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10415 NOTTINGHAM RD.PDF11111111111111 12400 10415 NOTTINGHAM RD 0 0 q 15- N0-ffiYin h/J�m Pct TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS(RECORDED)FOR: CRITICAL AREAS: W:�j V DETERMINATION: ❑ Conditional Waiver ❑ Study Require Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): &aq---� PLANNING DATA CHECKLIST DATED: �J SCALED PLOT PLAN DATED: J17,X J w SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT FOR: WATER METER TAP CARD DATED: OTHER: LATEMP\DSrs\Forms\Street File Checklist.doc +T6. to -- .'ext;�TBitr. LOZATe � �X.� , ' �f7.S2'_DItlVE yVAJ/ 72a 5f� �KST i9�7 \ ' .' \ ,1 \\ `` \\�`• •`'\ � � +N 2q3 cE;RFbRT . - INro R65/O_E/KC� I N i { ®•�o wax I I 12-6. I -ry �ri57 �-pvs7 �w — - SETBACKS: Af : . ...:..�.,.�r_,: 0 fir t�-Y -FRONT :..SIDE S7_-5..-LA A/......__. REAR �S /O fp 40 a' TEEr F APPROVED: AS N BY ENGINEERING c Date: r �7� ��a==• MAY 2 8 2004 ,L. PERMIT COUNTER PLANNING DATA NAME: DATE: 3-IG--ow SITE ADDRESS: LI i - Q'QPLAN CHK#:OLI - OCn `7 PROJECT DESCRIPTION: /-\.,A,-I r4, _ SZ— REDUCED SITE PLAN PROVIDED? es / No MAP PAGE: ®,v 3 CORNER LO / No FLAG LOT: Yes / ZONING: �7c — g CRITICAL AREAS DETERMINATION #: C3 L4 — 3 L4 ❑ Studv Reauired: QF-Waiver ❑ Conditional Waiver SEPA DETERMINATION: ❑ Fee ❑ Checklist ❑ APO list w/ notarized form ❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger) empt SETBACKS: Required Setbacks: i -7i 5 , le. A I Street: 2S `@e$ Side: Right Side: 2� i X%,q-i Actual Setback ' i Street: Left Side: Sa - Right Side: °� 6 Rear: a� Street map checked for additional setback required? Ye No / DNA ❑ DETACHED STRUCCTT RES: ROCKERIES: c3 +o ❑ FENCES/TRELLISES: U. BAY WINDOWS / PROJECTING MODULATION: ❑ STAIRS / DECKS: PARKING: Required: Actual: :;'- LOT AREA: 15..; 14 1 01 (o Z�q T&-)--o Q LOT COVERAG Calculatinns- •u'5-® o.6,3 ;+.4' �E30cka, ,A Liaco eCr BUILDING HEIGHT: �` d Datum Point: Datum Elevation: $ (D Maximum armed: + ' D-Cl Actual Height: I Q::1 C -I r.> 2 14 LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes /IQ i, rt_0 r� Plan Review By: NewBPP1anningDataForm.D0C Critical Areas Checklist,* CA File No: Site Information (soils/topography/hydrology/vegetation) �. Site Address%I;ocation:G;" 2. ' Properiy Tax Account Number: DO l ( 3 005 to 5113 ba 3 7C6 00 C(P 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? ,yes; no. If yes; how is site developed? 5. Describe the general site topography heck all that apow. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% (a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal.. distance of less than 33-feet). Other (please describe):: 6. Site contains areas of year-round standing water: Approx. Depth: 7. Site contains areas of seasonal standing water:_ ; Approx. Depth: • What season(s) of the year? 8. Site is in the floodway floodplain of a water course. no 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; meadow ;shrubs ; mixed urban landscaped (lawn, shrubs etc) X 11. Obvious wetland is present on site: n n For City Staff Use Only 1. Plan Check Number, if applicable? 2. Site is Zoned? 3. SCS mapped soil type(s)?LL'7T7Y �.oA n O C Alm %-AiL� L>+� �F'�� t yc 9= /6V, 4. Critical Areas inventory or C.A. map indicates Critical Area on site? 5.. Site within designated earth subsidence landslide hazard area? 14� DETERMINATION ' STUDY REQUIRED WAIVER Reviewed bv: A . E:;�G* �o Date! O 0 4- Critical Areas Checklist.doc/4.22.2003 0 0 City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of the application to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at N-jarplo ; .� ma ,•� v; n; soi toxURHM A nn11nATIffil 131A A mk o� ne ` Date Received: City Receipt #: Critical Areas File #:_ Zco4—gQ3q; Critical Areas Checklist Fee: $135.00 Date Mailed to Applicant: 3—to--Q!J A property owner, or his/her authorized representative, must fill out the checklist, signand date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other . pertinent information (e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assistant staff in completing their preliminary assessment of the site. . The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate ore incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authori�-s applicatio ton the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT `_ X 5�� � DATE Property Owner's Authorization \4 By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection gnd-postjJng.attendant to this application. SIGNATURE OF OWNER DATE Ow,er/Applicant• �-Mk\v_ (!)`Er l Name O�i l J`/O ITZJ Stree Address City State Zip Telephone: L_L_._1 _, u2 ` Email address (optional): Applicant Representative: Name Street Address City State Zip Telephone: Email Address (optional): • Critical Areas Checklist.doc/4.22.2003 •D=irL• . � to o` 1gv :GY75T_.BL2ri�GtJZt(ivP:.:J.{� �.SF_:ZL'1�!ST.'�g57 ` .�8C79ZD27VEWAi--_-.- .. 7ZOSF GmK5r�9'37:. 'P��s�otit�Criort ezo a_Fv2g3y 840� 2Al�lN.DR1✓E-RIviN(, _3Z55F _ 7 -r4tG. ._._. 2� --'F — — -- -- — — 7 DTC tERik�F .... 2e9, I " t2-o 2E_a NEB New 1�4cC®APPROVib AS NOTl�E By ERING jZ01-OCATe- -0 9 - c4RF.Y�RT FX/S7/Nrp F�sS/OE/KC�. Q F. � .� O s� 4! � . �: \\•``\�\ ' �l.%fsf_5F�=:�_ -__.- .:. - � � is 607 . w • I. I 52-0 wax � Q JT to j �2-0 i -m Fx�sr �-�xis7 %�1✓! l�i��i-T(� SETBACKS:S Alma m-Y oMT- FRONT _3d gp 0 s /0 QO 4.0 APPROVE Bl( PLANNING — 0 N .9 � PA. -2 MAY 2 8 2004 PERMIT COUNTER Critical -Areas. Checklist Site Information (soils/topography/hyrldrology/vegetatio 1. Site'Addre s%Location: (044S D 2. , �Pioperiy Tax Account Number: CA File No: lop vDS; of 3. Approximate Site Size acres ors ware feet �/ � tatj l• Y � 4. Is this site currently.developed? yes; no. , s If yes; how is site developed? �1 5. Describe the general site topography. eckall' 6t ap Flat: less than 5-feet elevation change over entire site. i Rolling: slopes on site generally less than 15%` (a vertical rise of:104eet over; a horizontal distance of 667feet). Hilly: slopes present on site. of more than. 15%:and less. than 30°,6"(a vertical rise'-of•'10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical:rise :of 10-feet over a horizontal'.) distance of less than 33-feet). ` �. Other (please describe): 6. Site contains areas of year-round standing water: _; Approx. Depth: 7. Site contains areas of seasonal standing water: nn '; Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? Flows are seasonal? (What time of year? ' ). 10. Site is primarily: forested ; meadow ;shrubs ; mixed urban landscaped (lawn, shrubs etc) 11. Obvious wetland is present on site: n n For City Staff Use Only 1. Plan Check Number, if applicable? 2. Site is Zoned? 3. SCS mapped soil type(s)? �1ti 'i C-nPA v r�-,�N c:)Y �.oa /'� 0-'F L 4. Critical Areas inventory or C.A. map indicates Critical Area on site? f' o 5. Site within designated earth subsidence landslide hazard area? DETERMINATION STUDY REQUIRED �.. WAIVER E Reviewed bv: 4. Date: [0 f'1 4- Critical Areas Checklist.doc/4.22.2003 {i. City of Edmonds i , Development,'§ viees Department`:y Planning Division "Phone: 425.771.0220 ` Fax: • 425371.0221.. The Critical Areas Checklist contained on :this form -is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior' to his/her submittal of the application to the City. A..property•'owner,,or• his/her authorized representative, must 'fill out the checklist,•sign-and date it, and submit it to the City. The City*will review the checklist,?'make a . precursory site visit, I ana ;make a determination 'of : the b The purpose of the Checklist is to enable City ; staff 4o : su Sequent steps necessary; to complete a development determine whether any potential Critical Areas are, or perm't application. may be,,present on the subject property. The, information ,Please submit a vicinity;map,,along with the, signed copy needed to complete the Checklist 'should', be easily of tt isform to.assist`Citystaff, in?finding•and locating, the available from observations of the site or data available at, ` specific' piece of 'property described on this form. In NI addition, ,the applicant shall include .other pertinent �L: information (e.g. site plan, topography ,map, 'etc.) or studies in conjunction with this Checklist to assistant staff I nni 0 ATIMI flit 9;., �,0�� nc r""J in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application' agrees to release, indemnify, defend and hold • the City of Edmonds harmless from any and all. damages, including reasonable attorney's fees, arising from any action or infraction ;based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and'correct to the best of my knowledge and that I am authori- applicatio ton the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT � '\\ '-� ` _k, L "S, DATE Property Owner's Authorization v By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection attendant to s application., SIGNATURE OF OWNER DATE Owpeer/Applicant• �-� b' i Name O l Stree Address a fylDnck !� City State/ I Zip Telephone:217 K2`�� Email address (optional): Applicant Representative: Name Street Address ' City State Zip Telephone: Email Address (optional): Critical Areas Checklist.doc/4.22.2003 P�'bff�ERECEIVED PERMIT EXPIRES CITY OF EDMONDS JSE PERMIT ZONE NUMBER a(T) -'5- %' bL CONSTRUCTION PERMIT APPLICATION JOB su1T�/` ADDRESS � �J � � (� ` � � (} K OWNER NAMEM ME OF BUSINESS 9 . ©A PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS LID FEE S O 1 �L / IV07 7"/A(� 14A A4 �'^�7�! PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESUP Approved Required SRINtreet R etPennitUse Street Use Permit Ilegtl CITY }}--yy ZIP eo oz os %Oaq TELEPHONE '' I� /� 4-'��rr"1°�, EXISTING EXISTING PROPOSED REQUIRED DEDICATION FT Inspection Required p Sidewalk Required G UnderwoundQ ,� mow• ^"' NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED / t��j"�(/t��/••��r,/r�• U11 / , /45RJ r*^ YES 13 NO C3 a ADDRESS / q/ p OX �� REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE = CITY ZIP W+ ". C0�1O TELEPHONE �] EPY✓ 87-7,57 1 / / A NAME CBL a Y 0-��% A1f` - I `� l k ENGINEEFjI G REVIEWED BY DATE C ADDRESS FIRE IEWED BY DATE W CITY ZIP TELEPHONE r u :� STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADBa INSPECTION REO'D BOND POSTED OYES JLo $ SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED I EXP ❑NEW RESIDENTIAL P ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FE) PROPOSED SETBACKS (FT.) ALLOWED` PROPOSED SiDEEREAR! / //�0 FROt4T . L/A SIDE REAR ADDITION ❑ COMMERCIAL COMPLIANCE OR17 ❑ / 0 U ]FRONTT `l °� 53 �� �d ! V`' CHANGE F USE . V` ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN PARKING REO'D PROVIDED! LOT AREA P NING EW D Y DATE 6 FENCE ❑ REPAIR C 1 CYDS ❑ ( X Fn REMARKS ❑ DEMOLISH ❑ TANK ❑ OTHER d' RETAINING WALL FIRE SPRINKLER ❑ ❑ G PO ROCKERY FIRE ALARM (TYPE USE, BUSINESS ACTIVITY) LAIN: a ^ CH KED BY TYPE O N TRUCTION OCCUPANT GROUP C ME NUMBER OF NUMBER OF DWELLING f CRITICAL AREAS OU_ 3� [NUMBER SPECIALINSPECTION AREA OCCUPANT STORIES UNITS REQUIRED ❑ YES LOAD DESCRIBE W RK TO BE DO REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 - Sl" t tMoto cemo ��4 JaO�.i kFA I S IN 511\atE j, AA0 -Y VALUATION V. $142) 131 $ 2 Description FEE Description FEE U Plan Check ()-]T State Surcharge rj HF.�L SOURCE �� GLAZING % LOTUSLop E % Gam/}' Building Permit Z- City Surcharge � PLAN CHECK NO: /4-0b 7 VESTED DATE Plumbing S Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMITCOVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLII ANY CONSTRUCTION ON THE PUBLICDOMAIN Grading (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. � Engr. Review . III d PERMR APPLICATION: ISO DAYS PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN. 180 DAYS i Engr.ln$pPCt SEE BACK OF PINK PERMITIFOR MORE'INFORMATION' .. 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND. AND HOLD HARMLESS THE CITY OF 2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection • a<„4,, .:' Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY S FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due -y 5 / �, S = NOR LIMIT IN ANY WAY THE CrrrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt aY r%L ,�, I , I HEREBY ACKNOWLEDGE THAT I HAVE GIVEN IS CORRECT; AND THAT 1 AM THE OW ER, OR THIS APPLICATION; DULY AUTHORIZED INFORMATION of APPLICATION APPROVAL THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIG E GE DATE C42^�I�)I� OFFICIALS.210hiATURE DATE /,• �2 771-0220 S Y A ENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL EXT 1333 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FIL.E YELLOW - IN PECTO PINK -.OWNER GOLD - ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING _ -{- UC15� I 6 Ay, OF, G= +Z1O 400 J2'o ?� l vU� y-:: 720 G��SlSZ' 9� 3�0,41 b- iTY— a 1 �-- 'Nk --.. + ! T C2�f459 _ ! SDR 35 MATERIAL I .O r°o SCH 40 `0 N-12 � r � olo i 1 WAIL Ai.ic:, /- /C/y' ...._.. o /a . 00 4-0 AP�PROV p BY PLANNING &u%� R CEIVE® MAY 2 8 2004 PERMIT COUNTER Yl 7:�9619& RECEIVED MAY 2 a .2004 PERMIT COUNTER