1515 10TH PL N.PDF1111111111
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1515 10TH PL N
I
ADDRESS: ad
TAX /y
TAX ACCOUNT/PARCEL NUMBER: 00
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: V�'� DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER): D
�nLc
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LOT:
LID #:1D5
BLOCK:
LATEMP\DST's\Forms\Street File Checklist.doc
South side of the House
Back
X Door
1" Copper
@ 1.8' deep
12' /
4'
i
X
13'
X �
X
14'
X
±wrwe
of E,0* CITY OF EDMOND,S' TIIATERLINE AS —BUILT
� c::) ADDRESS 1515 10th PL N HOMEOWNER Shaw
CONTRACTOR SCALE
NTS
DATE
&t. 1890 6/3/2005 BY Nima M.Moghaddam No PERMIT2005-0456
#P20
Critical Areas Checklist cA File lv°:
Site Information (soils/ topography/ hydrology/ve etation)
1. Site Address/Location D otbI
2. Property Tax Account Number: 2-7a� 0 R DO0rg
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _k`y�s; no.
If yes; how is site developed? Viz —
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.7-7 .
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.
9. Site contains a creek or an area : where water flows across the grounds surface? . Flows are year-round?
J Flows are seasonal? (What time of year? ).
10. Site is primarily: forested : meadow ; shrubs mixed
urban landscaped (lawn, shrubs etc) 1/
11. Obvious wetland is present on site: O
For City Staff Use Only
1. Plan Check Number, if applicable?
v
2. Site is Zoned? iZ $ - 1 2
3. SCS mapped soil type(s)? 5 .— A (,w.A - k,-66 , I c�-- pv.
4. Critical Areas inventory or C.A. map indicates Critical Area on site? No S .k ,4, 1. „o w, -- 175' e=!14 - ^0* s
d— I. 6u
S. Site within designated earth subsidence landslide hazard area? N6
DETERMINATION
STUDY REQUIRED
Reviewed
3
WAIVER
`ac. 1 g9�
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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
City Hall (Critical areas . inventories, maps, or soil
surveys).
Date Received: lJIU0
City Receipt #: 3 t
Critical Areas File #: - DO /
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:-f/-�(,S
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 fiunished 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 dri .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.offioials and the staff of the City of Edmonds to enter the subject property for the
purposes n and posting attendant to this application.
SIGN OF O R_ r,..�,1'"- -L �� DATE
Owner/Applicant:
u� Un � � Ar
Name. '
�Ids Pt I'
Street AddrkeAss
City . State Zip
Telephone: 4 2f7 -7 1 -1� - U r 11:77
Applicant Representative:
Name
Street Address
City State Zip
Telephone:_
Email address (optional): Email Address (optional):
•` -=F' ATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAIf OF BUSINESS
MAILING ADDRESiq
S
' G�--
CITY7�TELEPHONE
�/XuJ ,Z? -
NAME'< 0 5 T I Q 1 1 A W + 0, d
ADDRESS''
W 12. AL Gib
CITZIP �101 �.D 2 TELEPHONE
, / -7 4 —71 z
NAME .r CB';?Pe
TELEPHONE
.PROPERTY TAX ACCOUNT PARCEL NO,
II.
.
2-70
woe) -fo `l /00
❑ NEW
0 RESIDENTIAL
PLUMBING / MECH
ADDITION
❑ COMMERCIAL
❑
COMPLIANCE OR
❑ MIXED USE
CHANGE OF USE
REMODEL
❑ MULTIFAMILY
❑
SIGN
❑GRADING
REPAIR
❑
FENCE
lCYDS
X FT.)
❑ DEMOLISH
❑ TANK
❑
OTHER
GARAGE
❑
RETAINING WALL
❑
❑
KLER
CARPORT
ROCKERY
FIREALARMRE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
�12- 5 FT NEw MA-4
SO ' F% 17C—_Ck.._.
PERMIT EXPIRES
t ,
PERMIT
NUMBER V
JOB In SUITE/APT#
ADDRESS �-' (� P` TQ
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
EXISTING PROPOSED
Street Use Permit Required
Inspection Required
'
REQUIRED;DE1DICATION FT
Sidewalk Required
Underground
Winna required
METER SIZE '
LINE SIIZr�E
NO. OF FIXTURES
PRV REQUIRED
/
YES 13 NO i3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
4L
REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARCE OR CU
SHORELINE_OR ADS#
INSPECTION
SEPA
$.,..
REQ'rD��,,
COMPLETED EXEMPT
V
YES 16NO
to
CA#
ZONE
SIGN AREA
HEIGHT
WAIVEIj,
` I %
ALLOWED PROPOSED
ALLOWED PROPOSED
STUDY/ 13
i L
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE
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REO'D PROVIDED
REMARKS
TYPE OF CQ TRUCTION CODE OCCUPANT
V OO�DE GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED C YES LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCT RAL E G�
BY:
VALUATION
$ ! 1 V 0D2-
�M�-,<...�Z. N 1�
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SL%
VESTED DATE
C,20
Building Permit
O
City Surcharge
/
PLAN CHECK NO:
0
Plumbing
�'"
Base Fee
-'
Mechanical
THIS PERMIT AUWFIORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
3 OONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
t SEPARATE PERMISSION.
Engr. Review
f
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w PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
En r Inspection
g p
a PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'
y `APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
1
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE,
Fire Inspection
Receipt # b
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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
I
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I 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 16:27.
FF IALS SIGNAT RE 9ATE
SIGNATU E (OWN R O AGE DATE SIGNED
25
10f
/ op
!% 21101
771.0220
"
AT E/j,
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY
EXT. 1333
A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / ISC1101 IRC110.
R INAL -FILE ELLOW -INSPECTOR
PINK -OWNER • GOLD - ASSESSOR
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ZONE: RS-12
LOT SIZE: 19,517 SQ FT (290 x 67.4')
GRADING: LESS THAN 50 CU YDS. USED ON SITE.
IMPERVIOUS: SINCE 1977 : 432 SQ FT DECK
> 312 $Q FT LIVING.
744 SQ FT NEW.
HEIGHT CALCULATIONS:
DATUM: WATER METER 100.0'
A. 93.0' C. 98.0'
B 98.6' D. 93.0'
TOTAL: 382.5' -�4 =95.6' + 25'=120.16' MAX
PROPOSED RIDGE: 117.9'
l k
V—
—
ADD GUTTERS/DOWNSPOUTS
AND SPLASHBLOCKS
�I OWNER/CONTRACTOR IS R
FOR EROSION CONMROL A
NI
APPROVE® BY PLAKI;ill
6/4 l045"
AL
LEGAL
SE 13 T 27 R 03 RT 81. BEG INT C/I.2NDAVE
& C/' NEWPORT AVE AS PLATTED IN ORG.
PLAT OF N. EDMONDS TN S 38'34"OOW ALG C/L
2"D AVE 134 FT TO TPB. TN N 38'34"OOE
8.17FT TN N 51'02"00W 29OFT THE S 38'34"OOW
10.19FT TN SWLY ON A LN PL TO C/L OF 2"D AVE
57 FT TO ESTB. FENCE LN AGREED BTWN PARTIES
TN SE LY ALG SD FENCE LN 290 FT TO C/L
2w AVE TN NELY 57 M/L TPB.__
..
U -0' N Ew
P E Imo.
APPRCh'EU AS NOTED
aY
Date;
P—k. RESIQEN
i KEw
RECEIVED
FEB 17 2005
PERMIT COUNTER PAUL & CAROLE SHAW
1515 lOTM PLACE NORTH
EDMONDS WA 98020
7756533
TAX NO: 27031 300 409600
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