21012 WOODLAKE DR.PDFiiiiii lill lill
13764
21012 WOODLAKE
DR
CITY OF EDMONDS
ZONE PERMIT
NUMBER 9 SOaO*7
CONSTRUCTION PERMIT APPLICATION
o. SUITE/APT
ADDRESS In J,�g —/),,
OWNER NAME/NAME OF BUSINESS
J�PM 45 tjj-t1-( *- #eA I-je.- &e e fe- P-
1E..1 DESCRIPTION CHECKI
SUBDIVISIONAO
LID NO,
MAILING ADDRESS 0
A / o / 2— ,#,/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
PROPOSED
TESCP App,iwrid
RW Permit Required
Street se Permit Rq*d 11
Inspecution Required 0
Sidewalk Required 0
CITY ZIP ENUMBER
,/,_I TELEPHON
lk 6 &
NAME
-muEASIZE
LINE SIZE
rO- OF FIXTURES
PRV REQUIRED
YES 0 NO 0
I
ADDRESS
REMARKS
CITY ZIP
TELEPHONE NUMBER
Z
NAME
'D,4"flf"t
ADDRESS
/1/70 7 3 /�'Z.
0
ENGINEERING MEMO DATED REVIEWED BY
'I
z
CITY
Il0firb 17�eo -?V-Z'P7S-
2. 1
TELEPHONE NUMBER
Yi 9 go 6'00 2. Y
FIRE MEMO DATED -- REVIEWED BY
STATE L CENSE NUMBER E
444'=c 4 043 11 Ex P;7,'QN1AT
VARIANCE 08 CU
i
ADB#
----
SHORELINE I
Legal Description of Property - include all 6asements
SEPA REVIEW
COMPLETE EXEMPT
SIGN
ALLOWED
AREA
I PROTSED
HEIGHT
A�OVVED JPROPOSE?
z
� x
x
I
w1h
—
LOTCOVERAGE
ALLOWED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
CP
Pro=
TAX A I
IPROPOSED
4V
OT AREA
0,
—.eP Way
z
Parcell4o.
�,7"
12 NEW RESIDENTIAL PULIAMIN"ECH
REMARKS -
COMPLIANCE OR
1:1 ADDITION COMMERCIAL CHANGE OF USE
0 REMODEL APT. BLDG- SIGN
'NECKED BY
ITYPE OF CONSTRUCTION CODE
VAI I
14
OCCUP NT
GROPLL5
I
GRADING FENCE
EIREPAIR CYDS. I x—FT)
I
]..US. E] WOODSTOVE SW M POOL
INSERT HOT TUE6rSPA
GARAGE
_] RETAINING WALU
CARPORT ROCKERY ��AL
SPECIAL INSPECTOR JAREA
REQUIRED OYES
—54195Q yz�-
JOCCUPANT
LOAD
MA—R..
PROGRESS INSPECTIONS PER USC 108
z
(TYPE OF US , BUS NESS OR ACnVITY) EXPLAIN:
r
k
NUMBER
OF _L
OF
NUMBERG
OWELLIN
CRITICAL
AREAS '?V— rK,
0
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE IATTACH PLOT PLAN)
10f-t r1k 14 r- 7- 1) -E-6- k- -2g,06,91
FINAL INSPECTION
REQUIRED
VALUATION
FEE
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
777�
%
PLUMBING
No. 9F� - F-7
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curts, sldewpiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 190 Days
P..R Limit: I Yeiltr-�Mvldd Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
23
I
Successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
I
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 shall not be deemed to
modify, waive or reduce any requiremsini of any city ordinanc:
nor limit in any way the City's ability to enforce any ordinanc
provision."
PLAN CHECK DEPOSIT
e7 7
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
Information given Is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authoriled agent of the owner. I agree to comply with city and THIS PERMIT
a ate laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until
ti
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code I the State of WaShIngton relati.fig to Workmen's COmpensa. WORK NOTED Deputy; and fees are paid. and receipt is
tion urance . ACW 14'". INSPECTION acknowledged in space provided.
SIG A RE to ER OR ADEN EPARTMENT
'EDMONDS
CITY OF OF�� T�
PRf
CALL FOR RCLEASEb BY
ATTENTION INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNI711. A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. Lion 771-0220
BC
SECTION 109 PINK — Owner GOLD — Assessor
10247 - A-- �,/ A713
CA FILE NO. C(4- - 15 6
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: Z-10(2-
2. Property Tax Account Number: -000-007---000
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Y yes; _ no.
If yes; how is site develo, H 0"'k &
5. Describe the general site topography. Check all that apply.
Flat 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 of 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 d= 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: Approx. Depth:
7. Site contains areas of seasonal standing water: IJ 0 _; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway " 6 _ floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? "o Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow _; shrubs mixed
urban landscaped 0awn,shrubs etc)
11. Obvious wetland is present on site: A) D
890.199-
City of Edmon&
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmondspdor
to his/her submittal of a development
permit 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).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
RECEIvED
JUL
PERIN111T C;0VINITER
and submit it to the City. The 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shaU include
other pertinent information (e.g. site
plan, topography map,, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that)Ithe answers provided are
factual, to the bert of my bowledge (fill out the appropriate column below).
Owner / Applicant:
Name
21olZ 4,,��ob,(AA-&- �)R,
Street Address
4fF�/n,0 Ale) 5 6)4 9 810 2 (-�,
city, state, ZIP
Signature -
Applicant Representative:
Name
Street Address
-771-1240
Phone city, state, ZIP Phone
Date Signature Date
7( p
13
I
CITY Copy
I
4
.2s . --> I
PLANNING DATA
NAME: —
SITE ADDRESZ'
DATE:
's &7
ZONING: PLAN CHK#:
PROJECT DESCRIPTION:
CORNER LOT_/V Yes/No) FLAGLOT (Yes/No)
SETBACKS:
Required Setbacks:
Front: �� Left Side: 5* Right Side: Rear:
Actual Setbacks:
Front: Left Side: IS Right Side:
-_ /';� Rear:
Street map checked for additional setback required? —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed: Actual: C
BUILDING HEIGHT: I
Maximum Allowed:— Actual Height:j_/
Datum Point: I- Datum Elevation:
A.D.U. CREATED?: _N4
SUBDIVISION:
g�41
CRITICAL AREAS #:.
SEPA DETERMINATION:— /1*1
jv-
LOT AREA:
OTHER:
4k CA FILE
Critical Areas Checklist
Site Information (soils/topography/hydrplogy/vegetation)
1. Site Address"cation: 7,10(?- 4)o0bi-Aa M
2. Property Tax Account Number. -4900-OOZ--000
3. Approximate Site Size (acres or square fed):
4. Is this site currently developed? _.y yes; no.
If yes; how is site developed?_L-LC�)�..
5. Describe the general site, topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less dian 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Effil3r. 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-fect).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less dm 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water. 0 _; Approx. Depth:
What season(s) of the year?.
8. Site is in the floodway A) 6 floodplain IJ 0 of a water course.
9. Site contains a creek or an area where water flows across die grounds surface? Flows are year-
round? A-..)O Flows are seasonal? A) 0 (What time of year?
10. Site is primarily: forested meadow ;shrubs
mixed
urban landscaped 0awn,shrubs etc)
11. Obvious wetland is present on site.- . A) D
RcVOI/04194
&90.199-
City of Edmon&
Critical Areas Checklist
Ile Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmondsprior
to histher submittal of a development
permit to the City.
17he 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. Ile
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).
An applicant, or his/her representative,
must fill out the checklist� sign and date it,
RECEIVED
J U L 2.0 -1994 - .
PE HMIT COUNTER
and submit it to the City. Ile City will
review the checklist, make a precursory site
visit, and maim a determination of the
subsequent steps necessary"to complete a
development permit application. -
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel'
with enough detail that City staff can find
and identify the subject parce 1(s). In
addition, the applicant shall include
other pertinent information (eg. site
plan, topography map, etc.) or studies in
conjunction with this Cheddist to assist
staff in completing thew preliminary
a ssmefit of the site.
I have completed the attached Critical Area Checklist and allW that the answers. provided are
hctual' to the best of my knowledge (fill out the appropriate column bellow)
I ,
Owner / Applicant -
Al
N=3*
2101Z
SUW Addrew
Applicant Representative:
Name
C—AAIoMOS 6J,4 913026, 771-1216p
City, State, ZIP Phone GIN State, ZIP Phone
Signature Date
S4natum
Date
tbl. 14)
-- ;- '- A - -
PF4VY,-
JUL 0
p2nivily CIO, dlkly�,EIR
Ow"KIPTIOW L.CT2. 1pl�
VOL.., 54' PAqi:- -�54,p
,5NoHvo,,�4 ccwN-rY
APPLICATION
for
V
.he City of Edmonds SIDE SEWER PERYaT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
........................................................................ — ERMIT No.-477
OVITNER .............................................................................................................. CONTRACTOR . ............ ..................
2-1017- KI
ADDRESS............................... ..................... ......................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . .............................................
NAMEOF ADDITION .........................................................................................................................................
0
0
0
0
Approved:
DATE ....... ------- By
APPLICATION
for
Tho City of Edmonds SIODE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION F] REPAIRS
OWNER ....... ........ 00" . ....... .. . .... .... CONTRACTOR No.
14 BLOCK No . ............................................
ADDRESS ... . ......... ........ jq- t ...... k1 ................ LEGAJ, DESCRIPTION: LOT No. C;� - --------------------------------------
NAME OF ADDITION ......... qPe0.?,% - ------ �-- .. � 6-solook ........................................................
0
0
-4
0
Al -
Approved:
RECEIVE,D
MAY 14 1974
DATE................................................ By ......................................................................
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application: 21012 Woodlake Drive
DEPARTMENT
COMMENTS
DATE
W A T E R
2,7 '74
tr'ql
S T R E E T
44;cz, azdr-k-, /2"ax-
X
S E W E R
on A6ZI�11,---2167 Ails,
0/7
N 0 T E S'
4t
BUILDING
DEPARTMENT COMMENTS
9/1/71
BUILDING DEPARTMENT
PERMIT APPLICATION
AppHmut F=
im'de Hmvy ums
UM; PERMIT
ZONE NUMBER
-mr---
ArDRESS /'0
j TA(OR NA or BUR -
z C-
-VE—RMISSIBLE % ACTUAL
LOT COVERAGE LOT COVERAGE
MAILING ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
0
CITY
144;:
TZLEPHONZ NUMBLA
7 ;7 4/ —/ 2- 72
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REXR
.4
NAME
ADDRESS
LEGA L LOT VARIANCE OR CONDITIONAL USE
0 YES NO PERMIT NUMBER
PLANNING v&PT. APPROVAL DATE
CITY
TELEPHONE NUMB - ER
STREET R/%%
EXISTING 8-1 REET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT.
0
044) dn),
ST,
REMARKS
a
tA1712-
CHECKED BY
CITY
TZLZPHONZ NUM—B-a-
2,7
METER SIZE
SERVICE SIZE
CLEARANCE
ICHECKED BY
.TA
'1:�- 3 —0 2- 6c�
CNISM NUMBER
REMARKS
0
Legal Description of Pro rt (Show Below or At h To r Copies)
/-0 z:
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
FIRE ZONE
I TYPE OF CONSTRUCTION
STREET IMPROVED
I [] YES 0 NO
SPECIAL INSPECTOR REQ IRED
0 YES [:] NO I
OCCUPANCY GROUP
RESIDENTIAL GAS
NEW LINE
NON-RESIDENTIAL SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL ( .... . .... x .......... In.)
El 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,
HE Af&§-�-
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF W6WR-f0T-13Z—D0-RE
040AS rx"-�f cr A)r4j L";:j
Plan Check No .....................
Valuation
Fat-
No.-
BUILDING
PROPOSED UBE
PLUMBING
HEAT & GAS LINE
PLOT PLAN (Indicate Building setbacks, abu tUng streets)
tRETAINING
1p
FENCE
SIGN
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL