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21409 86TH AVE W
ADDRESS: _12_1i�) 7-4 ?9V
TAX ACCOUNT/PARCEL #: LVC) -3-75 0 X 406'5-a�2
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS.#: DETERMINATION: []Conditional Waiver E]StudyRequired VWaiver—
CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER —list permit #'s): Ttty_ J_om-00,fl
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
,WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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"Noth this Pamit OPPMV81 PfOOM
=Wu all6wing -or permi�tTg the
ee of any currently excisting illegal,
b Ming, structure
nonconforming or unpermi U I L
or site coudition which is outside &i.e scope of the
permit application, regardlest of whether
building, structure or condio=-is-showff —6 the
site lan or wirig:.-Su -_ building, structure or ING
I '_dm U j B*Y 51
iti n ay be the su
con su ect of a separate
edo e t action."
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Zone-, C �9-
Setbacks Reguired Actual
Front(W 3 ?!�2 RESUB
Sides sEP_ 28- . 2012--
Other BURMING DEPARWENT
Re:ight CjTy or. F I t)MONDS
F
PLANNING DATA STREET FILE
SINGLE FAMILY RESIDENTIAL
Name: Ed 4 MtA
Date: 9 /2a/ A:) -
Site Address: ;(�qoq gC
04� Ave,
Tax Parcel:
Project Description: Ale4z) afecJK OrN ccxus�-
04� \no"e.'r_
Plan Check #: 2.LV),0\;L080\
Reduced Site Plan Provided: (fD/ NO)
Zoning, 5Z
Map Page:.,,�
Corner Lot: (YES /do
Flag Lot: (YES 16D
Critical Areas Determination #: C�9,A=%aW7Z
El Study Required
Waiver
SEPA Determination: Eke"'P�::
13 Exempt
El Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist El APO List with notarized form
Required Setbacks
Street:
Side:
Side:
Rear:
Actual Setbacks
Street:
Side ag
Side ;)-0
Rear:
El Detach�d Structures:
El Rockeries: No-Ne- %klocon OiN
El Fences/Trellises:
0 Bay Windows/Pr'ojecting Modulation:
5d Stairs/Deck: Propeaed dexkmdiox3nd an -.�,4 .3'
Height
Datum Point:
WA
Datum Elevation:
1A
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided:
Lot Area:
Maximum Lot Coverage: 35% Proposed: a,
Lot Coverage Calculati . ons. No C-\-'Awn�*A (&.�L C-014 ka-021-� vk Lknc�co-ad
—J et.3f
ADU Created: (YES
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES A-0)
11 .... .... I -
Comments
Plan Review By: Planning Data Form 07-14-09