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22317 95TH PL W
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TAX ACCOUNTIPARCEL NUMBER:QD54A2QQ2.0[30D
BUILDING PERMIT (NEW STRUCTURE): I g 62-j
COVENANTS (RECORDED) FOR:
CRITICAL AREAS :-06 * I la DETERMINATION: El Conditional Waiver 0 Study Required *Efwaiver
DISCRETIONARY PERMIT #
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: 10145-10(o
- -k- F.
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
I
LID #:
L 0 T: - k 1.7, BLOCK:
LATEMP\DS'Ps\Fonns\Street File Checklist.doc
0 PLANNING DATASTREET FILE
1111.�-, - Vf, 0", -
NAME: J0rjjj U19&rL4a
SITEADDRESS: P1 DATE: 10-0-3-2-006
ace, Wzbt PLAN CHK#:_b��- �4
PROJECT DESCRIPTION: gemov-& eyl,!5t1yj9 oaraP., add n-cw @ar-aq
_a4ld,
REDUCED SITE PLAN PROVIDED?: &`s� No)
MAPPAGE: 104 CORNER LOT: (yes i FLAG LOY: (Yesj(R
ZONING: P-5 — S CRITICAL AREAS DETERMINATION#: 20065-011-f-
Study Required:
Waiver
Ll Conditional Waiver
SEPA DETERMINATION:
C3 Fee
C1 Checklist
C3 APO list. wl notarized form
Ll(Needed for 500 cubic yards of g(ading. Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
a Exempt .0 g(adfrig popo.�'e'd,
SETBACKS:
Requifed Setbacks:
)Street': �V Side: 3'51 R e: car:
C19MP1.WQy tuft ight Sid R
Actual Setbacks:
Street: t�?' Lreft Side:. RifrW Side: Rear: el -P
Street map checked for additional setback required? (Yes I No I
DETACHED STRUCTURES:
, C
LJ ROCKERIES: N 0 nP, c2VI 0WVj .7 h 0 W r) j tr, p a V1
Ll FENCE SITRELLI SES: N"p, C 0,y) 6 i ir, P I a yj .
�7VIOWyj Oy) C7i_jr, PILIV,
BAY WINDOWS I PROJECTING MODULATION: 60L4fyj tv
, p Y!oj� e
STAIRS /DECKS: N OYI C, C-7" 0 V V1 0%n C �,?
V 7 p Ll y) - C_ _+--k7o V ��)
PARKING: Required: Actual.- 7e
LOT AREA: 13
LOT COVERWGE:
Calculations: (,,0VtyA3U
A
BUILDING HEIGHT- D
DatumPoint: EAP,&- pu)� PL- W DatumElevation:
Maximum Allowed:— 011'.0 1 44 Actual"eight: —C'
A-D.U. CREATED?: (ELYes
J C)ne, ��tt*j" C71n I)WrV.
SUBDIVISION:_P1i1fjAr_,rc,,�, E2jy- ()Dj, r)-po TP--1?7.
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED:
OTHER:
ju.0
t18-0
115.6
41_(0- 6
L+ -=
119. 11,16
AV&r1q3e, G"10U-
+ 2�vj) _:�
Plan Review By: LA'�4 J (Jo Ut4t,-/, 144-isl,; M04
Ne%vBPPIannjngDataForm_D0C
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: Da317 q4- F� 1^,/ EA
CA File Noj_25 7
2. Property Tax Account Number: 3� Go
3. A proximate Site Size (acres or sq7feet): J�,'760 Sri
p
4. Is this site currently developed? _ yes; — no.
If yes; how is site developed? 6wre'11141t' Jf1k rine, csbi�k 4�;&
5. D ribe the general site topography. Checlk`all that apply.
7 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: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the fl6odw�v 'o'
floodplain f a water course.
9. Site contains a creek or an area where water flows acros S thegrounds surface? Flows are year-round?
Flows are seasonal? (What time of year? Y
10. Site is primarily: forested shrubs xed
J
ZZ
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
------- — — ---- For City Staff Use Only
1.
Plan Check Number, if applicable? 0 vie-, j�j i \[-CA
2.
Site is Zoned? RS-S.
3.
SCS mapped soil type(s)? E5` A I AtA-mvP 04 - 000 aYl I a Y1 61 W M P Ity 2, 2; 1- S 10 j2C _'5
4.
Critical Areas inventory or C.A. map indicates Critical Area on site? NOY)e, ShQWV1-
5.
Site within designated earth subsidence landslide hazard area? NQ-
DETERMINATION
STUDY REQUIRED X WAIVER
Reviewed by, j2 LIkIrA—,l Date: Of) C5-
hm
Critical Areas Checklist.doc/3.25.2004
OV D #P20
0
Date Received: 0'3 /11 1,0 0
City, of ?�dmonds
City Receipt#:
Development Servi6i�'D
Planning Division 1U Critical Areas File #: 71005- It 4—
Critical Areas Checklist Fee: $135.00
Phone: 425.771.0220 12005
1 Date Mailed to Applicant: 6-18-Cro
Fax: 425.771.0221
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on th'is form is to A property owner, or his/her authorized representative,
be filled out by any person preparing a I I Development must fill out the checklist, sign and date it, and submit it
Permit Application for the City of Edmonds prior to to the City. The City will review the checklist, make a
his/her submittal of the application to the City. precursory site visit, and make a determination of the
bsequent steps necessary to complete a development
The purpose of the Checklist is to enable �ity staff to su
permit application.
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information Please submit aLjvEici1n!itDyLEmM along with the signed copy
needed to complete the' Checklist shoul I d be easily of this form to assist City staff in finding And locating the
available from observations of the site or data available at specific piece of property described on this form. In
City Hall (Critical areas inventories,, in oil addition, the applicant shall include other pertinent
surveys). information (e.g.. , topography map etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/hernis heirs, and assigns, in consideration on the processing of the application agrees
I
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
I
attorney's fees, arising from any action or., , infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its agents or employees.
By my signature, I certify that the infarmat,ion and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file thi lication on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
Property Owner's Authorization
By my signature, I certify that I have a,
and grant my permission f6r the public
purposes of inspection and postingatje
SIGNATURE
Owner/Applicant:
-C/r
J V) 1--�
Name
I ---, �� --� I A
e- '7 D-
N- I-- I
I the above Applicant/Agent to apply for the subject land use a i li�a'tion',
pp
and the ' staff of the City of Edmonds to enter the subject property for the
this,,,4pplication.
DATE
City State Zip
Telephone:
Email address (optional):
Applicant Repr�sentativc:
- 9 cl� cx� - 2�1 1_-_r-A:;�--
Nkuee'
--:reem,5�d Aif AZ
Street Address
City State Zip
Telephone: r-,206-p
�Oen Email Address (optional):
E - , . -T
EXEMPTION FROM CONTRACTOR REGISTRATION
VERIFICATION FORM
The undersigned property owner or contractor has applied for a building permit from the City of
Edmonds and claims that he/she/it are exempt from providing contractor registration in accordance with
the provisions of RCW 18.27. The property owner, by their signature below hereby verifies to the City of
Edmonds that:
0 Value of work under $500.00. The aggregate contract price of labor and materials
and all other items required for the project is less than $500.00 and is not part of a larger
opertation to be undertaken on the property. The person employed to do this work has not
advertised nor otherwise put himself forward to the permittee to be a contractor or
qualified to engage in the business of a contract. RCW 11,27*090,9),
Work performed personally on own property. The undersigned verifies that all work
done, under this permit will be done by the permittee personally on his/her own property
and that the improvements constructed on the property are not being undertaken with the
intention and purpose of selling the improved property.
0 Commercial property exemption. The permittee is the owner of commercial property
and the owner's own employees will perform all maintenance, repair and alteration work
on the property. No work will be done by contract under the permit. RCW 18.27.090(13).
0 Licensed architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, licensed electrician
or licensed plumber operating within the scope of his or her license. RCW 18.27.090(14).
0 General Contractor. The owner is the General Contractor for the project and is required
to hire a minimum of two licensed subcontractors (unrelated building trades or crafts). The
general contractor is responsible to verify all State licenses of subcontractor. RCW
18.27.010
THE UNDERSIGNED PROPERTY OWNER HEREBY VERIFIES THAT ALL
INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF HIS
OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE INFORMATION
PROVIDED ON THIS FORM IS FALSE, HE OR SHE UNDERSTANDS THAT THE BUILDING
PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
Dated this _ day of � 20_
PROPERTY OWNERJPERMITTEE
WITNESS:
Print:
LATEMP\BU1LDTNG\F0RMS\ex,cnT contractor regis verif form.doc03/28/01
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Chapel 22f
City of Edmond's I HUI flLt Per.rnitNo: 61VO-WIV,
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue DateAp - /
3 Llo6
f
A. 'Address or Vicinity of Construction: 11-1-31-1 g5ft
B. Type of Work (be specific):
C. Contractor: 774, We_e" Contact:
Mailing AddTe's's: 124 Phone: go4p JYF,- X1 7
& 'd 09
State License #: Liability Insurance: Bond:$
City Business License #: OftA� e)X4,VL,,+4 f
D. Building Permit #, (if applicable): C%r171 Side Sewer Permit # (if applicable):
E. F-1 Commercial Subdivision City -Project EJ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
F-1 Multi -Family Single Family bther
INSPECTOR: Mmaunt
IW %— - - - - — —f - , -
F. PAVEMENT CUT: F1 YES 0 G. SIZE OF CUT x
CONCRETE CUT: [_1 YES 0
G. [I Mail Approved Permit F-1 Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Ap��icant understands by hislher signature to this application helshe holds the City of Edmonds harmies�s from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that ma - v be made against the Citv of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
"costs and attorneyfees-by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITYFORCES, AT WHICH TIME A DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
# Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification veri ing completion of the
y.,
required training in their possession.
# Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City-
appro�ed material prior to the end of the workday - NO EXCEPTIONS.
+ Three sets of constr uction drawings of proposed work are. rgquired with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE�ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Xoht) C)WAO
-CITYUSKONLY
.,FOR,:
Approved -by: Ri gh t qf7,WayFe*e:
Tim e Authorized: Void: After-. U�61[]ra i tt/ Disr'd0ti6ivFe0/Fdh
AAP--, "OMAO Ifisp'e I c�
Special, Con d itions: e J(4 666 Fee
,,91,4475 Totql-,Fe-'e: L
Recei0t.,No..- .
lssued`by,:�- 1 170
- �K;F&ArA
REQUIRED INSPECTIONS:
Call 425-771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK:, & "oQ 4Ao_1e,0( F/Z36-7DATE:
Inspe'ct'o_'�x_1s'_Sig`_ n�ature
CADocuments and Settings\CurtisNy Documents\Fonns\Engnmg\ROWpermit_.doc
Revised 10/01/03
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t,-Iinimize the amount o� existing vegetation that you must disturb �or construction.
Keep out o� sensitive areas and their bv��ers.
All disturbed areas shall be, covered and/or mulched �Nithin 12 hours, i� they ore, to
remain unv�or�,ed �or more, than 2 clays. (-7 clays �rorn May. I to 5opt. 50)
Areas not belnc3 v�orkecl �or 30 clays or more, shall be, vec3etoted, unless the,
r-.,ounty determines that Ninter v�cother makes vegetation establishment in�eosible.
IF this is the, co5e, it must still be, more, permanently stabilized, usinc3 methods such
as bonded �iber matrix, or other more stable 5MF's.
51opas and stockpiles 5H:I\/ or steepor and more, than 10 �eot o� vertical rolie�
shall be, covered i� they ore, un�Norkod �or more, than 12 hours.
All areas not being v�orkecl prior to October 1, and are, being seeded, shall be
sooded by September 25. Mulchirc3 is rec�uired to protect all seeded areas until
an acloopote eroNth is established.
Areas that are being hyclro5ooded shall have a tocki�lcr mixed into the
hydrosood to help stabilize, mixture, onto the, soil.
F-nough cover material to su��Iciontly protect all disturbed areas shall be,
stockpiled on the, site at the beginning o� the, v4ot season.
Perimeter Frotection:
Perimeter protection to �Ilter sediment �or 5heetvNosh shall be, located doNn5lope
o� all disturbed aroo5 and properly lr5tctfI&0 prior to upslope, eroding.
50 Ilrear �eet o� silt �erce per ocre, dncl th'a'\necessary stakes to hold the �ence
in place, sholl be, stockpiled on -site. // \\\ \ ENC.H MAR< ELEC.. E30>
120.0'
WATER METER
POWER VAULT
—ss— SAN. SWR. PIPELINI
I
Zone Comer Mg
S Ri Actui
Setbacks Enuired ctual
I
Front
Sides
Rear
Other -7
RIGHT-OF-WAY CONSTRUCTION PERMIT
AND INSPECTION REQUIRED
X
X
r
ADD GUTTEF'n,"7,,OWNSPOUTS
AND st-LmiHBLOCKS
WATER SEWER
INSPECTI NS REQD
CALL 425-771- 220 EXT. 1326
S"Nowai :10 /U13
'L"'vuHvd-30 ervidithe
5001 9 � 130
ensa&j
ACCEPTABLE TMHJ
MATERIAL
SDR 35
SCH 40
N -12
F810 HANCOR
V ,�*r
(;z
APPROVED AS NOTED
BY ENGINEERING
Date:
GUTIM' ADOWNSIDaffs
TO CONNEC7- TO EXIST. SyST.
OWNEFUCoNTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
TEMPORARY CONSTRUCTION
ENTRANCE REQUIRED
IMI=ER\\/IOU5 5URFAr-.,E r-.,ALr-.,:
EXIS7. SUILDIN6 ROOF OUTLINE : 2665 SF.
EXIS7lNr--; r..O\,/r-RED FORr-.,H : l2aSF.
EX1571NC5 r;)RIVENA",r : 111�-7 SF
EX1571N6 PATIO : N/A
PROP05ED ADDITION '71-75F
F'ROF05ED SARASE 5565F
FROP05ED 1�)Er_-,< : N/A
EX1571NS BUILDIN67 ROOF OUTLINE TO BE REMO\/EL;� -701� 5F.
EX1571NS C.,O\/ERED FORr-.,,H 70 BE REMOVEI;): N/A
EX1571N(5 1'_-)RIVENA"�r : 1155 5F
EXI57IN& 6ARASE TO BE REMOVEI�) : 622 SF
A Pi 0 9; A "0)-7 "t=
REMA I N
HT 122,,&'
4.
L A IN
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LEGAL EDE52RIFITIQN.. FARCEL LDESCRIFTION LOT CQVERAG�E,
ADDRESS: LOT AREA 1-710201
2251-7 :�15TH FL K EXISTIN6 5UILDIN0 AREA 211101
EXISTINO SANITARY' 5ENER EDMONDS, NA EX 5T N6 TO BE REMO\/ED 663,
TO BE RE -LOCATED ZONINO: EXISTIN6.7 BUILDINr--7 TO REMAIN AREA 116251
6 R5-a PROPOSED ADDITION AREA -71,71
FROPOSED ADDITION TAX FARGEL #
I YNU �� I UKT
AREA = -71-7.00'
TOTAL SOIL r_.,UT $ FILL:
CUT: -7
F ILL: 5 "rDS
REMAIN ON SITE 4 '*rD5 (SFREAI'�) IN FRONT'�rARD)
Zone - �5— a Corne'Aff) Flag . IVO
Letba,
cks
AMUi_,,d
Actual
Front W
k�
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Sides
Rear .
Other cy
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ReLaLt
LL
L � ��-4.
1150
SG.f-'=T.
Sa.F7.
Sa.F7.
SO.F7.
Sa.F7.
707AL PROPOSED L07 CO\/ERAC-;E 2 164' SO.F7.
96" BU I LD 1 N6/L07
AVERA6E (5RADE = Ilcf,15'
MAX ALLO�NrD R16DE HIE6H7 = ll,�.151+ 25' = 144.15
PROF05ED HEI,65HT = 145.55'
APPROVED BY PLANNING
..... .....
B R I A N
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C, H I T F_ C, T S
M1315T AVENUE NE5T
5EATTLE NA 16111
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SITE PLAN
r%wr om mom FILECOMPUTER FILE NAME
WREU 25061-5
DA TE
05.25.05 REV 10/28/05
RESUj? SHEET NUMBER
OCT
Sul DIN EPAR ENI 0000,
8 y G 7M
C17 OFDEDMONDS
UNPUBLISHED WORK (D 1999 BY R.BRIAN CORBETT ARCHITECT
O.S-q�S-7
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