21223 96TH AVE W.PDFiiiiiiiiiiii
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21223 96TH AVE W
ADDRESS: r9-2 3
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE): IR 51-1 - 67C;2,/
COVENANTS (RECORDED) FOR:
CRITICAL AREAS 0/d— DETERMINATION: Ej Conditional Waiver E] Study Required
I -
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
620n�f Q39#
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
1/m
LID
SHORT PLAT FILEAM60 G&Ub�0 LOT:- BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
LATEMP\DSTs\Forms\Street File Checklist.doc
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ing or unnor—w—,
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proper* lines.
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BUILDING DEPARTMENT
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/DDRESS
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PERMIT NPP
STREET FIL
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STREET
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FILI? PLANNING DATA STREET
SINGLE FAMILY RESIDENTIAL
Name:
Date: q Z�;ZcxLcje�
Site Address:
)AN6en"e, \,\Ie
Plan Check #: oG �c
04/
Project Description: Taje� 4�M�e�
Q
Reduced Site Plan Provided: NO)
Zoning:
Map Page: 1,51-1
Corner Lot: (YES
Flag Lot: (YES
Critical Areas Determination #: 1929/ - 20-4
0 Study Required
9 Waiver
SEPA Determination:
Exempt
Needed (for 500 cubic yards of grading or site within 200 feet of Puget Sound or Lake Ballinger) A//A
0 Fee 0 Checklist 0 APO List with notarized form
Required Setbacks
Street: (,7644 Ave W)
Side:
Side:
Rear:
161
ActualSetbacks -*-rc,
Street: 96
Side:
Side:
Rear: 16"4-
1:1 Detached Structures:
0 Rockeries:
Fences/Trellises: Ato ia�vb� ko ex I lien
Bay Windows/Projecting Modulation:
0 Stairs/Deck:
Height
Datum Point: N
Datum Elevation:
Maximum Height Allowed: 16 Actual Height: q
Other
Parking Required:
Parking Provided:
e:��\
Lot Area: A/0 C-�
Maximum Lot Coverage: 'ArO/. \1J Prnnosed:
Lot Coverage Calculations: 0 e_
ADU Created: (YES /0 Q
Subdivision: MIAn4e4_ A6V A10, '5, L_4 y
Legal Nonconforming Land Use Determination Issued: (YES 10
Comments
Planning Data Form 2-7-06.doc
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PLANNING DATA
NAME:
SITE ADDRESS: Z 3 Avc 6J. DATE:
ZONING: PLAN CHK#- 2-2-1
PROJECT DESCRIPTION: 7' 1, A�L 2
CORNER LOT IT- —(Yes/No) FLAG LOT —(Yes/No)
9 5- P, 4�4
SETBACKS:
Required Setbacks:
Front: Z5' Left Side:-75' Right Side: -75' Rear: 15,
Actual Setbacks: r. Aw-W.,
Front: -40, Left Side: —""5Z-' Right Side: 7 5' Rear: �92-
Street map checked for additional setback required? Yet A-4r e-&44Yes/No)
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LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED__,4j (Y/N)
LOT COVERAGE:
Maximum Allo wed:
_.Actual: 14,05e
BUILDING HEIGHT:
Maximum Allowed: 2-5-, ___Actual Height: /.f , 5-'
Datum Point: 2%--A.Datum Elevation:
A.D.U. CREATED?: k6
SUBDIVISION:
CRITICAL AREAS#:, 94' 2'0-)
SEPA DETERMINATION: "y-
LOT AREA: 13, Z,5-S
OTHER:
Plan Review By:
OffleApenniPplandaLdoc
PLANNIMr. nATA
NAME:
SITE ADDRESS: DATE:
ZONING: Vl(� --PLAN CHK#:
PROJECT DESCRIPTION:
CORNERLOT FLAG LOT
-(Yes/No)
SETBACKS:
Requked Setbacks:
Frontc. Left Side-
._Z?,r'LRIght Side:
AcfuaL3ejbqck,%-
Front:
Street map c _9�/1-LI-eft SIde:2yjLRIght SIde:_LLLRear:. 66 r
hecked for additional setback required?
(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED �(Y/N)
LOT COVERAGE:
Maximum AIIowed:_a20_&_ne) Actual: 1d7 /GV,9,)
BUILDING HEIGHT:
Maximum Allowed., ......... Actual Height:
Datum Point: ---------------
Datum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
- &A"
CRITICAL AREAS
SEPA DETERMINATION:
OT AREA: /15. 1'�mR Z, -
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OWNERICONTRACTOR IS RESPONS%f- FbFl
EROSION CONTROL AND DRAW*
IN-SPFOITION REQUIRED
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APR 10 2000
DEVELOPMEW SERVICES CTR.
CITY OF EDMONDS ea
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ST KET FILE Critical Areas Checklist
Site Information (soils/topography/hydrologylvegetation)
1. Site Address/Location: . A1,22 -3 7 6 /-//- 4 W - - (41- VX,
2. Property Tax Account Number: 57;2-,Y/ - 04 C) - 400 f4 - 0 C)
3. Approximate Site Size (acres or square feet): 2 1
4. Is this site currently developed? __��jes; — DO. RECEIVED
If yes; how is site developed? -, e,,> 4 OCT 3 1 1994
5. Describe the general site topography. Check all that apply. PERMIT COUNTER
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 than 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 wate r: /VL) Approx. Depth:
7. Site contains areas of seasonal standing water: IV,5 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IV-) floodplam of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 4/0 Flows are seasonal? Ali (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wedand is present on site:
Rev 0."193
0
*90 -'19
GtY 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 Edmonds prior
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 ftom
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
must fiH out the checklist, sign and date it,
RECEIVED
OCT3 1 1994
PERMIT COUNTER
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determiriation 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 parcei(s). in
addition, the applicant shall 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 the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below). '
Owner / Applicant:
Name
Street Address
�7 7 --e -'7
C'
e,)4YL9,,W -f'-LW4 YffoR, J
City, State, ZIP Phone
Signature� Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
:DATE RECEIVED
CITY OF EDMONDS,
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ro /V', I 1- 0 j
MAILING ADDRESS
71
/ ,,,I
CITY ZIP TELEPHONE
vo
16-23'1 112
NAME
ADDRESS
CITY ZIP TELEPHONE.
NAME
ADDRESS
PERMIT EXPIRES
USE PERMIT
ZONE
(s-%
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
6
LOT NO:
LID NO.
LID FEE$
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
inspection Required
Side.alk Required
REQUIRED DEDICATION— FT
j Underground
I wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
�Z
YES 13 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR,EROSION CONTROUDRAINAGE
A-
5S
ENGINEERING REVIEWE7D DATE
FIRE REVIEWED BY DATE
I CITY ZIP TELEPHONE
z
0
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY VARIANCE OR CU SHORELINE OR ADBi--t INSPECTION BOND
REO'D IPOSTED
PROPERTYTAX ACCOUNT PARCEL NO. SEPA REVIEW SIGN AREA HEIGHT
I COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED . PROPOSED
0
uj A
NEW
RESIDENTIAL
.... . . ....
MBINj;) MECH
10 QPLU�
ADDITION
C:] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
APARTMENT
SIGN
REPAIR
GRADING . CYDS
FENCE X
( FT)
DEMOLISH
F-1 TANK
0 OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
RENEWAL
P: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0. r_1
L 2 j / /v' G
—
,Z�
NUMBER
NUMBE�OF'
CRITICAL I Qj
to OF
DWELLING
AREAS
o STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Z/-
z)z) 0 U/
a
z
Ct
LLJ
z
z
Lu
LAU
5
LL
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED P SED
APPO
FRONT �IDE REAR
FRONT UP SIDE REAR
I
9
I
".
3
1451"
72,
All
z
z
PARKING
REO'D I PROVIDED
LOT AREA 4.PIAN
R5 �ED
BY /�E
*
I
CHECKEDBY I TYPE OF CONSTRUCTION CQfj.� OCCUPANT
GROUP
SPECIAL INSPECTOR JAREA', OCCUPANT
REQUIRED [:) YES ,,,/ LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D1 E
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
1 4k
BUILDING
/ 'L .3�
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
-GRAQIW Q�F
D DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
cc PERMIT APPLICATION: 180 DAYS
Lu
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
_3
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS TH CITY OF
_j E
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
Ir
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
RECEIPT
t
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
R CEIP
TOTAL AMOUNT DUE
. .....
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT,AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIAL IG N R E PATE
SIGNATURE (OWNER OR AGENT) DATE SIGNED
(425)
v
771-0220
.,RE ASED BY DAfE
9
ATTENTION
EXT 333
-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
L - 0 kx
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
I
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAY
4 ORIGINAL -FILE YELLOW-INSPEC TOR[
PINK - OWNER GOLD - ASSESSOR
5/98