
company and 2) frozen fund for financial institution, Which ever they prefer. I will
also need a copy of the the contractor's liability insurance naming the City of
Edmonds as additional insurer (see attached requirements #6), Also 30 day
notification.
Sincerely,
XaT& qas-zejag
sm-4n ;Vew-er e66--le"tataT
Vew6�aaxor .5,-,zv&ej Vctamfeuwt
6x# 4 V�4
&,a,. ao
11/13/2008
-COMM. RNAL- DATE NOU-17-2� TIME 15:47 *** P.01
MODE = MEMORY TRANSMISSION START=NOU-17 15:46 END=NOU-17 15:47
FILE NO.= 042
STN NO. COM ABER NO. STATION NAME/TEL.NO. PAGES DURATION
001 OK a 94256727147 004/004 00:01'14"
A.�"��0 ED
- City of Edmonds
1P Development Services Department
Build ing-Engi neering-Plann Ing
121 51h Avenue North -2nd Floor
A Edmonds, WA 98020
Phone: 425.771.0220 Fax: 425.771.0221
COVER PAGE
X
To: F r o rn: `T�4w;
Date Transmitted: //�j Recipient's Fax No:
�7 No. of Pages:
I I (including cover page.)
If there are any problems during transmission or documents are received incomplete, please
call 425. 771.0220 and ask for:
L:Temp/jana/(offns10SFAX
.(A
E A S X 9 E N T
THIS AGREEAMNT inade and entered into this 6th day of
May, 1963, by and between WEST COAST MORMAGE & INVESII!ENT CO.,
a Washington corporation, herein referred to as First 'Party, and
CLARENCE 0. BLACKWELL and RUTH BLACKWELL, his wife, herein re-
ferred to as Second Parties, and XARGAAET ANNE RIGGAS, a widow,
herein referred to as Third Party;
W I T N E S S X-T H:
WIMREA3, theFirst Party is the vendor under a written
contract of sale between -the First Party and the Second Parties,
with reference to the real property situate in the County of
Snohomish, State of Washington, referred to herein as Parcel A,
and described as follows:
All that portion of Tract 24, Plat of Meadowdale
Beach, according to plat thereof recorded in
Volume 5 of. Plate, page 38, records of Snohomish
County, described as follows: Beginning at the
southwest corner of that portion of Tract 24 lying
oast of County road; thence in a northerly direction
sloog the easterly margin of said road 92 feet; thence
easterly parallel to south boundary line of. Tract 24
a distance of 120 feet; thence outherly -parallel to
the County road 82 feet to the :otith� b6undiw-�..k line
of Tract 24; thence westerly along said 'b646diry line
120 feet to the point of beginning, situate in the
Oounty of Snohomish, State of Washington;
and,
WHEMS, the Second PartLes are the vendees under the
above mentioned contract of sale with the First Party, with refer-
ence to the above described real property referred to as Parcel A;
and,
INERW, the Third Party is the owner of the property
situtte In the County of Snohomish, State of Washingtol
A4
:1-7 IMM".-.7
...............
.1
to herein as Parcel 8, described as follows:
All that portion of Tract 24, Plat of Meadowdale
Beach, according to plat thereof recorded in
Volume 5 of Plats, page 38, records of Snohowish
County, described an follow:i: Beginning At the
southwest corner of that portion of Tract 24 lying
east of County road;.thence in a northerly direc-
tion along the easterly margin of said road 82 feet
to the true point of beginning; thence continue
northerly along the easterly margin of said road
for 60 foot; 'thence easterly parallel to south
b4coundary line of Tract 24 a distance of 120 feet;
.thence southerly parallel to the County road 60
feet; thence westerly parallel to the south boundary
line of Tract 24 for 1.20 feet to the point of be-
ginning, situate in the County of Snohomish, State
of Washington;
and,
WHIRZA3, a driveway and carport exist on the comm
an
boundary between the above described parcels A and 8, and have
been In use In connection with said properties for some times and
the parties hereto wish to express in writing their agreement
with respect to the continued use and enjoyment thereof;
NOW, THXRZFORS, in consideration of the mutual covenants
and agreements herein expressed, it is agreed as follows:
1. There is hereby created'an easement for a common.
driveway and a common carport over and across that portion of:. ibi
property described above as Parcel A andthat portion of the.
Property described above as Parcel B, upon which there now exists
a driveway and carport, said carport being approximately 24 feet
in width and approximately 241fect in length, along the comma
boundary line between .,said parcels; Provided* however, that the'
use of. the 'carport by each of the owners of the respective Parcels
of real Property described above shall be restricted to the balt
0:9 said carport Immediately adjacent to the property of each of
Said parties.
4.6
2. The owners of said parcels shall share equally in
the expense of maintenance of the common driveway and the res-
pective portions of the carport used by each of them, but no
structural change shall be undertaken of the carport without the
consent of the other party.
3. The easement created herein shall be'deened a
covenant running with'the land and shall be binding upon the heirs,
administrators, executors, successors and ass igns of the parties
bereto.
IN WITM3 WHEREOF the parties have hereunto set their
hands and seals the day and year first above written.
A A 4 r..
VZ3T INVESTUENT CO. -
By:
Byl
MM
STATIC OF WASHINGTON) —z
.
COUNTY OF K I N Gj
.On this 9th day of May, 1963- before me personally
appeared D. L. McDonald and Daniel C. Rolctk
to me known to be the pmajdsnt and Ss=Vtja
of West Coast Mortgage & Investment Co., the corporation that
executed the within and foregoing instrument, and acknowledged
thetaid instrument to be the free and voluntary act and deed of
said corporation, for the uses and purposes therein mentioned,
and on oath stated that they were authorized to execute said
instrument and that the seal affixed thereto is the corporate seal
of said corporation.
affi
53 W=ZOF' I reunto not my ho and
L seal t7j�n
i1nd ye
of Washington, residing at Seattle
STATIC ori*VAaK'1NrJT(K)
COUNTT or K I N 0)
On this day personally appeared before me Clarence 0.
Blackwell and Ruth Blackwell, his wife, and Margaret Anne Riggas,
a widow, to so known to be the individuals described in and who
executed the within and foregoing instrument, and acknowledged
that tbey signed the sane an their free and voluntary act, for
the moos and purposes therein mentioned.
GIVU UK= MY BAND.. AL SUL this fth day of
may
Zur %no DUN
of Waskington, r9sidial at ft*ttt*