22507 95TH PL W.PDF111111111
9353
22507 95TH PL W
CAFILENO
Critical Areas Checklist
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Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Locati.on: 905-o-7 - qs-% PL�A-e-e t-�s7-
2. Property Tax Account Number: 5-Yq3-opo07V- onns'
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _Zyes; — no.
If yes; how is site developed? KOUVC.6'
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire
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 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Wo Approx. Depth:
7. Site contains areas of seasonal standing water: 1110 Approx. Depth:
What season(s) of the year?
8. Site is in' the floodway No floodplain_ M 0 of a water course.
9.. Site contains a creek or an. area where water flows across the grounds surface? Flows are year-
round? 14 0 Flows are seasonal? M o (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) v-'-
11. Obvious wetland is present on site: t4 0
4:�V' 11r, — 417— 00
City of Edmonds
-VW CRITICAL AREAS CHECKLIST 5W
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
p 't application.
errm
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. 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 Areas Checldist and attest that the answers provided are factual, I to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
DAVID JE�J-GF�J
Name
9 CTU -ST
Street Address
�D/VLOAJO S, 'W14 �p 2,o
City State Zip
7-7f
Telephone
Signature
Date
Applicant Representative:
,41- CzAJ45-d
Name
ST.
Street Address
C-bLOAJ&S AIA- 16PO2-o
C ity State Zip
7 7 6 73 7,3
Telephone
Signature
Date
creceptlon\janakad.doc
(over)
PLANNING DATA
NAME: DA\J 11). TFNSIEN
SITE ADDRESS:12-'507 26114 ft-.W. DATE:
ZONING: —PLAN CHK#:. 00 -2)07
PROJECT DESCRIPTION:
CORNER LOT W),—(Yes/No)
SETBACKS:
FLAG LOT W6, � (Yes/No)
Required Setbacks:
Front: 2,151 Left Side: -7 VS I Right Side: -7 IJ2-1 Rear: I
Actual Setbacks:
Front: Left Side: 91 Right Side: Pb Rear: -7 S'
Street map checked for additional setback required? __(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED— (Y/N)
LOT COVERAGE:
Maximum Allowed: '31G2,&�/51372-S—Actual:
BUILDING HEIGHT:
Maximum Allowed: 05' Actual Height:
Datum Point: - Datum Elevation:
A.D.U., CREATED?: MO,
SUBDIVISION: VIO
CRITICAL AREAS
SEPA DETERMINATION:
LOT AREA: 115,300 FT -
OTHER:
Plan Review By:
t3-1 -oo,
14 1 ACT-
c:Ti1es\peffnjtNAp1andaLdoc
I I
DATE RECEIVED [PERMIT EXPIRES 10 IIIia/
7 /,of VO
CITY OF EDMONDS
7CONSETRUCTION
USE PERMIT
ZONE C-If2 '20,0'a
95 NUMBER , E.47
PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEPSUBDIVISION NO.
0.
LID NO.
LID FEE $
P?Qr> jem-51iff—Ai
CC
MAILING ADDRESS
'TST"41PLAC-C WEST
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
RW Pamilt Required
EXISTING — PROPOSED
Street Use Pennit Req'd
Inspection Required 0
Sidewalk Required C)
CITY ZP
I
TELEPHONE
6P111.0AQ)S ?p z 0
f4r- 7 -7.?- 7`5�/
REQUIRED DEDICATION— FT
Underground
Whing required 0
NAME
ME�!"R SIZE,
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
14—L— ce
I I
Y ES 0 NO3<
ADDRESS
REMARKS
z
z
30 5T-
N ONTRAC&� 2ES2SLBLEC9AEROSIaCO= INAGE
69
a
—
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CITY ZIP
TELEPHONE
6-DA4oNDS
�42s-776-7373
C, ea±G F-
NAME
Cblll - .37VC.
I
MENGI'.NEER*_1`NG'
—REVIEWEDIDATE
ADDRESS
-5 11 -
iC
. FIRE REVIEWED BY DATE
CC
CC
6Q17g I .�. ...
CITY ZIP
TELEPHONE
2
Ir- 27, /027 5 5 3
IZA.
: � �. VARIANCE OR CU
'.. .., . � .. w: . . ;. .
SHORELINE OR ADB#
INSPECTION
I REqD
BOND
POSTED
STATE LICENSE NUMBER EXPIRATIO DATE
CHECKED QY
..
:
0 YES 0
.��POMPLETE, :;EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
Qj
PROPERTY TAX ACCOUNT PARCEL NO.
zi
S-qq 3 020 - 074 020S
EXP
I
NEW RESIDENTIAL, PLUMBING MECH
LOT 66VOAG'E'
.-ALLOWED. :. I 1 1,
PROPOSED
REQUIRED SETBACKS (FT.)
.
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
Ca"'AUDITIO'N 0:, COMMERCIAL COMP LIANCE OR
�Vi �115
9/IE)i 75;
z
2
:.PHANGE OF USE
1:?'-REMODEL C] . APARTMENT - F-1 SIGN'—
...
REO PROVIDED—
:LOT AREA
UINN G R 'VIE DATE
0.
C] GRADING FENCE..—.
REPAIR CYDS C3 FT)
HEMAR S
DEMOLISH 0 TANK, 0 OTHER:
z
o GARAGE 0,-RETAINING,,WALL, RENEWAL
CARPORT -:ROCKERY, .0
9
(TYPE OF USE. BUSINESS OR ACTIVITY.)_.EXPLAIN:
CHEC
TYPE OF CONSTRUC;ION
CCUPA
OCC
CU
0.
.
V
GCOUP
NUMBER
OF
NUM BER OF
DWELLING
CRITICAL
AREAS OP
00
Lu
0
SPE IAL INSPECTOR
AREA 6, CCUPANT
o
STORI ES
UNITS
NUMBER
REOUIREID 0, YES.
I Fq 4(40 LLOAD
DESCRIBE WORK TO BE DONE
AlzA.,- 2-
REMARKS
PFIOGRESS,:INSPECTIONS PEWUBC108/FINAL INSPECTION REO'D
0
_j
C
A 6/-
AV -
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLORE %
11-ki
BUILDING
611 L_ F, 14, + :&_ i_),
PLAN CHECK NO: OC)_30 7 VESTED DATE
I
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
—pip
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
.j SEPARATE PERMISSION.
STATE SURCHARGE
Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
uj IN INTEREST, AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY OF
_j
lAN&6eArMG
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
"&P6&TIf%rl`EE S. 0
M< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
jd4AIZW/0.� C)
RECEIPT
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT 2_
/S63f_
_j
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
RE71
TOTAL AMOUNT DUE
47T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT., AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
'APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This ap lication is not a permit until signed by the
CALL p
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
,
Building Offici I or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW` 18.27.
SIGNATURJ� (91NER ORjr9jNT�) DATE SIG
>'ED
LS GNATURE 0 TE
(425
J/0.
'711' �/00
Al
771-0220 =01
ITELEASED Y DAT9
ATTENTION
EXT1333
ao,
/0////Ool
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
/_O�1, INAL - FILE - YELLOW - INIPECTIR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK - OWNER - GOLD - ASSESSOR
I
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SITS PLAN
Z 50 -7 - 9 S-M rL, w �-,!7,r 5C.-ALE 1* = 20'
A7 ;D�Y L /NING
AS EM6 00
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ACV f?USAoLoe-r---S
K�ONAAWS
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21,
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RECEIVED
OCT 17 2000
NORTH PERMIT COUNTER
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