BLD2004-0516 MISC DOCSil
ADDRESS:
Ot of Edmonds, City Clerk
y ..
..1121.5th Avenue North
��&4,_WA-98020
200407140508 5 P S
07-14-2004 01:46pm $23 00
SNOHOMISH COUNTY. WASHiNGTON
OF NOTMCATION
ANDP�D�MNMCATIONMOLD EL4RMILESS
Reference #:
Grantor(s):
Grantee(s):.
H.Vvc4e7T
Additional on pg.
re,oat 4 '�e wn
Legal Description (abb � '� ),.%
—22 _YRng_fZ f ,_Qt
—Block Plat
Assessor's Tax Parcel ID#(s): ) 0 0 r7- 0 0
(1)_ ob 2 2/:2"`,00L_ - (2)
_—Asses"Ps TAX Pa rrel EN not yet assigned
CM 0F.EDX0"S'---.
APPROVED FOR RiCORDINP
B DATE.-2W
- WPAGE-L0F
Under the review procedures established pursuairt6'thi Stlk . te.-BuiIding Code,
incorporating amendments promulgated by the C4: of'&'lmon`:
ds, and as a
prerequisite to the issuance of a building permit for the coNtrU . etibn ofifiresidential
structure and attendant facilities, the undersigned 0)VN1ERS'C'!f-Pr`q`pi 46,hereby
covenant, stipulate and promise as follows:
. ..........
---I. Descriptift of Subject Property,
AP�
ARV D FOR RECORDING
IG
2ww
L
A Ut'--5-
This covenant of notification and
IncteMAH-1
��anon/hQdJiUrmless relates to a tract of land at the street address of
/A
j::UZ A jahiI5 t (If.//q (insert street
1, Edmou'ds-Snohomish County, Washington and legally described as:
Ar - t7 J�a <
2. Notification and Covenant of Notificatfon..� the above referenced site
(hereinafter "subject site") lies within an aria.,r*h-.ha§-h�en identified by the City
of Edmonds as having a potential for earth subsidente or li . ndslide hazard. The
risks associated with development of the site have -�-C'Vu ..0-iluated by technical
consultants and engineers engaged by the applicant qs'a:.pa`rt---6 . Uthe process to
obtain a building permit for the subject site. The results' --of- the p6ji
sultAint's reports
and evaluations of the risks associated with development a , ri %
in -budding
permit file number QLM&-Jf- Mflo (insert number) on file "'With" the: Ci . t of
Y
Edmonds Building Department Conditions, limitations, or%-`P---r6h-ibid0-ns---9n
development may have been imposed in accordance with the recox'hifiend* atio-"-s'-; OC
.... ......
FAPPJ�VEEFOR RECOPDWG
DATE-7/2/a/
P YI
A q
3 OF15
the.,cdnsulta,ufs.4fi the course of permit issuance. The conditions, limitations, or
pi-bbi6itioni may:'r"e"4uii*hre ongoing maintenance on the part of any owner or lessee or
may rk�qufre madifir.-Stions, to the structures and earth stabilization matters in order
to addresg' futdrie"o r .... changes in soil or other site conditions. The
statements and :6ndftioas proposed by the OWNERS' geotecbnical engineer,
geologist, architect an or'stripi6fural engineer are hereby incorporated by reference
from the contents , of the-Ae,. - hi`fu * By as if herein set forth. Any future purchaser,
lessee, lender or an�ooer.R�rsdn 4cquiriug or seeking to acquire an interest in the
property is put on notke,O6e.em`*st0ii . ce..Oftbe content of the file and the City urges
review of its contents. Tlie'illi may"be reviewod during normal business hours or
copies obtained at the Buildhig Depart * m6t, City of Edmonds, 121 5th Avenue
North, Edmonds, Washington 9802Q.--
3. Indemnification and Hold undersigned
OWINTERS
hereby waive any and all liability associat�d:
.With* dqkelopment, stating that they
have fully informed themselves of all risks,as ......
with development of the
property and do therefore waive and relinquish an: y ;and a.h c.A:uses of action against
the City of Edmonds, its officers, agents and empl6yees #yi�mgfrdni and out of such
development. In addition, the OWNERS on behalf of thimsel�esjt . heir successors in
interest, heirs and assignees, do hereby promise to indemm�ffy apd" 'harmless the
City of Edmonds, its officers, agents and employees from any".16's's'...er ligbility or
damage of any kind or nature to persons or property eith .. 6 . r.,cih . Q.r-'*dg t he site
resulting from or out of earth subsidence or landslide hazard,
the issuance of any permit(s) authorizing development of the site, '6t`o&_*urrhi - j 01F*.
APP VEP FOR RECOMIN
T
-7,
B tU DATE;
PA OF t7)
.............
aris.ing misleading, or inaccurate information provided by the
OW
,NER-5,-their ��p,16yees, or professional consultants in the course of issuance of
the building'periftit...,
. ............. .
4. Iftsuftncdl�aulrement. In addition to any bonding which may be
required duri�g 'th� c6u.6i4f "development, the Community Services Director
has/has not (strii� oin'� �p&iffcally required the maintenance of an insurance policy
for public liability coverage in. ille amount and for the time set forth below in order
to provide for the finanic : I-T�sp sibifitieses
1.0 tablished through the indemnification
and hold harmless agreemenfAhb*vP;-"'
.. ...... ..
5. Covenant to Touch and Concern the Land -This covenant of
notification and indemnification/hold harm -less tou&eis' ... concerns the subject
..........
tract and shall run with the land, binding, obligatijig and/or Wuring to the benefit of
future owners, heirs, successors and interests `Q ' r aity * 011 . er.,.person or entity
acquiring an interest in property, as their interest may 4ppeaf.'.,Ttils�'provision shall
not be interpreted to require a mortgagor or lender to inidemnif "tbe"City except to
y.,
the extent of their loss nor to obligate such persons to mainl�in`ihe-kWra ice above
required.
..... ......
APPR *VEFOR RECO 0
B DATE
r
P
........ A47 Of!aq
. 0 day of ?IP0 C4
OWNER(S)
......... ...
%, By:
. ......... By:
. .. ...... ...
By
STATE OF WASHINGTON'...'-
COUNTY OF
I certify that I know or have s�tjsfacto�ry-iyidexice that �—tiC-P\caj
igno this instrument and
acknowledged it to be (his/her) free and voltintAl ry-act. &:X.fhe purposes mentioned in
this instrument
DATED this day of A
NOTARY PUBLIC
My commission e1p, �res:
Notery PubW'
L,\TENMBUELDING\NMAD0WxCo,vENANT State of Washh-4tm-
CHELEA M. WARINNER'
My Appointwwnt ExplTa Feb 98, 2*.
Sent By: J8 ASPHALT PAVING3
425 778 08153' AlDr-13-05 16:13; Page 11/1
J.B. ASPHALT PAVING
ASPHALT PAVEMENT SPECIALITIES
Parking �01`5, oriveways
F?oadways, Patolunq
22228 95th P1. W.
Edn-ionds, WA 98020
(425) 774-6537 - Fax: (425) 778-0815
PJO'�PSAL 5110) ITTEC TO
ADDRESS
/",-, <�— .3 C) /0 6—
706 -NAME AN� "OCATION
'� 0
-7
Propiroat NOTliu. TO CUSTOMERS
ibis cQntrdQIQ, is iegistered with the 5tato of 'Plashinglon.
lqist�alicn iio� 313ASI'0110CS. a�,, qeqpr;m.�pecialty contractor
and i;as, pngted will, lifir,
. . state a bond or cash deposit of
S6.000;$4.000 for the PUTOM4 of satistyino claims against the
contractor for negligent or improcier wurK or oireecholcootraclln
the runduct of the contractor's business. Tnis bond or cash deposit
may not be sufficient to cover a 02im which night arise from the
work done under your contract If any supplier of materials used in
your construction project or any employee of the Contractor Or
subcontractor is not paid by (Ilti conliactoi or subcontractor on
yuui job. your property may be liened to force payment.
DATE
PHONE
t for
c hereby submit 'Pec0ic-at'On5 and cstirnates.subjct t(I -11 tp
,ri-ns and condition5,35 59
'a �!�:
'A
0
r%
payment Due 15 clays following statement date
prjrjnils� it required. will be tho owners reSP01151t)'111Y
All materiAl iq guaranteed as specified.
We shall not be liable lor dlamage to SePtIC tank5, underground pioes or contluils not visible 1rull, *ulface.
VVe rannol be responsible for 5vograde tailur8b-
A finance charge of 1% Per month (12% annual perceniar
ge rate) wilk be imposed on any Past due bai3mCe
In c;jvs�e suit is inStituled on any portion of this contract, reasonable attorneys lees and court coSts will be
added to this contract.
VVE PROPOSE hereby lo fUrnish rnaterial ;Lrd I.-4hnr - COMDletP in accordance Wilh a0ove
dollaru
1pt C n or lhr 1, H 111 ID
Note: ThiS pg()PQ5al tl�131.lne w1indrawn by us if
nnj arcciDlecl withill !pe ) 0 a Yn.
A C, (-, F P1 E [) , T h id 3L)OVP v riCt-, 5ppcif iC ati-.)n.,; a ud
Qr)jjdlti�n�, afv GatiSf8c-10rY ',ind Arp hP(CbY ann*I.olcd
Y�)U irp atAtl0flZed in do the work as %;ACIticd
Paymen' wdl be maOv as outlim,.d above.
Dale
A�jltwri/PCI'r
�;i7,nattap
-,f F��tin)A;�r
ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (MWDMWM
06/30/2004
PRODUCER (425)483-9822 F
5)493-4002
THIS CERTIFICATE JSUED AS A MATTER OF INFdRMATION
Neville & Neville Insurance
18311 Bothell -Everett Hwy
ONLY AND CONFERb NO RIGHTS UPON THE CERTIFICATE
HOLDEPLTHIS CER71FICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 180
Millcreek, WA 99252-9778
INSURERS AFFORDING COVERAGE NAIC #
iNsuRED Unique Homes
R E: C.0
INSURER. A: CONMCTORS BONDING & INSU CO.
02719
David & Bohkee Cooper dba
IS07 filst PI NE
JUL 0 2 04
INSURER 8:
INSURER C:
Kenmore, WA 99028
DEVELOPMENT SERVICES CTI
ray OF EDMONDS
I INSURER D:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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 SU13JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLIUES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-
NSR
AWL
INSIRI
TYPE OF INSURANCE
POLICY NUMBER
PDICCY EFFECTIVE
DATE (MUMDOM
POLICY EXPIRATION
DATE (NMMD00Q
UMITS
GENERAL LIABILITY
—
INSSF0495
09/26/2003
09/26/2004
EAcHOCCURPENCE
$ 1,000,0001
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PRFMISFS (Ea .,'Macw
$ 300
__j OCCUR
CLAIMS MADE f X
10001
$ 5'wO
MED EXP (Any one Person)
A
PERSONAL& ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEWL AGGREGATE LIMIT AP;:UES PER:
PRODUCTS . COMPIOP AGG
$ 2,000,000
_x] POLICY F] JEcOT El LOC
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED 51NGLE LIMIT
(Ea -cident)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
KRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per aocident)
$
PROPERTY DAMAGE
(Per accident)
GE LIABILITY
_AUTO ONLY - EA ACCIDENT
$
ANY AUTO
17
OTHER THAN _EA ACC
$
$
AUTOONLY_ AGG
EXCESSIUMBRELLA UABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE
$
-AGGREGATE
$
HDEDUCTIBLE
$
RETENTION S
$
WORKERS COMPENSATION AND
WC STAIIJ- OTH-
EMPLOYERS! LIABILITY
E.L. EACH ACCIDENT
$
ANY PROPRIETORIPARMERIEXECUTIVE
OFFICERIMUMBER EXCLUDED?
If yes. describe under
E-L - FA EMPL-0
S
E.L., DISEA SE - POLICY UMIT
$
SPECIAL PROVISIONS bekyw
OTHER
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT I SPECIAL PROWWONS
ERIFICATTON OF INSURANCE
CM OF EDPKNWS
IENIFER READMAN
121 STH AVE N
EDMONDS, WA 99020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED E T14E
EXPWATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL
10 - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE,,,�
Richard Malown�y
.�. %�& a.# R QACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed- A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)-
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement A statement on this Gertificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative Or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or atter the,coverage afforded by the policies listed thereon.
AGORD 25 (2001M)