BLD2001-0734 LEGAL DOCSRETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
CONPOpMeo Copy
10102 2001,0020364
12001 11:25
P-0004 RECORDED AM Snohomish
County
COVENANT OF NOTIFICATION
'AND INDEMNIFICATION/HOLD HARMiL SS
E
Reference #: 4 7 ;:W
Grantor(s): (2
Grantee(s): Ci, 7- Additional on pg.�
Legal Description (abbreviated): Sec�—�Twn--�Z V�g_�l
OR Lo`t—/----Bl0ck—.Pla1
Assessor's Tax Parcel ID#(s): (1 (2 --9ZM9t--
------- Assessor's Tax Parcel EN not yet assigned
CITY OF EDMONDS
APPROVED. FOR RECORDING
Dy:—&,�L— DATE441 V& PAGE / 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:
I. Description of Subject !r �e
EAPPR SVF:-FOR RECORDING:
BY: 2 I;_ I
j DA T E:
PAGE
_ OF
This covenant Of notification and
indemnification/hold harmless relates to alract of land at the street address of
;;72 Aeew44e-
(insert street
address), Edmonds Snohomish County, Washington and legally described as:.
2. Notifleatio i and Covenant of Not -If,
cation, 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. T_ he results of the c . onsultant's reports
and evaluations of the risks as sociated with development are contained in building
permit Me number,��P�— �_� (insert numbei) 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
APPROWED FOR RECORDING.'
BY: DATE:_
PAGE OF
the consultants in the course of permit issuance. The conditions, limitations, or
prohibitions may require ongoing maintenance on the part of any owner o . r 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 e I ngineer,
geologist, architect and/or structural . engineer are hereby incorporated by reference
from the contents of the Me as fully as if herein sefforth. 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. Thefille 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 I 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 act! I on agaist
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
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 otit of earth subsidence or landslide hazard, arising from or out of
the issuance of any permit(s) authorizing development of the site, or occurr . ing or
EAPPRVED FOR RECO
BY . : WIWN
W�! DATE: A
PAGE
OF
DONE this day of
nX%rXTV,n,(0-%
. By..
By:
'By
STATE OF WASIHNGTON
ss:
COUNTY OF kdtam�
I certify that I know or have satisfactory evidence that P"2-- Q-
signed this instrument and
acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in
this instrument.
DATED day o
0- -M -0, -1
?AM
*0
�VPTjn�Tp,
NOTAIRZY PUBLIC
0
MY commission expires: t 0 - 0
3 414WO
LATEMMUILDINGWEADMCOVENANT
From: Marcy Jones At: Whitfield's United Insuranc( Agencies Inc To� Marie-2nd Floor Fax*: (425) 258-6944 Date: 9/18/01 08:53 AM Page 1 of 1
ACORA CERTIFICATE OF LIABILITY INSURANCE 'OP ID Mill DATE (MMIDDi
HAmmc-2 1 09/18/01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Whitfield's United Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Commercial Lines Department HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 1127/ 3425 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Everett WA 98206 INSURERS AFFORDING COVERAGE
Phone: 425-258-2300 Fax:425-258-9363
INSURED
Hammerhead Construction
Services LLC
6947 coai Creek Parkway SE#290
New Castle WA 98059
COVERAGES
INSURER A Mutual of Enumclaw Ins Co
INSURER B.
INSURER C:
INSURER D�
INSURER E
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN S R I
LT R TYPE OF INSURANCE
POLICY NUMBER
POTLrCCY EFFDCTY'IVE
DA = MM DIV
POLICY EXPIRATIO
DATE Mi
LIMITS
1 GENERAL LIABILITY
EACH OCCURRENCE
1000000
FIRE DAMAGE (Anyone fire)
50000
A MERCIAL GENERAL LIABILITY
PK94325
07/05/01
07/05/02
CLAIMS MADE 1-1 OCCUR
MED E)(P (Any one person)
S 10000
PERSONAL & ADV INJURY
S 1000000
GENERAL AGG:ZEGATE
S 1000000
GEN'L AGGREGATE LIMrTAPPUES PEP
PRODUCTS - CCMPiOP AGG
S 1000000
7 PDLICY [7 J'E'C'T- F-� LOC
AUTOMOBILE
LLA131LITY
ANV AUTO
COMBINED SINGLE UM17
(Ea accidient)
ALL OVIAJED AUTOS
S--�EDULED AUTOS
RECEIVEC
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
HIRED AU70S
NON-OVNINED AIJ70S
SEP 1 8 2001
PROPERTYDAMAGE
(per accident)
BUILDING DEPT.
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
OTHERTHAN EAACC
I
ANY At;T0
S
AUTO ONLY AGG
EXCESS LIABILITY
EACH OCCURRENCE
S
._7 '77
OCCUR C LAIMS MADE
AGGREGATE
DEDUCTIBLE
RETENTION S
WORKERS COMPENSATION AND
TO Y I.IT I JOTH-
ER
EMPLOYERS' LIABILITY
E L EACH, ACCIDENT
E.L DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
I
OTHER
A HIRED, LEASED
PK94325
07/05/01
07/05/02
250 DED 30,000
i RENTED EQUIP
I
DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTfSPECIAL PROVISIONS
CERTIFICATE HOLDER IS ADDED AS ADDITIONAL INSURED AS THEIR RESPECTIVE
INTEREST MAY APPEAR IN WORK PERFORMED BY THE NAMED INSURED.
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CITYOFE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 OAYS WRITTEN
City of Edmonds
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL
fax 425 771 0221
2nd Floor Attn: Marie
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
121 5th Ave N.
REPRESENTATIVES.
AUTHOR
Edmonds WA 98020
ACORD 25-S (7197) (DACORD CORPORATION 1988