19721 86TH PL W.PDF8211
19721 86TH PL W
ADDRESS: /11/ //;,(/ —
TAX ACCOUNT/PARCEL NUMBER: 090 ev!v 1��
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: EJ Conditional Waiver R Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED.
EASEMENT(S) RECORDED FOR: -
PERMITS (OTHER):, ac�---g�v
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:-//b--7
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LATEMP\DST's\Fornis\Street, File Checklist.doc
I- -
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The City of Edmonds
APPLICATION
for
SIDE SEWER PFXMT
0 INSIDE E] REPAIRS
CARD No - -------------
EASEMENT No - ------------------------
OWNER .... #OAI-A-1.0 ----------- -------------- --------- ---------
7*
HOUSE No . ..... ...... zr ..... ...... . ........... I ---------
CONTRACTOR ............... ................. ............ --.— ........... PERMIT N
STREET
AVENUE LOT No. - ---- -- ---- BLOCK No - -----------------
f��-.w ---------------------
NAME ADD - ------- --------------------------------
/V 4=---
M
Date Approved:
BACKFILL WORK ORDER ISSUED --- ......... --------- --------- DEPOSIT, $ .........
.............. ......
SEWER WORK ORDER ISSUED -------------- -- -------
DATE .... ---------- ---- 33Y
a
NOTICE:
a rrr a nty—Or-a—c C U.f- :d
-N:o
The information . Shown on the attached
I -A was compiled for use by the City Of
map�s)
Edmonds/ its Employees and Consultants.
Th..e City of �Edm.onds does not . warrant the
accuracy of anything set for.th on.t ' hese
Map(�-). Any person or entity,requesting a
copy should conduct an independent
ation shown on
inquiry regarding the inform jm*ted to,
-tF�e -map(s)/ Including, but not H I -h
th . e lociation of any sew-er, stub shown. Suc
sewer stubs may or may* not exist and may
at the location shown.
or may not exist
Neither the City of Edmonds nor its
ernpl-o-yee-s o-r office-rs -sh-a,11-1 be !--ia-b-'Fe for the
information given on this map(s), nor for
Ided based
any one representation prov
upon said map(s).
CITY OF EDMONDS
CIVIC CENTER - WATER -SEWER DEPARTMENT Can PRospect, 6-1107 when work
Is ready for inspection. (No inspec- N2 1342
SIDESEWER PERMIT tions Saturday, Sunday or holidays.)
ADDRESS ...... -- ............. -19�7.2.1
OWNER ....... --- j?er-latli ...................................... CONTRACTOR ........
.. .. ...... - - .........................................
Permission is granted ....... November 26,
............................. ...... 19§5— for ...................... daYs, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
A1'rENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property May obtain a permit to construct sewer Inside Pioperty 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.
NOTw- No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewer's when you get permit.
NE -To. 3—Top of side sewer must have at least 30 Inches coverage at property line and 12 inches inside property line; mlnlmum grade of 2%.
No bends in grade sharper than % will be permitted.
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 ap-
Purtenances except to Insert the pipe into the wye.
Critical Areas Checklist CA File No: VOO 5 - 7- �-
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: I el -7-7 -6"d* P1 - [A) 6) N Qx>
2. Property Tax Account Number: On 5-6 622 J) (7) 0 Q0 V Q 0
3. Approximate Site Size (acres or square feet): 1:2r. 1
4. Is this site currently developed?'* yes; — no.
If yes; how is site developed? < -1-f 1Z -
5. Describe the general site topography. Check all that apply.
XFlat: 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 oil 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: �jp ; Approx. Depth:
7. Site contains areas of seasonal standing water: �jo ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway UT) floodplain — of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
k�p Flows are seasonal? (What time of year?
10. Site is primarily: forested __; meadow shrubs mixed
urban landscapeq(�n,�tbs etc)
11. Obvious wetland is present on site: Ub
1.
2.
3.
14.
5.
For City Staff Use Only
Plan Check Number, if applicable?
Site is Zoned? R � — 9
SCS mapped soil type(s)? A Id
Critical Areas inventory or C.A. map indicates Critical Area on site? /V/q
Site within designated earth subsidence landslide hazard area? A10
DETERMINATION
WIRED
Reviewed bv: "(-
2— Y
Date: 31 ��ZO
WAIVER
Critical Areas Checklist.doc/2.17.2004
#P20
0� EDA,, City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
C) %3 Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Pen -nit 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: 03
City Receipt#:
Critical Areas File M 09-A 7- 00 8 00 7-2--
Critical Areas Checklist Fee: $135.00
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 deten-nination 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, defe : nd 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 t is licat* on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE —Z-A ?� �0
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 application.
Owner/Applicant:
1-a4l rAj ?ftgn
Name
�A/
Street Aadress
Z6-
city State Zip
Telephone(�J,-5�77 -7 6- 14�1 !44n
1-/
Email address (optional)�:
D-/.-/ /
DATE
Applicant Representative:
]�Z L-twx7s) -T-kE INC-
Name "—
-2
7
Street Address
L4, 1�1
City State Zip
Telephone: -:1!7/,- 600-7
Email Address (optional): tawP— 6emAP6i!?'J-n.C&&,
V
6�ZIO-e217V
Site Plan
SCALE: I"=20-00'
of 10, 20, 50, 40' 50' bO'
Heiqht Calculations
A 104.0
5 1042
0 1051
0 104.5
MkERA65E 104.1
TrAX:25' 12q.1
ACTUAL 1152
D.P. AT HATER MANHOLE IN
ROAD SET 0 100-00'
-kplp-
HATER
M.H. 0 100-00'
0'
ri
-1
0-
Site Address
IcM21 66TH PLACE H.
EDMONDS, KA 418,026
Owner
LORI CLIFFORD
141121 bbTH PLACE H.
EDMONDS, KA 115026
Assessor's Parcel No.
00565200000400
Drainage
PRE-ICN&
AS EXISTING7 - NO NEH IMPERVIOUS, NO NEH
ROOF AREAS. CURRENT DOWNSPOUTS TO
SPLASHBLOOKS.
-�T
EXIPTIN6
OVERHAN&&-------]
--44
EX15TIN&
CONCRETE
DRIVEKAY
31-:20'
EXISTINrz?
RESIDENCE
Lot Size
1:2,1116 50. FT.
Building Footprint
2,105 50. FT.
LOT OOVERA6E- 11-2%
Erosion Control
NON- NO NEH &R.OUND 015TUR5ANCE.
APPROVE[) By
PLA livi G
Impervious Surface Area
Zone—
12 5 - Of
Comer
Flag.
EXISTINO PROP05ED
FT.
Setbacks
ReqWred
ROOF 2525 2&:25 50.
-AMIJ
VRIVEKAY 15"1 -15-1
Front
75-
>2y-
HALKS 2'T& 214�
500
Sides
-7. TT'T)
L1(
PATIO/DECKS 500
Rear
/S-
-LL--92-
TOTAL AREA 4560 4560
Other
NET NEH AREA 0 50. FT.
-7 ROOF AREA) _j!eig]
(ADDITION 15 UNDER EX15TINC
At C'
."r PATIO
. ( ONO.
L4,* -- ROOFLINE
�---I'x 105'Af
(IN-FI -L EXI
COVE
DECK
AjPPRO D AS NOTED
GINEE
Date f
lu
PLANTER
0 STREET FILE
RECEIVEL
MAR 0 3 2008
BUILDING DEPAhiMErs"
CATY OF EDMONDS
— — — — — — PREPARM BY
THE UmEN cOMPAW IW,.
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