21003 WOODLAKE DR.PDF11111111111111
13760
21003 WOODLAKE
DR
E
E
ADDRESS: Y/1)0,0 WOOC116t Ke.., bt-
TAX ACCOUNT/PARCEL #: 00�o?� 7 70060
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver Study Required E] Waiver
CRITICAL AREAS #: DETERMINATION: El 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:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: IF
LID#:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: 4[1-51
GEOTECH REPORT DATED:
STREET USE]ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: 2- - 7 --b
OTHER:
L:\TEMP\DST's\FormsXJana's Street File Checklist 5-14-08.doc
PLANNING DATA 10
SINGLE FAMILY RESIDENTIAL
11 STREET F:I�fl
Name: m.�
Site Address: C�10o-� � r
Date: 15'- ?-9 - i)�
Plan Check #: BL-D-)o09-
Project Description: 6 V"
Reduced Site Plan Provided: UY�S NO)
Zoning:
Map Page:
[Corner Lot: (YES / &0
Flag Lot: (YES
Critical Areas Determination #: C-IZAr —ft3 -7
El Study Required
E*'Waiver
SEPA Determination: e,-?K
fN�-Exempt
Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist 0 APO List with notarized form
Required
Street:
I Side: S -7 "'9
Actual Setbacks
Street:
Side: VJ
ide: :5
PS
10
Detached Structures:
El Rockeries:
El Fences/Trellises:
Bay Windows/Projecting Modulation:
Stairs/Deck:
Height
Datum Point:
Datum Elevation:
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided:
Lot Area:
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations:
ADU Created: (YES / NO)
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES / NO)
Comments
0 U-1
Plan Review By: S-"�3
Plannino Data Forin 04-11-06.doc
0
Deck Plot Plan
Property Owner: Chris Maden
Property Address: 21003 Woodlake Dr
Parcel Number: 00637700001500
N
Property Line 901611
12'
25'
existing
deck addition
-Z
961711
161411 16' 16'
161 611 :F-
EXISTIN�LG HOUSE
Driveway
4112"
211811
109,51,
>
F2
Sidewalk
Woodlake Dr.
Center of Right -of -Way
,"S") T R E E T F I L E MAY 2 6 2009
201 DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Buildihg Permit Applications
Proposed Property Address of Application: 21003 Woodlake Drive r �- �/ o
DEPARTMENT
COMMENTS
DATE
W A T L A
- /4
S T R E E T
S E W E R
- 4j za2f
0,
N 0 T E S !?:;, - -
I 7-qV�
BUILDING
DEPARTMENT COMMENTS
re - , , -"I*
BUILDING DEPARTMENT
PERMIT APPLICATION
Appliesm FM
inside Kmvy 'Anes
USE PERMIT
ZONE NUMBER
-JOB
ADDRESS
a'
NAME WR NAMS OF BUBME-88)
6�2
�
PERMISSIBLE ACTUAL %
LOT COVERAGE LOT COVERAGE.
MAILING ADDRE89
PERMISSIBLE HEIGHT PROPOSED HEIGHT
0
CITY
EDIAWof
TEIJE ONE NUMBER
Az 8_947-1A
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REAR
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ In.
NAME
REMARKS
ADDRES
CHECKED BY
CITY
TELEPHONE NUMBER
METER SIZE I
SERVICE SIZE
CLEARANCE
CHECKED BY
91—ATE LICENSE NUMBER
..
I—TYUCENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE
i TYPE OF CONSTRUCTION
STREET IMPROVED
I [] YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES El NO
RESLVEN GAS
I ry TIAL LINE
NEW
NON-RESIDENTIAL SIGN
ADD I RICT kI NG
DEMOLISH El WALL,
ALTER EXCAVATE PENCE
OR FILL ( .......... Ft.)
REPAIR PRE -MOVE' SWIM
INSP. POOL
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER or
DWELLING
UNITS
NATURE TO BE DONE
Plan Check No .....................
Valuation
Fee
Receipt No.
BUILDING
PROPOSED USE
PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indicate BuildinS setbacks, abutting streets)
tRETAINING
N
Ov"T 9 1973
FENCE
SIGN
WALL
SWIMMING POOL
DKUOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
APPLICATION
for
The City of Edmonds SEDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
OWNER .... 31- f f � 17 ........ ........................................................... CONTRACTOR ..... :PPL ...... ...... ........ SS�Z�Jt� ........... PERMIT No.
ADDRESS .... jgf cc 3 &,,o a /
.................................... LEGAL DESCRIPTION: LOT No . ........ Z ............................ BLOCK No . ............................................
NAMEOF ADDITION ...... . .......... 4,1.1 .................................................................................
0
0
0
Approved:
DATE................................................ By ............... ......................................................
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
ENE�T 4 S-5&
........................................................................ I ........... . ...............
OWNER .............................................................................................................. CONTRACTOR eAr-KHOM .. PERMIT No . ......
0 Sb . ..........
ADDRESS ..gYPPE!> ....... . ........ I.:. ... 3.F0%* LEGAL DESCRIPTION: LOT No . .................................... BLOCK No . ............................................
k N P(=�l P L -rtC�ON
NAME OF ADDITION ..... V .................................. -.P.. Vge.,a ........ tNMM..' ............ ............................
0
I N
7=77�
'MOTMI'T
�(OiOier�:� oi
Installed;WlAc.
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8 9 0 1 9 C5 -
r VAIr" All
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RIGHT-OF-WAY CONSTRUCTION
PERMIT. Permit Number. -3 �-211
Issue Date:
A. Address or Vicinity of Construction: - 21003 Woodlake Dr. (9501428)
B. Type of Work (be specific): Install New ServIce
C. Contractor: Washington Natural Gas CoLapagy
Mailing Address: 815 Mercer Street
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2299
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 0 Commercial F] Subdivision 0 City Project KI Utility (PUD, GTE, WNG, CABLE, WATER)
E) Multi -Family E] Single Family Other
INSPECTOR: S CTOR: A 4 cvH
F. Pavement or Concrete Cut Yes G. Size of Cud 2) 2 x 4 H. Chargq�,$
APPLICANT TO READ ANJbSfGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hoigd�p City ofEd..ndharmIessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ogqi4st the City of Edmonds, or f its departments or
employees, including or not limit6d to the defense of any legalproceedings including defense cbiii8, and attorney fees by reas.w;:n . tingthispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIAA PO4,A.PERIOD OF ONE YEAR,,FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL tl�Efi#IAL S(REET PATCH
IS COMPLETEO BY CITY FORCES, AT WHICH TIME 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 reclfiired for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
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.
Ihave read the above statements and understand the -permit req 'remnn sand the pink copy of thepermit will be
available on site at all times for inspectio
Signature: (Contractor or Agent) Date: Nov. 10, 1994
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
I FOR CITY I TQR nm.v I
A
APPROVED BY:
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: A6,F CuT
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
C7()
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
E
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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Addendum to City qf M�W 5(>,-1PNkD-S
Right. of Way
Permit Application
Submitted by:
window.,
-WNG-to-
water imain dept h -w- water
-Urxnown,
S&W-6t'
to gas Ma n --G�-water hydrant
D.Ox 1.869). S"nk..WA 99111 (206).62.2-6767
En4ineerinig Aide
Washinqton Natural Gas
i 020� C', 5 C) 14 ?1-8