21515 98TH AVE W.PDF111111111111
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21515 98TH AVE W
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ADDRESS: 215i15 %q7-m 1-ft4e &)
TAXACCOUNT/PARCELM ;170325W10B300
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS DETERMINATION: [j Conditional Waiver El Study Required aiver
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit Vs):
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
Applicant Shall repair/replace all damage to
utilities or frontage improvements in City
right-of-way per Cfty standards that is caused
or occurs during the permitted project.
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OWNER/CONTRACTOR IS RESPON
FOR EROSION CONTROL AND DRAI
Me as e
17 A 14 4# If/
Zone— IR'5 — 9 Corner Flag_
Setbacks kSqu�red Actual
Front W
Sides N —5 7`5 1
Rear E;
Other
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140
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APPROVED BY PLANNING
4. (0 .1
L/
RECEIVED
JUN 0 6 2011
BUILDING DEPARTMENT
CITY OF EDMONDS
House Plot Plan
V — / / '/*,
-'16 - -0
IMPERVIOUS SURFACE CALCS
Exist. House Roof Outline: 2135 sf. (19550'
Exist. Garage Roof Outline: 559 sq. (1955)
Exist. Driveway:Apt-4Y-30,e/0fp (1955)
Exist. Front addition Roof outline: 108 sq.(1980)
Ground Level deck: 306 sq (1980-2000
Exist. Shed Roof Outline: 126sq. (2009)
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City of Edmonds
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.
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 parcel(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:
Applicant Represeritative:
rA R L iU c L->
'-T-0 Y"k UJ t F /7-4
Name
Name
a
Street Address
Street Address
AS
Sa _(� _ U_�)
City, State, ZIP Phone
State, ZIP Phone
Signature
Signature Date-
CA FILIW.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegelf.-tion)
1. Site Address/Location: R ON Lj
2. Property Tax Account Num�e__r: .2 `7 r-) 3 _00
I /__1 A",
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? --Zyes; no. 41l,
If yes; how is site developed?-
5. Describe the general site topography. Check all that apply.
Fiat: 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 water: Approx. Depth:
7. Site contains areas of seasonal sta:nding water: I(JO Approx. Depth:
What season(s) of the year?
8. Site is in the floodway__L 'a floodplain of a water course.
9. Site contai�:!jrk or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetiand is present on site:
For City Staff Use Only
.1. Site is Zoned?
2.,,,,:,,....SCS mapped soil type(s)?
Wetland inventory or C.A. map indicates wetland present on site?..
4. Critical Areas inventory or C. A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
6. Site'designated on the Environmentally Sensitive Areas Map?
.DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed by:
lann6� Date
RcV01AW94
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BUILDING DMilON Appit— rif
PERMIT APLICATION Initimifis He., Li
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TOTAL A-NT Ilur
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12.
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APPLICATION APPROVAL
no ; .1d in 41,., :he -A ---d Ith-11. -- 11-
.. t 'niplo'eIl I. -... of the L,�, C�& If the SIIII of
This "'lic.,ion I, not . pternit
teL.'s, to well, C-peinse!" 1--c'.
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stnul lip" by "Iti'dirt, Official of
N OTIE: P"t 000 YOWL ... pt DEMOLITIONS M FILL
fees all
I, D, Pity: and paid. and
PE vi—I -4telooel lic� 11141
I'm.
'ec, pI is acknow edged in space prts-
=MITS
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CITY .1
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ATTENTION
IT S LINLAWFU� TO USE On OCCLtP1 A 0. SIR�ITOO.E PINK - 0-1- GOLD - A-
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LINTIL A FINAL I�ECTIOPi I-& SEEN NIAOE NO APPIFQ
A CERTIFICATE OF OGGLIPANCY *4AS BEEN GRANTED. UBC �.306
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4!-:Cityof Edmon0s.,
RIGHT-OF-WAY CONSTRUCTION
PERMIT Pe . rmit Numbex-.
I! ue Date:
SS
A. Address or Vicinity of Construction: 21515 98 Av W (9603949)
89 0 B. Type of Work (be specific): Install Service
9 C)
C. Contractor: -Washington Natural Gas Contact: 356-7500 X7596
Mailing Address: 11.77 75 St SW vixerett Phone:
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial EJ Subdivision 0 City Project [K] Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family F] Single Fanidly n Other
INSPECTOR: I14SPECTOR: \/Vk,VL,*J
F. Pavement or Concrete Cut:` 0Yes WNo G. Size of Cut: .,--x H. Chargq_$
N e,lcG
APPLICANT TO READ A IGN ro
INDEMNITY. Applicant understands and by his signature to this application, agreei'it6 ho t City ofEdmonds harmless from injuries, cfamages, or
I .� / -
claims of any kind or description whatsoever, foreseen or unforeseen, that may be. madeitgainat the City of Edmonds, oe �Lny of its depar
tments or
employees, includingor not limitedto the defenseofany legalproceedings including defenieco8ts, andattorneyfees by reason ofgrantingthi8permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIAZSTdRA PERIOD OF ONE YEAROFOLLO�W'&G THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety" shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patch6id' i�ith asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above state nd. undertand thepermit requirements and thepink copy of thepermit will be
available on site at all asofrorlrs.,`ians7t�es.
1��A
J Signature:
Date: 11-27-95
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY. USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: RESTORATION,,FEE:
PERMIT FEE: 30 - 0
TOTAL FEE:
COMMENTS: RECEIPT -FEE -
DATE: ISSUED BY- 71. An
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
Natu a!
AV&dWKjbnfrxvWCoirV&W
Addendum Lo: %.JLU OL ISOMOUGS
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Digineering Aide
Washington Natural Gas
1356-7500 X7596
/VO
Key:
-V- Water
Watermain depth -G- Gas
-SS- Sever
gas main -& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Strcet SX. Everett. Washington 98203. (206).155-3331
APPLICATION
for
The City of Edmonds SIDDE SEWER PERNaT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . ..........................................
109-07100
OWNER ------------ M.A. Jacobson
-------------------------------------------------------------------------------------------------- CONTRACTOR ................ ..................................... ........................................... PERMIT No . ......................
ADDRESS ........ fn ... . ............................................. LEGAL DESCRIPTION: LOT No . .......................... ------ ............ BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
0
E
Dye Tested On Sevier 1972
Approved:
DATE...................................... ......... By ..................................................... ................