960639.pdfU
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION rT r
OWNER NAME NAVE OF BUSINESS ADDRESS / .y 1 1
tV 4U � � i i LI' LEGAL DESCRIPTION CHECK SUBDIVISION NI
LIUG aUnuis,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I TESCP APPIo d ❑
L'II�
yLIP
TELEPHONE NUMBER
EAISTING _—_REODIRED DEDICATION _____..
PROPOSED --
RWPe11,t RegP,d ❑
Shoal Uae Permit Rea, O
of "l—RepuileG ❑
NeQiPred ❑
—MESldellik
ME IER SIZE
LINE S12E
I NO OF FIYTDRES
PRV nEOUIRED
VES ❑ NO ❑
ADDRESS
REMARKS
CITY
ZIP
TELEPHONE NUMBER
NAME
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED DY
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STATE LICENSE NUMBER UPIRATION DATE
SIGN AREA
ALLOWED I PROPOSED
SEPA REVIEW
COMPLETE JEIE MPT
EKP
ADB NO
Legal Description of Property - include all easements
SHORELINE N
VARIANCE OR LU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
m FRONT SIOE REAR
HEIGHT I
LOT COVERAGE
LJ
U NEW
& RESIDENTIAL
PLUMBING
El
ADDITION
COMMERCIAL
MECHANICAL
APT BLDG.
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REMODEL
LJ SIGN
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REPAIR ❑ GRADING O I FENCE x_FT)
CHECKED BY TYPE OF CONSTRUCTIONCODE
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ElDEMOLISH INSERT OODSTOVE .HOT TUB SPA WIM POOL
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SPECIAL INSPECTOR
AREA
.CCU A i
A•�"��
❑GARAGE ❑ RETAINING WALL/ L.O/Kr4�rrY
REOUIRED
AYES
LOAD
CARPORT ROCKERY
MARKS
(TYPE F usE. eusl E O Acr v rYlwJ��nw:
PROGRESS INSPECTIONS PER UBC 305
w NUAIPER NUMBER OF
DUNI
CRITICAL /w�//,-Q-
m0 ST OnIES TSLINGQ�IT
JARNUMBEEAS R / • / 1
DE CRIB£ WORK TO BE GONE (ATTACH PLOT PLANT
M 2
FINAL INSPECTION REQUIRED
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
iWAI:.-1Ri;r GLAZING
e/e
PLUMBING
k.
Plan Check NO.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFRL
Any construction on the public domain (curb£, sidewalks,
dNveways, marquees, etc.) will require Separate permission.
STATE SURCHARGE
Permit Application: 100 Days
Permit Limit: I Year - Provided Work It Started Within 180 Daye
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse, heirs, assigns and
END. INSPECTION FEE
r Successors in mterest, agrees to indemnify, defend and hold
w harmless the Clty of Edmonds, Washington, its officials,
aemployees. 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
PLAN CHECK DEPOSIT
omodify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
pI OVI slop.'
-
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
slate laws regulating construction; and in doing the work authoriz•
AUTHoFgES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid. and receipt Is
lion Insurance and RCW 18.27
INSPECTION
acknowledged in space provided.
SIG ryATURE OWNER OR AG NTI DATE SIGNED
DEPARTMENT
t'
I� l iCj t
'ITY OF
EDMONDS
OFFi SIG 4TURE l
�,�jC
ATTENTION
CALL FOR
ASED DaIE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 -OCGV ORIGINAL — I'de YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Ow,er GOLD — Assessor
10287
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fn ron State -
OF
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Adult family Nome LiccMC
In compliance with and pursuant to the laws of the State of Washington and the Minimum Licensing Requirements,
of the Department of Social and Health Services a license is hereby granted
to VIRGINIA a sTAIUM MWENDAR License Number 52 H 011196
to conduct and maintain at 2311-7 75TH PLACE
city of EDMONDS , zip code 95026 , county of SNOHOMISH
State of Washington, an Adult Family Home for the care and supervision of adults as follows:
24-hour family care for no more than sxx adults .
num
This license shall be in force from the 11TH day of JAtd my ,19 96, to and including
the -t i TH day of JANUAU , 19 97, subject to revocation for due cause.
Snecial Terms:
NOTE: This license is not.transferable, and is valid only for use by the individual(s) to whom it Is Issued and at the location above
described. Issued by Authority of Chapter 172, Laws of 1967, and RCW 70.128.
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CITY OF EDMONDS BARBARA FAHEY
MAYOR
260 5TH AVENUE NORTH EOMONDS, WA 98020 (206) 771 -0220 • FAX 1206) 77/-0221
COMMUNITY SERVICES DEPARTMENT
F 0 Public Works . Planning • Parks and Recreation • Engineering
,t. 189
May 13, 1996
Ms. Virginia Mwendar
23117 75th Place West
Edmonds, Washington 98026
RE: Adult Family Home @ 23117 75th Place West
The purpose of this letter is to inform you that it has come to the attention of the Building
Division that your adult family home has not met all local provisions for permits and
business licensing requirements as mandated by WAC 388-76-19091. Adult family homes
are still a fairly new use and it has taken several years for local jurisdictions to develop a
working relationship with DSHS to coordinate regulations. Moreover, the state law
governing adult family homes is specific in that it is the applicants' responsibility to check
with the City to ensure all local codes are met, but our research indicates this is typically
being overlooked by the applicant.
Enclosed is the City handout for Adult Family Homes that we have sent to all licensed
care facilities in Edmonds City limits. It is our intention to gain code compliance from all
the licensed homes so that local mandates are enforced equally. Please review the
enclosed materials and contact me at your earliest convenience to setup a meeting so that
we can discuss how your adult family home can met our City codes. I can be reached at
771-0220 if you have any questions. If you find that the handout and submittal
requirements have adequately answered any of your questions and you do not feel that a
meeting is necessary, you may apply for the required permits and licenses at City Hall and
Building Division between the weekday office hours of 9:00am to 5:00pm.
Thank you,
0�
Jeannine L. Graf
Building Official
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CA f Y..CLFRK BUILDING
A 'CITY OF EDMONDS
505 BELL STREET NOTICE OF LIMITATION AND COVENANT OCT [ 199G
EDMONDS, WA 98020 ADULT FAMILY HOME
I�
WHEREAS, the undersigned owners of property located at a� (� Pl W
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 the applicant's intention to utilize the
O 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
GO trigger certain requirements relating to the fire suppression and exiting requirements; and
G� WHEREAS, the City ha 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") iri
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 (a 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 residents or attempts
to r nt, lease or otherwise provide residence for additional residents above
the 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. Subiect Tract. The above stipulation and promises shall app to and run with
the land with respect to a residential structure located at ZAIP 3� PE W
Edmonds, Washington and legally described as:
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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 W5 in number. .
/99exulr # 960639 f%Fi5' �t�vcc Sz Ho///9(
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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.
DATED this 1\ A h day of S e 'a A , 199 i n
ACCEPTED BY:
PLICANT/PROPERTY OWNF(J
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Apprt a
eannine L. Grar
Building Official
Ap i nt � p
Owner
owner V71V 6- Q i A /M W � Nb /-I 9
COVENANT AND NOTIFICATION
ACKNOWLEDGED: "
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington )
)ss
County of Kam)
I certify that I know or have satisfactory evidence that MvJenA4v signed this
instrument, on oath stated that hewas authorized o execute the instrument and
acknowledged it as the(title) of h 1 a (name of party on
behalf on whom instrument was executed) to be the free and v� oluntary act of such party for
the uses and purposes mentions in this instument.Subscribed and sworn to before me
this I lA "I day of SX+_t 119 9 Ca
lJ�167�i lv`/
Notary Public in and for the State of Washington.
My commission expires 31. 20 19ci
certify that I know or have satisfactory evidence that `SAY'Lv.tfu AkUJe"A,1 , signed this
instrument, on oath stated that he/she was authorized to exdcute the instrument and
acknowledged it as the OWtn 2nr (title) of N I (name of party on
behalf on whom instrument was executed) to be the free and voluntary act of such party for
the uses and purposes m tions in this instument.Subscribed and sworn to before me
this day of ( 19 CA b
Notary Public in and for the State pf Washington.
My commission expires '-DJ. 2011 9
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LITemplFormsW Cov.Doc
2AU96
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RECORuLU
96 SEP 26 AM 9: 35
UUIIOR
SNOHOMISH COUNT'f. WASH.;
DEPUTY._
The land referred to herein is situated in the County of Snohomish,
State of Washington, and is described"'as follows:
That portion of Lot 4, Block 2, Lake Ballinger Land Company's Plat Subdivision Nc
i, as per plat recorded in Voltme 9 of Plats, Pages 57 and 58, records of
1
Snohomish County, described as follows:
Commencing at the Northwest corner of said Lot 4 and running,
THENCE Southerly along the arc of a curve to the right with a radius of 350.00
feet and following the Easterly margin of Bradley road, a distanc-. of 146.2 feet
to a point of tangency;
1 THENCE continuing along said road margin South 13"22'3011 East, :!37.30 feet;
THENCE North 89-11102" East, 104.22 feet to the point of Beginning of the tract
herein described;
THENCE North 0"4815811 West, 72.71 feet;
THENCE North 89"25'21" East, 122.54 feet, more or less, to the 1••+sterly margin
of old Interurban right of way;
THENCE Southerly along said right of way margin, 75.00 feet, mire or less, to a
point from which the point of beginning lies South 8901110211 West;
THENCE South 89°1110211 West, 102.20 feet, more or less, to the point of
beginning;
i
TOGETHER WITH an easement for ingress and egress over the following described
strip of land:
The South 10 feet of the following described property:
That portion of Lot 4,block 2,I.ake Ballinger Land company's Plat subdivision No.
1, described as follows:
Commencing at the Northwest corner of said Lot 4 and running,
THENCE Southerly along the arc of a'curve to the right with a radius -of 350.00
feet and following the Easterly margin of Bradley road, a distance of 146.2 feet
to a point of tangency;
THENCE continuing along said road margin South 13-22130" East, 172.30 feet to
the point of beginning of the Tract herein described;
1 AtNCE continuing south 13"22130" East, 75.00 feet;
THENCE North 89-11102" East, 104.22 feet; .
THENCE North 0-49,581, West, 72.71 feet;
., THENCE South 89-2512111 West, 130.52 feet to the point of beginning;
Situate in the County of Snohomish, State of Washington.
9609260 006 VO1. 321 4PAGf ll72
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TO PERMITTEE AND/OR OWNER
PARTIAL APPROVAL
l�90' 19q� /4IOLATION
CORRECTIONS REQUIRED
Permit Number �� 81�.3 2 Owner
Job Address 7-S R k 1
j� NO PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY
fl WITH ALL APPLICABLE CITY CODES.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
C----SO.REC
TOPWORK -UNTILAUTHORIZED ToCONTINUE BY CITY INSPECTOR.
ONS LISTEDBELOWMUSTBE MADE: BEFORE WORK CAN BE APPROVED AND/OR THENEXT PHATISE IS STARTED; TO AVOID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET.
LjAPPROVED PLANS MUST BE AVAILABLE TO INSPECTOR ON SITE.
LjWORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
Ll CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
DRECALL FOR INSPECTION.
III=- ' - �7>��-r-c_.r/-o� G�
to
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
DAYS OR PENALTIES MAY BE APPLIED.
FOR INSPECTIONS CALL 771-0220.
LJBuildingDivision Li Planning Department 4JEngineeringDepartment Lj Fire Department
CITY OF EDMONDS
Inspector g Dale
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DATE
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TO: PERMIT COORDINATOR, BUILDING DIVISION
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FROM: FIRE DEPARTMENT DATE
Z (4 7
ENGINEERING DIVISION DATE
PLANNING DIVISION DATE
OWNER �' /n Vlle4/ /%/ ADDRESS__
PERMIT #—q4 0//2,39 ADB# NA INSPECTED ON 1'Z4
)77
A field inspection was conducted to determine compliance with approved
plans. Final approval
denotes there are no objections to the granting of
Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
Other inspected 019- 01i"6 . A�Fi
PASSED FIRST INSPECTION - CONDITIONS NOTED
`/1.
A FAILED INSPECTION - OUTSTANDING REQUIREMENTS -
RECALL FOR
INSPECTION
I. +,J -725;0— - e-0 M 5 c7 r�D
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2.
! JAN 2,'-. 1997
3.
"^'DS FIRS
4.
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OCCUPANCY OR FINAL APPROVAL DATE Z/ BY
�RE-INSPECTED - APPROVED DATBY
RE INSPECTED - FAILED
I.
2.
RE -INSPECTED APPROVED
/OCCAPRV L 12/96
DATE BY
DATE BY
BUILDING
J A N 2 2 1997
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
.�
Well .......................
Pier/Porch................
Retalning Wall............
. Slab Insulation............
PLUMBING:
Underground .............
Rough -In ......... I.......
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 ......
RADON MONITOR AT SITE.
FINAL APPROVAL
FOR OCCUPANCY..........
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