21503 90TH AVE W.PDF1111111.111111
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21503 90TH AVE W
ECEIVED
PERMIT EXPIRES
CF
I USE
ZONE PERMIT
CITTOF EDMONDS
CONSTRUCTION PERMIT APPLICATION J B SUITE/APT#
ADDRESS
OWNER NAME/NAME OF B SINESS 404 `9C6A,
PLAT NAME/SUBDIMSION NO. LOT NO. L�D NO.
M MAILING ADDRESS L D FEE $
W
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
RW Permit Required 0
Street Use Permit Req'd 0
0
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspect on Required 0
SIdowa:k Required 0
REQUIRED DEDICATION FT Underground
V A6
T' t Wiring required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRVREQUIRED
YES 0 NO 0
W
ADDRESS REMARKS z
z
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
cc z
W
CITY ZIP
TELEPHONE 1,a,
NAMA
A_j
m ADDRESS
4 1
t� 11� (aZ
M
"- CITY ZIP
z
TELEPHONE
0
77- 1)
lyll�o
STATE LICENSE NUMBER
EXPIRATION DATE
Cl�qCKED BY
A� e) /0
PROPERTY TAX ACCOUNT PARCEL NO.
0
W oo
NEW RESIDENTIAL
PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
0 REMODEL C] AP ARTMENT
E] SIGN
GRADING FENCE
REPAIR CYDS X FT)
DEMOLISH TANK
OTHER
ARAGE 0 RMERING WALL RENEWAL
'bd
Z CARPORT R Y
r- (TYPE OF USE�.BUSINESS OR ACTIVITY) �EXPLAIN:;
U
�i NUM13ER
OF
NUMBEROF
DWELLING
t�
CRITICAL
AREAS
o STORIES--./
UNITS
NUMBER,
DEqCRIBE WORK TO BE DONE
L? r) 6"t
ENGINEERING
FIRE REVIEWED BY DATE W
5
LAL
MRIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO-9
POSTED
I
0 YES _�e
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWE PROPOSED
— -
-4-
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROF�OSED
FRONT SIDE REAR
FRONT L/R SIPE REAR
psz
z
PARKING
AREA
PLANNING REVIEWED BY UtFr
REO'D I P� VIDED
/LOT
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'��IIV
1, 1.9
CHECKEDBY ITYPE FT$TRUC.ION CgDp--%,- OCCUPANT
GROUP
SPECIAL INSPECTOR
JA,REA OCCUPANT
REQUIRED YES "q
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
FEE
PLAN CHECK FEE
2
HEAT SOURPIE
/1//,V
GLAZING %
LOT SLOPE %
( f::� e., A,r)
BUILDING
s
PLAN ItHECK NO-
0/_
VESTED DATE
PLUMBING
61/7
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRADING/FILL
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
ENG.* REVIEW FEES
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITYIPF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM
-LANDSCAPING I
ANY AND
INSPEOTION-FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
PLAN CHECK DEPOSIT
RECEIPT
z'
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTOMODIFY, WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
TOTAL AMOUNT DUE
RECEIPTI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILLBE EMPLOYED
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE CABOR CODE, OF THE STATE OF WASHINGTON �. RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OqPCIALS SiGNATURE DATE.
SIGN4TOE (OWNER ORAd`ENT). 7
DATE SIGNED
(4 2 E-5)
771-0220
A17ENTION
EXT 333
f�ltl_EA L BY D?,kT E I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX,
ORIGINAL - FILE
PINK -OWNER GOLD - ASSESSOR
5198
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CEIVED
FEB.,2 3 2001
HOL%J_ A\jc.,-
coo�,fjz- M*�, * � S' DEVELOPMENT SERVICES CTR.
1000 1 /1411 CITY OF EDMONDS
AS "OTED
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev: Sery. Dept: �2-ow
City Receipt No: k /0
Date Mailed to Applicant:
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 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. The 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.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. 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 Areas Checklist and attest that the answers provided are I factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
city State Zip
�/Z, 5�- 7 7er-- 1,.'Pr
Telephone
Signature loo"
Date
Applicant Representative:
Name
Street Address
city State zip
Telephone
Signature
Date
d:rweptiort4onatCACLHandoLit.doc Revised VIM=
cA FILE No.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrol.ogy/vegetatio
I Site Address/Location:
2. Property Tax Account Number: 5,-61,0 qe'Oepeg /4/,0 0 0
3. Approximate Site Size (acres or square feet): ree,()
4. Is this site currently developed? yes; _no.
If yes; how is site developed? M e�-
5. Describe the general site.topography. Check all.that apply.
Flat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than IS% (a vertical rise of 1 0-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
I 0-feet over a horizontal distance of 3 3 to 6.6-feet).
Steep grades of greater than 3 0% present on site (a vertical -rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Ala Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 0�� fioodplain--.,� �,o of a water course.
9. Site contains a cFe5k or an area where water flows across e grounds surface? Flows are ar-
.round? /1/41 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:
..............
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CA FILE NO.
Critical Areas Checklist
opography/hydrology/vegetatio
Site Information SOESTt -------------------------------------------
1. Site Address/.Location: �7—IS-';195 'fAo�-e-
2. Property Tax Account Number: 0 '9 ep "'-9 1'�le
3. Approximate Site Size (acres or square feet): e% 7e, 0
4. Is this site currently developed? --Zyes; _no.
If yes; how is site developed?
Aft e--
5. Describe the general site.topography. Check all that apply.
Flat: less than 5-feet elevation change over entire *site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round'standing water: Ala Approx. Depth:
7. Site contains areas of seasonal standing water: �4/-" Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain
o_ of a water course.
9. Site contains a c�e5k or an area where water flows ac�o7A!ie grounds surface? Flows are
, year-
round? /C/41 — Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow—
�_j shrubs mixed
urban landscaped (lawn,shrubs etc) V ae�--57
11. Obvious wetland is present on site:
V
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e
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. . . . . . . . . . . . . . . . .
City of Edmonds
.
Development Services Department
Planning Division
Phone: 425.771.0220
-fac. 1%90
Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept: 4 L;7i3oc)
City Receipt No: i /0
Date Mailed to Applicant:
CRITICAL AIREJAS 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 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. The 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.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
city State Zip
tl . 7, 7
Telephone
Signat—ure
Date
d:rwept1oftqena/CACLHandwA.doc
Applicant Representative:
Name
Street Address
city State zip
Telephone
Signature
Date
RevisW 411MM
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APPLICATION
for
The City of Edmonds SME SEWER PERNaT
NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . ..........................................
111-04400
OWNER.......... D.O.U0.1dS ... P0.03 --------------------------------------------------------------------- CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
ADDRESS ...... 21503 - 90th Ave. 1-1.
.................................................. ................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ......... ..................................
NAMEOF ADDITION .........................................................................................................................................
F- I
L
0
Dye Tested On Sevier 1972
Approved:
DATE................................................ By ................. ......................................