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10624 240TH PL SW.PDFiiiiii lill 11 4305 10624 240TH PL SW ADDRESS: TAX ACCOUNT/PARCEL NUMBER: ' 9D�%D�O� BUILDING PERMIT (NEW STRUCTURE): COVENANTS(RECORDED)FOR: CRITICAL AREAS:. �0lJ (1�iDETERMINATION: ❑ Conditional Waiver ❑ Study Required >(W aiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DA' SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT FILE: LOT: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: LID #: BLOCK: L:\TEMP\DSTs\Forms\Street File Checklist.doc #P20 °moo City of dmonds Development Services Department Planning Division Phone: 425.7.71.0220 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 maybe, 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: / ° Y City Receipt #: Critical Areas File #: �= Critical Areas ChecklistFee: $15 .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 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 authorized o file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENTVA� DATE ` • V 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 appl}nation. a SIGNATURE OF OWNER Owner/Applicant: �AA,R V, -a4N l CK.I�_ Name 10C Z4 240-�- TL SW Street Address V � I J 1�02_0 City State �/ �7Zip Telephone: � �2.. �- 4- ( Email address (optional): DATE L • t5 . D 1 Applicant Representative: kR15T[N �1y5b� Name U2 Street Address DMON�5 WA -80ZD City State Zip Telephone: -42 ' 1-74 - � 1247 Email Address (optional): �aU,r'IDVIG�I?�71� (got • � � #P20 • Critical Areas,Checklist CA File No: U_NW(-AEyJ ��Je Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 6 O raz 4— 2_4 1. FL w 2. Property Tax Account Number: 005 6 4 100 2-02-4 oo 3. Approximate Site Size (acres or square feet): . 7, t54 5 6& • F T• 4. Is this site currently developed? byes; no. If yes; how is site developed? 5. Describe the general site topography. Check all that apply. Y 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: NO ; Approx. Depth: Site contains areas of seasonal standing water: N O ; Approx. Depth: _ What season(s) of the year? 8. Site is in the flopdway M O floodplain _ 0 , 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: NO For City Staff Use Only 1. Plan Check Number, if applicable? sup . y p pi . o µ q q 2. Site is Zoned? R•5 " g 3. SCS mapped soil type(s)? ' s �i�. r7Y0:yi .kU Sand U I�D Q wi - 8' •�'" $ 4. Critical Areas inventory or C.A. map indicates Critical Area on site? 5. Site within designated earth subsidence landslide hatard area? I`10 6ITE DETERMINATION STUDY REQUIRED WAIVER Reviewed 'by: 6-M OL/ (10 C" 01-loo Date: 07 , 1 S .1Y0 0g Critical Areas Checklist.doc/2.5.2009 0 0 ---]1 PLANNING DATA STREET FILE SINGLE FAMILY RESIDENTIAL Name: � Date: Site Address: ot?- Tax Parcel epds-b �©0 aDaLo D 1 Project Description: a 3(� �0 v1, Plan Check #: Reduced Site Plan Provided: YES I Zoning: Map Page: Corner Lot: / NO) Flag Lot: (YES Critical Areas Determination #: K-)-oo -06, ❑ Study Required R Waiver SEPA Determination: 7-? �- fi3--Exempt ❑ Needed (for over 500 cubic yards of grading) ❑ Fee ❑ Checklist ❑ APO List with notarized form R u/red Setbacks Stree ' o`" Side: r Side: S Actual Setbacks Street: {�3 r L i�de: Side: S-i of ; Sfi a 3 ❑ Detached Structures: ❑ Rockeries: ❑ Fences/Trellises: ❑ Bay Windows/Projecting Modulation: ❑ Stairs/Deck: Buildin Height Datum Point: Datum Elevation: Maximum Height Allowed: t,-S a Actual Height: / (s- Other Parking Required: Parking Provided: Lot Area: i S q ) Maximum Lot Coverage: 35% Proposed: D Lot Coverage Calculations:�5 ADU Created: (YES / 0 Subdivision: Legal Nonconforming Land Use Determination Issued: (YES / O Comments �k.S p�vp�SoV� oeS nu+ � � 1 1��- �ti c� ram. � o-J f �`t l ��a _� •�-e� �-� s l2. �. ®��� G� L ri �\ A Wes. Plan Review By: Planning Data Form 07-14-09.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). 4 m 0 in M N N � CONTACT OLYMpIC VIEW _ WATER/SEWER DISTRICT I fx ANY t2EPA ►as prae FO®TING DRAINS TO BE TIED INTO Dt2Yvv c-t-L 0 v •w ' t'r�t�C%'rG� i lYi�[ii2__ m OPEN o t4 to I I ,�A K Applicant shall repair/replace all damage to utilities or frontage Improvements in City right-of-way per City standards that is caused - or occurs during the permitted project. SITE PLC 1" = 20' — Oil 17 A ()pL�5 PROJECT ADDRESS / OWNERS: MARK JANICKE MARY LOWRY 10624 240TH PL SW EDMONDS 98020 206-642-4472 TAX No: 00564900202400 LEGAL: H.K.SCHROEDERS REPLAT OF FOREST GLEN. BLK 2 LOT 24. LOT SIZE: 7,841 SO FT .18 ACRE ZONE: RS -- 8 "Nothing in this permit approval prooess "be interpreted as allowing or permitting the maintenance of any cuixently existing illegal, nonconforming or unpermitted building, structure or site condition which is ourside the scope of the permit application, regardless of whether such building, structure or condition is shown on the site pplan or drawing. Such building, structure or condition may be the subject of a separate enforcement action-" SCOPE OF PROJECT: ADDITION TO REAR OF 236 SO FT KITCHEN / UTILITY ROOM. RE -CONFIGURE INTERIOR POWDER. LOT COVERAGE: EXISTING RES/ PORCH: 1348 SO FT ,�oTic-L nu-zd. ` ADDITION: 236 Sg FT 1584 SOFT 20.2% iACTOR IS RESPONSIBLE CONTROL AND DAMAGE GUTTERS/DOWNSPOUTS TO CONNECT TO EXIST. SYST. IMPERVIOUS: PRE-1977 RES: CONC PATIO: DRIVE EAVES 162 2306 SOFT 1348 SO FT 561 235 POST 1977: ADDITION 236 SO FT EAVES: 66.9 292.9 SO FT GRADING: LESS THAN 5 YARDS. USED ON SITE. Zone ,. S- Comer„y_Fla& IJ Setbacks Reguirod Actual FromOk" ` - Sidesw/5 -Rev— Otherle- Height I CONTACT DURING PERMIT PHASE: KRISTIN HANSON HANSON DESIGN 652 ALDER STREET EDMONDS 98020 425-774-7129 hansondesign@hotmail.com CONTRACTOR: UN -DECIDED AT THIS TIME. HEIGHT CALCULATIONS: (E 71 DATUM: WATER METER: 110.5 ` A. 10V B. 100.5' C. 100.' D. 100.5' 402.' 402. 4 = 100.5' AVERAGE 100.5' + 25' = 125.5' MAX 115.5' PROPOSED. tPR0VE BYPLANNING 0 APPROVED 0 Y ENGINEERING 7/1 �J �D�9o�-yam i CIP C,r E0110OIND3