20911 HILLCREST PL.PDF11111111 lill 11
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20911 HILLCREST
PL
TAX ACCOUNT/PARCEL NUM13ER: 5z
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: ZQ /-- o — DETERMINATION: E] Conditional Waiver [] Study Required 22,Waiver
DISCRETIONARY PERMIT #'
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED: —
SCALED PLOT PLAN DATED: -f
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
q276SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fomis\Street File Checklist.doc
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City of Edmonds
SIDE SEWER PERMIT
Address of Construction:
PERMIT NO: 9772 ,,
PERMIT EXPIRESAW40/
Property Tax'Account Parcel No. 62-:� /6 42T 41z9,5 444:2 7
Attach copies of all access and utility easements _�Verified and Approved b -
Owner and/or Contractor:
Contractor License #:
uilding Permit #o=3 -z970.0
�Single Family Invasion into City *Right -of Way: El Yes E�-Ko
El multi -Family (No. of Units *RW Construction Permit #
Commercial (No. of Units Cross other **PrivAte Property: El Yes E;�No
El Pu' c "Attach legal description and copy of recorded easement.
Owner/Contractor
Owner or conGctor signature "and acknowledgement statement: 131t;
...wkBv signing for this permit I certify that I have read the City's.public handout entitled
ide Sewer Specifications, and shall comply with all City requirements, outlined therein.
W CALL DIAL -A -DIG (1-800-42ff-
7:5-555) BEFORE ANY EXCAVATION
W FOR INSPECTION CALL 425-771-0220 extension-F rw
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
:FOR OFFICE USE ONLY
.. .. .... ..
Pe r mit Fee Repair Fee $ Issued By:
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee 15.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN,
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO —Date: Initial:
Partial Inspection: Date: Initial:
P rUal Inspection: -Date: Initial:
'FINAL INSPECTION APPROVED: Date: 16111 (/ZI)O Initial: - ZL As -built to Street File: F�
t� PERMIT MUST BE POSTED ON JORSITE t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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PRI V. RD
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ED* CITY OF EDMONDS SIDE SEWER AS- BUILT
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ADDRESS
ci Q), 20911 HILLCREST PL
HOMEOWNER CONTRACTOR: SCAL
PMA CAJ U N NTS
DATE DRAWN PERMIT
6k 1890 10/13/03 BY 1. Abila NO. 9772
R E
mA)amuM DRIVEWAY SLOPE
ALLOWED 14% JUIL 2003.
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AppRovED AS NOTED
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ca IL BY. ENGINEERING
LOT AREA
MAX. cOVERASE Date: q'
.0
BUILDIN6 AREA 2,05245. .
ACTUAL COVARA&E 21.75 90,
IMPER\/10U15 5URFACF
LOT AREA = 5,182 S.F.
MAX. IMPERVIOUS SURFACE 50%
BUILDIN& AREA
(INC. OVERHAN65 4 &UTTERS) 2,5115-F.
DRIVENAY5 4 NALKS 565 S.F.
TOTAL iMP. AREA S.F.
WCTUAL PERCENTA&E 55.47 %
LE(5AL DE50RIPTION
LOT 4
CHAPMAN SHORT FLAT
IN SY41/4 OF SECTION IcI, T.27 N.,.R.4 EJ KM.
CIT'r OF EDMONDS
SNOHOMISH COUNT-r, YqA5HINr-,TON
ONNER
PMA DEVELOPMENT LLC
Iq4OO - 55RD AVE N.1 Sy1iVT.F" SEM
L'rNNYqOOD, NA q5036 NSPEC17ONS RE01)
CALL 425-771-0220 EXT. 1328
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City -of 14,monds
Deve , lopment Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
DATED RECOtD: (C)
CITYRECEIPT#: iigN
Critical Areas File ot — (619
Critical Areas Checklist Fee: $45.00
DATE MAILED TO APPLICANT:
E
CRITICAL AREAS CHECKLIST.
The Critical Areas Checklist contained on this form is The City'will revie'* the checklis� make a precursoi y
to be filled out by any person preparing a Development site. visit, and make a det'ermina . tioll 6f:the subsequent
Permit Application for the City of Edmonds prior to steps necessary to complete- 4 development permit
his/her submittal of a development pern-dt to. the Cit*. application.
The purpose of the Checklist is to enable City staff to Please' su*bmit*a'v*ici
nity map, alo with i
ng the s gned.
determine whether any potential Critical Areas are, or copy of this f
orm to, assist City staff Jri.,- finding and
may be, present on the subject property. The., locating the specific piece of pro erty described on this
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information needed to complete the. Checklist should form. In addition, the. applicant shall in' lude other
c
be easily available froni observation's of the site *or data pertinentinf6rmation(e.g. sit
e plan, -topography map,
available at City Hall (Critical areas inventories, �maps`,` etc.) o*r studies in conjunction with this Checklist to
orsoilsurveys).
assistant staff An completing their preliminary
t e si
assessment of h ite.
An Applicant, or his/or representative, fritist fill out the
checklist' sign and date it, and 'submit it to the City. -
I have corn leted the attached iCRITICAL'AIREAS CHECKLIST and aftes I t t 6 , t� th , e an'sw'
p. ers provided are
factuAl to the best of m knowled�e (fill out theappropni
ate co umn e ow).
PLEASE PRINT CLEARLY
Owner/Applicant: Applicant Repire s-entaii.v'e:,-
Estate of tvbybelle ChapTen Ca�b�d&surveylng & Engineering (Randy Devoir)
Name Name
31116 363rd Ave N E
Street Address
P 0 Box 326*
Street Address
Arlington M 98223 Arl!nQton VA 98223
city State. Zip City State Zip
Telephone: MQ-4M-1�13 Telepho
ne,�_
Signature Signature
Date:
c:my&c==tdspc11man/fbrm9CACL ForaLdoc
S:3hueAcmprJ&na/fbmisCACL Formdoc
Date: 12-19-01
PLANNING DATA
TE:
SITE ADDRESS:
PROJECT DESC
REDUCED SITE PLAN PROVIDED?(G�/ �No
MAP PAGE: CORNER LOT: (Yes
FLAG LOT: & No
j
ZONING: rz&-�; CRITICAL AREAS DETERMINATION #: -76
U Study Required:
U Waiver
UConditional Waiver
SEPA DETERMINATION:
Q Fee
U Checklist
El APO list w/ notarized form
(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake -011111vull
Exempt G08 C� cg)
SETBACKS:
Required Setbacks: -7. S' OJLR-
Street:—Left Side: Right Side: Rear:
Actual Setbacks:
�� _ StrL%T, �2c:� Left Side: -7. S- Right Side: 2-0 Rear: '50
Street map checked for additional setback required? (Yes / No NA)
QDETACHED STRUCTURES:
UROCKERIES:
El FENCES/TRELLISES:
L3 BAY WINDOWS / PROJECTING MODULATI I ON:
USTAIRS / DECKS:
PARKING:. Required:_a__ActuaI:=--=Q
LOT AREA: Q Ll 20
LOT COVERAM
Calcul tions: '%' -7 —' Q LI.->
1 C-kjr�� C.
BUILDING HEIGHT: +0 sk-kfodl i
- C219 CA MQA A A- I I' . /f Ll 1(). 0 a
Datum Poin Dat& Elevation: "
Maximum Allowed: L1 2 5- --_Actual Height: �- 3(o =.O�;
-A
A.D.U. CREATED?(&/-Y-ejs—
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: CY-e-S �/
Plan Review By.
1411 . -7
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NewBPPIanningDataForm.D0C
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WON
PRIV. RD
I CITY OF EDMONDS WATERLINE AS —BUILT
A
6 ADDRESS HOMEOWNER
20911 HILLCREST PL PMA
CONTRACTOR SCALE
CAJUN I NTS
DATE DRAWN WATERLINE
1 /1 3X0,
0 3 BY 1. ABILA NO. 2003-0733
L/0,3
PERMITEXPIRES
eas
C11Y OF EDMONDS
USE
ZONE
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS ; W'11
SUITE/APT#
ffilticost ru
WE OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
Ma t)
LID FEE $
MAILING ADDRESS
ALO -YI�Rexow.
Z2,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
TESCP Appr:7d
RW i.. R k.
Street Use Permit Rsqd
Inspection Required 13
Sidewalk Required 13
Undergrowd
Wiring required 0
C ZIP
2y"o,;�A 4re
TELEPHONE
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AV_,P-heT77 &Q—/
METER SIZE
I
LINE SIZE
7. OF FIXTURES
PRV REQUIRED
YES13 NO 13
I —
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Ur)W
4f,
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DAIE
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FIRE REVIEWED BY 13ATE
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CITY ZIP
TELEPHONE
VARIANCE OF'
SHORELINE ORADB#�
INSPECTION
REO'D
YES ONO
BOND
POSTED
$
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STATE LICENSE NUMBER EXPIRATION TE
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SEPA RE VIEW
EXEMPT,
EXP ,
SIGN AREA;
AL�6WED, PROPOSED
HEIGHT
ALLOWED PROPOSED
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PROPERTX TAX ACCOUNT, PARCEL NO.
7/!�
NEW ENTIAL . N M H'
ESio �PLUM
COMPLIANCE OR
ADDITION 60MMERCIAL
0 10 El CHANGE OF
LOT VERAGEL:,
�ALLNEICCO� PA606SED`�
REQUIRED, SETBACKS (FT)':
FRONT, -�:SIDE �:REAR
I'j
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
I` '.21
REQ`D OVIOED
LOT AREA.
4
PLANNING REVIEWED BY D�A*r
CL.A
REMODEL MULTIFAMILY SIGN
FENCE
REPAIR CYDS X FT)
REMARKS
OT HERL�,
E] DEMOLISH TANK
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E:i GARAGE 0, RETAINING WALL,. o, F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
RE
I[TYPE OF USE BUSINESS ORI A,CTIVITY) EXPLAIN:
CHECKED BY
S4"
TYPE OF CONSTRUCTION
V_
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Ct77
OCCUPANT,,;*2
GROUP
NUMBER
,�Op
STORIES 2-1
NUM134R : of,
DWELLING
UNITS
CRITICAL %,!�
AREAS;0
1 N UMBE
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a
ON
0
CTI
SPECIAL INSPE ON
REQUIRED
0 YES
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PR 0 GRESS INSPECTIONS�PEWUBC 1 08/FINAL INSPECTION REG-0
9
VALUATION
Description
4_FEE Description FEE
Plan Check
State Surcharge
GLhZING_% LOT SLOPE %
Building,pprmit.r
City Surcharge
1
PLAN CHECK NO: VESTED DATE
3
n, �3
',Plumbing
,
Mechanical
THIS PERMIT AUTH1ORrZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
32
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 180 DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
0
x
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
NOR LIMIT IN ANY WAY THE CITVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
.
Landscapeinsp.
Recording Fee
Total Amt. Due
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN is CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND�l DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
0 0
IN VIOLATI OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
1.�
WORKMEN' ENSATION INSURANCE."D RCW 18.27.
CALL
FOR INSPECTION
This application is nots permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
SIG NE 0 AGE �/ I DATE SIGNA J.1_
(425)
OFFIC118L&Ar4ATURE DATE
13
Ir -0/fioT
I _
771-0220 1 DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
M 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5
ORIGIN A' - Fit E - YELLOW INSAECTOR
PINK -OWNER - GOLD -ASSESSOR
COPIES GREEN - ACCOUNTING
E,
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F7 Z, .94a el
57, !a
MILPIN& CQVERA&E
LOT AREA = q,41 cl S.F.
MAX, COVERA6E xx %
IBUILDINC7 AREA = 2,052 S.F.
WCTUAL COVARA6E 21:75%
ItIFERVIOU5 SURFACE
LOT AREA = 5,-752 S.F.
MAX. IMPERVIOUS SURFACE 50%
BUILVIN& AREA
(INC. 0\/ERHANC75 4 &UTTERS) 2,511 S.F.
VFZIVEViAY5 4 YqALK5 = 565 S.F.
TOTAL IMF. AREA = 5,5-7q S.F.
ACTUAL PERCENTA&E = 55.47 %
AL DF-50RIPTION
LOT 4
CHAPMAN SHORT FLAT
IN 5Y41/4 OF SECTION 1q, T.2-7 N., R.4 EJ KM.
CITY OF EDMONDS
SNOHOMISH COUNTY, YqA51-11N&TON
QMER
PMA DEVELOPMENT LLC,
111400 - 53RD AVE KI SUITE :200
LYNNY400D, NA diaOB(b
SITE PLAN
SCALE : I"
0 20 40
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BUILPIN5 0Q\/ERA(5E
LOT AREA = q,41q S.F.
MAX. COVERASE XX %
BUILI';�IN6 AREA = 2,052 S.F.
ACTUAL CO\/ARA(5E 21.75 %
IMPERVIOU15 5URFACE
LOT AREA = 5,152 S.F.
MAX. IMPERVIOUS SURFACE 50%
E3UILPINry AREA
(INC. OVERHAN&S 4 6UTTERS) 2-511 S.F.
PRIVENAYS S NALK5 = 565 S.F.
TOTAL IMF. AREA = 3;5-7q S.F.
ACTUAL FERCENTA&E = 55.4-7%
LE6AL DF-50RIPTION
LOT 4
CHAPMAN SHORT FLAT
IN SN 1/4 OF SECTION lal, T.2-7 N., R.4 EJ N.M.
CITY OF EDMONDS
5NOHOMISH COUNTY, NASHIN(5TON
ONNER
FMA DEVELOPMENT LLC
Iq4OO - 33RD AVE N.1 SUITE 200
L'i'NNNOOD, NA c15056
AUG 2 - 2933
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