21124 PIONEER WAY.PDF11111111111111
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21124 PIONEER
WAY
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TAX ACCOUNTIPARCEL NUMBER: -7J 7,3 00 000 / do
BUILDING PERMIT (NEW STRUCTURE): P% - 0 145
COVENANTS (RECORDED) FOR-
CRITICALAREAS:— ql-loq DETERMINATION: [] Conditionat Waiver E] Study Required Waiver
V
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMP\DS'Ps\Fomis\Street File Checklist.doc
"A xiifiAte' Site Size (acres or squar , e
ppro feet):
-,.,,Is this.site currentl y- d L�-jyes,*- no-..
�A, I eveloped R EGV�
-yes;'how is site- developed?!,-,k
5 'De b pogra
scri e the �eneial site to phy. Check all that Apply.
:PE
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
Me of 10-feet over a horizontal distance of 33 to 66-fe6t�"
Steep: grades of greater t han 30% present on site (a vertical rise of 10-feet o*v er
a horizontal distance of less than 33-feet).
Other. (please describe):
6. Site contains-,areas.of year-round standing water: Approx. Depih:
—7., — Site cbntains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodwaY_t2_/_'q floodplain of a water course.
9. Site contains a cree
,� or an area where water flows across the grounds surface? Flows are
year-round? P? / /0 Flows are seasonal? — (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) *----
11. Obvious wetland is present on site: ft
1. Site is Zoned?
2.. SCS mapp, e d s o il . ty . p . e(s)�
Wetland inventory or C.A, m4p indicates wetland present on site?
4. Critical Areas in v*entory or C.A. -map indicates Critical Area on site?
5. Site wid-tin designa-Ped earth subsidence landslide hazard area?
en
6. Site designated on the Environm 't'ahy'Sensitiv . e Areas M . ap?.*
1.6
AcaLchLdov Rev 02/11/97
lth6
W�-�'-� be by any?,, person!'. pt�parin Wth";hebklist;�,,z�ii " d'daite'dit. it �t6
gnJan
R"
Deve'1'0� Pe dit �;K Cit 6-T e Cit W
Of a &Mopment predursoiY site'visit, and make a determinati
f y y
,Edmonds prior, to- his/her submitfal- 1. miike
on of the.'.'
thi siabse ue t steps nece§sary t6'coiplete a d6vel
permit to e City..
opment
f- 4 -,�,,permit appli
cation.:
'Me "purpose of the Checklist is" t6ehable City'staff to- Please submit' a, vicini
ty map along with the signed
an' Critical Areas are I
determine -whether ' y`p6teniial or,'. -copy ofthis form to assist City staff in finding and
may',., present..on the.'subj eict property- locating the specific piece of property described on
informatiod* needed tci-complete',th6.Checklist:should - -this'- form.", -In'addition, the, applicanvshall include
be easily available from observations of the site -o:r`:'.'-other'pertifient information (e.g., site plan, topography
data available at City Hall (Critical Areas inventories, map, etc.) or studies in conjunction with this Checklist
maps, or soil surveys)..__,__ -to assist staff 'in completing their preliminary
-.,J,",.,assessment of the site
I have completed the attached Critical Areas -Checklist -and attest that th6'answeriprovided are ffictual, to the
best of my knowledge (fill out the appropriate column.below).
Owner/Applicant:
Name
Street Address
city State
Telephone
Signature
Zip
Applicant'D presentative:
N�e
Street Address
W,4
City State Zip
Telephone
Sigdature
9fZ
Date "V
Dat�'�%' 3, 1
(over)
cmveption�anakaddoc
4
4C's t 18 9 Q
Date:
To:
Subject:
Transmitting
CITY OF, EDMONDS BARBARA FAHEY
MAYOR
250 5TH AVENUE NORTH - EDMONDS, WA 98020 (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works e P16nnihd and Recreation * Engineering
Letter of Transmittal
June 20, 1997
John W. Mellor
Critical Areas Checklist
Copy of the completed Critical Areas Checklist
For Your Information: XX
As you requested:
For your file:* XX
Comment: This completed Critical Areas Checklist is a
site specific determination, not a project
specific determination. You must bring in a
copy of the completed critical areas checklist
with any permit application, or your
application will be rejected. Permit
applications include Building permits,
Conditional ' Use Permits, Subdivisions,
Variances, Applications to the ADB land
use applications, or any other
development permit applications.
Note attachments:
Sincerely,
Diane M. Cunningham, Planning Secretary
* Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
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CD
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CITY of EDORDS ftmLn E
For Inspection Call 771-:3202 STREET FT
Address of Construction:
Property Legal Description (Include all easements): /0
,1F.5 PA , J
S E W E R
PERMIT NO.
P E R-11-1 T
EDMONDS
TREATMENT PLANT
Owner and/or Builder:
0 Al 13
Contractor & License No: 13 o 4 k1 1 r, R 1 3 46
Singl:e Family Residence I—'
Mul ti - Fami ly (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No I-' Yes .(If Yes., Right -of -Way
Construction Permit required. Call One -Call -Center (1-8'00-424-5555) before any
excavation.)
Cross other Private Property: No Yes (if Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
0?
I certify that I have read and shal * I comply
with the items listed on the back.
Permit Fee:
Trunk Charge:
Assessment -Fee:
Issued*By:
Date Issued:
Receipt No.:
F. /'9
Date
Partial Inspection:
Comments Fate Initial
Final Inspection Approved: 9 -A--& "Akl
- —Ta —te --Initial
Rejected:
ason
PERMIT MUST BE POSTED ON JOB SITE
White Copy 7 File Green Copy - Inspector
_5 —i
Date tial
Buff Copy - Applicant
Side Sewer Drawing
The City of Edmonds
EASEMENT No - ------- -------- --------------
NEW CONSTRUCTION Up REPAIRS 0 LID NO. Irn-1 -------- - ASMT. No - ------------------
OWNER Cat4-s-r ---------------------------- ----------------- CONTRACTOR .-Bozs ------ AA&"-t,4 -------------------------------- ..— PERMIT NO.
JOB ADDRESS ------ f )A jO - WAY ------------ LEGAL DESCRIPTION: LOT NO. --A ------------ ------------------ BLOCK NO— E-�D IM� 0 N =IDS
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-lTRtkTM-ffN, --- T --- �0-' �-E- AA N T
................. ---------------------------------------------- --------------------------------------------- ----------- ------- ------ I ---------------
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4"c�* -wtic
74'
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P1 0 t4 E F-R W kY 36LS
IM01401fteJ4'r
PWW-0001-1 1/75 (REVA 1/78)
NAME OF ADDITION Q-!5 S
21124 Pltc,4es-m woi,
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4.5113P
4"c-o.wve
c� *e4ep �
Approved:
% --------- By .............
-�V -
.-#- 7/5
USE PERMIT
CITY OF EDMZrNDS ZONE Nab- 0145
CONSTRUCTION PERMIT APPLICATION
joB
NALIE (OR NAME OF BUSINESS) AIJIJKtbZ) 011,Z q t�,),4 V
LEGAL DESCRIPTION CHECKJ SUBDIVISION NO. L ID-N-0-7-
fi rde 4 DcLu�� 0 e L
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MAILI ADDRESS I Aa
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CITY, TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
3 P4� -7 EXISTING �ep REQUIRED DEDICATION !!:I
5e-0-72'lc I
PROPOSED
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
LLJ
(8
ADDRESS STREET USE PERMIT REQUIRED 0 /t
W
Z
SEE ENGINEERING MEMO DATED
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51
CITY TELEPHONE NUMBER 16
NAME REMARKS
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ADDRESS
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�L A), METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
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CITY -TELEPHONE NUMBER
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REMARKS
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STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADS NO.
Dr, L ALLOWED PROPOSED COMPLETE EXEMPT
Legal Descr ption of Property - Include all easements
(show i fou r copies) SHORELINE#
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5:
VARIANCE OR CU PLANNING REVIEW BY DATE
412
^107' 1167C loae/a� -��s7f 7110- C
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YARD HEIGHT, LOT COVERAGE
,4, 4, rx�9^1
A FRO;WT 71 E� /R4A R
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REMARKS
(L
I,nq NEW RESIDENTIAL PLUMBING
ADDIALTER COMMERCIAL M MECHANICAL
REPAIR RETAINING WALL M SIGN
ICODE
EXCAVATE FENCE CHECKED BY TYPE OF CONSTRU HEIGHT
0 R F-1
DEMOLISH OR FILL x -F7) /Y",CTIIN
PRE*MOVE INSPJ swim SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
E] REMODEL COMPLIANCE INSP. El POOL REQUIRED GROUP R,,.3 LOAD
I
WOOD STOVE/ 0 YES I
INSERT APT.BLDG RENEWAL REMARKS
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U)
NUMBER OF STORIES NUMBEROF
ED
DWtLLINU
C3
0
Y-7-e
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VALUATION FEE
r-C 'CAxit "P.
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
mit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend andr hold
21
harmless the City of Edmonds,' Washington, Its officials,
.j
2
employees, and agents from any and all claims for damages of
a:
<
whatever nature, arising directly or Indirectly from the Issuance
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of this permit. Issuance of. this permit shall not be deemed to PLAN CHECK DEPOSIT
modify,. waive or reduce any requirement of any city ordinance
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x
nor limit In any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
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
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authorlz- AUTHORIZES This application Is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ti n Insurance.- INSPECTION acknowledged In space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE DATE
EDMONDS
771-3202 RELEASED BY: DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK - Owner GOLD - Assessor
102-78
V40 TO: Building Division
_M',
Planning Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After rev i e,..i -.of -the, subject' Building Permit application, vie have the following
comments
-Connection to City water system required.
2. Connection to City sanitary sewer system reqiiired.
3. Right-of.�way permit required for any work on City property.
4. Driveway slope'not to exceed 1410
5. Backwater valve required if downstairs plumbing is below elevation 01
upstream manhole.
6. Water and sewer 1 ines to be separated by 10 foot minimum.
M.........................
MUNW2111""
GO.,6/82
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PFOJECr REVIEV CHECMST
Pr417ECT miel-Aw PM7ECT ADDRESS: 2112q9bWe'fL 14,ky,
CN RECEIPT DATEt
Reviewed by: (initial/date)
C)OMMENTS
PLANNING
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3ETBACKS.CHMM - Planning
VARIANCE/SETRACK ADJ.
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IMMUMENTAL FEMURES
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&,-VEHICLE ACCESS
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iMD REQD FOR PUBLIC IMPRDVh
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-MIS 00MITICtqS &- GT40UND
IATER FIETD CHECKED
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3TREE'r PAVTNG REQUIRED
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EXISTING WATER KAIN SIZE:
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WATER'METER SIZE
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SERVICE LINE SIZE
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HYDRAM"SIZE EXISTING
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