1540 9TH AVE N.PDF1111111111119855
1540 9TH AVE N
i
0
ADDRESS: /6 2 /fj
TAX ACCOUNT/PARCEL #: �
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: �J�'"/� DETERMINATION: ❑ Conditional Waiver ❑ Study Required , Waiver
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED: '7
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED: 9
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
PLANNING DATA STREET FILE
SINGLE FAMILY RESIDENTIAL
Name: . Date:
er,z, - --------
Site Address: Plan Clieck !t:
Project: Description-. Mcde,\ Ar `A J Floor 10e4rm,,,\ �p�,r. �. Eup�d -Qr'oc.\- ' e4c-
ZAC)
on S\'ee -ar•d1 � a � d -Floo �, b cA
Reduced Site Plan Provided) NO) Zoning: 1^
Map Page: 20q Corner Lot: (YES NO' Flag Lot.- (YES J O)
Critical Areas Determination # : GR CQpgQQu�,
❑ Study Required
Waiver
SEPA Determination:
XExempt
❑ Needed (for over 500 cubic yards of grading)
Cl Fee Cl Checklist CI APO List with notarized form
Required Setbacks
_
Side: � Side:
Actual Setbacks
Street:: Side: Side: Rear:
Detached structures: jFx►� O-.r"S,«�
❑ Rockeries:
❑ Fences/Trellises: Norge-ShcxJn�
❑ Bay Windows/Projecting Modulation:
❑ Stairs/Deck.-
Datum Point: Datum Elevation:
WA, M A" er=_cP !Z - e t kco
Maximum Height Allowed: �/ (t�Q•_�/ � Actual Height: aO / —
—�-�
other
Parking Required:
Parking Provided:
—
Lot Area:
Maximum Lot Coverage: 35% Pfo po : 9.3
Lot Coverage Calculations- !F",-,'' Res'den`� 1 Gq m E",S} = lo$z ExezPC X'=aygr
Fx psi, G�arazq�= 3y� � �crs�. Gt-epn l�uu� lYD � ' — lG =p
V
ADU Created: ( YES /®
Subdivision:
Legal Nonconforming Land Use Determination issued: (YES /0
Con�inents
I&*
Plan Review 8y: fUmilly Oata forth °,_„ {6 d0C
_............. __ ....__.._ _' - .#P20
...... _ ...._.,
°f 9A0�o City. of Edmonds
Development Services Department
Planning Division
Phoiie: 425.T71.0220
!40• t $qo : Fax: 425.771.021.1
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 staid' 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 IM (Critical area inventories, maps, or soil
sti;veys). .
Date Received: 5,1 ; 0
City Receipt #:
Critical Areas File #:_ G A'L0QS 0D5'1-
Critical Areas Checklist Fee 135:00
Date Mailed to Applicant:. — O v -_
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 desmW 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 Checidist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his1her/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
attorneys fees, .arising from any action or infraction based in whole or part upon false, misleading, inaccurate -or
incomplete information fumished'by the applicant, hb&erf is 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 applica ' on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE 2-1 kA
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 n q=don and"Isting attendant to this application. � f
SIGNATURE OF OWNER C�' �� '^'�
. DATB. D
PLEASE PRINT CLEARLY
er/A Brant:
Ba
5
Name
-lc,52-1D Q A�
-Street Address -
�OM�r� L."Dk 9cw
City State Zip
Telephone: 4 2H_ 7 -� L . 21 e2l
Email address (optional):
Applicant Representative: -
CIAEin��R C-xt04B_,,-)i � AWN rr1
Name - -
119 U).
Street Address
�-7)EA z= ' OA 94511 `l
City State Zip
Telephone: 2_C�o. 2—�.�b225
Email Addr= (optional): G�e-ISe.,.-,- t�D
�1c�c-mac,J'c 1'.Fee, . ►
#P20
Critical Areas Checklist cAFile N°:. CA- - 3-
Site Information (soils/topography/hydrology/vegetation)
1. Sitie Address/Location: _ 1614D Ct A AyG
2 Property Tax Account Number:
3. Approximate Site Size (acres. or square feet): Q (L?6- P S
4. , Is this site currently developed? yes; no.
If' how is site developed? f�� 1 rl Cs t^ �1 6`j Qc h ► �C t-1C �= - CT R� 1�. j-L�
.5. Describe the general site topography. Check all that apply.
_ Flat: less than Weet 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. MC) ; Approx. Depth: —
7. Site contains areas of seasonal standing water•. 0 % Approx. Depth
What season(s) of the year?
8. Site is in the floodway W_ floodplain 14Q) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
N Flows are seasonal? (What time of year? ).
10. Site is rimanl . forested • meadow -shrubs ; II&I
.urban landscaped (Iawrti, shrubs etc) .
ed
• 11. Obvious wetland is present on site: N D
For City Staff Use Only
1. Plan Check Number, if a' Tlicable?
2. Site is Zoned?. S T
3. s)? ( S w� o V' 1S o S C 1'w god /` G�
4 Critical Areas inventory, or CA hap indicates Critical Area on site? Y W
5. Site within designated earth subsidence landslide .hazard area?
DETERMINATION
STUDY REQUIRED C WAIVER
Reviewed by.- - Date: 5--�Vof
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT STHREEEASEMENT No . ..........................................
T FILE NEW El REPAIRS
OWNER ... 67!_445 —IA..%4 --------_- ... W ........... -------- CONTRACTOR ------ ........... ............................. PERMIT No.(,_ilf�
4=
ADDRESS .............. ----------- ....................... ..........
................... ..... :;�� .. LEGAL DESCRIPTION: LOT No ..................... ........ BLOCK No . ............................................
NAME OF ADDITION ............... ........... 4z . . cl......�-•---•------......-----.......................................
APP
MAR I
Approved:
DATE
MEMO FROM:
DON HERON
0
/3 '73
1866 11V7L L /3 ew TT(% 6 AND C° /l/ Ci�/q�i L. 577 ///r /
1 l-6r 9 G- A/ G Al4 /2 C-6,S 5 7S 7
2 iV0 ST 7-1<1
C Gy si '711 IV / �. .T,,) ,T/'
t CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Can PRospect 0-1107 when work
is ready for Inspection. (No inspee- �4
S:IDE SEWER PERMIT tions Saturday, Sunday or holidays.) �IW O 2826
- ADDRESS...............1540_.-----9th-..Ayenue..North
...........................................................................................................................
OWNER ...................Gustay.....ruse.....---------............................. CONTRACTOR ............. MgW, inc.
Pernlission is granter] .................. ar'Ch 19 19.6.8.., for ........................ days to REPAIR or CONNECT a. side sewer
With City Servers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been Inspected.
T•" 'F No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
:�.1• No. 3—Top of side ewer must
hve at r than least
30bi pees coverage at property line and 12 inches Inside property line; minimum grade of 2 %.
No bends in sh rpe
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to Improper work which may develop within one year of completion.
NOTE No. 5—It Is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or Its appur-
tenances except to insert the pipe into the Rye.
.G=r,
c:.;i:, DDsDSGZo2..
1540 �am-77
lwffiwlw�0-12
SUB
JUL 21 2DE18
BUILDING DEPARTMENT
CITY AP EDMONDS