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22021 76TH AVE W.PDFIIIIIIIIIIII 6351 22021 76TH AVE W ADDRESS:VZ,� / - -71Y LIF- Z4 J TAX ACCOUNT/PARCEL NUMBER:, g_1;7_-7 bt/-�3 �Z L�& BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required 4W91-ver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS lqq,� PLANNING DATA CHECKLIST DA SCALED PLOT PLAN DATED: SEWER LID FEE SHORT PLAT FILE: SIDE SEWER AS BUILT DATEDIA q t / SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT FOR: WATER METER TAP CARD DATED: OTHER: LOT: I LID #: /M BLOCK: SIDE SEWER PERMIT(S) #: LATEMP\DSrs\Fomis\Street File Checklist.doc e OIV4 keec AA-, CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEiNAME OF BU ss d SA jell IL // c 4a.) i1i MAILING ADDRF55 Z 3: ,� n 0.%1 / ;7d jVesT 0 , 'FCITY - zip QTELEPHONE NUMBER I �p M WA473?11,21) F/d., ADDRESS CITY NUMBER NUMBER LICENSE NU&M EXPIRATION DATE r/y e An&V .61 Description of Property - include all easements Property T Account Of-3— 0 5TI rcel No. P:x 1:1 5KRESIDENTIAL NEW 2 .00' COMMERCIAL ME6H N�CA"(,- ADDITION' 1:1 APT. SLOG. sl'G� REMODEL 1:1 GRADING FENCE I REPAIR — CYDS. x _FT) 1:1 DEMOLISH wOODSTOVE INSERT SWIMPOOL HOT TUB/SPA PARAGE eCARPO RETAINING WALL/ ROCKERY RENEWAL ITVPF nF USE. BUSINESS OR ACJIyITY) qXPLAIN ,FWMBER NUMBER OF ICRITICAL' REAS NUMBE _IA7 OF DWELLING yA A L STORIES UNITS I- R 7-3 TO BE DONE (AVACHPLOT PLAN) U-S—E P I E . RMIT WNE Z 4 NUMBER 960100 -��p JOB SU =TE/APT # ADDRESS 2.2.OZ/ 1w, Aloe k/ — PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. EXISTING — REOUIRED DEDICATION --cm — METER SIZE LINE SIZE I Nor OF FIXTUI DATED TESCP Approved 0 W Permit Required 0 treat Use Permit Req'd (3 inspection Required 0 Sidewalk Required 0 PRV REOUIRED YES C3 NO 0 0 Z W Z BY SIGN AREA SEPA RE IEW ADB NO. PROPOSED COMPLETE EXEMPT HORELINE 0 EXP I I/ VARIANCE OR CU PLANNING REVIE BY DATE X V_ 9 SETBACKS — FEET HEIGHT, LOT COVERAGE/ Z 10 EAR FRONT SIDE RE!A�ARKJI (L 'Walt Ae"Ir 1.5siowvee- 'HECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT GROM SPECIAL INSPECTOR AREA OCCUPANT REOUIRED 13 YES F1W LOAD PROGRESS INSPECTIONS PER UBC 305' FINAL INSPECTION REQUIRED 7- ALUATION FEE _/lee PLAN CHECK FEE BUILDING HEAT SOURCE: % PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on private prop-efty ONLY. . GRADINGIFILL Any construction on the public -domain (curts". sl dewplks, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Permit Application: 180 Days STORM DRAINAGE FEE Permit Limit: I Year - Provided Work Is Started Within 180 Days . "Applicant, on behalf of his or her spouse, heirs, assigns anT ENG. INSPECTION FEE successors in interest, agrees to Indemnify, defend and hold the City of Edmonds, Washington, its officials harmless employees, and agents from an y and all Claims for damages oi cr re arising directly or indirectly from the Issuance < whatever natu I�suance of this permit shall not be deemed to P LANFHFCK DEPOSIT of this permit. modify, waive or reduce any requirement of a iny city ordinance 0 B City's ability to enforce any ordinance nor limit in any way th TOTAL AMOUNT DUE provision." I hereby acknowledge that I have read this application; that t;e ATTENTION APPLICATION APPROVAL information given Is correct; and that I am the owner, or thja duly authorized agent of the owner. I agree to comply with ,9.1ty and THIS PERMIT This application is not a permit -until state laws regulating construction; and In doing the work authoriz- AUTHORIZES ONLY THE signed by the Building Official or his/her ed thereby, no person will be employed in violation of the Labor WORK NOTED Deputy; and fees are paid, and receipt Is Code of the State of Washington relating to Workmen's Compensa- acknowledged in space provided. tion Insurance and RCW 18.27. DATE SIUNt:U INSPECTION DEPARTMENT DATE I NATURE IOWNER OR AGENT) TURE CITY OF EDMONDS CALL FOR TE E DATE ATTENTION INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGI.NAL — File YELLOW — inspector UNTIL A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. �,BC PINK — Owner GOLD — Assessor CHAPTER 3 0 E f%c—%or-I vr_u MAR 0 6 1995 - PERW COUNTER r2, C7. f L I z Iz Zq pp N LAN 47 p..t> APPROVE s' -ro 67 ti i r) E RECEIVED PERMIT EXPIRES f CITY OF EDMONDS YSE PERMIT ZONE fcvq, NVMBER2(;r,\j3.- 4�� &L) CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS', //0 OWNER NAME/NAME OF BUSINESS e-hqeles PLAT NAME /SUBDIVISION NO. LOT NO. I LID NO. MAILING ADDRESS I LID FEE $ _fESCP �App�ed Awe id. PUBLIC RIGHT OF WAY PER OF ICIAL STREET MAP RW PamUt Required CITY zip TELEPHONE EXISTING PROPOSE611, Street use Permit Raqv Inspection Required 13 REQUIRED DEDICATION— FT Sidewalk Required 0 underground Whing required 13 NAME M ET ER'SIZE LINE SIZE j O.,OF FlXTqRES PRV REQUIR ED e, Val &A 4tZ-75 -2, YESO NO 13 ADDRESS REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY- ZIP Iu k, TELEPHONE 2b -Ti A C, NAME Ck # . . . . ow"oAlk-Z ENGINEERING REVIEWED BY DAT E 0 ADDRESS f J�?d 0 3 FIRE REVIEWED BY 6ATE CITY ZIP TELEPHONE rL 8 STATE LICENSE NUMBER EXPIRATION DATE— BY VARiANCE.OR CU SHORELINE OR ADB# REQD INSPECTION 1$ BOND POSTED FCHECKED [3 YES JMLO SEPA REVIEW COMPLETE E SIGN AREA ALLOWED PROPOSED ljrf- HEIGHT A4OWED, PROPOSED PROPERTY TAX ACCOUNT PARCEL NO. - 12"1 003 49!rl 00 EXP CINEW RESIDENTIAL PLUMBING LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT) FRONT SIDE REAR PROPOSED SETBACKS.(FT) FRONT LJRSIDE Alo WAIRC. ADDITION COMMERCIAL COMPLIANCE OR 'A CHANGE OF USE PARKING REVIEWED 7 RE MODEL MULT.T.AMILY 0: SIGN REO'D PROVIDED LOT AREA PLANNING BY/ DATE IL i G FENCE E] REPAIR CYDS ( x -.?-- ARKS OTHER DEMOLISH TANK ho*----AaVw-�IWZ44�4Q - . . -1 GARAGE RETAINING WALL F RE SPRINKLER sei. CARPORT ROCKERY F:RE ALARM (TYPE OF UP f. BUS170S OR ACT[Vr.rY.) EXPLAIN: . mriimc CHEdKE By D T YPE OF 99N STRUCTION I � I Cm OCCUPANT/I :91!� GROUP 01 NUMOR" NUIAER OF CRITICAL - .. OF DWELLING AREAS �f �CIAL INSPECTION SPE I , AREA . OCCUPANT 0 STORIE� UNITS NUMBER 7-) -aim REQUIRED [] YES LOAD DESCRIBE WORK TO BE 00 REMARKS r PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D j- . -. - .. -_ - .- .1 .. - .001 x-J Av, ,wew v-40/e e.^ lu 212Y.41. "A 7 ...; VALUATION A4 Atn23 IF- 1) Diiiddptlon FEE esc Iption FEE Plan Check Ztate Surcharge HEAT SOVRCE SLOPE ::Vo Building Permit 5 City Surcharge PLAN CHEC /V2 VESTE1?.DATf I . n .6a:A THIS PERMIT AUTHORIZES ONL , Y THE WORK NOTED_ THIS PERLIT C6, S, FORK TO,, :M6chanical 50 It BE DONE ON PRIVATE PROPERTY. ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS;�DR E IVEWAYS. MARQUEES ETC.) WI�L REOUkR,, k: SEPARATE PERMISSION.. 491(o Engr. R eview PERMI'll'APPLICATION: ISO DAYS L PERMIT LIMM IYEAR - PROVIDED WOR K IS STA WED WITHIN 180 0 AYS I Eggir."Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION C A*NL : ; OWBEHALF,Q -APPLI f:HIS CtR HER SPOUSE, HEIRS. AS16?,116 AiAI UCCESORS i ' ; Rev Fire Jew Plan Chk. Deposit Aa IN INTEREST, AGREES..TQ INDEMNIFX. DEFENDL AND HQLD HARMLESW THE,crrY,-OF 2 EDMOND 'WASHINGTON, ITS!O FIC . EMPLOYEEs: AND AGENTS FROM ANY. AN P, f. LAILS 'ALL Fire Inspection Receipt # CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING -DIRECTLY. OR INDIRECTLY ;FROM.THE ISSUAAdE OF iHIS PERmrr.-ISSUANCE OF THIS PERMIT SH.ALL:Nb,f�.BE: ' DEEMED T Ob FX WAIVE -OR REDUCE ANY'REQUIREMEN'r" OF MY CITY ORDINANCE LandscApelnsp. Total Amt. Due 0 NOR:UlMrr IN ANY WAY THE CrrY`S ABILITY To ENFORCE Atf� ORDINANCE PROVislOw. Recording Fee Receipt # . IHEREBY ACK N OWLEDGE THAT I HAVE READ THIS APPLICATIO . N; THAT THE, INFORMATION GIVEN A&CORRECT; AND THAVI AM THE'OWNER, OR THE DULY AUTHORIZED AGENT OF - 7. APPLICATION APPROVAL THE OWNER I AGREE M COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_ t: This application Is not a permit until signed by the , �TION;OA D.IN DOING THE WORK AUTHORIZED THEREB)� NO PERSON WILL:BE.EMPLOYED . V L T IN ION -OF THE LABOR.CODE-Of THE STATE OF WASHINGTON RELATING TO , 'CALL FOR'INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowledged in- pace provided. WORKMEWS $KENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE D�TE SiGN4TOR OWN15A'OR AGE" DATES'IGNED �(425) 7.71 -0220, it E I—OLIA 4a .,'RELEASED, DATIf ATTENTION EXT 1333 v IT I S UNLAWFUL TO USE OR OCCUPY A BUILDING OR. STRUCTURE UNTIL FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,A CERT101 CATE OF OCQUPA14CY HAS,BEEN GRANTED. VBC SECTION 109 LE ll I SPE/TAR E N PINK -OWNER GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES, GREEN - ACCOUNTING CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS 01, AV*,, W. FI—Ty ZIP TELEPHONE NUMBER " M OWC2 4 66 1� -1 *1 P) b 10 1�? 0624 <;,111 CITY ZIP TELEPHONE NUMBER oo� D )�� I V* 0 046t 4? NAME !105 CITY STATE LICENSE NUMBER EXPIRATION DATE - include all easements Tax Account ParcelNo. RESIDENTIAL P L U M 41N 'Fr1K9W ADDITION COMMERCIAL MECHANICA REMODEL APT. BLDG. SIGN REPAIR DEMOLISH GARAGE GRADIAG N — CYDS. WOODSTOVE INSERT,,. F7 RETAINI'Nd WALL/ L-J ROCKERY FENCE I x —FT) SWIMPOOL HOT TUB/SPA RENEWAL USE ZONI!ItA -2 4 PERMIT NUMBER 93070,9 I ADDRESS 2202J,,-A6 All-e— 1,41 UITE1APT#j 2 NUMBER OF STORIES NUMBER OF 0 DWELLING M I I UNITS 0 DESCRIBE WORK TO BE DONE IATTACH PLOT PLAN) c4l )( 1? (a I t rO K A 12- 1 [a.] PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved EXISTING — REOUIRED DEDICATION RW Permit Required Street Use Permit Req-d Inspection Required �8, PROPOSED Sidewalk Required 0 REMVKS JL -j ENGINEEKING MEMO DATED REVIEW BY METER SIZE IBUILDING SUPPLY SIZE NO. OF FIXTURES SIGN AREA $EPA REVIEW ADB NO. ALLOWE PROPOSED COMPLETE /V )k 1EXEMPT SHOREL NE; 7A- EXP VARIANCE OR CU REVIEW BY DAT6f A P-) - 4rH - 1-12 1 , M ��N� . ldll?ly SETBACKS — FEET I , . FRONT 'SIDE -_0 REA HEIGHT I -- ---- 6 LOT C6vERA E CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT SPECIAL INSPECTOR I AREA OCCUPANCt UPANT REOUIRED 13 YES GR LOAD -Occ PROGRESS INSPECTIONS PER UBC 305 FINAL INSPECTION REOUIRED VALUATION PLAN CHECK FEE BUILDING HEATSOURCE: GLAZING PLUMBING Plan Check No. 23:17 C;/ MECHANICAL This Permit covers work fo be done on private property ONLY. GRADINGIFILL Any construction on the public domain (curts, sidewelks, - STATE SURCHARGE driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days . Permit Limit: 1 Year - Provided Work liStiri6d Within 180 Days STORM DRAINAGE I FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE ,n successors in interest, agrees to indemnify, defend and hold U2 harmless the City of Edmonds, Washington, its officials, 5 employees, and agents from any and all claims for damages of < whatever haiurle,'arlsing directly or Indirectly from the'Issuance of Yft permit; Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT modify, waive or reduce any requirement of any city ordinance TOTAL AMOUNT DUE I nor limit In any way the City's. ability to en.for0b.,any ordinance 01 provision." I hereby acknowledge that I have read this application; that the Information given Is correct; an that I am.the owner, or the duly ATTENTION authorized agent of the owner.11 agree to comply with city and THIS PERMIT' stat 1 1 r lating construction; and In dolng the work authoriz. e aws Logu AUTHORIZES ed t.0erebi . erso will b&4mployed in violation 0419. Labor Cot N knt "' N 13 ngAV rela*j. Wor rl IS pensa. #1 ONLY THE WORK NOTED - . .nT tionsInE INSPECTION RE ER OR,kb X_ TE SIGN �5 DEPARTMENT CITY OF EDMONDS ATTENtION CALL FOR INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL I ' NSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC CHAPTER 3. 10247 3u ---q,15� 113&W-11 2JD APPLICATION APPROVAL This application is not a permit until signed by the Building Official or his/her Deputy; and fees are paid, and receipt is acknowledged in space provided. FF�S S G T R '111. S SIG)IIA U E DATE thlw') /() - / � -- e�, 3 ELEAYED CV DAIT 1012q) 3 ORIGINAL — File YELLOW — inspector PINK — Owner GOLD — Assessor M uj I'- 0 Z 9 a 2,2� eONC-. WA4- I -.."i4mNro -�: 6**-IAA�40 t tr 11 4; K 0 AAV )Y)STL— ee Sri --."cjjlt4rjr UMUr, N ro AK-f 2z) -PL5W S REET FILE, 0 STREff FILE * 40. 1 CITY OF EDMONDS 250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 774-0220 - FAX (206) 771-0221 COMMUNITY SERVICES DEPARTMENT 1,1890 C) 'Zi Public Works e Planning e Parks and Recreation e Engineering LE=R OF TRANSAInTAL Date: April 23, 1993 To: M. Travers 834*S. Donovan St. Seattle WA 98108 Subject: CRITICAL AREAS CHECKLIST Transmitting: CA-93-100 F6r your information: x As you requested: For your file: Comment and return: Note attachments: Comments: **1OU MUST BRING A COPY OF YOUR CRITICAL AREAS CHECKLIST WHEN YOU SUBMIT YOUR BUILDING PERMIT APPLICATION** cc: C. Campbell 22021 76th Ave. W. Edmonds WA 98026 Planning Division rindi Cru7, Planninq SpCr-pfar-y Incorporated August 11, 1890 Sister Cities International — Hekinan, Japan LAURA M. HALL MAYOR City of ]Edmonds Critical Areas Chec'klist The Critical Areas ChwMist contained on diis form is to be filled out by any person prqmnng a Development permit Application for the City of Edmonds prior tA hisiher a0binittal of a development permit to the cify� Ile Purpose of the Checklist is to enable CitY Staff to daCT01inewhether any potential Critical Areas are or may be present on the. subject property. Ile information needed to complete the ChwHist shouldbe easily available from observations of the site or data available at City Hall (Critical Areas i - inventories, maps, or soil surveys). An applicant, or his/her reprCsentative --fill. " must Out the, Chccldist.-sign -and date it, and submit it to the City . ike city win review the checidist, wa a precursory site visit, and make a determination of the mbsequent steps ncccss=Y to complete a development Permit Vplic!ation. With a signed copyof this forn4 the afflican't should alsO submit a - i ity map v1cnH of the parW'wilh enov;gh detail that City staff can f ind and identify the, subJect parcel(s)- In addition. the applicant is encouraged to include any other pcfincnt information or swdics in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Area ChOcIdist and attest that the answers providedare factual, to the best of my knowledge (fill out the appropriate column below)_ Owner / Applicant: , e � - , r- prow, Marne o V-*J Kit Title - -Z --2 0�-L 1 Street Address "IptoN-Wc lqq� 6103 Uty, State, Zip Phone Signature Date Applicant Representative: M - __VR-P4,4EA4;' AXXX-*4 Marne A&C"V-M� Title 9> S + C-.2. orm- Street Address 45 to ?J 12, City, State, ZIP Phone USignaturj Iq 5 e Date 0 . . 9 Critical Areas Checklist Site Information ProjectName: 44*%.M1eft1kXA.. OASP.it Number. Site Location: t —1(01 -4 W .— Property.Tax Account Number. -Z 0+1015* 1000 -e Approximate Site Size (acres or square feet): Of Have you filled out a Critical Areas ChocIdist for a project on this sito before? General Site Conditions 1. Has the site been cleared or logged? No Date of most recent action: Soils / Topography 2- In the Snohomish County Soil Survey, vAmt is the mapped soil type( s)? 3. De=ibe the general site topography. Check all dw apply. Flat: less than 5 feet clevat ion 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-) Ifilly: slopes present an site of more than 15% and less than 30% ( a vertical rise of 10 feet of horizontal distanm) Stoep: grades of greaW than 300/a present on site. comments 4:�*44 i UP*,**r-J 7 :Determination N um - ber. geviewe4 Planner Date Rey 3/27n2 jEET FILE Critical Areas Checklist Site Information Project Name. 4^MIP ftWLA- Permit Number. Site Location: Property Tax Account Number. 01561 Oc�o Approximate Site Size (acres or square feet): Have you filled out a Critical Areas Cheddist for a project on this site before? 0 General Site Conditions 4 1. Has the site been cleamd or logged? 00 Date of most recent action: Soils I Topography Z M &c Snohomish County Soil Survey, what is the mapped soil type(s)? 3. Describe the general site topography. Check all- that apply. less d= 5 feet elevation change over entire sitr- Rx)lling: slopes on site generally less than 15% (a vertical rise of 10 feet over a -horizontal distance of 66 feet.) Hilly.- slopes prescnton site of more than 15% and less 1han 30%p ( a vertical rise of 10 feet of horizontal distanc�_) Stocp: grades of greatcr than 300/a present on site. C�omments evwm i U;t� Hydrology/Vegetation. 4. Site contains areas of year-round standing water 5. Site contains areas of seasonal standing water. N) 40 —Approx. Depth: 6- Site is in the floodway 00 floodplain tJO of a water 'course. d require WMI V f L I :.Qeterminatio� Nu�nbe' C) _5�43 R6,ie�v4 Acy 3127/92 0 0 City of Edmonds Critical Ar6as C*hecklist 'Me QiticaliVeas Checklist contained an this form is to be filled out by any person preparing a Development Permit . Application for the City of Edmonds prior tO his&cr submittal of a development pcm2it to the city- 17he PuqxMC Of the Chccl dist is to enable City staff to determine whether my potcatial Critical Areas am or may be present on the subject pwperty. The inf-rmatio. ceded to c=Plft the Checklist should be easily available fiorn observations of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). An applicant. or his/her representative. rnust fill out the chocidist. sign and date k and submit it to the City. The City will review the checklist, a preanwry site visit, and make a determination of the subsequent steps necessaryto complete a development permit appliclation. With a signed copyof this fom3� the applicant should also submit a vicinity map of the parcel with enough deW dw City staff can find and identify the, subject parccl(s)- In addition. the applicant is encouraged to include any other pertinent information or sttidies in conjunction -with this Checust to assist staff in completing their Preliminary assessment of the site. I have completed the attached Critical Area Checidist and attest that the answers provided'are factual, to the best of my knowledge (fill Out the appropriate column below). Owner / Applicant: d! � - e-V 0^40Al P Name Title 'Z "2 0"L 1 —1 AIM— - L.*J S Address go Vow �--W C' '174b bla-% City, State, Zip Phone JF Signature Date Applicant Representative: 1A4---VR-AAAEA4:;' Axxx,+4. Name AJU-"V—Me� Title E�S'q- C.�. Street Address S Wj=k,1-X— k^K.Ijetob -1(,,-2, City, state, ZIP Phone t- —tj�lq . Signature Date 0 0 PLANNING DATA has pbe-r-, NAME: 6�e�� DATE: ��;2-1 //2:� hv(� SITE ADDRESS: 1 -7j,,-4-41-' �VTLOV PLAN CHK#: PROJECT DESCRIPTION - REDUCED SITE PLAN PROVIDED?: Ms / 0 Y MAP PAGE: CORNER LOT: L/No) FLAG LOT: Ye- L-s ZONING: CRITICAL AREAS DETERMINATION #: q3 - /Oo ElStudv Reauired: C*-Ikalver El Conditional Waiver SEPA DETERMINATION: UFee 0 Checklist APO list w/ notarized form ' N-eeded fo . r 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger) OExempt e-c. s; z;�W%D. exceeds 'G-vc cydll� SETBACKS: Required Setbacks: Is4re Street: 1 ±> Left Side: Right Side: 10 .ftlr� Actual Setbacks- f - Street: /-,�o Left Side: Right Side:_ Rear: Street map checked for additional setback required? ()LevfjNo DDNA) U DETACHED STRUCTURES: L] ROCKERIES: U FENCES/TRELLISES: El BAY WINDOWS / PROJECTING MODULATION: 13 STAIRS/ DECKS: PARKING: Required.!2-- Actual�-Z— LOT AREA: q10-oe:0 LOT CO ERAG= Calculations: Ate BUILDING HEIGHT: S v Datum Point:—,--& M444-wlel- COVINA31 Elevation: — Maximum Allowed: 4 ctualHeight: A.D.U. CREATED?VKc SUBDIVISION: I LEGAL NONCONFORMING LAND USE- DETERMINATION ISSUED: .Z+- NewBPPIanningDataForm.D0C W Critical Areas Checklist Site Information projectName: '"permitNumber: Site Location: Property Tax Account Number. 04�10004e Approximate Site Size (acres orsquare feet): 1 SS5- Have you filled out a Critical Areas Checklist for a project on this site before? 0 General Site Conditions 1. Has the site bem cleared or logged? 00 Date of most recent action: Soils / Topograt)hy 2- In the Snohomish County Soil Survey, what is the mapped soil type(s)? 3. 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 over a horizontal distance of 66 feet.) )Billy.- slopes present on site of more than 15% and less than 30% ( a vcrti--1 of 10 fea of horizontal distanm) -RgtEIVED Steep: grades of gMter than 30% present on site. JAII 1 4 2003 Comments 4AAMi UP-YW%fJ PERM OUNTER Hydrology/Vegetation. - 4. Site contains areas of year-round standing water 00 5- Site contains areas of seasonal standing watec 00 Approx. Depth: 6. Site is in the floodway - 00 floodplain VJO of a water course. 7. Site contains a creek or an area where water flows across the grounds surface? 00 flows are year-round? _ANLO Flows are seasonal? 0 a 8. Site is pri'marily: forested meadow ;shrubs mixed 9. Obvious wetland is present on site: 10. Wetland inventory or map indicates wetland present on site: 11. Cnitical Areas inventory or map indicates any Critical Area on site: /Y C/ Revi 4— Determination Number-. Plann,tr Rc� 3127/92 OWNER ..... .......... ... .... s .................................................... CONTRACTOR J'-4� . ......... ................ ... ...... . PERMIT NO (e,' � STREET ........... 4, -0 -s' HOUSE 1�0. ... ....... AVENUE LOT No . .... . 5 ......... * ...... ...... ......... . .............. BLOCK No . ................ ........................................... to riv Wvr &1e., r NAME ADD pj'L4),#,,a - ............... ....... I ...... ...... ............ ......................................................................................... ..... ..... rV. Lu, g e, - �1� �C -9 ��t 07r s - Lo s,-'e" ;'o 7 X'4vk. tv, , co v- v%'e IS 46' �&a S a 1�ck 4tl, 40 r Yo' VN Date, BACKYILL WORK ORDER ISSUED ........... ...... .......... DEPOSIT, ............ SEWER WORK ORDER ISSUED ........... .......... ............. APPROVED WAR 9 1964 . ... . ....... .............. A., _11 I j- 4 J7 C. 191), *City of Edmo*nds PERMIT NO: - WW SIDE SEWER PERMIT PERMIT EXPiREs_qAaL&). laoal LID # Address of Construction: o Property Tax Account Parcel No. z2 -7 04c2q 00 3 o,5- / 0 0 Attach copies of all access and utility S'djor Contractor: ' C 'k Contractor License #: ()-AD AD A' 0 Single Family r-1 Multi -Family (No. of Units F� Commercial (No. of Units - M Public and Approved by Iding Permit #: Invasion into City *Right -of Way: El Yes XNo *RW Construction Permit # Cross other "Private Property: Yes )<No "Attach legal description and copy of recorded easement. Owner or contractor signature and acknowledgement statement: .By signing for this permit I certify that I have read the City's public handout entitled Side Sewer Specifications, and shall comply with all City requirements outlined therein. Date W CALL DIAL -A -DIG (1-800-4*5555) BEFORE ANY EXCAVATION W W FOR INSPECTION CALL 425-771-0220 extensio e_- 24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED. Job Site Ready YES NO —Date: Initial: Partial Inspection: Date: Initial: Partial Inspection: Date: Initial: FINAL INSPECTION APPROVED: Date: uilt to Street File: El f k? i UT- f� PERMIT MU8T BE POSTED ON JOB SITE t- White Copy: File Green Copy: Inspector Buff Copy: Applicant L;temp;bldgforms-,sspermitjlg4/00 m3epON VNIMVMG _0 SINN P9 cl tvu '�oi'v Is W/I 00-4 :3.Lva 9A s;�I' .9,03 2(211-:� G7-1 JIVN P 'Q 5CP tj Nmvua :.ke a AONddV 110-101 1 a-ivos wick [ '.H ISA 000.'F, H.09N�U�15-, SJ-*4�12N,97 +1 ((nsV4ns;,v) jsb000l� I -lztw;��p AcNvs hol.LV,21A AA08t ddY =15ct Ole= C1101 -IV-LO.L NV`d Or lAdO3 A113 .451 19 = (avol QWG cl�OH2 MIN 4S4 01 = Q'Vol CVSCI (:3'60H7 80J. �!ilv,)N f7ign.7 Ora N'VHI SG�5-1 1711-4'�:Ir? 19N/6�1'205P -19NIC"�91Z �Q G z -- aw-1 CNOH2 JOLL S5n�U :100,'4 LO 7S.- .7r G)�7 G)-7 KA "7z 0 N ±-0/— 7-mTr- U-21HIO umewnN -LowuMd 111; 1 H N V IVIOI:1=10 '00 f:D .:BIVO (13AOHddV -.5 1 I "�WHAUX-n- F T8BNhA0 I W-mm-m-mm IMN lf�- ad ILY- 1-7(Y-f -Ssa8aav al )Vt. u p >180M lN3VVlHVd3G 6 mine 'S(INOVVC]3 Jo A-Ljo 6 96w ZOOZ- I -L OAT, 430JJE[ I 1164 nN ONINNVId Ag 03AOHddV 2t Z: r 0 19 �5( :Hoorla 7q :TIWL smouvriaxiva iLaouvit�msium aD?M,TJTAJOD HUOD Af)HHNH 2 V-5 i'01 x"1101 �epl X�I. 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