1047 EDMONDS ST.PDF11111111111111
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1047 EDMONDS ST
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ADDRESS: l 0`- a
TAX ACCOUNTIPARCEL NUMBER: �l�L►O�f'Z C�2��
BUILDING PERMIT (NEW STRUCTURE): q
COVENANTS (RECORDED)
CRITICAL AREAS:— 9 227- DETERMINATION: ❑ Conditional Waiver ❑ Study Required krWaiver
DISCRETIONARY PERMIT #'S:6,�d 03° I Lq
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED: g �'
SCALED PLOT PLAN DATED: r-), I q 94
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DA'
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LID #:
LOT: Z BLOCK:
L:\TBMP\DSTs\Forms\Street File Checklist.doc
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NOTE: `
THIS IS A FLAT
SITE, THERE ARE NO
CONTOURS SHOWN.
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WATER CONCRETE
METER DRIVEWAY
70.0 °`
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DATUM POINT:
TOP OF WATER
METER CASE, REFERENCE
ELEV. 100'-0'
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BUILDING DEf
WORK STGA V
ADDRESS
OWNER �Ta'%/Z-L-
APPROVED DATE:
A) nG OFFICIAL
PERMIT I�
s
NOTE:
CONTRACTOR SHALL VERIFY INDICATED
SITE ELEVATIONS (FOOTPRINT
RECTANGLE CORNERS RELATIVE TO
DATUM POINT) PRIOR TO EXCAVATION.
ANY DESCREPANCIES $HALL- BE BROUdHT'TO
NOTE: -
CONTRACTOR SHALL VERIFY LOCATION
OF UTILITIES AND COORDINATE SERVICES
INSTALLATION.
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PLANNING DATA
SITE ADDRESS:1P1% �,ytX Sla DATE:
ZONING: " (D PERMIT#:
PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks:
Front:,Zo Left Side: 15 _Right Side: Rear:
Actual Setbacks:
Front: , jo Left Side: Right Side: _Rear:��
FLOOR AREA: 32 1 , ( �
LOT COVERAGE:
Maximum Allowed: 2Z0 —5 �ctual:
BUILDING HEIGHT: I
Maximum Allowed: /2��% Jr 2� Actual Height: /2G/
SUBDIVISION:
CRITICAL AREAS #: Iq ` ) 2 2 —4"
SEPA DETERMINATION: N �T
LOT AREA: —77C)(D
OTHER:
Plan Review By:
or90.19y
City of Edmonds
Critical Areas Checklist
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 a development
permit 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
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
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RIKIr COIJNTE
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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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name _
Stree�ress
�+
State, ZIP Phone
�t'A _ :
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date Signature - Date
• CIDLE NO. CSC -q3 —&-D%
Critical Areas Checklist
Site,Information (soils/topography/hydrology/vegetation
1. Site.AMress/Location: J
2. Property Tax Account Number: �2--Z d ��k
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes;
11 no
�
If yes; how is site developed? Yam' 1 —�'y.
5. Describe the general site topography. Check all that apply.
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
1 / horizontal distance of 66-feet).
V 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: l/0 ;Approx. Depth: _
7. Site contains areas of seasonal standing water: _'j\j 0 ; 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? x( D 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: _ 0
-- .... For City Staff Use Only
C
1 Site is Zoned? ✓ 67
2. SCS mapped soil type(s)? >� C C ► ,� tI
3. Wetland inventory or C.A. map indicates wetland present on site?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
6 . Site designated on the Environmentally Sensitive Areas Map? (;
DETERMINATION
STUDY REQUIRED
WAIVER
Reviewed by::
CA -93-ac';i
Planner
CONDITIONAL WAIVER
Rev 08/19/93
The City of Edmonds Side Sewer Drawing EASEMENT NO. -------------- ._........
218-02400 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO..- .... .......... ASMT. NO.._.-_-.-.----._
OWNER .... PONALD ... "AJ SH--.-----. CONTRACTOR ........_........
-•------------•.............•-----••-•--•---------------------------------......------------............... ------.....-----...... PERMIT NO. - -------------------
JOB ADDRESS .... 1047-.F1�'In1VnS--ST=-------------------------------•------- LEGAL DESCRIPTION: LOT NO. ---•------------• -------------------- BLOCK NO.-....--------------------•---------
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--•---••---------------------•---------......-----••----• ••••--••------------...• •-••...-•••-•--...---•------•--•-•-•••-•......-••---••••. •--•• •••-••-----•--•-•-=
NAMEOF ADDITION --•-----• ..............•----..........--•- •---••-•--•--------------•--••------•---•---•-•------•-•---------------..
DYE TEST ON SWER
Approved:
i
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PWW-0001-11/75 (REV.11/78) DATE ---------------------------------------- - -- BY --------------- ---------------- ------
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
118-02400
OWNER----.......DonalJ-.Wa.ls.................•---.....-.........-----•---.--------------------. CONTRACTOR ................... -•---------.....---.....................--•--................................ PERMIT No.......................
ADDRESS .......1047..EdR10nd..St.e...-•----------------•---------.......--•--.............. LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No.............................................
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NAMEOF ADDITION..............................................................•-------.........---.......................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By................---•----.....................................
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2-4'-�" IS`
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RITA MILLER
1047 EDMONDS STREET
EDMONDS 98020
425-771-9159
TAX No: 0043 4204 262400
LEGAL:
CITY OF EDMONDS, BLOCK 042-DO
LOTS 24 & 25 LESS N 5 FT FOR ALLEY
LOT 26 LESS W 20FT & N 5 FT PLUS
ADJ S % VAC ALLEY. ORD 516
LOT SIZE: 70' z 110' = 7,700 SQ. FT.
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APPROVED By ENGINEERING
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' APPROVED BY PLANNING
RECEIVED
MAR 12 2004
JA' WiA ' PERMIT COUNTER
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