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23931 78TH AVE WIiiiiiiiiiiiii 15219 23931 78TH AVE W 25931- �-(', A1�. �� � . 0 TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: OTHER L:\TEMP\DSTsTdnns\Street File Checklistdoc a41intton State ADETAOF SOCIAL HEALTH SERVICES Adult family Home License 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 city of to Divinia o. Zabala (Hyacinth Adult Homecare II) License Number 453100 to conduct and maintain at 23931 7 8 th Avenue West Edmonds 98026 zip code , county of Ring State of Washington, an Adult Family Home for the care and supervision of adults as follows: 24-hour family care for no more than 2 adults number I This license shall be in force from the 12 th day of June 19_ the 12th � 98 , to and including day of June , 19 99 , subject to revocation for due cause. Special Terms: Jr_ _ _ — RIMNathaniel E . Dotson Liel;&%»r -- —' Gregory a Smirk RS, MP Lietwing AutAority 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. Ds"s 10-17c1 (Mm. 1/91) RETURN ADDRESS: City of Edmonds, City Clerk 121 5th Avenue North Edmonds, WA 98020 NOTICE OF LIMITATION AND COVENANT ADULT FAMILY HOME Reference #• Grantoe(s): (1) ahh�FtWo 7-4AfkA (2) 1,21Vl,4-4 Z4.44 Additional on pg. Grantee(s): City of Edmonds Legal Description (abbreviated): Sec .32 Twn 4?77 RnQtr SW OR Lot Z Block Plat 2 Z W Assessor's Tax Parcel ID#(s): (1(2) _Assessor's Tax Parcel ID# not yet assigned AUTHORIZED FOR RECORDING City of Edmonds By: OM Date: Page / of 3 WHEREAS, the undersigned owners of property located at 2 3 q 3/ 71-r /94,r- 1'YeST 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 applicant's intention to utilize the 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 trigger certain requirements relating to the fire suppression and exiting requirements; and WHEREAS, the City has notified the applicant that the permit will be issued conditioned on limitation of residents to 2- 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") in 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 7WO 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 Two residents or attempts to rent, lease or otherwise provide residence for additional residents above the 7_1A10 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. Subject Tract. The above stipulation and promises shall apply to and run with the land with respect to a residential structure located at 23931 F& Ake West , Edmonds, Washington and legally described as: //PAL 150,(. ✓y , C.o Skdd ✓11/w✓ l ISIkk GY6 f.L- Ol- .Eflsf 95- 7f?I oyt uksrl-7o ,gel as lVocry /.2s,,ce,f 4o7-8 nW G(i✓O Y3 11✓T /A/ Tt> TXf SOW71 - : .25" ,4ef oyC We.sf !-7O reel- .SO 1-oTB 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 3 in number. 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. AUTHORIZED FOR RECORDING City of Edmonds By: Ted Date: '04198 Page L of 3 DATED this 21 Sr ACCEPTED BY: OWNER: Jeannine L. Graf Building Official A411 #4.5 -3/oZ) /eWlr #�;So NOTIFICATION day of ��'� 4e4— 19,20 NOTARY FOR OWNER SIGNATURES State of Washington ) )ss County of ) APPLICANT/PROPERTY Applicant iAA Applic t Owne Owner COVENANT AND ACKNOWLEDGED: Mortgagor I certify that I know or have satisfactory evidence that 1 0 i k; A �7d 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 on whom instrument was exe the free and voluntary act of such party for the uses and purposes me ,e Gl °OAA instrument. Subscribed and sworn to before me this s� /S7" ,19 `, % TARy •�, _ w p0B0C • Notary Pu is in and for thp, State of Washingtaby� --../t 9 My commission expires©®/ '1ii u �i(NASN,��000 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 on whom instrument was executed) to be the free and,voluntary act of such party for the uses and purposes mentions in this instrument. Subscribed and sworn to before me this day of ,19 Notary Public in and for the State of Washington. My commission expires AUTHORIZED FOR RECORDING City of Edmonds By: ifs Date: l•f 9 Page 3 of 3 L:\TEMP\BUILDING\FORMS\ADF-COV.DOC