21908 92ND AVE W.PDFiiiiiiii lill
8937
21908 92ND AVE W
PLANNING DATA
SITE ADDRESS: Z A V-L-"' DATE: /2 — 6
ZONING: p S I K PLAN CHK#: q5- - zo -L
PROJECT DESCRIPTION:—Adl 4 L -
SETBACKS:
Required Setbacks:
Front: ?- 5- Left Side: Right Side: 7 �'?- Rear: 1
Actual Setbacks:
Front: Left Side: —Right Side: Rear:
CORNERLOT A10 (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED A/0 (WN)
LOT COVERAGE:
Maximum Allowed: Actual:
BUILDING HEIGHT:
Maximum Allowed: Z, 3- Actual Height:
Datum Point: Datum Elevation:
SUBDIVISI
CRITICAL AREAS #: q67 - 2-13
SEPA DETERMINATION: C4 e, m4
LOT AREA:
OTHER:
Plan Review By:— �4 0. r- u,",/1's
RECEIVED
1 7
JAN 0 8 1996
PERMIT COUNTER 7
STREET FILE v. v-Je 6 1
4 31
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APPROVED BY PLANNING
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Registration JOHN D.C. 158 D 2
JOHN DAY CONSTRUCTION
21908 92nd Avenue West, Edmonds, WA 98020 -
(206) 778-2202 Mobile Phone: 947-5650 Pager: 993-1586
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!,CITY OF EDMONDS
SIDE SEWER PERMIT
Address' of Construction: Z,
Property Legal Description (Include all easements): 7 -7
PERMIT N2 1, 8.743
EATIVIENT PLANT
Dip,
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Owner and/or Contractor: OA,�, y Cy
State License No. Building Permit No. ye�a,�
Wsingle Family Invasion into City Right -of -Way: In/No El Yes
0 Multi -Family (No. of Units-) RW Construction Permit No.
C1 Commercial Cross other Private Property: 0' No El Yes
El Public Attach legal description and copy of recorded easement
I certify that��rhave read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
CALL DIAL -A -DIG (1-800-424-55 55) BEFORE ANY EXCAVATIONI
OFFICE USE:ONLY
FOR INSPECTION CALL 771-Mg, PUBLIC WORKS DEPT.
";R --35 -
Issued By
Permit Fee:
9c-
Trunk Charge o?, Date Issued:- /
Assessment Fee: A) 119 Receipt No
Lid No.:
Partial In spection: Date - Initial
Comments
Reason Rejected:
Final Inspection Approved: Datd_�� �,(, lnitiale:�-�-
Date-initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
The City of Edmonds Side Sewer Drawing EASEMENT NO. - ---------------------- ----- - ---------
NEW CONSTRUCTION REPAIRS LID NO. 2.1.3 .... ASMT. NO - ------------------
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OWNER ................................................................................................ CONTRACTOR ................................. .......... PERMIT NO.
.........................................
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JOB ADDRESS .... Z ........... 40 . ....... w---
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
NAMEOF ADDITION ........................................... ---------------------------------------------------------------------------
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its*
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Approved:
PWW-0001-11175 (REV.11/78) DA .-/:7-2,3 - ------------- By
10 Jf ladd—
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A
g�qO5 qzv� OYI,(,Aj 101 . *1 "
RECEIVED 41.7r
JAN 8 8 1996) ITY Copy. 11-If
PERVAIT COUNTER
Av, CM&
9.0 PIC
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1 A14-ld
14(
li_� 110, �EPORT NUMEIR PR
PREVIOUS-RPTNO
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PACIFIC TESTIN
LA BORATORIES
EXECUTIVE OFFICES - Seattle, WA . EASTSIDE DIVISION - Bothell, WA TACOMA DIVISION - Tacoma, WA PORTLAND DIVISION - Portland, OR PENINSULA DIVISION - Poulsbo, WA
(206) 282-0666 - FAX (206) 282-0710 (206) 485-4244 - 451-8436 - FAX (206) 485-4611 (206) 922-9299 - FAX (206) 922-1512 (503) 224-2248 - FAX (503) 244-5266 (360) 297-8821 - FAX (360) 297-8828
MAILING
ADDRESS
ATTENTION:
PROJECT
PURCH.ORD.
LOCATION Cj 01IK' 1""Oe-NUMBER
REPORTEID/J,J,,,�,.//�` .
BY DATE 4"2
REVIEWEDv
BY DATE
PERMIT C CERTIFICATE
NUMBER --V( ' -NUMBER-
ARCHITECT
ENGINEER
CONTRACTOR
4 ro e- jV40 6�1
. lr�
ASTM TEST METHOD (AS APPLICABLE) MODIFIED YEW NOD EXPLAIN:
EQUIPMENT IDENTIFICATION AND S/N (AS APPLICABLE) WORKCONFORMS YESe NOD
"This report is provided for the information of the client only. The reproduction of this report, by any method, and its transmit-
tal to a third party, by any means, except in full, without the written permission of Pacific Testing Laboratories, is prohibited."
"This certification attests to the accuracy of the results obtained from the actual test performed and/or observations made
within the defined scope of the work. Certification snail not be construed to represent inspection, approval or acceptance of
other associated work or a warranty of design or workability of the specification requirements."
Certified Report by
Pacific Testina Laborato DATE
COSTCODE
Contract Min. " TOTAL HOURS
FIELD CONTACT- DATE Chargeable Hours
FIR 89-2
CA FILE NO. Gmn
V qua Aao -------
Critical Areas Checklist
Site Information (soilshopography/hydrology/y tion)
1. Site Address/Location: AAk
-610:Z. -,-56L- or-c7 REECEIVED
:Z 7`7
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4- Is this site currently developed? !?/-
-yes; - no. !'PERMIT COUNTER
If yes; how is site developed? S-111i r4 /2
5. Describe the general site topography- Check all that apply.
'*'/- Flat: less than 5-feet 'elevation change over entire site -
Rolling: slopes on site je*ally less than 15% (a vertical rise of 10-feet'over 'a
horizontal distance of 66-fect)-
Hilly: slopes presM on site of more than 15% and less than 30% a vertical rise
of 10-feet -(w7er'.a* 'hoirizointal distance of 33 to 66-feet)-
Steep: grades oiireater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feei).
Other (please describe):
6. Site contains areas of year-round standing water: AX9 Approx, Depth:
7. Site contains areas of seasonal standing Approx. Depth:
water.
What season(s) of the year? 1,40A_1
8. Site is in the floodway_'- A/0 fl am Al of a water co'urse.'-'
9. Site contains a creek 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 Qawn,shrubs etc)
11. Obvious wetland is present on site: X-la
For City Staff Use Only
:I. is'Zoned? 12t:,—e
�.4:_..SCS mapped soil type(s)? -Pr >' lle.AVt�r_> LJ<_1;AJ LAW
.3% ed
W and inventory or C.A. rnap indicates wedand present on site?.—
n tical:Areas inventory or C-A. map -indicates Critical, Area on site?
S a W within'designated earth subsideno6-landslide hazard area?
designated on the Environimentally Sensitive Areas Map? W(,-'
]DETERMINATION
-STUDY REQUIRED
CONDMONAL WAIVER
11_ae�WAI V
ER
:Riiviewied by:
p4a Date
RCV01104f"
q ;4,:64
4
11
X-
;, 90 .1-99
CiWbf Edmon&
Y:
Critical Areas Ch.ecklist
'Me Critical Areas Checklist contained on and submit it to the City. 'Me City will
this form is to be filled out by any person review the checklist, make a procursory site
preparing a Development Permit . visit, and make a determination of the
Application for the City of Edmon44 prior subsequent steps necessary to complete a
to hisfher submittal of a developn*nt- develop . ment permit application.
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. Ile
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,
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 (eg. site
plan, topography map, etc.) or studies in
conjunction with this Cheddist to assist
staff in completing their prelirninary
assessment of thesite.
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 Wow) -
Owner / Applicant:
Applicant Representative:
V
Name Name
Street Addres's Street Address
�7k() 210
City, State, ZIP Phone City, State, ZIP
C�, /"� — /,— �; r -
Signaturee/' Date Signature
4L C.
CITY OF EDMONDS
.CONSTRUCTION PERMIT APPLICATION.,
0 NJ
USE
ZONE PERMIT
NUMBER !9ro(00.78
JQB
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ADDRE55 .... SUITE APT
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OWNER NAME NAME OF BUSINESS
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EGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
LING ADDRESS I
L2
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
TESCP Approved 0
RW Permit Required 0
Street'Use Permit Req'd 0
Lolly ZIP
TELEPHONE NUMBER
'7 7?-2,2,6
P
PROPOSED
Inspection Required 0
Sidewalk Required 0
a:
W
uj
NAME
/"E
NO. OF FIXTURES
PRV REQUIRED
YESXNO 0
ADDRESS
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W
W
RE�ZKS
CITY ZIP
PHONE NUMBER
0
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cc
0
<
cc
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NAME
ADDRESS
ENGINEERING MEMO DATED i REVIEWED BY
CITY ZIP
TELEPHONE NU IMBER
2,;7- 621,
FIRE MEMO DATED REVIEWED BY
W
cc
STATE LICENSE 'NUMBER EXPIRATION DATE
A—
SIGN AREA
PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
ADS NO.
Legal Description of Property - include all easements
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EXP
SHORELINE
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VARIANCE OR CY
- 1
PLANNING REVIEW BY
4. . - L- L"', A.111� I
DATE
SETBACKS — FE ET
FRONT REARI
—REMARKS
HEIGHT
fLOT COVERAGE
Property
Tax Account
Parcel No. 716 6, 6 7 al
EINEW RESIDENTIAL F-1 PLUMBING
ZADDITION COMMERCIAL MECHANICAL
REMODEL APT.OLDG. SIGN
z
0
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0
03
0
GRADING FENCE
REPAIR CYDS. I— FT)
x
F] I
DEMOLISH WOODSTOVE SWIM POOL
INSERT
0: HOT TUB/SPA
GARAGE — RETAINING WALL/
CARPORT ROCKERY RENEWAL
CHECKED BY
TYPE OF CONSTRUCTION
I A
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co
OCCUPANT
GROUP-7
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9 PECIAL INSPECTOR
REQUIRED
C3 YES
0, _�� // ---
�AEb
0 ANT
LOAD
REMARKS
PROGRESS INSPECTION'S PER UBC 305
(TYPE OF USE. BUSIN�SS OR ACTIVI Y) EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNI I
TS
CRITICAL
AREAS
I NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
/1,00 AAfi
FINAL INSPECTION
REQUIRED
Cl ??7/L1j /")1A
VALUATION
F E
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING//
PLUMBING
Plan Check No.
MECHANICAL
N
:5-0
This Permit covers work to be done on private'property ONLY,
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
GRADINGIFILL
STATESURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Aoplicant. on behalf of his or her spouse. heirs. assions and
ENG. INSPECTION FEE
CA 1-[Lr-- NO.
Critical Areas Checklist
Site Information (soilshopography/hydrology/v tion)
1. Site Address/Location:
—0 10 2 0 J<_C
2. Property Tax Account Number: 3 :Z
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed?
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 10-feet overa
horizontal distance of 66-feet).
Hilly: slopes prese
It on site of more than 15% and less than 36% a vertical rise
of I 0-feet IS* er'a 'horizontal distance of 33 to 66-feet)-
Steep: grades oi Tjreater 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: A10 Approx. Depth:
7. Site contains areas of seasonal stabding water, Approx. Depth:
What season(s) of the year? X10"V
S. Site is in the floodway /f_/0 floodplain A/,p of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year7
round? 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: Ala
For City Staff Use Only
:1. Site is'Zoneidr.)
'its soil type(s)? -0, 5— L-440
2..:...
mapped
_.,Wetland
inventory or C_A_ map indicates wetland present on site?
4 ...... ..
C --Areas inventory ex- C.A_ map -indicates Critical Arm on site? k,,
n
5�,�%.-........�it�wid�n'-designated earth subsidenc6-landslide hazard area?
ite, d6si&ited on the Enviroomentilly Sensitive Areas Map? /v (11
]DETERMINATION
'STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
R�viewed by ... 12-
lqat(ner Date
RcVCIA)4(94
Vj
&90 . 199 - f- . .
City of Edmon&
Critical Are- -a s
G P11%
he-cklist'
Ile Critical Areas Checklist contained on
this form is to be fined out by any person
preparing a Development Permit
Application for the City of Edmond; prior,
to hisfher submittal of a developw6fit
permit to the City.
1"be purpose of the Checklist is to enable
City staff to determine whedxx any
potential Critical Areas are or may be
present on the subject property. Ite
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, inaps,
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.
V,Fith 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 infomiation (e.g. site
plan, topography map, etc.) or studies in
conjunction with this CheckrLA to a%iA
staff in completing their preliminary
assessment of the site -
I have completed the attached Critical Arm Checklist and attest that the answers provided arc
factual, to the best of my knowledge (fill out the appropriate column below) -
Owner / Applicant: Applicant Representative:
Name Natne
_2
Street Addres's Street Address
City, State, ZIP Phone City, State, ZIP Phone
C�,
Signatutee/Z' Date Signature Date
A
0
NOTICE:
r a n
FaU
0 -a c. c ..
form atjon'*shown on the attached
The in
map(s) was compiled for. use by the City of
Edmonds'; its Empl-oyees and Consultants.
Th,.,e CjtY of 'Edm.onds does ' not ' warrant the
accuracy of anything set for.th on these
M a p ('s"). A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding the Inform . ati on shown-o
including, but not limited to,
tFR_� -map(s),,
c ion of any sewer stub shown. Suc
the lo' at'
sewer stubs may or may, not e.xist and may
..or may not exi t at the location shown.
s
Neitheir the city of Edmo*nr.,41 S1 nor its
emp'fo-yee-s o.r off ice-rs -shal-1 be 1--ia-b-I.,e for thE
n on this map(s), nor for
infor . mation g ve ided based
any one representation prov
upon . said map(s).