21100 SHELL VALLEY RD.PDF11111111111111
13040
21100 SHELL
VALLEY RD
ADDRESS:2/1�do 0�hdl - I
&,/I- MX2,53m 1
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE): 7 7- 6 7�ZZ
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: D Conditional Waiver [] Study Required E] Waiver
DISCRETIONARY PER -MIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):_./f 77- OW
a - X 76 &zYe-�
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATE
SIDE SEWER PERMIT(S) #:27�25
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LOT:
LID #:
BLOCK:
LATEMP\DSTs\Fomis\Street File Checklist.doc
PERMIT
USE NUMBER -7_7�]_74
NE
OU ILDING DEP R i%poicant Fill
ICA inside Heavy i'les
ADDRESS
PE Q��Jg UPL SINES!:) C' SUBDIVISI NO.
(OR LEGAL LO LOT AREA —4'-' i
THIS pp'�PERTV
.111AILI, ADURCSS STREET R 1w 4P ,T. DEFICIENCY
NUMBER F-r- C)
LFPHONC COMF. PLAN q1W
T' z
REMARKS
W
NA'i� CHEPKEO By W
U
W z
NESS ST E AND/CR UTILITV WORK R/W PERMIT REQUIRED W
TELEPHONE NUMBER qEO-D' 0 YF_- YES
UCITY
UNDERGROUND
WIRING REQ*D. y o-, ONO
NAME
:,y�--.Y�VrRIFIED By
PC C.NNr
SANITARY SEWER N:S
0 rA..R'�1!5
F:�.-IC SY_�.EtA 0'.'
U ... C NUMBER
< AIN7V'C B'y CITY ENG.
r
r, M IT
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z IKS
0 LICENSE NUMBER
11751, NUMUFF,
U ST, Lice
-,—,,;:5z-7 01-111-
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Attach Four Copies
(S,,%O,A 3elow
L gal Description of propp,ty
ENV. REVIE AD 0.
z SIGN AREA
2 — — — ---------
A'-- �WED SED CORWLZ
W1
R�_AARKS
< DATE
VARIANCE C NWj r IFW By
— -----------
LOT C VERA r
YARDS I
ej, FRO
FIRE ZONE 7
OCCUPA 4T
N EJ GN AREA
ADD E] RETAINING SPECTOR LOAF3
DEMOLISH WALL REQ J3 No
C3 Y CS THIS SITE IS LOCAT D IN THE CITY
EXCAVATE I_ X_," PI -AN ECKED By OF EDMONDS. LOCAL SALES TAX
ALTER OR -LL 1Lee\\J1C5 s U D BE CODED 31.04.
PRE-MCIVE P-. -M.
REPAIR ..S.. OCR OF REMARI-S <:�r IC) N,�, 12.E-� G�
NUMBER OF S*rORICS n'-'CLILING
-tITS
N ZT—UpE_3P�6RKTC' f BE Do"r L631-
2—
VALUATION F E
PLAX CHECK
!"FR0FCSL0 U1. NO.
'Z. f
2q G'9 -A- 0
r_ SETBACK% UILOING
LOT IN d CA
ACIUTTING �4TRJ:.ZTS)
PLUMBING W
HEAT & GAS LINE >
FENCE z
s I GN
-T 0
RF.TAINING WALL U
SWIMNItN1 P30L
TOT AL AMOUNT DUE
u". t the in -
iI here:)Y 20cnOwledg, that 1 he oWner 01 d,ly aut%ol-
forniatirn !�'v�:n is �0,'Tec' =d that I t I I APPLICATION APPROVAL
he oNvn,r j'apee to z�"T'Plv -ity ;nd st3te 13NIS TegU' ATTENT;ON
-,,;),!zed Uierzby. no �e.non I permit
work au- This application is not a
ud*in doing tj.c
WM;Inagton THIS �'RM Icial Or
l3flon of the 1-2110. ccu� (.f tte Statz AuTHORIIIES and
""ii'be 'c Ca I io.pensoliol` Llsuz""L�e- until si&nt!d by the Building Off'
ONLY THE :-.:s T)cputv; and fees are paid,
C. - PTO-
OLI'rto'�S and FILL I is ' cknr�wlcdged in space
'lit G" '1'..CIT(Except . .. ,I in 9G WORK NOTED rec 1p a
;crr,lit, w), ch sh3libe cOMPIcc Onths.) V' a, GNA RE
Impleted i!L�_ix
IN SPECTION
1,qi)VED-INI BUILDING. I�Pll ba On, A
_I ____ RTME-T
i;ATj5F7
q OR
Cily OF
EDMONDS IDATE
to p!rn Check FL,? 775-2525
,VOTE: Afiolicant Subj"-,*
on private proporly ONLY. ORIGINAL Vila YELLOW Inspector
be do I GOLD - Assessor PINK O-;ier
T')i-4 Pormit ccvfnl"�Ori; to i rrIgIln �cI,b5, ide-al a, drivawaYs,
Any cc,r-,,,_ct;o.j , thn pulal c d to P37MISSiOn,
,T,,-qve,.rs, 0".) will re,4.4- WPM`o
RIP
It
V_
0 PLANNING DATA 0 !1 STREET=FILE I
Name: WOVOLM L- S-V19Wr-2V1
Date: C) -
,P, - -p-:� - -,�, 0 C)
SiteAddress: JJJQ0 c7Vwu vaJIN P-oac-4.
Plan Check #: BLD-200&::� 0
Project Description: 41)U (,0YV1Ph'0,V1Ce1 (10WRW f-tvov 5ar a 6 C
Reduced Site Plan Provided: (YES / le
[ Zoning: P-5 - G / PF-P, - 1.9-+,5
Map Page: --Tc.
orner Lot: (YES
Flag Lot: (YES
Critical Areas Determination #:
El Study Required A- — w iT/vi'OY oyx i Li
El Waiver
SEPA Determination: Ue"D-�
0 Exempt
El Needed (Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form).
Re Setbacks
Street:
Side:
Side.
Rear:
Actual Setbacks
Street:
Side:
Sid
Rear:
El Detached structures: a
El Rockeries:
El Fencesarenises: 0,10 �-,U
11 Bay Windows/Projecting Modulation:
El Stairs/Deck:
Parking Required:
Parking Provided: -1-2 PaAJtd)0V--
Lot Area:
Lot Coverage:
P/MA� ct or
Lot Coverage
Calculations:
Height -
Datum Point:
till:
Maximum Height:
cove"I.
ADU Created: E NO)
(Y
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES
Other
Jonm a ppk � C-aK UYI
10�� 2--FAQ0VtP (VVI"
Plan Review By: gf� ae�
174
40
00 V11- / / e
/Y
0;100
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 175-2525 for side sewer inspections BEFORE covering any portion of the construction.%
(Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspeettons.1
ADDRESS LOCATION OF CONSTRUCT10"
pWp=Ty LEGAL DESCRIPTION --------------
OW7,UX AND/Olt BUILDER ---------- --------
---- - ------ -- * - -- - ------ * ----------- * .............. * ........
ME & ADDRESS ---------- --------- 1-; ------- .. ................ ew
'I -77V
ew ........ I 19,W, for repair and/or connection. of & side sewer to the CHY 8&ldtary 5
on is gTmted . ....... 4-�--.
qpm4*m in scoordance ;;;iii'dt� of Edmonds ordinanCIO&
A'TTXNTION IS CALLICD To TlEEE FOLLOWING: pl yed 0 strOt
property may obtain IL permit to construct sewer inside property line. A licensed side Sewer Contractor Must be em 0 to 0 n
XorX No. I -The re it has been inspected.
side =9'.Coet area- Do not cover any portion of sewer befo -Of-WaY Permit obtainable from the city Engineer's office.
_of_wa,v requires an Invasion of Right
OW No, 2-All work performed in city right 11.16.030 and Regulations governing Side sewers when YOU get permit- grade of 2%. No bends in XrAft
10M No. 3.-Obt&ln full Information regarding ordinance
%I&= No. 4-Tbp of side sewer must have at least 30 inches coverage at property line said 12 inches inside property line; minimum ibl& for failure due to hDPrOW
sharper than % win be permitted. restored to original condition. COntractOrz shall be respons
o. $--Trenches In street must be water settled azid surface of street
work which may develop within One year of completion. or in the permit, or to do any work on the main sewer or its appurtenances except to W
NOTE NO. 6-It is unlawful to alter or do any other work than is provided f
—* th. .. into the wye.
DIS-421PROVMD 0 DgLte� --- ------------------------------------ By ---------------- AM
APPROVED ... /" �-r - - r� W ------------------ BY
Remarks: ----------------------------------------- - * ------ * ----------- *"* ........... *
By---------------- Dat45L ---------- - -- - -- - --------------- By ----------- ----
------------------
N BOTH permit Copies MUST Be Signed BY owner of Firm Performing Construction PR'OR '.ro rLequ=� w
J- ... .... herebY certifY that the side sewer installation constructed under this permit
.. . . .......... . 0— 74—�'i ----- iio
&��n; ru. n)
(owner of con;ract;W, 2&r
was installed in amordance with au governing ordinances of the CAY Of Edmonds- .................. .... 9 19 .........
Dated this ------- - ------ - ----------- day of-
-4 .4 Check BEFORE you tug for: Water [], Gas [], Telephone 0, Power 0' Sewer U' Li
APPLICATION
The City of Edmonds for EASEMENT NO . ............. ------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS Ej LID NO . ............... - ASMT. NO . ..................
OWNER ------ ----------- 11-4c - - ----------------------------- CONTRACTOR ---- C--t-A ..... C�,k ---
. ....... PERMIT NO. 2,a
JOB ADDRESS ------- Pl::�LEGAL DESCRIPTION: LOT NO . ......... . ................... BLOCK NO . ............. ......................
........................................................................................................................ .........................................
U)
NAME OF ADDITION ....... --* ................. - ------ ..... ............
Approved -
DATE........... .
Ot-City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASMT. NO . ..................
OWNER tl P .............. PERMIT NO'.
......................... I -------------------------------------------------------------- CONTRACTOR ---- b2f� " '1 !2
-0 ------------------------------------------------
JOB ADDRESS ....... ------ led .......... LEGAL DESCRIPTION: LOT NO . ...... 3 -- ? ------------------------ BLOCK NO - ------------------------------------
... .. .. ... .. ...... ......... ....... --- ---
S ?Q r i's t c ei
........................................... ......................................................................................................................
NAMEOF ADDITION .......................................................................................................................
Approved:
DATE............................................ By ............................................................
11/75
PG
Al, 611INGTON
Ju�'F7'CioUl
.....421 67H AVENUE NO.
;MM!DNDS!..WA MM
"ACC
��.ORV DWELLING UNIT COVENANT
ProperV'Ad.df . ess I 1 10 . 0 Shell Valley Road, Edmonds, Washinaton 98026
7—
Assessor's Pa*rcel-Number: 00649900003300
Legal Descri p tidn: SlibLC PARK DIV. NO. 2 (PRD) BLK 000 D-004,OT 33 TGW
1, the undersigned,*'R*av*e*,att�iingd"approvaI for an accessory dwelling unit (ADU) at the
property address aboy ' e*:*in ac�ord�-e_ with the provisions of Chapter 20 21 (Accessory
Dwelling Units) of Etimbridi'Gommitnity Development Code (BLD-7.00:+-010-f-)
I agree and understand that 'kt is:"'m*"y".Pes'poip'.ibil�t�*t�-notify all future property owners or long-term
lessors of the existence of tht-,Abt and-1hal-iis wp-s6ce is predicated upon the occupancy of
either the ADU or primary dwAnig.iil�i ' t-b� the-6wner of the property Additionally, I will notify
all prospective buyers of the lim . adtipti's on..use and maintenance of the ADU as stipulated in
Chapter 20 21 (Accessory Dwellin� Un ' ug) of the Edmorl&,Community Development Code An
example of the limitations of the A013"per Chapter ;0'11 is'die property owner is required to reside
in the pni-nary or accessory dwelling unit for 6 inofths qu.t of�every year
Finally. this covenant shall be recorded in.opr&r tq-&'tify.�:ll cu:rrent and future property owners
that if any conditions of the ADU approvalare Vl�la :'thep:roperty owner will be required to
=1
remove all improvements which were added-toco �rt tke'�rininry dwelling unit into an ADU and
restore the site to a single-family dwelling unk.
Propee
Propei
Date:
STATE
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that hl-4/1444kti
signed this instrument and acknowledge it to be his/her free and voFuri act.ficir th4 uses
and purposes mentioned in this instrument
ust be smudged Dated vL hA
Signature of
Notary Public
0
Residing at (E.
My Appointment
Expires
THIS DOC IENT MUST BE RECORDED WITH SNOHOMISH 6OUNTY AUDITQ'k.
97 1 PG
CITY CLERK JE6074 IBM 0
COY OF EDMONDS COUNT BVINGTON
121 15)TH AVENUE NO.
;MM!DNDS...WA NM
ACCESS RY DWELLING UNIT COVENANT
ProperV Ad.df . ess 11 , 10 0 Shell Valley Road, Edmonds, Washington 98026
-7-
Assessor's fe'rcel-Nymber: 00649900003300
Legal Descriotidn: Slib-LL! PARK DIV. NO. 2 (PRD) BLK 000 D-00-LOT 33 TGW
1, the undersigned,"Navie I -iimi'm9d"zipproval for an accessory dwelling unit (ADU) at the
property address abov * e':'in ad�oi6��e. with the provisions of Chapter 20 21 (Accessory
Dwelling Units) of Edmbpdg*.'PomT�nity'Development Code
I agree and understand that 4 is:"'m"'y':Pes'p*oi.is*'ibil�t)� (o'notify all future property owners or long-term
lessors of the existence of th&,Af3'6 and-fhaVis e4i-s6ce is predicated upon the occupancy of
either the ADU or primary dwehig.tiliiit-b� th,e-6wnerof the property Additionally, I will notify
all prospective buyers of the hmitd11pn,,,,,on,u9e and maintenance of the ADU as stipulated in
Chapter 20 21 (Accessory Dwellin� Un " us) of the Edmoadi%Community Development Code An
example of the limitations of the ADU"per Chapter ;011 is't:he property owner is required to reside
in the primary or accessory dwelling unit for 6 inothlis qu.t of�every year
Finally. this covenant shall be recorded mx�er 19-ftify.611 current and future property owners
that if any conditions of the ADU approva . hare Vjolated;`tliep�operty owner will be required to
N
remove all improvements which were addect-t ' o c&V�rt tke'�riniiry dwelling unit into an ADU and
restore the site to a single-family dwelling unit.
Property Owner Signature:
Print Name: I f. L J Atf tJ CL i !c 0
. ...........
Property Owner Signature: ..............
Print Name:
Date: C2
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that ;4
signed this instrument and acknowledge it to be his/her free and vofuii��ry, a c t, fo : r th� uses
and purposes mentioned in this instrument
ust be smudged Dated
Signature of
0
Notary Public
Residing at CQtAJ
My Appointment
Expires
THISDOC IE14T MUST BE RECORDED WITH SNOHOMISH 601UNTY AUDITQR.
OV FfjAf Q1, CITY OF EDMONDS
1P 1h
121 5 Avenue North Edmonds, WA 98020 RECEIVED
Phone: 425.771.0220 Fax: 425.771.0221 - Web: www.ci.edmonds.wa.us
DEVELOPMENT SERVICEs DEPARTMENT - PLANNfNG DivisioN JUN 18 200Z
EDMONDS CITY CMK
MEMORANDUM
To Linda Hynd, Deputy City Clerk
From Gina Coccia, Planner
Date June 18, 2007
Subject Statement on Accessory Dwelling Units
We have received a notarized "Statement on Accessory Dwelling Units" for the property located
at 21100 Shell Valley Road (File Number BLD-2007-0107).
If you could kindly take this up to the County to get recorded and provide me with a recorded
copy at your convenience, it would be greatly appreciated. We have charged the applicant $47
for this recording requirement ($32 for recording a legal sized document plus $15 for your
efforts).
Please let me know if you have any questions or run into any problems with the document.
Thank you for your time!
L:\TEMP\Gina\Templates\Memo-Clerk'sADU.doc Page I of I
PUBLIC WORKS DEPARIMENT ECKLIST
BUILDING, PERMIT
N
ST
VAUeY RX0
(address) . kdate)
CY
Street Right -of -Way Existing—
0 REQD
Z
Access Easements Existing,
QD
g4
Utility Easement Exist'
REQD
W
Lot Per Subdivision Plat
Assessor
W
Site Plan Checked for Accuracy
2JAI I
Z
Underground 14iring Reqd.
Check Accuracy of Legal Description
Z
Review by
Datend)1-7n
Existing Water Main Size
Water Main Required
Service Line Required �V44141
Hydrant Size Existing A,�A-
ce.
Hydrant Reqd Per Fire Code
Size
W
Detector Check Meter Reqd.
Cross Connection Inspection A-)0
E-4
Fire Department Comments
Water Itter Charge Reqd Cpf 2 92
Review by. 1"45-�-"
Date
Septic Tank Design Approved 1-)A
Date
Septic Tank PexrrrLt Reqd.
Permit No..
Sanitary Sewer Availabi
Proi - Pe,9-7-
Drawing N6.
File No.�
Side Sewer Availability 7V
Sanitary Sewer Connection Fee Reqd.
:3:
Review by.
Date 1;2 -9-??
W
Open Ditch Existing_,,k;k�-
�Reqd.
Culvert Reqd. d V-d"
Size
P4
Catch Basin Reqd. Adw-F
Indicate on Site Plan
0
Shoulder drainage maintain collection on swale open runoff
W
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review b gg���...�Date
Y-4
Revised: MO-1977
Page 2
Street Paving Reqd.
Curb and Gutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd. Al"
Right -of -Way Construction. Permit Reqd.
Bond Reqd. for Public Inprave-nents .4
Street Name Sign Reqd.
Other -Signing Reqd.
Pre Permit Site Inspection made an
z
0
BY: SEWER
WATER
P-4
V)
z STREET
H
ENGINEERING 6 �Ij
Special Requirements listed in nKm to Coummity Development Deparment,
Building Division
BY *14 Date
o All items filled in an Building Permit Application (
P4 BY 15FT!�J- Date
P4 Drawings Stanped and Notations Made
PL4 BY Date
4
Approved by Public 'Works Department
Revised: 1v 10-1977
CITY, copy
e;� ovr3f k1a I
-iv cu.*WC-;p offict
+or �t4orcvvl 9
(P ) I if
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ACCESSORY DWELLING UNIT COVENANT
Property Address: 21100 Shell Valley Road, Edmonds, Washin2ton 98026
Assessor's Parcel Number: 00649900003300
Legal Description: SHELL PARK DIV. NO. 2 (PRD) BLK 000 D-00-LOT 33-TGW
EO & UND INT INTR 102 SUBJ ESE PUD & GEN TEL
1, the undersigned, have attained approval for an accessory dwelling unit (ADU) at the
property address above, in accordance with the provisions ofChapter 20.21 (Accessory
Dwelling Units) of Edmonds Community Development Code,
I agree and understand that it is illy responsibil I ty to notifyall future property owners or long-term
lessors of the existence of the ADU and that its existence'Is predicated upon the occupancy of
either the ADU or primary dwelling unit by the owner ofthe property, Additionally, I will not I fy
all prospective buyers of the hi-nitations on use and maintenance of the ADU as stipulated in
Chapter 20.21 (Accessory Dwelling Units) of the Edmonds Community Development Code, An
example of the limitations ofthe ADU per Chapter 20.2 1 is the property owner is required to reside
in the primary or accessory dwelling unit for 6 months out of every year,
C,
Finally, this covenant shall be recorded in order to notify all current and future property owners
that if any conditions of the ADU approval are violated, the property owner will be req6ired to
remove all improvernents which were added to convert the primary dwelling unit into an ADU and
restore the site to a single-family dwelling unit,
Property Owner Signature:
Print Name: I L L 1 A0 L C L 14
Property Owner Signature:
Print Name:
Date: :21;- AA
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that LJA/",oA-t1 L. floo-lljt4
signed this instrument and acknowledge it to be his/her free and voluntary act for the use—s
and purposes mentioned Ill this instrument,
must be smudged, Dated:
Signature of
Notary Public:
Residing at: (� Z�C&h,�
My Appointment
Expires: LQ-
UST BE RECORDED WITH SNOHON4TqT4 r�r)tjkrry A I tnT'Tlrlk
1%.