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10518 242ND PL SW
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TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS(RECORDED)
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ,p�J Waiver
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED
EASEMENT(S) RECORDED
PERMITS (OTHER):
'W3-
15 V
PLANNING DATA CHECKLIST DATED: V �O-
SCALED PLOT PLAN DATED
SEWER LID FEE $:
LID
mP Paihb
SHORT PLAT FILER K� �T � \Q n LOT: BLOCK: Vo4 U
SIDE SEWER AS BUILT DATED:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #
WATER METER TAP CARD DATED
SIDE SEWER PERMITS) #:
LATEMP\DSTs\Forms\Street File Checklist.doc
•
•
PLANNING DATA
NAME: 1-J: C¢ m,) tf-f - DATE:_ 10130103
SITE ADDRESS:_ 1 a5 1 S - 2-4 Z" P+. Sw PLAN CHK#: 03-qS3
PROJECT DESCRIPTION:_ A -A 5, ram, w A e„^&Y,rc RAkt
REDUCED SITE PLAN PROVIDED?: es / No
MAP PAGE: 003 CORNER LOT: Yes / o FLAG LOT: Yes / No
ZONING: 0- S - $ CRITICAL AREAS DETERMINATION #: 03, 1 Sa
❑ Rh+riv Rnnidrad-
QJ 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)
UExempt
SETBACKS:
Reciuired Setbacks:
Street: S • Left Side: Right Side: '• Rear: ! S
Actual Setbacks: 6 aOt� F..•
Street: 534' Left Side: /5 , Right Side: 3-2' Rear: 4o
Street map checked for additional setback required? (Yes / No / DNA)
DETACHED STRUCTURES:
❑ ROCKERIES:
❑ FENCES/TRELLISES:
❑ BAY WINDOWS / PROJECTING MODULATION:
STAIRS / DECKS: P44, "D r ZM
PARKING: Required: 2 Actual: 1 t 1
LOT AREA: O, Z i A -cry- x 4 3: ito 0'/r,� . _ 9 1 4g o
LOT COVE
Calculations:
BUILDING HEIGHT: 19'
Datum Point: Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?: o Yes)
SUBDIVISION: --
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / o
OTHER:
Plan Review
NewBPP IanningDataForm.DOC
of EDP O City of Edmonds
p. O
Q -5 Development Services Department
Planning Division
Phone: 425.771.0220
�0c t gqo 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
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Receivecl:YIF
City Receipt #:
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
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, 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 or
incomplete information fumished 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 authorized to fil s application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT "*
DATE
Property Owner's Author*/ation
By my signature, I certify thatUlve auth ' ed 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 and,posting attnt Xo this applicatioy0,1
DATE �y —
Owner/Applicant: Applicant Representative:
A -?,-
Name Name
Street Address
City State Zip
Telephone: c "be', —, :53�6 — 4g< y
Email address (optional):
Street Address
City State Zip
Telephone: gp-�- 7iy- 581U%
Email Address (optional):
Critical Areas Checklist.doc/4.22.2003
Critical Areas Checklist CAFileNo: D3-'�V
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): �, .2/ .
4. Is this site currently developed? kyes; no.
If yes; how is site developed? �i�/ ti f ��q�,��� ��S1Dfi4Cf
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 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: _&6 ; Approx. Depth:
7. Site contains areas of seasonal standing water: AO ; Approx. Depth:
What season(s) of the year? 't"
8. Site is in the floodway �A(O floodplain ,.(1/� 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 s03ft- mixed
urban landscaped (lawn, shru s etc)
11. Obvious wetland is present on site:
For City Staff Use Only
Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)?
4. Critical Areas inventory or C.A. map indicates Critical Area on site? Njc .
5. Site within designated earth subsidence landslide hazard area? _1,,)n+ ,, , A ht k
DETERMINATION
STUDY REQUIRED
Reviewed
WAIVER
Critical Areas Checklist.doc/4.22.2003
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APPROVED AS NOTED
BY ENGINEERING
./
Date: ze —r 150
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Impervious Surface Calcs.
Exist. Building: 1272 sq.ft.
Exist. Driveway 384 sq.ft.
Exist. Patio 170 sq.ft.
Proposed addition 212 sq.ft.
Proposed patio 180 sa.ft.
Lot coverage 28.6%
Lot area 0.21 AC
Lpt slope flat
OWNG RESIDENCE APPROX 1.272 SQ R
PROPOSED ADDITIONS 212 SO Fr
01 _ _ _---
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SETBACKS:
FRONT
SIDE
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WISEMILLER ADDITION
REAR
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SITE PLAN /VICINITY MAP
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10518242nd Place Ski+, EDMONDS WA 98020
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Impervious Surface Calcs.
Exist. Building: 2272 sq.ft.
Exist. Driveway 384 sq.ft.
Exist. Patio 170 sq.ft.
Proposed addition 212 sq.ft.
Proposed patio 180 sq.ft.
Lot coverage 28.676
Lot area 0.21 AC
Lqt slope Flat
19.0'
I 1 I
I I o I
y(o�� 100.0' ----
SITE PLAN
SCAM 1" = 1a-W
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SIDE .
REAR.--_.
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PROPOSED ADDMONS 212 SQ FT
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