21502 92ND AVE W.PDF1111111111 .11
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21502 92ND AVE W -
ADDRESS: 9a Vf
TAX ACCOUNT/PARCEL NUMBER: S-6) IF, 0 CDO c) 0 1 CDC)
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICALAREAS: Mog-/T;2- DETERMINATION: n Conditional Waiver 0 Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): (
PLANNING DATA CHECKLIST DATED: OUIC6
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORTPLATFILE: LOT: ID BLOCK: 'D -0C)
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LATEMP\DS'Ps\Fomis\Street File Checklist.doc
PLANNING DATA
NAME: DOLVIOL/ MI'll-eff DATE: D il I 1 (0 J.,Q 0 6'
SITEADDRESS: 7-1602. q-j_Vjd Al/le. W PLAN CHKff: DE5- 2>-+
PROJECT DESCRIPTION:- 0-f-Ck—
REDUCED SITE PLAN PROVIDED?: (Yes / No)
MAP PAGE:- I E5 CORNER LOT: 0 No) FLAG LOT: fft§le
ZONING: P-5 "9 CRITICAL AREAS DETERMINATION #:
U Study Required:
NWaiver
UConditional Waiver
SEPA DETERMINATION: 6.&t&nQt
LJ Fee
LJ Checklist
LlAPO list w/ notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
01 Exempt
SETBACKS: W 0 H41
Required Setbacks: WiCcpt- 60LA+h
-Vol 154 Spl- Street:�Eeft Side: .57, W910 Side: Res
Actual Setbacks: I W pG't S 0 U 141 NDrM Gtrr-e-l_
C-0 61, Street: (0 0 LeWSide: 63, RiT
_#ft Side:
Street map checked for additional setback required? (Yes No VENILrA
DETACHED STRUCTURES: N one, S Yl C)Vvvl
ROCKERIES: C-X j fj-t� V1 � " rb C�- Wa I 1 1( 6�1 0 W V1 bA F'P'e-' a +D Mt1tt S-C-f-JOAGil- S)
LJ FENCE S/TRELLISES: t4 0 Y1 C, GY1 0 WVI -
Ll BAY WINDOWS PROJECTING MODULATION: N 0 V1 C' �A'o W K
N STAIRS/ DECKS:
PARKING: Required: 2- Actual: - 7--t- 0 ID I 1(e a,'
LOT AREA: o, i ci aorC6 ( eno c,0 a�,_s_e_ssor ) ,v 6
LOT COVERAIE�_, I -
Calculations: t, X - C,0 VCYm 8e, IV ( 2.13 X 15;� ) ^V 14600 + PrOP06CCI Cie-c-
B"n nuir- 94PIr-UT ( -,is X -r )
Datum Point: Datum Elevation:
Maximum Allowed: —Actual Height: N D C Vi &Leo
A.D.U. CREATED?: �.Yes) U
Nzwo-7—
SUBDIVISION: MkAV)QCX..Ad4 ND + E�l V- 000 V-00 1-0+ 10
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: fftal&
OTHER:
Plan Review By:
% -2,15 7- *0
Ne%vBPP1ann1ng0ataFomi.D0C
APPLICATION
for
The City of Edmonds$,'.'.," SIDE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS E]
11 o-osono
OWNER............ Stan.l.e.y ... Warin.g ------------------------------------------------------------ CONTRACTOR ............................................. .................................................... PERMIT No . ......................
ADDRESS ........ �1.5.02 .... ... 9-2n.d ... A v.e ...... W., ............................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
.. ..... .. .. .... .. ----- -- - .-
0
0
0
NAMEOF ADDITION ..........................................................................................
Dyejested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
CA File No: OA 1 -7
Otritical Areas Checklisf
Site Information (soils/ to
pography/ hydrology/ vegetation)
1 Site Address/Location:
2. Property Tax Account Number:
acres or sqqarf 00;
3.1 Approximate Site Size,.( '70 k
evtYi
d' es; no.
4. Is this site currently develope ? -/,�y
If yes; how is site developed?.
5. Describe the general site topography. Check'aU that apply.
Flat: less than 5-feet elevatio . n c�ange over entire site.'
Rolling: slopes on site generally less than 1�% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more than 15% and les's than 30% a vertical ris e of 10-feet
over a horizontal distance of 33 t6 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): aa&s,-. c& 100 1,�l kAD11 WAI
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of sea * sonal standing water: Approx. Depth:
What season(s) of the year? ': ---------------------
8. Site is in the floodway IVO floodplain NO of a water 'course.
9.. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
A/0 Flows are seasonal? AA� (What, �!i&f year?---).
10. Site is primarily: forested ; meadow -1/t) shrubs -,tld ; mixed IVO
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site:
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Crifical Areas Checklist.doc/3.19.2001
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City' offdmoads
Development Services Department
Planning Division
Phone: 425 .771.0220
I soz Fax: 425.771.0221
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 the application to the City.
Ile 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).
bate-ke'b6ivecl: 6- 2-2 -02
City Reppip
4 ' M -�2� 2-
Critical Are'as File*: � 'C>Zq0Q — 0
Critical Areas Checklist'Fe,e- $4
Patq Mailed. to . Applicant:� �—-072
A property owner, or his/her- authorized representative,
must fill but the checklist, sign and date it, and submit it
't& the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
su�se4uent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of thislorm to assist City staff in finding and locating the
I 1. ;.,. 11 - 3:� P
specific,,piece of. �property described on this form. In
, addition,' the* ap�lic�nt 'shall include other pertinent
mf6imation" (e.g. ; site plan, .'topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
,-in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the. application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or pait upon false, misleading, inaccurate or
incomplete information ftimished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith subn-dtted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENil��, DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant,t
p tt4 application.
SIGNATURE OF OWNER
Owner/Applicant:
nA,.,,r) ,J Vle-de - Milker
Name
2"19, o �, ?� LYE t4,11
Street Address
,��Z0
OIJS
City State Zip
Telephone:
Email address (optional):
I DATE
AppHcant
Name
Street Address
city State - Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
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CITY OF EDMONDS
BUILDING DEPARTMENT
W 0 R K' FVe,,C -
ADDV SSKj��
OWNER —
APPROVED DAT%_!(
BLDG. OFFICIAL
PERMIT NUMBER
k
49
RECIERVED 0
AUG - 5 2003
PERMIT COUNTER
t
STREET FILE
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