19014 DELLWOOD DR.PDF10885
19014 DELLWOOD
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TAX ACCOUNT/PARCEL #- j" Tr
A
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BUILDING PERMIT (NEW STRUCTURE) #:?z-pkA i It
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COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: 05!(M
DETERMINATION: Conditional Waiver El Study Required
Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver E] Study Required
Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER - list permit #'s):
LAN
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID#:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
'OTHER:
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L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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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 Applicationlor the City of Edmonds prior to
his/her submittal of the application to the City.
Ile 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).
0
Date Received:
City Receipt r101?
Critical Areas File #:
Critical Areas Checklist Fee: , $135.00
Date Mailed to Applicant:_ 61o?&1,0Y
A property owner, or his/her authorized representative,
must fill out the checklist. sign and date it, and submit. it
to the City. Ile 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.
ne 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 to file this'application on the behalf of the owner as listed below.
SIGNATURE OF APPLicANT/AGENT*
DATE
Property Owner9s Authorization
By my signature, I cer* that I have authorized the above ApplicantlAgent 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 DATE
I . PLEASE PRINT CLEARLY � I
Owner/Appfi4bmt-
p
V /Vo r Ki C!,
Name. I
Street Address
��"" 1 1
(;- C>z-
city State Zip
Telephone:
Applicant Representative: '
Name
Street Address
city State Zip
Telephone:
Email address (optional): Email Address (optional):
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1.. Site Address/ Location:
2. Property TaxAccount Number: _. 0041SCCUDD k_100
3. Approximate Site Size (acres or squar�e feet):
4. Js this site currently developed? -Zyes;
If Yes; how is site. developed?
CA File No: '�,akUMM(.e D
5. Describe the general site topography. C5
eck all that apply.
Flat: less than%5-7feet 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).
My.: slopes present on site of more than 15% and less than'30% (a I . vertical rise of 10-feet
over. aholorizontal distance of 33 to 66-feet).
Steep.: grades of greater than 30% present on site (a vertical rise of 10-feet over a hori . zontal
distance of less than. 3:34eet).'
Other(please describe)..
6. Site contains areas of year-round standingWater. N 6 Approx. Depth:
7. Site contairLs ar'eas''of seasonal stari water: No
ding Approx..Depth-
What season(s) of the year?
8- Site is in the floodway floo4plaih A/ 0 of a watercourse.
9. Site contains a creek or an area where water flo s across the grounds surface? Flows are year-round?
Flowsare-seasonal? M (Whattimeo year?
f
10. Site is primarily: forested rn�adow ;shrubs n-dxed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use 0ifly
1. Plan Check N
2. Site is Zoned?
3.
4.
SCS mapped s
Critical Areas inventory or C.A. map indicates Critical Area. on site?
5. Site within designated earth subsidence landslide hazard area? A/O
DETERMINATION
-S Y REQUIRED WAIVER
40PLANNING DATA
SINGLE FAMILY RESIDENTIAL
Name:
Site Address: q �)_ejt Lz Plan Check #
Project Description: (Oc" 'r\cK-A-V\ -b-4 exxAj !zs�dss cR- k^oL4_%e)_.
Reduced Site Plan Provided: YE_ NO) n?�
Map Page: CO- Corner Lot: (YES Flag Lot: (YES
Critical Areas betermination 9:
El Study Required
19 Waiver
SEPA Determination:
Exempt
Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist C] APO List with notarized form
t - cks
Street: Side- Side Rear-
65 � 1
Actual Setbacks
Street: Side-(, c!ar:
Sidee
OE: c1q)
Detached Structures: Ex lz�, ed S\,\o CC\ A-a-_� �0 �00_ C'0'-\'f'eACW fykz - "2" moo
Rockeries: No,,e .�n
Fences/Trellises: -Ore-r\C'P_
El Bay Windows/Projecting MoQlation: Nc'ne,
El Stairs/Deck:
it
Datum Point- Datum Elevatio n:
e;7.
Sax
Maximum Height Allowed: ��klais 0 Actual Height: 12WI.,
Other
Parki4Required:
Parking Provided:
Maximum Lot Coverage: 35% posed:
Lot Area: \a.,,,q_q'6
=-a, a60 Adz,
Lot Coverage Calculations.
ADU Created: (YES
Subdivision-
Legal Nonconforming Land Use Determi fio-niss
mi ued - (YES
col"Inents
$* IS")
Plan Review
Pt�tlq Data folal 04-11-06 d0C
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT LYUN PLANT
1EMENTNo . ..........................................
NEW CONSTRUCTION 0 REPAIRS
2� d/
................... .......................................... PERMIT No.
OWN.. ........ 11A ....... CONTRACTOR /3:4 .. . .. . ........... . ..............
ADDRESS ........ G-1p .. a/ ........... V)-
... .......... .. !! ...... LEGAL DESCRIPTION: LOT No . ....... /.7 ............................ BLOCK N . . ..................
or
4
..........................
NAME OF ADDITION ...............
Lu
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1,PPhOVED
FEB 1.31967
.. ....... ..... .
P�`J-
Approved:
DATE: ... 9 .... ........ ... 7� ......................
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be - rXi731gS1,geA1,di, r
': b divided noo thrue i
"Nothing in this permit approval PrO088a 11M lbe 110XV lf,alioll, I _,ach shd mum a.�,et n, ni,man
interpreted as allowingor permitting the
Mlperw liw_ ni w,q Ime, and 7.5' e�j,;h jh,j�l
mainten of any currently existing III all relnwflipg fin:� V�ch ;!,�,i mu'l k: twd,[
nonoo !'-0,1q. 11,;Wde'll ph,q I
olilsi 0 e �07 go 00c) i-roc
'Cation, regardless of whether such
uilding, re or condition is shown on the.
site las drawing. Such building, structure 0
con&,tIaion ay be the subject of a separate CL
V Owner: Cheryle A. Mehrling
enforcem,zit action. 19014 Dellwood Dr.
SIUIRFAC M Edmonds, WA.
EXPOSED
COVERED WITH Impervious surface calcs
Exist. building roof outline:,M50.sf.
Exist driveway: 326sf. i b
Ut Exist. rear patio: 234sf. ?6P
SP S q,5,16 Exist front patio::7-5&-',/-,;' p
GUTTERS 0� Exist storage shed: 525se.,
SOT -10 ST - sysX. vop� p� Exist. stone wall: 40
To �0%% S Proposed powder room addition: 72sf. a
,#;(row 7 *V 70 ID P- \15 sm o PropotiN bath addition-. 136sf-
ww 6t ov- 01 -
rNji,16-oo, +
A A,10 Z:)
r Av
aw P014 Lo eA iz,2_14 �sr.
W .0i, &D2�S5(_,
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4 .170, A=,. V 4
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A61GH-f CALC4.
101 . . I
14)1.1 Aut RA(-r 6;ZAI)� - Mal ?LhiA
166, q
— 4C_1 u A L 113.1� OWNER/CONTRACTOR IS RESPONSIBLE FofiLALC I" ': 20
CONTROL AND DRAINAGE
MAIMuM f 1".6S EROSION
Zone pc:�:Z Flag&L
Cornerflo DA-rum Pf 168,
Setbacks ReQuired Actual -To kc(W1-4h�E a U M suf-"1151
Front (E) 26, JUN 2 MA6, �PL RECOVED
S i des (,qvs, qQ :7-61 'ag 8
"KWA-St 9-mr-
Rear M 15 L (Ag%cler MAY41, 2000
Rlp
Other C IN OF DAM31
Heiebt *Iyoke,.. qW., C� ET FILE BUILDING�DEPT.
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JUL 10 2008
BUILDING DEPARMIENI
CI7V OF E-D%ICNrS
U'.xisting storage shed is to be divided into, three 120 sq- 1-t.
sheds. The new locations ofeach shed ITILISt Meet MilliIII11t))
required setbacks for accessory SITLICtures: 25' fironi cast
property line, 3' firoin Nvest propcil ' N, linc, and 7.5'each froin
all reniaining property fines. Each shed niust be UIIJCr
120 sq. ft, and all %N oi k IsILISI be coniplelcd prior to occupailcy
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RIGHT-OF-WAY CONSTRUCTION
PERMIT
y Permit Number:
Is -sue Date*: C",
A. Address or Vicinity of Construction:
B. Type of Work (be specific): ��V(,
IQW- -C.
8 9 0 1. 9 C5
C. Contractor: U) o-+, , v (7.) o 5
Contact: (2, j i
Mailing Address: V)q e 4x 4�;-t Zc- Phone: Zz 4- - -7--2. -7 fl�
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. n Commercial E] Subdivision EJ City Project Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family Other
INSPECTOR: I INSPECTOR: w4'
F. Pavement, or Concrete Cut (D-Ye's 0No G. Size of Cut: ;?— x 41 H. Charge$
APPLICANT TO READ AND SIGN
-INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmleseftom injuries, damages, or
claims of any kind or descHplion whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and azzomeyfees by reason ofgranting this per7nit.
THE CONTIZACTOR IS RESPONSIBLEFOR WORKMANSHIPAND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWNG THE FINAL INSPECTION
AND ACCEPTANCE OF THE WORK ESTIMATED RESTORA71ON FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departmeii
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes. 771-0220
Street shall be. kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site atall timesfor inspection purposes.
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
....... ...
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER QC-T 15f- DAYS DISRUPTION FEE/FUND I 11:
SPECIALCONDITIONS: JLL pleg�prJ VAlorA- RESTORATION FEE:
-ro .8r- eAyco Pr acz /JF- PERMIT FEE:
JZ ;5y0i PF—kM17-j TOTAL FEE:
COMMENTS: RECEIPT NO:
DATE: ISSUED BY: 0
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
IC---- M., 1601
SERVICE PRE-INSPECT10hoPORT 12
WNG 836.8 S
SERVICE ADDRESS
DATE GAS REQUIRED
EX STUB
LOC.
NO� EX. STUB
FOOTAGE REQUIRED
CONDITIONS
METHOD'
STUB
CONC PS
PUNCH INSERT W/CU OR ST
SOD DIRT
OPEN TRENCH
EX. SERV
INSERT W/CU
W/ST
3A,
NO. EX SERV
FOOTAGE REQUIRED
TWIN
SERVICE
CONDITIONS
METHOD
CONC SOD
DIRT
PUNCH INSERT
ROCKERY GARDEN
PLOW OPEN TRENCH
D-4 CALLED FOR LOC. OK'D
EXCESS OF 3' RULE (RES)
METER
CHANGE MSA LOC.
CUST. VERIFIED MSA CHANGE
& ETC.
L! NOTIFIED OF MSA CHANGE
EXCESS WAIVED
BACKHOE
BOARD & IRONS
EXTRA CONES
EQUIP.
NO PARK BARRICADES
METER HOODS
BORE MACHINE
PLOW
SOD CUTTER
COPPER PULLING EQUIPMENT
REMARKS & SKETCH:
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Cl,
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PRE INSPECTION Bv
DATE
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Yl,(. --%�-'C. Cof- -
LEGEND
S FOUND CONCRETE MONUMENT AS NOTED
SET REBAR/CAP #40524
FOUND REBAR/CAP At- MtTED
SET LINE STAKE
SET NAIL/SHINER AS NOTED
(P) PLAT DIMENSIONS
(M) MEASURED DIMENSIONS
(C) CALCULATED DIMENSIONS
BASIS OF BEARINGS
S01*34'06"E ALONG THE MONUMENTED
CENTERLINE OF 76TH AVENUE.
REFERENCES
PLAT OF DELLWOOD VILLAGE, RECORDING
NO. 1233668, VOL. 16, PG. 93.
i vr_
TO LOT 16
ZZ M,
'Zi
6' WOOD FENC -7
ZOT 17
0 FOUND MAG -NAIL
�b
AND 'SHINER 40.2
'22
2.6'
tOT 16
(49
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CONTROL DETAIL
NOSCALE
MAY
A
N88*23'31% 115. 0 0'(P)
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BUILMIG DEP
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— — — — — — — — — — 7 — — — — — — C A T E
RECORDER'S CERTIFICATE SURVEYC GERTIR
THIS MAP REPRESENTS VEY MADE BY ME OR RECORD OF
FILED FOR RECORD T"HfS ------ D A �r --- 20-- UNDER -MY DIRECTION.' ORMANCE WI TH THE:
F?
_114E
RDING ACT AT
REQUIREMENTS OF
RECO
AT ----- M IN
TIR, SEPTEMBER 200!�..
E REQUEST OF,7$51--,
TH
A
BOOK ----- OF SURVEYS AT PAGE 221A THE STEV DWN. 8 y!
,REQUEST OF ALLIED LAND SUR 19014 DELA"
VEYINt;
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CHK.
S Certificate No, ------------- ----------- yl.
RECORDS
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NOTES
7w10,1;? A
RVEY-
INSTRUMENTATION FQ g$,V A
i ANI
TATION
Myd4lk
WAS A SOKKIA 5
A
in
ED W
PROCEDURES US
TRAVERSE, MEETINq'i*-'-',.. CEDING
40,
_W4
STANDARDS SET BY
332-130-090.
A
THIS SURVEY WAS PERFORMED
WITHOUT THE BENEFIT OF A TITLE
REPORT AND DOES NOT PURPORT TO
SHOW ALL EASEMENTS OF RECORD, OR
20 10
OTHERWISE IF ANY. 0 20. -940*
ALL MONUMENTS SHOWN WERE VISITED
ON 9-13-05 9CALE IN FEET
SURVEY OF
THE NORTH AND EASTERLY PROPERTY LINES OF LOT 17
DELLWOOD VILLAGE ACCORDING TO THE PLAT THEREOF
RECORDED IN VOLUME 16 OF PLATS, PAGE 93 RECORDS OF
41
SNOHOMISH COUNTY WASHINGTON
I'v
(0
SUBJECT TO EASEMENTS, RESTRICTIONS, CONDITIONS AND Q�
COVENANTS OF RECORD, IF ANY.
Vv
Q
SET MAG
0-1i NACt 'x
N
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WV?
VERN
LIN
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UMENT-,��
I N CASE
V L�."M.. tA krS,
_k
FO ND I!* IROWPIPE A
Ol
17
NO CAP
DOWN 0.8
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AT CALC CORNER
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15
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01
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;Q
01 �7
\—FOUND 1" PINCHED
PIPE DISTURBED
ilQ
1,11HAN 1 9
(3Lj;lLOiNIG DEPT,