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BLD1994-0579 LEGAL DOCSCITY COPY ••s � J APPLICANVOWNER LIABILITY LANDSLIDE ACKNOWLEDGEMENT DECLARATION 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 and his/her design professionals. 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 tsite, or any prospective lessees of structures or portions of a s -1-ure on the site, of the slide potential of the area. q-5--9Y �h Date Erin A. Comstock q---)_1y Date Brian J. Comstock -,";;2 Given under my hand and official seal this day o 11994 STATE OF u' lll�GTON, U s s. County of S Eti'11� On this day pers"lly appearA before ate $AFEC O U 1 to me known to be the individ al described in and who executed the within and foregoing instrument and acknowledged to me that signed cite same as free and voluntary sct and deed (or the purposes therein mentlolted. C--� 4. Q GA -Poi wades, my 11amd and official spat l� I dui 0 � My appointment e S'4114rN in urul /U! Iho Said 1.1 w%jilijig u/ ...._.__. � �•• �— •� TL•34 641 ai 14 SAFFCl1 Tau#• Inturonce ConWtsnv ACKNOWLEDGMENT . ORDINARY M 6ERMIT COUNT ER File No Applicant (f075'T(�G/� AFFIDAVIT OF MEADOWDALE LANDSLIDE PERMIT POSTING STATE OF WASHINGTON ) ) ss. COUNTY OF SNOHOMISH ) 61mSAOC7 being first duly sworn, on oath, deposes and says: That on the o� �� day of 19_?y the site located at / 0 7 IT lk y P/a c'e was posted as prescribed by Ordinance No. 2661 on the subject property. This posting begins on the day the City accepts the permit application for review and shall remain until building occupancy is granted. Signed c/►-v► Signed�,�,"..�. Subscribed and sworn to before me this day of y?�( 19. Notary Public in and for the State of Washington. Residing at �.,, Lt% BUILDING MAY 2 Q 1995 Request For Waiver of Owner Insurance Re: Permit #940579 Building Official May 19, 1995 City of Edmonds To whom it may Concern, I am writing to request a waiver for the requirement for Owner Insurance Ordinance #2866. I feel this is an excessive burden for a single family residence, and feel it should be waived since other owners have been granted waivers for this Ordinance in the same Subdivision. Thank you. Respectfully, Brian J. Comstock 1107 Daley Place Permit #940579 Sedgwick Sedgwick James of Washington, Inc. Sedgwick James Building, 2101 Fourth Avenue, Suite 1700, Seattle, Washington 98121-2344 Telephone 206 441-5900. Facsimile 206 448-9235 October 19, 1994 City of Edmonds Building Division 250 5th Ave. N. Edmonds, WA 98020 Re: Comstock Jewelers Inc. Jewelers Mutual Businessowners policy #139709 I have enclosed the following; ( ) Endorsement(s) effecting the policy ( ) Loss payable/Mortgagee endorsement ( X ) Certificate(s) of Insurance If you have any questions, please call me. Sincerely, Susan Haringa j Account Administrator Select Accounts SH:to encl. Insurance Broking Risk Services Employee Benefits � DATE (MMIDD/1fY) _ AL tRD I CERTIFICATE OF INSURANCE P&oDucER' - -- — -- 1 1 0/ 19 9 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE S E D G W I C K J A M E S O F W A HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR S U I T E 1 7 0 0 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 2 10 1 F 0 U R T H A V E N U E COMPANIES AFFORDING COVERAGE SEATTLE, WA 98121 COMPANY A Jewelers Mutual Insurance Co. INSURED COMPANY Comstock Jewelers Inc. Geraldine & Brian Comstock B COMPANY 102 1/2 5 t h Ave. S. C COMPANY Edmonds WA 98020 D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO L TYPE OF INSURANCE POLICY NUMBER POLICY (M�" UPS A GENEiALUABIM SBPWA139709G 10/30/94 10/30/95 GENERAL AGGREGATE $ 1000000 X PRODUCTS-COMP/OPAGG $ COMMERCIAL GENERAL LIABILITY CLAIMS OCCUR MADE X PERSONAL & ADV INJURY $ EACH OCCURRENCE $ 5 0 0 0 0 0 OWNER'S & CONT PROT FIRE DAMAGE ( Any one fire) $ MED EXP ( Any one person) $ 10 00 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accidnet) $ HIRED AUTOS NON -OWNED AUTO PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: $ ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM WOR IAAMS COMPENSATION AND EMPLOYER'S LIABILITY STATUTORY LIMITS $ EACH ACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE - POLICY LIMIT $ DISEASE -EACH EMPLOYEE $ OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATTONSA OCA ITEIMS IT IS UNDERSTOOD AND AGREED THAT THE CITY OF E D M 0 N D S IS ADDITIONAL INSURED CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CJWCELLED BEFORE THE C I T Y O F E D M 0 N D S EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BUILDING DIVISI O N 2 5 0 5 T H A V E N E D M 0 N D S, W A 9 8 0 2 0 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE Hamm NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY IOND UPON THE OOMP ITS AGENTS OR REPRESENTATIVE& AuIQI�REPRESENrATTVE S E D G yiI C K JAMES OF WA, INC PA(MD CORPORATION 1993 ACORD 25-5 3/93 2 6- 48 CITY CLERK CIVIC CENTER `\ EDMONDS. WA 98020 COVENANT OF NOTIFICATION AND INDEMNIFICATION/HOLD HARMLESS ' Under the review procedures established pursuant to the State G'\1 Building Code, incorporating amendments promulgated by the City i 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. unes:.ripticr. of Cz:b�act Proper. This cc;;enant of notification and indemnification/hold harmless relates to a tract of land at the street address of s_JQJ 00 l-� � P���� (insert street address), Edmonds, Snohomish County, Washington and legally described as: o M m CD C7; CD /076©r,- 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 o.f WSS52079A/0006.040.034 WSS/klt 02/08/90 -1- roc. 29 59 PAGE1213 BUILDING FEB 9 - 1"0 3'. the risks associated with development are contained in building permit file number (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 interestin 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 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 WSS52079A/0006.040.034 -2- WSS/k1t 02/08/90 Ohl9 0 2 959pa��1214 von. 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 4i-aae/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: (insert insurance requirements and time period, if any --if no insurance required, so state.) WSS52079A/0006.040.034 WSS/klt 02/08/90 -3- vat. 2 9 5 9 PAGE 1215 5. 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 day of ��r, , 199X. OWNERS) By: By: Ll� am STATE OF WASHINGTON ) ) COUNTY ss: OF titi�v\) I cert'fy that II know or have satisfactory evidence that Lvt �`�'ti� l�Gisigned this instrument and acknowledged' 9 WSS52079A/0006.040.034 WSS/klt 02/08/90 ly J4V9y2.VV4VJ MEM voL. 2 9 5 9 PAGE 1216 it to be (his her) free and voluntary act for the purposes -.. nit , eq N.nin this instrument. �. Y(.' his day of(��i�"` 199 07 v: CAL NOTARY PUBL C/ �,. My commiss�' r( xpires: d "(a STATE .,OF WASHINGTON ) COUNTY OF� ���k) I certify that I know or have satisfactory evidence that "�uuti, Amil v���.c signed this instrument and acknowledged o be (his/her free and voluntary act for the purposes .-.-.. H U t'ic ed in this instru ent. DATED'.this S_� of day , 199q r a p NOTARY PUVBC� - % My commisn OF WASHINGTON ) ) ss: COUNTY OF ) pires: I certify that I know or have satisfactory evidence that signed this instrument, on oath stated that (he/she) was authorized to execute the instrument and acknowledged it as the (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 day of , 199_. NOTARY PUBLIC My commission expires: WSS52079A/0006.040.034 -5- WSS/klt 02/08/90 I.P: voL. 2 9 5 9 PAGE 1217 �r vi "DATE (MM/DD/YY) 10/31/96 THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORNATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Jewelers Mutual Insurance Co COMPANY Geral di ne & B r i an Comstock COMPANY 102 1/2 5 t h Ave. S. C Edmonds WA 98020 COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY E PO ICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MM/DOlYY) UMITS A GENERAL LIABILITY J P W A 9 0 5 2 2 9 1 0/ 3 0/ 9 6 1 0/ 3 0/ 9 7 GENERAL AGGREGATE $ 1 0 0 0 0 0 0 X COMMERCIAL GENERAL LIABILITY 0-0-CLAIMSFx] MADE OCCUR OWNER'S & CONT PROT PRODUCTS-COMP/OP AGG $ 1 0 0 0 0- PERSONAL & ADV INJURY $ EACH OCCURRENCE $ 5 0 0 0 0 0 FIRE DAMAGE ( Any one fire) $ MED EXP ( Any one person) $ 10 0 0 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTO ( AA B U I L D I NA, G rr NOV V - 1 1996 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ WORli COMPENSATION AND EMPLOYERS LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL WC STATU- TORY LIMITS OTH ER EL EACH ACCIDENT $ EL DISEASE - POLICY LIMIT $ EL DISEASE - EA EMPLOYEE $ OTHER CRIPTION OF OPERATIONS/LOCATIONSNENICLE=PECIAL ITEMS IT IS UNDERSTOOD AND AGREED THAT THE CITY OF E D M 0 N D S IS AN ADDITIONAL INSURED CITY OF E D M 0 N D S BUILDING DIVISION ?50 5 T H AVE N _DMONDS, WA 98020 "'"""��""" '"` SE IPJWICK DAMES 0F WA, INCl