17701 69TH PL W.PDF11111111111111
14916
17701 69TH AVE W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: 060730W
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:— DETERMINATION: E] Conditional Waiver 0 Study Required Kwaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
Flo]
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:4U/d(p
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: Le BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L\TEMP\DSTs\Fomis\Street File Checklist.doc
77
A A �d�
-gAPPROVED AS NOTED
BY ENGIN ERIN
'-Date:
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eFence must be located on private propert3.
12� eProperty owner responsible for determini� [g
property lines.
eFence shall not enclose or prevent access o any
City maintained utilities.
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PLANNING DATA
SINGLE FAMILY RESIDENTIAL
7=FIL7E ]
Name:
Date: q
Site Address: q .401 - r" 94 6..,r� Week
Plan Check#: cls �5
Project Description: Cor%e�ir-GkA- -ft- 171 0,,\ C1,1W, n I C\6,
Reduced Site Plan Provided: NO)
Zoning:
Map Page: /-/0 7
Corner Lot: 00/ NO)
Flag Lot: (YES
Critical Areas Determination #: CA-3CCG-037
0 Study Required
9 Waiver
SEPA Determination: gxcx�,�
0 Exempt
11 Needed (for 500 cubic yards of grading or site within 200 feet of Puget Sound or Lake Ballinger) N/A
0 Fee 0 Checklist 0 APO List with notarized form
equired Setbac, J
treet,
Side: (A0
Side:
65)
-A diij/. 5�ibacks:
Street:
i e ed nn
I Side:
r0ne-(
ear:
Does street map require Idditional setbacks? (YES NO AA)
Detached Structures:
Rockeries:
Fences/Trellises:
Bay Windows/ Projecting Modulation:
Stairs/Deck:
Heigh
Datum Point:
Datum Elevation:
Maximum Height Allow�d:
Actual Height: C- e—
Oth&
Parking Required:
Parking Provi�ded: No
Lot Area: At
C,
Maximum Allowed Lot Coverage: 35% Proposed:
Lot Coverage Calculations: 1-ko
ADU Created: (YES / U
0
Subdivision: C�\es-r-x �Affl tlanor Lck G
Legal Nonconforming Land Use Determination Issued: (YES
166f�inen&-
Plan Review By:
Planning Data Form 2-7-06.doc
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...... .. ...................................................
......... ....................... CONTRACTOR ........... PERMI No. _..J.
.......... ...
RESS ......... . ...... ............. BIX)CK No . .............................. .
............... . / ..
ADD ....... ..... LEGAL DESCRIPTION: LOT
NAME OF ADDITION .............. ........ ....... .........
. .....................
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CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
-1107 for
Call 716 side sewer inspections BEFORE covering any portion of the construction.)
y
Inspection will be provided within 24 hours after request. NO Sat., Sun., or ho ids, inspections.
7:
JIADDRESS LOCATION OF CONSTRUCTION ...... �.;.N ....... ................. —211 ........
--------------------------- ...................... ............................
OPERTY LEGAL DESCRIPTION ..... rherry Hili "-ANU
.......................................................................
................................................. . ...................... . ........................................................................ --------------
- J" -- ------- i ---------------- ----------------------------- ------------------- ------
9 � HILLI
--------------------------------------------------------- .............. : ................... . .......................................................
....... OWNER AND/OK BUILDER .......................................... S M ES
'Vinson -Se-vnr Ccn�structinn - 1GO39 d, Ezirc;,
0a
CONTRACTOWS NAME ADDRESS..;.t�'* . .................................................................................................. 2 ac 13
............ ................................
Permission Is granted .......... L-� ....... .. A ................................... iq-72�., for repair and/or connection of a side sewer to the city sanitary 7
sewer
system In accordance with City of Edmonds ordinances.
-T
A*ENTION IS CAT D TO THE FOLLOWING:
T TE 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
E
side sewer in street area. Do not cover any portion of sewer hefore it has been inspected.
No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from. the City Engineer's office.
TE No. 3--Obtain full information regarding Ordinaries 11.16.030 and Regulations governing side sewers when you get permit.
OTLE
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at Property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--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. 6—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 appurtenances except to in -
a
ert the pipe into the wye.
DISAPPROVEDDate ... . ................................... By ................ Da, e - ---- ---- Date ............... . ................... By ................
ROVED .....................
..... By .................................................................................
Remarks: ....... . ...................................................................... ............................
............. ------------------
................................................................. ............................................................................................................................................................................ .........
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
...................................... ... hereby certify that the side sewer installation constructed under this permit
............. ............
(Owner of Contracting Firm Perfrrming Construction) j
was installed in accordance with all governing ordinances of the City of Edmonds.
Dated this ... ........ ...................................................... 19.?
Telephone E], Power Sewer
V Check BEFORE you dig for: Water [j, Gas E], ED El Other E] -V V
7.
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41.
#P20 CA File No- 0
Critical Areas Checklist.
Site Information (soils/ topography/ hydrology/vegetation)
-201— (0 C�' /Oz tf 0 7. Cks
1.. Site Address/ Location:
Property TaxA 0
2. ccoun.t-Number: 9 (117 T-5 L 6X)
3. Approxiniate Site Size (acres or square feet):.
4. Is this site currently developed? ies; no.
;\_/y
7
If yes;;how is site developed?
5� Describe the general,site topography. Check all that apply-
6-"" Flat: less than 5-feet "elevation change over entit'esite.
Rollirig: slopes .-on, site.;,; generally less than 15%ja vertiml.-rise of 10-."fe
et over a --horizontal
distance of 66 -feet).,
1-*:; slo''�s presen�.on site o1i'more than 15% and less than 30% (a vertical rise 6f'10-feet
P,
over a horizontal distance of 33 to 66-fe
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
elo 7
For City Staff Use Only
1. Plan Check Number, if applicable? AV/A
2. Site.is Zoned?
3. SCS mapped soil type(s)? &a/ex%_—c)cxj wve_kk�4 a dy 6--c, 15- 4-o 25
pe
'b n
4. Critical Areas inventory or C.A. map indicates.Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
.::,;r,'6TUDX R Q
&F UIR — WAIVER
Reviewed bv- Date: q Ar. lry�
#P20
� C; 1 167 -
City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Date Received: �06
City Receipt M
'Critical Areas File#: t-2D06-003'7
Critical Areas Checklist Fee: . $135.00
Date Mailed to Applicant:— -1116
A - property er, i his/her' authorize representative,
The, Critical Areas Checklist contained on this form is- to own' or d
be filled out by any person preparing a Development must fill out the checklist, I signand. date it, and submit it
Permit Application. for the City of Edmonds prior to to the City.' Th6 City will review the checklist make a
his/her submittal of the application to the City. - precursory site visit, and 'make' a determination of the
subse-quent steps- ne.cessar.y.tq.cqnv1ete'a development
The purpose of the Checklist is to enable City staff to.
determine whether any potential Critical Areas,are, o I r permit application.
may be, present on the subject property. The Mif6miatio'n 'Please subn I ut a vicinity map, along with the signed copy
form to assist'City staff:ifi firi. ing, and locatin the
needed .,...tb � complete the Checklist should �be, easily of this, d 9
available from observations of the site or data available at, spe;cific. piece -of property described on this form. In
city,. Hill (Critical. areas inventories, maps, 'or soil, addition, the applicant. shalt include . other pertinent
t9pograp''
ifif6rinAtion (e�g.' site' p an * hy map, etc.) or
1. 1 "1 .1 .. ; .� ; 'Checklist to assistant staff
es in conjunction with this
in completingtheirpreliminary assessment; of the site.
The undersigned applicant* and his/her/its heirs on e processingp
�and.assigns, in consideration, * th f the application agrees
to release, indernnify, defend, and hold the, City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arisi 'from any action or,infraction based in whole or part I upon false rmisleading, inaccurate or
.9
incomplete information-furnisfi6d"by the applicant.-his/her/its ag-e,nt��or.&mployees.
By my signature, I certify that the ifif6rmati6n -and exhibits -herewith- submitted arc true �a�d c . orre cf 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 Atithorization:
By my signature, I cer*,thatJ 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 cnt the subject property for the
purposes of inspection and D'GisAm''g attendant.t6 this application. -
SIGNATURE OF OWNER DATE7. 6/).
j4
PLEASE PRINT CLEARLY
Owner/Appficant Applicant. -Representative:
Name
2Z :2 0
Street Address Street Address
NNI C-7 14 r
city State zip City State Zip
Telephone: Yl:,-- �J�S'L�7 Telephone:
Email address (optional): Email Address (optional):