21306 84TH AVE W.PDF111111111111
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21306 84TH AVE W
CriticaIAMEUALE
Site Information
Project Name: r-p-ckc e- Permit Number
SiteLocation: Zk'306 Vil-5 A"- W- Property Tax Account'Number et,(:r4-0cx-->-0o'7-o(
Approximate Site Size (acres or square feet): q T
Have you filled out a Critical Areas Checklist for a project on this site before? No
General Site Conditions It
1. Has the site been cleared or logged? Date of most recent action: _Um c-,
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? Akle— 6..C, 1 -,- k
-or"ru-f- I ;L 4�, I?
3. Describe the general site topography. Check all that apply.
>'— —Flat: less than 5 feet elevation dmge 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 of horizontal distance.)
Steep: grades of greater thari 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water tko
5. Site contains areas of seasonal standing water. K o —Approx. Depth: t4 JA
6. Site is in the floodway tA, floodplain NO of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? _qc> flows
are year-round? _L�. Flows are seasonal? tc.
8. Site is primarily: forested meadow ;shrubs _ ;rnixed o #-6--
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site: Rc,
11. Critical Areas inventory or map indicates any Critical Area on site: N10
For: City -Use- Only'
"STUDY REQUIRED:` Critic�l 'areas studi't' uired.-'.---:
is re
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as:stu
-CONDITIONAL WAIVER:- Critical are" ... dy.
----------
WAIVER: Critical study is hot reuire-cl.'
A/ areas a
.Determ* l6ation Ruri-iber. CA -:,P 1 -2-0 Revieweroo'
Planner Date
Rey* 3/27192
a 4
or 90-19"
City of Edmonds
Critical Areas Checklist
The Critical Arm Cled.1dist 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 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, and
submit it to the City. 17he 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
of the parcel with enough detail that City
staff can find and identify the sdi)ject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
!-A 1-. -S;-
Name
Title
Qk106
Street Address
. E-Arm,,,, 4 S ' (-'�->C- ? TO;L6
City, State, ZIP Phone
(C>
Date
Applicant Representative:
Narne
Title
Street Address
City, State, ZIP Phone
Signature
Date
0 CITY OF EDMONDS
CONSTRUCTION PERMIT APPLI
OWNER NAME/NAME OF BUSINESS
Cc- F 9- ,,, — -- I � I — __ — _
UJI MAILING ADDRESS.
Z
0
P////,
ADDRESS
Q 7 2 PIA, Z-7 77
CITY ZIP I TELEPHONE NUMBER
NAME
ADDRESS
CITY ZIP TELEPHONE NUMBER
V50r7er 961;>:;,
STATE LICENSE NUMBER j
Legal Description of Property - include all easements
(show below or attach two copies)
Tax Account Parcel No.
NEW
RESIDENTIAL
PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
EIREPAIR
APT. BLDG.
SIGN
DEMOLISH
REMODEL
EXCAVATE, FILL
OR GRADE
CARPORT
GARAGE
FENCE
I— x _FT)
swim
POOL
WOOD STOVE/ r7 RETAINING WALL/
INSERT " ROCKERY
RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
PERMIT
NUMBER
[�Vv 0 6�_ — ' —_ — SUITE/APT u
ADDRESS 243_)_0 F�q rm A)e WZ��7-
.EGAL DESCRIPTION CHECKI SUBDIVISION NO. LID NO.
Z07- -2, 5-17-el �
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, TESCP
APPROVED BY
EXISTING —_ REQUIRED DEDICATION
PROPOSED r
cc
RIGHT OF WAY CONSTRUCTION PERMIT REQUIREDK
STREET USE PERMIT REQUIRED 11
Z
C
SEE ENGINEERING MEMO DATED REVIEW BY Z
REMARKS 10
IF
METER 51ZE il/ ISUILDINpj?UPPLY SIZE IFIXTURE UIN—ITS
cc
Uj
7 .M
11V
6 SIGN AREA ENV. REVIEW ADS NO.
ALL WED I PROPOSED I COMPLETE I EXEMPT
01
VARIANCE OR CU IPLANNING REVIEW BY _TDATE
0
SETBACKS — FEET HEIGHILOT COVERAGE Z
Z
FRONT SIDE REAR Z
REMARKS
CHECKED BY
TYPE OF CONSTRUCTION
CODE —
HEIGHT
W-M I
'Z_A/
1 86
2.5-/
SPECIAL INSPECTOR
AREA
OCCUPANCY
-_
OCCUPANT
REQUIRED
GROUP
R3__
LOAD
C1 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305 Z
_j
7H1-9M,4L1WtSuL, AM -/9fb W4 f n, r4 e v Z �el 0
FINAL INSPECTION REQUIRED
- - VALUATION FEE
PLAN CHECK FEE
BUILDING
6r, 61) I/V cyas
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on.the public domain (curbs, sidewelks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit 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
u)
successors in interest, agrees to indemnify, defend and hold
2
harmless the City of Edmonds, Washington, its officials,
M
cc
employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0
modify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
x
nor limit in any way the City's ability to enforce any ordinance
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
SIGNATURE (OWNER OR AGENT) DATES1GNED
I NSPECTION
DEPARTMENT
1-3/2
Z/V/�
CITY OF
EDMONDS
ATTEfiTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10?1.9-1
—ZDO I 1,10-m
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL's SIGNATURE DATE
RELEASED BY -
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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Ob
90.00
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TO: Permit Coordinator, Building Division
FROM.: Dan Smith, Engineering Inspector
—2130(o
ADDRESS—,;�2-0 OlAate-4v
OWNER
PLAN CHECK #
After review of the subject building permit application, we have the
following comments:
1. Construction hours are: WEEKDAYS ........... 7:00 a.m. to 10:00 p.m.
WEEKENDS/HOL,IDAYS..10:00 a.m. to 6:00 p.m.
2. A Right -of -Way Construction Permit is required for any work on
City property.
3. Connection to City water system required. Fees paid.
4. . Connection to City sanitary s'e wer system required; obta.in separate
permit. Fees paid.
5. Water and sewer lines to be separated by 10 foot minimum.
6. Driveway must be paved a -minimum of 20 feet back from City
right-of-way; separate permit required.
7. Driveway slope not to exceed 14%.
8. Back water valve required if downstairs plumbing is.below
elevation of upstream manhole.
9. Builder/Owner responsible for containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way.
10. No burning -of construction refuse without approval from Fire Dept.
11. Street to be kept clean of debris, dirt, mud, and construction
materials. Contractor responsible for dust control.
12. Inspection required on drainage system, catch basin installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building division granting occupancy.
13. Repair or replace all defective existing curb, gutter, and
sidewalk. if intersection is involved, installation�of wheelchair'
access may be required.
BLGPER/TXTFORMS
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CITY OF ED
18 9 0 1 9
-Address of Construction: 9
Property Legal Description (Include all easements):
SIDE SEWER P E R RIT
e
PERMIT �12 8 213
EDMONDS
Owner and/or Contractor: I-eIPPY
z
State License No. . ee
Building Permit No.
V'Single Family
0 Multi -Family (No. of Units-)
El Commercial
El Public
Invasion into City Right-of-Way:il El Yes
RW Construction Permit No.
Cross other Private Property Ja,'�No 11 Yes
Attach legal description and copy of recorded easement
1,,6ertify tha!)�_ve read and shall comply with all city requirements
as indicateTon the back of the Permit Card.
1,94
DTte
CALL DIAL -A -DIG- (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE USE ONLY
FOR INSPECTION CALL 771-3202, PUBLIC WORKS DEPT.
PermitFee:_ :50 - &(D Issued By
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.: -
Partial Inspection: Date I nitial
Comments
Reason Rejected: Date -Initial
RECEIVE[
Final Inspection Approved: DateIW46 Initiat:!4-
AUU V 0 P'%- I
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
NOTICE:
a
--ac-cur
N'o warra
The information'shown on the attached
I of
map(s) was compiJed for use by the Gty
Edmonds, its Employees and Consultants.
Th,e City of �Edm.onds does not - warrant the
accuracy of anything set forth on t hese
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
ation shown on
inquiry regarding the inform
ited to
tHe -map(s), including, but not lim'
th'e lociation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location sh * own.
I s nor its
Neither the City of Edmonds
ernp'fo-yee-s o-r office-rs -sh-a-11.1 be Via.b.-IFe for the
information given on this map(s), nor for
any one representation Provided based
upon . said map(s).
pniw, ei(I iawaB eb!B
absomb3 io yliD GdT
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CITY OF EDMONDS STREET FILE ASSET INFORMATION SHEET
NEW
ADDITION
RETIREMENT
ASSET NO
ADDITION TO ASSET NO.
DESCRIPTION
skev*"re, U,4�1 21
SERIAL NO.
LOCATION :9 44
Av--P,-, 0.
DEPT. NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER (A) (2fT-q �Z
PROJECT COMPLETION DATE
COST '40 t 00
B.A.R.S. ACCOUNT NO. 411 , WO. 10 J4 - 3qS-, Oo, 6.3
10 ESTIMATED LIFE 2- v Y-S
I
INITIATED BY
DATE
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
xDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
ttnp INITIAL
DATE
A:�
VERIFIED BY
PROCESSED
BATCH NO
DEPARTMENT FILE
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