10602 240TH PL SW.PDFiiiiii IIIII iiiiii4300
10602 240TH PL SW
Ofob22- 240± PI &by0
TAX ACCOUNT/PARCEL
DD- S6(
BUILDING PERMIT (NEW STRUCTURE): 1� I r 1
COVENANTS (RECORDED)
D-2>-bi ID -
CRITICAL AREAS: O I DETERMINATION: ❑ Conditional Waiver ❑Study Require�*Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: D(�; - 01�; " DJ
SCALED PLOT PLAN DATED: 0t — (/D ✓ 03
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\DSTs\Forms\Street File ChecklisLdoe
Christian and Samantha Asay is •
10602 240th Place SW, Edmonds, WA 98020
Lot 16, Block 3, H.K. Schroeder's Replat of Forest Glenn, According to the
plat thereof recorded in volume 15 of plats, pages 25 and 26, in Snohomish County Washington Scale: 1 ° = 20'
APPROVED AS
BY ENGINEE
Date:
4
+97.3' +97.2'
-----------------------------------------------
ED
i ADD GUT`fERS/DOWNSPOUTS
N AND.SPLASHBLOCKO
i ® Existing Deck 458sq.ft. +98 2' r
+98.5'
i----------------- • i
---- -----------------
i __
Proposed Two- . i
Story Addition
rn I
i
i
r
+99'
Existing
Cement
Slab
478sq.ft.
17ft.
Existing Residence 1272sq.ft.
00----------
+98'
Existing
Asphalt
Driveway
346sq.ft.
Porch I
18sq.ft. I
N
I Cn
I
N2o
Proposed One -
Story Addition
i 123sq.ft.
i
i
r
1�Oft.—►�
----------- -------- i
+98.3'
r
6755
80, _ +98.5'
MINER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
240th Place SW
---------------
---------------
I J
-------------------------
SS Top of SS Manhole Cover htof Way T ,TFILE
Center of Rig
Imoervious Surface Calculations
Existing Building Roof Outline:1447sq.ft. (Const.1957)
Existing Asphalt Driveway: 346sq.ft. (Const.1957)
Existing Porch:18sq.ft. (Const.1957)
Existing Deck: 458sq.ft. (Const.1998)
Existing Cement Slab: 478sq.ft. (Const. 2000)
Proposed Addition: 891 sq.ft.
RECEE r IIED
lliY•a-5 U L' J
Height Surface Calculations Lot Coverage:1779sq.ft. (23%)
A: +98.5' X _ Note Lot Area: 7600
B: +98 2' Tax Account Parcel #: 005649-003-016-00
lay++ c - etLv";� M Lot Slope: 4%
C: +98'
D: +98.3' r : Prci.'_-A J
Average Grade: +98.25'
Actual: +120.83'
Maximum: +123.25'
APPROVED BY PLANNING
ZONE
SETBACKS:
FRONT ZS'
SIDE
REAR 15
OTHER 04-30-03
HEIGHT 26 '
,4°F ED& City ofdmonds
Development Services Department
Planning Division
Phone:. 425.771.0220
1890 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. Received: a _C — 0
City Receipt #:� i
Critical Areas File M
Critical Areas Checklist Fee: $45.00
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. Citywill, 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 famished 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 file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
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 and posting attendant to this application.
DATE 62. /B• D_4
Owner/Applicant: Applicant Representative:
/OL.Dz 240 A Many_ �r,J
Street Address
Etymon ds LvA 9 M?n
City State Zip
Telephone: 2pb - 5 q 2 - /. S51 .
Email address (optional):
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
OP� ED
°LN City o dmonds
Development Services Department
Planning Division
Phone: 425.771.0220
C. 1 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 ReceM16: a 1 2( — O 3
City Receipt #: , 1 4-`�
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
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 fording 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
attomey'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 convect to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
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 and posting attendant to this application.
SIGNATURE OF OWNER
Owner/Applicant:
G/tris 'ern 3 c3a42,*4 a 8a�
Name
to o2 246A MaCP_ &.J
Street Address
'Edmends u A 98d2o
City State Zip
ItOrTFAUDIT
Applicant Representative:
Name
Street Address
City State Zip
Telephone: 261. - 5 q 2 - /. S 51 Telephone:
Email address (optional):
Critical Areas Checklist.doc/3.19.2001
Email Address (optional):
11
SITE ADDRESS: 1 o (,o Z -
PROJECT DESCRIPTION: Ex
PLANNING DATA
ar
REDUCED SITE PLAN PROVIDED?:
MAP PAGE: 003 CORNER LOT: Yes No
TE: S/s,1e3
PLAN CHK#:03 - 184
FLAG LOT:
ZONING: 9-S -$ CRITICAL AREAS DETERMINATION #: 03 - I
❑ Study Required:
EfWaiver
❑ 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)
Hpp.tW, k � ' ^� -wJS.w r�.h.'wu1 a"�'"�
Exempt �""a
SETBACKS:
Required Setbacks:
Street: 25 , Left Sider Right Side: 7. s ' Rear:_
Actual Setbacks: -}a
Street: iW SISI,, Left Side: 17' Right Side: 1 O ' Rear: 23 '
Street map checked for additional setback required? (Yes / No / DNA)
❑ DETACHED STRUCTURES:
❑ ROCKERIES: nit S w+,^^
❑ FENCES/TRELLISES: n, i -.—
❑ BAY WINDOWS / PROJECTING MODULATION:
❑ STAIRS / DECKS: kl-s i,,-
PARKING: Required: 2- Actual: I �� I
LOT AREA: x 95 = O6 01 2-1-1 (,3
LOT COVE it 7Z � ►2►2 r 76d(3 —
Calculations: �yi„� 71,a0
BUILDING HEIGHT:
Datum Point: f*Q 3� 5 Qo. � r-c, t%. Lt an Mov PI atum Elevation: / oa
Maximum Allowed: 25' Actual Height: 2 2- , L '
A.D.U. CREATED?: o Yes 13' s ram.. Iw " k2W" . (Pb. . - ) ; rti„- 4 A-W, 1 Lk -A,
SUBDIVISION: 1 ,14 . Sc, „ eo..y i Qzn ie,, r-cn- G zn,\ . L.ar 13
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / o
OTHER:
Plan Review By:
V
NewBPPlanningDataFonm.DOC
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
'JAMkrDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
/ 0 6 o,2 2'16)4h Place- c5
CITY ZIP TELEPHONE
41,1n0 r7d.S 9$020 204 - 542 -1,1851
NAME
&OCL IJJend�'
ADDRESS
CITY ZIP TELEPHONE
Li,rrlwooct 78634 1q25_&q0_.3qo5
NAME F l n i S h Line CBL #
'Frank- CAr n}r
AD'5 $2Le 45441 A -it. SE'
CITY ZIP TELEPHONE
gnDho►')mish 782.94 H25- 3q,3 z0,02
STATE LICENSE NUMBER EXPIRATION DATE : • CHECKED BY
FINI5LC6tpQg �7, 1 '
PROPERTY TAX ACCOUNT PARCEL NO.
0o54 Llq -.A03- Diu-- 00
❑ NEW RESIDENTIAL
13 ADDITION ❑ COMMERCIAL
❑ REMODEL ❑ MULTIFAMILY
❑ REPAIR G, CYDS
nHFy., r..,•...
50
❑ DEMOLISH ❑ TANK
❑GARAGE RETAINING WALL
CARPORT ❑ ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
esicien+ial
NUMBER NUMBER.,.OF
OF 'y 10WELLING
STORIES l UNITS
.DESCRIBE WORK TO BE DONE
EXz�pansi on r f e
PLUMBING / MECH
❑
COMPLIANCE OR
CHANGE OF USE
SIGN
❑FENCE
( X FT)
❑
OTHER
FIRE SPRINKLER
❑I
FRE ALARM
PERMIT EXPIRES
USE PERMIT ,
ZONE NUMBER 410,, ;
JOB
SUITE/APT#
ADDRESS
10 Z 2L10 +1, PI-ace—SLJ
EAMO nC{S `
PLAT NAME/SUBDIVISIO oNO.
1'eS i-
LOT NO.
LID NO.
L "�
K. Sc17(D le iS - en
lip
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIECP
RW Pe Approved
Permit Required
Street Use Permit Req'd
EXISTING PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES ❑ NO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
it�5Vr:noWs REAtn : 1C. M061a0 4.D*0&"ars
1710A L_
+ V360 I mpaylo" = I T5
ENGINEERING REVIEWED BY
1). Fula,('" 611
FIRE REVIEWED BY DATE
C7
z
a
W
z
2
a
w
W
R
ic
VARIANCE OR CU
SHORELINE OR.ADB#
INSPECTION
BOND
REO'D
POSTED
OYES
/
19<0
$
: *SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
I
CJ
dam.. 5,
2Z G r
EXP
.
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLLZLOWEDD PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
O
.>5% 2j?.sJ
Z.'S 7 5- )Sc-
S7& �
z
#
PARKING LOT
AREA
PLANNING REVIEWED BY DATE
g
REO'D
I PROVIDED
I
/
I
REMARKS
t
CHECKED BY TYPE F b S UCTION 17,
OCCUPAY17
GROUPJ/
CRITICAL lll���...-
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMB%%��' / REQUIRED ❑ YES LOAD
]REMARKS
}r/� PRO RESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
iV14i iaV1A1ItJ .r_.,_, ►.i- .- -- ii - - ter_._- ._i_.
e n a n CJL hec. hoom_,, anct bedyomyt,
VALUATION
I
5 •O�
i
Description
FEE
Description
FEE
a
Plan Check
State Surcharge
d
HEAT SOURCE
JE le cly i G
GLAZING %
LOT SLOPE %
t ,y
Building Permit
City Surcharge
PLAN CHECK �/
STE.,:
D DATE
t
Plumbing
Mechanical
r
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO e .
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE..
SEPARATE PERMISSION.
Engr. Review
j PERMITAPPUCATION: ISO DAYS
•'
Engr. Inspection ,
..a.
i
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
,.
Recei:#
ptt
I „
ansca
Lda Ins
P P•
V,
Total Amt. Due
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording Fee
Receipt #
Y
1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NQ'P�RSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF i1SHINGTON RELATING TO
WORKMEN'S CO ENSATION INSURANCE AND RCW 18.27.
CALL
FOR INSPECTION
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
DATE
-� !
IVAZ
%7 425
• • 1 -0220
S NA R (OWNER R AGENT)
t - ��
DATE SIGNED
30 ^ O
REL ED BY DATE
ATTENTION M 1333 '
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI ORIGINAL -FILE YELLOW-INSPECTO
CATEIOF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
e402 PRESS HARD -YOU ARE MAKING 5 COPIES' GREEN - ACCOUNTING
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