22042 99TH PL W.PDFlill 11111111
1 9775
22042 99TH PL W
RECEIVED
4z-
"Nothin�p thisg%tolpPerrO PrOOess shall be SEP 17'2013
JnWrpm a r P �ttl APPROVED BY PLANNING'
. �g �10
'isaintenance [11'any cunrently existing 1114al, DEVEI-OPMENT. SERVICES
building, structure COUNTER
Rgriconforming or u�
iltside the scope of the
or site condition whic is 0
Irmit application regardless of whether such
ruilding structur; or condifion is shown on the
structure or
site Ian or drawillg. Such building, Dnq(l
conSition may be the subject of a separate
enformnent action,!
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ENGAWEERN G-DIVI S 10 N
Q AS NOTE
CITY OF
EDMONDS
BUILDING
DEPARTMENT
WORK ELTZ
- 1
ADDRESS -Z, -,70-Y-
-
�
OWNER
APPROVED DATE*
BLDG. OFFICIAL
PERMIT
NUMBER
P-X-D 2-o 13 - /013,
FILE
to""TREET FILE
q �� p C, '. 0
I'D -
STREETFILE. CA FILE NO..
Critical Areas Checklist
Site Information (soils/topography/hydrplogy/vegetation)
1. Site AddressALocation: �-az o tz - 9 A Lj
2. Property Tax Account Number: 00 1
3. Approximate She Size (acres or square feet):
4. Is this site currently developefflo
_j:L_jes; _ 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 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. b Approx. Depth:
7. Site contains areas of seasonal standing water. Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain, of a water course.
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 wedand is present on site.-
RevOl/0094
11liq
RECEIVED
&90 .19', -
City o fEdmon&
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 histher 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 histher representative,
must fill out the checklist, sign and date it,
JUN 14 1994
COMMUNITY SERVICES
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a of the
subsequent steps necessary to complete a
development permit application.
Vilith 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 Checklist to assist
staff in completing their preliminary
assessment of the'site.
I have completed the attached Critical Area Checklist and anest that the answers provided are
factual,- to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Lie-, A t-
Nam
� �L 0 � ;L — � �i '1' 'A
Street Address
Applicant Representative:
Nam
Stred Address
t�dpk-l>i&5 tj--L 9YO"2(-)
City, State, ZEP Phone city, state, ZIP
Signature Date
Signature
Phone
Date
"OrREET FILE qq -L9
CA FILE NO
Critical Areas Checklist
Site Information (soils/topography/hydrplogy/vegetation)
1. - Site AddressALocation: aa c,> YA - 9 A- - LJ
PAT
2. Property Tax Account Number.- A i 6 o i v c> .5 0 D CZ1
3. ApproAmate Site Size (acresor square feet): —
4. Is this site currently developed? V yes;_no.
If yes; how is site developed77-
5. Describe the general site topography. Check all dLat 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).
Irdir. 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 greatw dm 30% present on site (a vertical rise of 10-feii over a
. horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standingwatw. 1'—ib__;Apwx.DV&-
7. Site contains areas of seasonal standinj water: Approx. Depth:
What season(s) of the year?.
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? H- Flows are seasonal? _ (What time of year?.
10. Site is primarily: forested meadow shrubs mixed
urban landscaped Qawn,shrubs etc)
11. Obvious wedand is present on site.-
P-VOM"4
*Sod 1941.4
City of Edmonds
Critical Areas Checklist
The Critical Areas ChwMist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds
to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable
city staff to determine vohethcr any
potential Critical Areas are or may be
present on the sul:ject property. 1he
information needed to complete the
Checklist should be easily available ftom
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or histhcr representative,
must fill out the checklist, sign and date it,
RECEIVED
JUN 14 1994
COMMUNITY SERVICES
and submit it to the City. Ile City will
review the chec)&4 malm a precursory site
visit, and malm a of the
subsequent steps necessary . to complete a
development pwinit application.
With a signed copy of this form, the
applicant should also submit a vicinily map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcd(s). In
addition, the applicant shall include
other pertinent infonnation (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assIst
staff in completing their preliminary
assessment of the'sifte.
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:
&
Nmw
C> 17, "a(
Street Addr=
Applicant Representative:
Name
Stred Ad&=
C-d - PA,�k "e5 L'JeL 9,?0,2 () ? 9
city, state, ZIP Phone cily� StatC6 ZIP
Phone
Signature Date
Signature
Date
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
400-06600
OWNER........... Alan-L.... Keaton ............................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... g2.042 ... 99.th .... Pla.ce --- W ................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
.. ....... ..... .... .. . .. ..... ...
0
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
NOTIC�:
a.
-N'O...W.a r-r a
The.infor . mation'shown on the attached
map(s) was com - piled for use by the CitY 01
Edmonds/ its Empl.oyees and Consultants.
nt the
The City of.'Edim.onds does. not . warra
f anything set forth on these
accuracy 0
map(s). An . y person or entity -requesting 3
copy should c:onduct an independent
Ion shown-c
orm'at*
inquiry regard'ng the infi
I
tHe -M a P (S) 1; including, but not i'mited to/
n of any sew-er stub shown, Su(
the locatio
exist and ma�
sewer stubs may or may
t the location shown,
or may not exist a
Neit-heir the City of Edmoinc-41S, nor its for
emp`o-yee-s O-r office-rs sh.al-1 be 1--ja-b-l-,e
information given On this map(5), nor for
entation provided based
any one repres
upon'said. map(s).
0 STREET
F ILE
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
joa
ADDRESS
6;?R 0 4 CR, -
SUITE/APT
7X
#
( �,6 -� 5 we, it L
LEGAL DESCRIPTION CHECKI SUB VISIOVO.
LID NO
MAILING ADDRESS
11.
Z
0 P 0 PL
)1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 13
CITY ZIP TELEPHONE NUMBER
(AA 5 2 Y- or,,;?
EXISTING - REQUIRED DEDICATION
RW Permit Required C3
- Street Use Permit Req-d 13
NAME
OSED
inspection Required 0
Sidewalk Required
cc
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
U)
ADDRESS
0 NO 0
0
REMARKS
Z
cc
cc CITY zi PHONE NUMBER .
w
LU
NAME
Ow to cv-
cr ADDRESS
7 /C d 7-10 X) 4;1 4)4,1L) lfllo!�
ENGINEERING MEMO DATED
REVIEWED Y
CITY ZIP TELEPHONE NOM13ER
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA SEPA REVIEW
Legal Description of Property - include all easements ALLOWED A) PROPOSED COMPLETE JEXE
A 4- 1 1
I
VARIANCE ONCM I n ZkANN4N(rAE4?IEW BY
FRONT / -,/
,o SIDE / IZ.� REAR
HEIGHT
Tax Account REMARKS
Parcel No. 00� 00
NEW RESIDENTIAL PLUMBING
EfIDDITION COMMERCIAL MECHANICAL
la"REMODEL APT. BLDG. SIGN
G"ADy FENCE CHECKED BY i TYPE OF CONSTRUCTION CODE
1:1 REPAIR e1T -7 cy6s. E _FT)
L_j DEMOLISH
L_j Wo""v SWIM POOL
INSERT Li HOT TUB/SPA
SPECIAL INSPECTOR AREA
REQUIRED 13 YES
GARAGE '
RETAINING WALL/
1:1 c
E] ROCKERY RENEWAL
REMARKS
-Z
0
EOFUS EIUSINEPOFIACT.IVT��IEXPLAIN'
T3
PROGRESS INSPECTIONS PER UBC 305
1.4 VC5 I'd e- C4 c e-
NUMBER
NUMBER OP
CRITICAL
a
OF
t
DWELLING
AREAS
to
0
ST RIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
L;1-7—
FINAL INSPECTION REQUIRED
A)C,.) r-04- Sc,�,55o.-i Lr(&J5r :5
VALUATION
PLAN CHECK FEE
C4 A 0 5 P, _5� ef C14- e
BUILDING
1?1_2
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No. 0,
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns,and
ENG. INSPECTION FEE
NG- INSPEC
successors in interest, agrees to indemnify, defend and hold
.1
12
harmless the City of Edmonds, Washington, its officjals,
2
<
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0
X
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
0
TOTAL AMOUNT DUE
provision."
FEE
Z
Z
Q.
JOCCUPANT
LOAD
Z
to
, "ereuy acmnow euge , at ave.e. & s api, ca on; a
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and,
state laws regulating construction; and In doing the work authoriz.
THIS PERMIT
AUTHORIZES
T his application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
.
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy;and fees are paid, and receipt is
tion Insurance and RCW 18:27.
INSPECTION
acknowledged in space provided.
SI 7NTURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
0 ATURE DAA
CITY OF
EDMONDS
ATTENTION
CALL FOR
VTE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
102-87