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21005 WOODLAKE
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PLANNING DATA
NAME: Nlle,.,I-
SITE ADDRESS:_2/60S "'0111i"12 DATE:_z�4/.Fzif_
ZONING: k5 _'f PLAN CHK#: ?k-- 36�(
PROJECT DESCRIPTION: E411 IrIk
CORNER LOT (Yes/No) FLAG LOT, *0 —(Yes/No)
SETBACKS:
Required Setbacks-,
Front: X' LeftSide: _7�Z_ RightSide: -7yL Rear:
Actual Setbacks:
Front- -24' W Left Side: Right Side: Rear: /57
Street map checked for additional setback required?_4_,�/., (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
-Z ILM f
LOT COVERAGE:
Maximum Allowed:— —Actual:
BUILDING HEIGHT:
Maximum Allowed:—,25 Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?: /uw llk�
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION:
LOT AREA: 0 7
OTHER:
1PIanRevIewBy: JZ
cy,j
c%fi1cs%p=Wt%�p1a&Ldw
1890..,99,
CITY OF EDMONDS
PUBLIC WORKS DIVISION
SIDEWALKIHAZARDOUS CONDITION REPORT
I
OWNER: Kesi uerm
ADDRESS 21005 Woe take
Dr.
NAME OF REPORTING PERSON
HORIZONTAL CRACKS l" IN o
VERTICAL MISAI.JGNMENT 1/2'
Yes
LOCA11ON OF HAZARD:
I COST OF REPAIRS: S90.511
0 197
DATE OF INSPECTION
TIME REPORT RECEIVED
AREA TO BE SAWCUT
WIDTH 5
LENGTH 5 TlOTAL L.F.
TOTAL SIDEWALK
WIDTH . 5
LENGTH— 3 TOTAL SO. FT.
TOTAL SQUARE FEET
I PROPERTY OWNER'S SIGNATURE FOR REPAIR: I
I NAME OF PERSON(S)
I WITNESS
VED
I RESULTS OF ON -SITE INSPECTION
I PHOTO REQURIED YES
I INFORMATION ROUTED TO
AGE ADDRESS PHONE
AGE ADDRESS PHONE
COST OF REPAIRS
STREET SEC'nON
I COMPLETED BY DEPT. PHONE I
TO BE COMPLETED BY RESPONDING DEPARTMENT HEAD DATE
WHAT CORRECTIVE MEASSURES WERE TAKEN OR ASSISTANCE GIVEN? (IF NONE PLEASE EXPLAIN)
r-.-. re I;zk r
Z?,& 112 1= f') J A r- JA/ , 6 / J/ n
STREET SUPERVISOEg��� DATE [1111 ow L v
FINAL REVIEW (T(T BE COMPLETED BY P.W. SUPERINTENDENT) - DATIJIIWr-EIVED
P.W. SUPERINTENPFNT, DATE
bulairlL9 u lco I
COMPLETED FORM TO BE FILED IN ADDRESS FILE
(WHnE-RESIDENT COPY) (GAVANY-STREUr ADDRESS FILE COPY) (PINK-STRELrrCRLIW COPY) (GOLDENROD -PUBLIC WORK COPY)
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application: 21005 Woodlake Drive �JA
DEPARTMENT
COMMENTS
DATE
W A T E R
S T R E E T
lid:
S E W E R
ZK6�-Ie�p A-1
N 0 T E S ,
BUILDING
DEPARTMENT COMMENTS
9/1/71
m
DING DEPARTMENT Appueant Flu
Inside Heavy LWes
PERMIT APPLICATION
USE PERMIT
ZONE NUMBER
JOB
APDRESS
�t /
NAME (OR NAILE OF BUSINESS)
PERMISSIBLE 7, ACTUAL %
LOT COVERAGE LOT COVERAGE
PERMISSIBLE HEIGHT PROPOSED II EIGHT
4
CITY
TZLEMONZ NUMBLA
ACTUAL LOT AREA TOTAL BLDG. AREA
z
I
REQUIRED YARDS PROPOSED YARD
FRONT SIDE PEAR FRONT SIDE— REAR
---TU_,kKC0_d11_c6N_f)1TIONAL USE
LEGAL 1,0r VA
YES NO PERMIT NUMBER
W
A
ADDRESS
PLANNING DEPT- APPROVAL DATE:
CITY
5:: dk* e-, lfiiol
TZLEFRON2 NUMBER
STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY TH19 PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
NAM9
s-,
REMARKS
ADDRESS
s-s-
CHECKED BY
CITY
TZ=PHONE NUMBER
C-7)
ER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
12 2 -S 6 1 1
CITY LICENSE NUMBER
1
REMARKS
&z-- .5;Pxy ygn— --/0
_
IAS&I Description of Property (Show Below or Attach Four Copies)
—7- LA sa L A (A
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE TYPE �CONSTR TION STREET IMPROVED
WY7E S NO
GAB
aRESIDENTIAL LINE
NEW
El NON-RESIDENTIAL SIGN
ADD I I RETAINING
MDEMOLISH WALL
ALTER EXCAVATE PENCE
0 OR FILL ( .......... x .......... Ft.)
17 REPAIR PRE -MOVE SWIM
M INSP. POOL
SPECIAL INSPECTOR REQUIRED
YES NO
>6
OC
.rWIROUP
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04,
REMARKS
NUMBER OV 8TORIX8 NUMBER OF
D"LLINO
UNIT$
NATURE OF WORK TO BE DONE
A/(
Plan Check No .....................
Valuation
Pee
Receipt No.
BUILDING
PLUMBING
PROPOSED USE
HEAT & GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting streets)
.N
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
-NO - ----_------------
NEW CONSTRUCTION REPAIRS [:1 LID NO - ------------------ - ASMT. _Jc�
_7�
-4
OWNER-------------------------------------------- ....... ----------------------------------- CONTRACTOR ............................. ---------------------------------- PERMIT NO. ...........
-40T-NO� -0CK NO-
'::-_;�--LEGAL—DESCRlPTlON:- 1 ---------- ------- ------- BL - ---------------------
JOB ADDRESS, 2 — --------- --------------------------------------------------------------------
Q 'I
41�ik
6__i-�� -----------
.......... ------ By ----- 4�
e s " Signed, By "ro, 1 "
MVST Bb' ner i of Yi�fn Pekfqz!nlht,�5'PonAkuOtlon -PRIOR To- 'Reque�t r in
................... " 1. 1 .... I � - — I
orcjina#J�64�,'pf,.',the' City
Pat
64 tws
77 77 7 7 "77 T
I , Z
A"LICA71ON
to City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMFF
NEW CONSTRUCTION a' REPAIRS Ej LID NO. -lee-1 ------- - ASMT. Nc(:i�i>-
OWNER ..... . ........ -- ---------------------------- ------------- ----- CONTRACTOR ell� ------- 4A.11.t ................. --- --------
...................... .... PERMIT No.
JOB ADDRESS ......... Wj��o
,iV (0 -------------------- --- BLOCK NO - ------------- ----------------------
*ke -------- .. ..... LEGAL DESCRIPTION: LOT NO - ------- / -
................................................................ -- ...................................................................................
NAMEOF ADDITION --- CJ.U- -0. --------------------------------- ---------------------------------------------
REC EVVED
AAY 311974
Approved:
DATE.......... ................................ � By
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILIN67MDRESS
z
0
CITY ZIP- T ELEPHOI`Z_
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
ADDRESS
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
LEGAL DESCRIPTItNtFP��n�QP EtTY - INCLUDE ALL EASEMENTS
I . I " '�' F�_ r N -, —_ — ('211 L" '^ __" --tr' - �-r I I_
PROPERTY TAX ACCOUNT PARCEL NO.
-7-7,
000 - o I -,:z) Qa 4
F� NEW
RESIDENTIAL
PLUMBING I MECH
El ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
14 REMODEL
APARTMENT
SIGN
F1 REPAIR
GRADING
FENCE
CYDS
X
DEMOLISH
TANK
OTHER
GARAGE
z CARPORT_
RETAINING WALL
0 RENEWAL
ROCKERY
I- (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0.
0 17, Ir.
in
tu NUMBER
0
NUMBER OF
CRITICAL
In OF
DWELLING
AREAS
o STORIES
UNITS
NUMBER Alld
DESCRIBE WORK
TO BE DONE
USE
ZONE 6S_
JOB
ADDRESS
LEGAL DESCRIPTION CHECK
PERMIT EXPIRES
PERMIT
NUMBER 9 5083a
SUITE/APT#
SUBDIVISION NO. I LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP App—ed
0
Aw Permit Required
0
EXISTING — REQUIRED DEDICATION
Street Use Permit Req'd
0
Inspection Required
0
PROPOSED
Sidewalk Required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 - NO 0
W
REMARKS
z
z
a
z
ul
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY W
a:
U.
VARIANCE OR CU
ADB#
SHORELINE #
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOS
HEIGHT
ALLOWED PROPOSED
EXP _�C_
,
-
7,5 1 / -3
LOT COVERAGE
ALLOWED PROPOSED
'
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
-7j 1
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
1., z
3.'�l z �
-7 �411_ /54
LOT AREA
PLANNING REVIEW BY C(AfE
FT) CHECKEDBY I TYPE OF CONSTRUCTION COD OCCUPANT
I /_ A/ 1 '&_4 GROUP
SPECIAL INSPECTOR I ATIEA OCCUPANT
REQUIREDE] YES 2-11 LOAD
REMARKS
z
PROGRESS INSPECTIONS PER IUBC 108 -
A /11.0 1/1 J -A- ,'I
FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
__ - I-
=EA;S)URCE
. - ' -
=21157,
LOT SLOPE
BUILDING
"
PLAN CHECK NO:,,
VESTED DATE
PLUMBING
11-11
M,ECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WO�k Nd.TED. !THIS PiRMIT:,COVERS4ORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
4 !
73 DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MAROU91ES,ETC.) WILL REOUIRE
GRADING/FILL
SEPAPATE PERMISSION.
a:
STATE SURCHARGE
U) PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
ji "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
x EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALLNOT BE
DEEMEDTOMODIFY, WAIVEOR REDUCEANY REQUIREMENT OF AhY CITY ORDINANCE
PLAN CHECK DEPOSIT
76,
(E(460
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE
f 2-5q
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
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
application is not a permit until signed by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
receipt is acknowledged in space provided.
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
(425)
0j:FICIALS SIGNATURE DATE
771-0220 (_t%�
f
S DATE
A17ENTION Nll�'/ I!
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAI - Fit Ef YF'' OW - INSftCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSEISOR