21030 81ST PL W.PDF111111111111
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21030 81 ST PL W
PLANNING DATA
NAME:-
SITEADDRESS: DATE:
ZONING: -PLAN CHK#:
PROJECT DESCRIPTION:
CORNER LOT__9_(Yes/No) FLAG LOT- (Yes/No)
SETBACKS:
Required Setbacks:
Front- -fb " Left Side: 112'� Right Side: Rear: 117
Actual Setbacks: 9- t Ile,
Front: Z Left Side: jW' Right Side: —Rear:
Street map checked for additional setback required? AO __ (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED 9 _(Y/N)
LOT COVERAGE:
Maximum Allowed: Actual:-,.
BUILDING HEIGHT: Cq _(�/
,� OZ �,3
Maximum Allowed: Actual Height:
Datum Point: 91 '1 14',4 kL—Datum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION: M/ 14
LOT AREA:
OTHER:
PROJECT REVIEW CHECKLIST
PROJECT NAME:,.&
PROJECT ADDRESS:,�R/0,5c,) S,/ -4�e ao,
PLAN CHECK #:
RECEIPT DATE:
EVIEWED
BY- (Initial/Date)
PLAN.
W ER
COMMENTS
FIRE
BLDG.
SEWER
STREET,,..ENG.
Setbacks/Variance/Setback Adjustment
. . . . . . . . . . . . . . * . . . . . . . . . . . . . . .
Conditional Use Permit
....................
...........
2
ADB Requirements
3
Other Zoning Re uirements
-4
Underground Wiring Required
NONE ..................................
5
Lot Slope IS%
......... - - - - - - - - - - ....
6--
SEPA Environmental Checklist/Hydraulics Permit
0�k-
7
Tree Cutting Plan
8
Plat/Subdivision Requirements
Legal Description Verification
eAz-
10
Quit Claim/Street Dedications
Easements - Public/Private
kg�
PY 7
- 12
Engineering Storm Drain Review Fee
...... .. ....... ......
13
Engineering 2.2 Inspection Fee
. . . . . . .
14
Drainage Plan (On -Site)
15
Setback - Top of Bank, Stream, Water Courses
AIIA
I -6
Setback - Storm Drain Line
x, "XX
IT
Open Ditch - Existing
Al m
18
Culvert Required
Y
19
Culvert Size
......
20
Shoulder Drainage/Shale Open Runoff
..........
A.//,4.
21
Catch Basin Required
Re-4--,
-22--
Driveway Slope & Vehicle Access
. . . . . . . . . . . . .
. . . . . . . . . . . . I
23...
Sidewalk Required
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....
Curb & Gutter Required
. . . . . . . . . . . . . . . . . /Z
Curb Cut For Driveway Required
...... . . . . . . . . . . .
Street Paving Required
ft/
'Wo
27-
Right -Of -Way Construction Permit Required
. . . . . . . . . . . . . .
Street Name Sign Required
Other Signing Required
. . . . . . . . . . xx
Bond Required For Public Improvements
- --------
FEMA Map Check/Water Table
.:32---..
Side Sewer Availability
. . . . . . . . . . . . . . . ...... . . . . . . . .
"Irk-
3&'
Calculate Sewer Connection Fee If No LID #
Al
Create Street File
Existing Water Main Size
Water Meter Size
4
............... . . . . . . . . . . . . . . . . . . . . . . . .
37
Service Line Size
Water Meter Charge Required
7
Hydrant Required
:X.
Hydrant Size Existing --21
OIL-
- 4 1 -
Fire Line Charge Required - Sprinkler
A—
42
Street Cut
Miscellaneous
44
Reviewed By:
FIRE
0- \.
PLANNING EfiGINEERING P U,%] 0,-V. A
PU0110 V,,'%�JNKS DEP�
R E C 0 R D OF C 0 N T A C T S
1
21
2
22
3
23
4
24
5
25
6
26
7
27
8
28
RW PERMIT # DATE ISSUED RECEIPT #
9
29
10
30
11
31
1�
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT #99,3 6, DATE ISSUED'W/ 12'3/RECEIP'- h - 2�:�
T
14-
PAID $ RECEIPT # DATE
34
15
35
36
37
METER SIZE2/'/ PAID I &x:2-,CnATE 6P�1,9 RECE I PT #//7
18
38
19
39
20
40
fi
NE�
0 . �"980197
CITY,-:0FEDMONDS'
f -NUMBER-
'CONSTRUCTIOWRERMIT APPLICATIO JOB SUITE/APT N
WIN R NAM. /NA
ME.OF WS&ESS ADDRESS..
'DESCRIPTION C'�ECKI SUBDIVISION.NO ZLID-NO:
I/ 7t LEGAC
RILING ADDRESS
1.3 4, f6p
0 PU8jjC RIGHT, OF WAY PER'OFFICIAL STREET MAP. TESCP-�pproved 0
'CITY ZIP ' *-,�,o ' - - - - . X: RW Permit RequiredA/0 92� A
TELEPHONE NU . MBER I ING*� REQUIRED. DEDICATION:
X ST1110- Street -We Permit Req*d/Vgl
Inspection Required - -1E>0.
05 �Z� ?e*v_ �PROPOSED- 0
Mt. I . I I I Sidewalk Required I
MAM 0-
�INE SIZE NO OF FIXTURES PRV RE IRED
7NO 0
ADDRESS
W YES
A EMAR S 6
H z
77a A.),
< 61TY I ONE NUMBER A2! E, Q V //1 &__7 4--V: &JU 7--S
NAME
ir ADDRESS
RIN �41EMQ
DATED REVIEWED BY
0
A.
TEL PHONE 7 7
CITY ZIP :.NUMBER,.
z FIRE MEMO DATED REVIEWED BY-
�ul
8
STATE LICENSE NUMBER EXPIRATION DATE
VARIA ADB 0 HORELINE:iti��:
NCE OR Cul'
78
Lbgal Description of Propert inclu eaienrignts,
de all
REA�... t7 "HEIGHT
SEPAREVIEW--,_ siGri.A
COMPLETE] EXEMPT ALLOWED ]PROPOSED
o Lor r,4:- -±i
ze, �EXP 7.1
PROPOSED SETBACKS (Fr.),
�LOTCOVERAGE_ REQUIRED SETBA'CKS,(FT.)'
t(
ALLOWED I PROPOSED FRONT SIDE REAR: FRONT L/R SIDE -REAR
0
j eo (j z
A 7 Z.
7 z:
d":
_j Property
LOT AREA EW BY. DA
Tax -Account
Parcel Mo. DA
-7
RESIDENTIAL 'PLUMBINGNECH
COIiIIPUANCE OR
CHANGE OF USE:
RTADDITION: COMMERCIAL El
APT. BLDG. ...
MREMODEL El SIGN
'CODE
FENCE HECKED BY" OCCUPANL
GROU�
:jTYPE'OF:CON§TRUVTION',
D.REPMR CYDS X
-o'.swimpo&
WOODSTOVE PECIAL INSPECTOR OCCUPANT
E] DEMOLISH
INSERT HOT TLIB/SPA
REQUIRED LOAD
13 YES
4..,GARAGE, RETAINING WALL]
CA PORT L-1 RbCKERY 0: RENEWAL REMARKS
z
�E O,F USEIBIPSINESP�QFt ACTIVITY) EXPLAIN: PROGRESS- I NSPE4;,TjPNS,1PEK LtRCA 08
_j
rc I e- AJI., v
NUMBER�,OF CRITICAL to
16 5-i
W NUMBER
F1 'OF. :.DWEL�IN9,- APEAS
UNITS NUMBE
W tSTORIES
0
;DESCRIBE WORK10 BE DONE PLOT PLAN
Wont
C4
:0,1NAL:1NSPEqT!ON-REOU1RED, -
kf
VALUATION
LIM :1.0
FEE
C2
!PLAN CHECK FEE
Kly OILDING
PLUMBING. , jq
167;0 mle�.�W 5
;HEATSOURCE. - �Z
ec
an Zhi k, Nm, MECHANICAL.
'This':Permit.c
Y. GRADINGIFILL
overs,work'tolbe done on private property:ONL
-:A`n1y;','c** n-st"ructioti'.on-,thi3.oublic-domain-(curbq,-.-
0
*I�eiW�a *a, mar uees,�ett.).!will-require:separate pernilss on.
Y. q BTATE SURCHARGE
4;
;"i�-Ap
plic"66. iib Difo
STORM DRAINAGE FEE
Piertinit Limit: I .11`091i ProWded Work Is Slarted Vfithiri,180 Dopi
EN INS CT
_�'pplicant,-qn..behalf of his or her spouse,.heirs, assig s and G. PE ION FEE
An'
-.iuccessidis� . infere t;�`a'greei -,hold-
eo
w -harmless "the:, City
tr;damages-,of.*�'
2 employeds,-.arid agintslidiiiany-itnd,all clilmsl.fb
4 whatever nat*ure,.a.risi�'6:dliiictl�..or Indirectly from.the,is*iva6ce.`,
-peimit..Issuance:df,,this.permit sha A HECK 0 SW C72
�of;this 11 not*16i6* aimed t' Q PLAN C EPO
fmodify,' waive -or re Lice `- I of.any:city.or dinan' ce*;
0 d any, requ rement
norAimit-,In -any way the. Itr's ability,to enforce�any, d ce' . -tOTAL,_AM(jUNT,-DjE:,:.
gr lap
j;prov som,
ave read.this a'011"
n ormation given Is co I rrect; an th- p catlon;jhat'the-� ATTENTION
f d at, I am the.owner;�:or thjwduly."
APPLIbATION APPROVAL
'iLithorized, agiiiint'.0fthe. owner. f agree: to coirriply.with'city "n'
THIS -PERMIT-
-application is;.not 6 - permit until -
state'laws'regulating ponstruction;.and In doing -the work authorli-' AUTHORIZES This
or ONLY,,THE
persd III b olo, o the: 'a P!.
tedAher4by, no, VidAn violation. f signed bj'the�Bbilding�Officiil or his/her-
4`eh, t6h oiliting to Workmen'i Com pens WORK�.IAOTED
Code.of the'Statte.61' W a- Deput�;*, i1hd:fBbs' a're'**paid,:and receipt is
j,;; -,tIonAnsUrance:ancv C '2t?h -pro id
R W. .�27 . : acknowlebdii�jnspace V ed.
INSPECTION
'SIGNA AGEyn_'._1,
NER OR. G DEPARTMENT..
OFFICI :Sid REI� %J'
TE)�
CITY"� OF
EDIVI NOS',
1� ["A Z,
[ GRA
,S!A
iTo
43
Y
L fIELe7sib 6. .'-/'DIE
6A L Obh
5
1hS0bb1fi:dN
0 -OC
ITAS-U LAW T E' 3R � CUPY A. -BUILD
L IN(i OR;' RE
0 A AND . P P
'A OR IG I N 4C. '�Fiie. YELLOW — Inspector,.
A CERTIFICATE �OF -OCCURANCY� HAS BEEN GlANTED. BC� -20
V R
UNTIL A'FINA PE Tt rsi'�'H BEEWMADE -0
7.71" 2
SECTION 109 GOLD Assessor
PINK er
�01 ,
Nov
7- /7— C—x'01"?E5 '?0
CITY OF EDMONDS
890.19
Address of Construction: 'A
SIDE- SEWER PERMIT
PERMIT M 2 8936
Property Legal Description (Include all easements): -DE
F'UBLIC WORKS P7
Owner and/or Contractor:
State License No,
0. Single Family I
El Multi -Family (No. of Units
11 Commercial
El Public
Building Permit No. '��Fo/q7
Invasion into City Right -of -Way A No El Yes
RW Construction Permit No.
Cross other Private Property -A No El Yes
Attach legal description and copy of recorded easement
lify that I have read/and shaffr-c-amply-with
.-_?Il city requirements
clicated on the badk of the Permit Card.
/-�' - / - 7'�J'
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL V4-8M, PUBLIC WORKS DEPT.
Permit Fee: 7-71- 0 A -';IT
Issued By
Trunk ChargeA,57. zt
Date Issued:
Assessment Fee: Receipt No.:
Lid No.:- / (,�" /
Partial Inspection: Date - Initial
Comments
Reason Reje&d: Date -Initial -
Final Inspection Approved: Date I Initial
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3'90
A
The City of Edmonds
Side Sewer Drawing
EASEMENT NO . ............................................ I
NEW CONSTRUCTION REPAIRS r-� LID NO . .................. ASMT. NO . ..................
. _q --,
OWNER ---------------------------------------------- ................................................. CONTRACTOR .................................................................................... PERMIT NO. 8 .3.4
JOB ADDRESS .... c2ljo-,F�� .................. F . / - ................. LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
---- -- ..........
0
t
.............................................
z
,21030 ?/"'
rc"3 e—
Approved:
1-4
PWW-0001 -11/75 (REV.1 1/78)
DATE....... .................. By ....... ---------------------------------------------
NOTICE:
No---warranty..of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City Of
Edmonds, its Employees and Consultants.
The City of �Edrn.onds does not warrant the
accuracy of anything set forth on these
rnap(�-). Any person or entity -requesting a
copy should conduct an independent
I mation shown on
inquiry regarding the 'nfor
'm a p (s) , * I I I
t including, but not limited to,
the loc'ation of any sewer stub shown. Such
sewer stubs may or may- not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-11-o-yee-s or officer-,-) S'h-all be 11-abill-e for the
information given on this map(s), nor for
ion pr *ded based
any one representat' ovi
upon . said map(s).
Water Sorvice Drawing
The City of Edmonds
EA�, N41-NT NO . ................................. ......
NEW CONSYRUCTION REPAIRS 0 LID NU ASMT. NO . ........ .........
4 8
PERMIT No. NOMD
,CONTRACTOR ................................................ .... ...... . ..
OWNER... ........................................................................................ ...
..................................
-Z10.32 J;�JST LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO.
JOBADDRESS .............................. . .............................................. ..
............................................ : ................................................................. ...... ......
NAMEor- ADDITION .......... .................................................. ........................................... ..............
4f
7
0
-A
.1030
16n - 6( qr PL. W,
Approved:
DE ..... By ..M-t-.j5U R-4s ..............................
AT ........................ .............
Pw�V-00ul-1 1175 (REV.11 1178)
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