22706 92ND AVE W.PDFiiiiii iiiiii
8974
22706 92ND AVE W
City of Edmonds
U *
Critical Areas Checklist
ne Cd&:g Ann OwIffist card2ined an
this form is to be filled out by any person
prq)adng a Devetopment Permit
Application for the City of adMOO& pnor
to hi&4m submittal of a devekqnnent
permit to the city-
7U Puqxmof the, Checklist is to enable
CitY gaff to determine whether my
potential Critical Areas are or may be
present an the'subject pmpeq. The
iftfonnation needed to Ownplote ft
Checklist should be easily available from
ObserVatIOM of the alte or data availgbie at
City Hall (Critical Areas invamries, gap,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
aw VARtit it to the city. 7we city Will
Miew &e dzciTut, make a precuramy site
visk aW make a deftmination of the '
Subsequeat steps rzoessary to conTlee a
dcMopumu permit application.
Mith a d9fted =py of this form, the
should also submit a vicinity map
or PRK plan -ROW inRv-@duW 10--ft—of the parcel
with enono deud Oat City staff can find
and identify dw subject paTveks). In
addition, the applicant shaU Include
Odw VfttbMat Wennaflan (e,,& site
phas" topograoy amp, etc.) or studies in
C64unction with Ws Cheddist to "Est
staff in Computing their preliffenury
asessment of the site.
I have completed the attached Critical Area Checklist and attest dw the answers provided are
factual. to the best of m knowledge (fill out the aPPMprIM column b
Y ellow).
Owner I Appacant:
"V
,-Z-Z-706 PAC
AddMW
Appromat Reprawtative:
A g r hzemeg-
Nam
1
16 6.�-) 44V"J
yf�)s W% 9go Z-O WA- QrO,3
City, state, zip
Phone city, Stu&. zip Phone
'7*71- 67Jj--:
sisnaturs
Date SI M Date
S 900 �ah-951-2--
%-A 1*1"- CL -
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
L SiteAddressamWon: ;?7--70& 92-,�Jd flw,,5� tJ
2. ProPertY Tax Aceoutit Number: �4 4 3 -� 20 C) - 0 5 / - 000 7
3. Approximate, Site Sin (&Cres or Mpare feet): i �-c
4. IS this site Currently developW < ya; Vo.
If yes; how is site developed?-- iie) P 6 LO 6
S. ]Describe the gemal site topogaphy. Cho* an dw
-?4� Flat: -less tha� 5-feet eleysem Change over entire ske.
Rollivg: 90M On site gMrSUy I= than 1:5% (a Vertical else of 10-fM -Over
horizontal dismm of S&geg).
HUIr. 'SIOMMMO�SMOf 000"Idum 15% andlessd=30% (averticalrise
Of 10-1bet over a horbwtal, 4ismce Of 33 to 6&feet).
Steep: grades of greaff than 30% presm Ott ske (a verfical lise of 10-fM over a
borizontal disft � of lost *a 33-fed).
Other 4)lease describe):
6. SIM COMains arzas of year-round statuft water Nz) Approx. Depth:
7. Site CORWuS areas of Seasonal stabding WSW. tjc
Approx. Depth;
What season(s) of the Year?.
S. site is in the ftoway �ho, floodpiain of a water course.
9- SIM CORtalBs 9 Cod or M area whom wmer flows arw dw grounds SuTfaW Flows are year-
round? - ' AID Flows am seasonal? . - (What time of year?
10. Site is primari1r. fbrested ; MWOw _:shrubs
urban landscaped pawn,shrubs etc) mixed
11. Obvious wetland is preseAt on site: A)0
For cb� Staff us* only -
I. site is Zoned?
2. SCS mapped $oil typgs)? (0 A-j&L,,tA- Vr g- I zS--14e S
3. wadan� inva" or CA. mq indicata wctiad PICUM on site? 4y")
!-,C'itiC&l Am$ kventozy or C.A. map indirAta Cti&W Am on gite?, K6
*ii.t . a widili deeigWed corth subsidam kmWi& b=rd gra? - Q�A
ae�rzted on the Enviroamen'211Y Selmitive Ams Map? — N.
M300jalz
"SMYREQUMED
CONDMONAL WAIVER
WAIVER
Revfi��
D&W
Pest-WH
City of Edmonds
Critical. Areas Checklist
The. Cefu;g Ann Chedffist carytainedon
this form is to be MW out. by any pmm
prepulng a Development Perggift
Applicad,on for the City of Edmonds pnor
to his/her Submittal of a devdqmmt
permit to the city.
Mw PurPoseof the Checklist is to enable
CitY StRff to determine whether any
Pot=tW Critical Areas are or may be
presmt an ft subject pmpcq. The
inforinadon needed to complege ft
CheckUst should be-eWy available from
obser%tadocts of the site or d= available at
City Hall (Critical Aras invamjes� nqu,
" soid surveys).
An applicant, or his/her reprc=tative,
must fill out the.checklist, sign and date it,
and stibiift it to dw City. JU City will
Veview &E dzciTtst, make a precur=y site
visk, and make a detemination of ft '
SUWequWt Aqm nwnsary to complete a
&VdWamt permit lipplicatim.
Wuh a signed w9y of this form, the
ffl�a5 should also submit a VHWUtY map
or PW pulf for indiViTUW lots'of dw parcel
with ewtO demil that City staff can find
and iden* dw subject pwc*s). In
additiou, the appIlIcant sbafl Include
401w Pertinent infennaflon (e.Z. aft
PlIffis UPOV&Phy mW, etc.) or studies in
C61411311W011 with thits CheckHst to assist
sbff 10 COMPIeUng their pitlinduary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual. to ft best of m knowledge (fill out the appmpriate column
Y below).
Owner I Applicant:
cp'"V Si L"L-a
Kum. I
'-Z-2--70(
o
itreet Add"=
6 �� 9go Z-0
- vror4b.
city, state, zip 67,,Pone
SISUMM Date
Approwt Representative:
/6!5�2-i fiv-'� CI
Straet Add==
L-'Yyv�vwooc
city, State, zt# Phone
'719 A f4p
Date
C�ww�J--" s 44vewe—I 5 -- 909 904-9-S�Y-Z—
0
USE PERMIT
CITY OF EDMONDS
Z 0 E
ZONE NUMBER V(ou�)UL.
,JATION
CONSTRUCTION PERMIT APPLICATION
N
"Oe SUITE/A
ADOR
... RIESS :�,-L 70(o �172rvl-) /,IVC--
OWNENAME NAME OF BUSINESS
LEGAL
LEGAL DESCRIPTION DIVISION NO.
"7
LID NO
M AILING ADDRESS'
(/J,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING ED DEDICATION —
TESCP Approved 0
RW Perinil Required
SIreat Use Pe -if Ril
CITY ZIP
61Mo0/Q-5
TELE'..Nt NUMBER
7 7
71/- 1
PROPOSE
Inspection Required
Sidewalk Required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I AnnRpq--Z
I
I
YES C3 No E3
NUMBER
STATE LICENSE NUMBER IRAT 4TE
3%,Z
To pvtj bi q 9-Ur
1 —1 17% ... riMi— M P—rlt. - .11
Ta
,�'A.,Wn. -5
[XIEW
ErRESIDENTIAL
LUIABINGIMECH
:OMPLIAN EOR
ADDITION
COMMERCIAL
CHANGEOC Use
*REMODEL
1:1 APT. BLDG.
El
SIGN
GRADING
PENCE
REPAIR CYDS.
I X_ FT)
DEMOLISH WOODSTOVE
SWIM POOL
INSERT
HOT TUEUSPA
2<ARR,A-ET RETAINING WALL/
. .R ROCKERY
RENEWAL
:TYP 0 USE. BUSINESS OR ACTIVITY) EXPLAIN:
9A-9A6 C:
NUMBER NUMBER OF
OF DWELLING
1=
�-1 r5
STORIES UNITS
�Z7
DESCRIBE WORK TO BE DONE (ATTA e- PL& PLAN)
eoll Mycr P01-C 6U1(-p1"6
F.oP— t','t*A66 USE
REIIIENEDBY
51ON AREA
SEPA REVIEW
ADS NO.
ALLOWED
PROPOSED
COMPLETE
JEXEMPT
SHORELINE
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
1
1 7/31/5
SETBACKS - FEET
HEIGHT LOT
COVERAGE
FRONT25- -SIDE 7
REAR 15
1 T,
35-7.
REQUIRED YES I (0co IL
HIENIARKS
PROGRESS INSPECTIONS PER USC 108
FINAL INSPECTION REOUIRED
PLAN CHECK FEE
BUILDING
GLAZING
% PLUMBING
Plan Check No. .9?6— 165
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL.
Any construction on the public domain (curts, sidewf-lks,
driveways,' marquees, etc.) will require separate permission.
STATIESURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse, heirs, assigns and
END. INSPECTION FEE
successors In interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
whatever nature, arlsing directly or Indirectly from the Issuance
x
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
�0
provision."
TOTAL, AMOUNT DUE
Uw,
I hereby acknowledge that I have read this applicattom, that the
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
This 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 Compares.
WORK NOTED
Deputy; and fees are paid, and receipt Is
tion Insurance and RCkY-W7. -
INSPECTION
acknowledged In space provided.
E JOWNER 0 IDA I ED
DEPARTMENT
_WGN*TUR_E
-7 fl
CITY OF
OFFICI DA77
EDMONDS
III a
4
I NTO
CALL FOR
INSPECT]ION
RELEASED BY:
xh
WE
WI
IT 11 WF? USE OR OCCUPY A BUILDING OR STRUCTURE
I
L A FINI L INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL - File YELLOW - inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
4
PINK - Owner GOLD - Assessor
PLANNING DATA
NAME:.
SITE ADDRESS: 2 2- -�o6 - 9Z,^*o DATE: 71311-21
ZONING: ps-g PLAN CHK#: "26 - 16
PROJECT DESCRIPTION: " - P6(,--
V �Ij
CORNERLOT AJo -(Yes/No)
SETBACKS:
Required Setbacks:
Front: 05' Left Side: 7 Right Side: TI) ' Rear:
Actual Setbacks:
Front: 137' Left Side: 7 ��,l Right Side: 5�' Rear:
Street map checked for additional setback required? /U- - -;-pn±�Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED I\) _(Y/N)
"5jW _hru - 4V-4
LOT COVERAGE: 330-0
Maximum Allowed: 35% Actual: I zo,
BUILDING HEIGHT:
Maximum Allowed: 15-1 ActualHeight: )3.Z6'
DatumPoint: Datum Elevation: 010
SUBDIVISION:
CRITICAL AREAS #:— �6 -151 - L-_Y4\-<r
SEPA DETERMINATION:
LOT AREA: I - I V'O' � 15, 17,9 '
OTHER: 1&�, LZ—±23 &t= &&n
Plan Review By:
PERMIT APPLICATION REQUIREMENTS
STREET FILE
To: Applicant
From: Lyle Chrisman, Engineering lispedor
I Plan Check
Owner. NO-
.9
Address:-2,2!J e2.K Daw_LL4j_21�_�
kfter review of the subject permit application, the following requirements must be met
1. Construction hours are:
WEEKDAYS — 7:00 AbL-10:00 PALWEEKENDS/ROLIDAYS — 10:00 A.M.-6:00 P.M.
1. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on 'public property. (ECDC 1&60)
Thick haul route plan must be submitted and approved prior to permit
1. Builder/owner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 18.30.030d)
i. NO WORK SHALL BE DONE WITHIN 15 FEET OF S17JtAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACU'W' BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
1830.50G)
FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCm0m.
(ECDC 1&30)
INSPECIrIONS ARE REQUIRED ON STORM DRAINAGE SWrEMS, JJGffnXM AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIORTO 13ACKMJMQ OZCDC 1&30j
Repair or replace aU defective c4stitig =gk gutter and sidewalk a&jacent to the property. Ifan lnt=ecd= Is Involved, a handicap ramp
may be requistd. CDnftdw shall Med with the City Engbeerbs staffto determine dw extent ofmpair pW to Issuance ofthe pemdt
(ECDC 1&90)
Dnvew
,*�slope shall not exceed 14% withoa a warva. Evety attempt should be made to keep the slope below 14Y, Waiva granted to
Ar (ECDC IU0.060D)
0. Driveways must be paved timm property line tocifty RIGIrr-OF-WAY. A - -V at ate permit Is rquhe& (ECDc luoo6oC)
I. INSPEC17ONS ARE REQUIREI) ON DRIVIWATS AND MDEWALIKS PRIORTO AND AFTER POURING. (ECDC1&30)
2. No burning ofconstruction refitse without a permit fiern the Fus Departnient.
3. Connection to City water system h req*a There h a chargeftthewatermeter.
0ZCDC 7.20)
4. A back water "We h M"hed 1fdownstaks plumbing Is below die elevjdon ofqstrem manhole.. WW 7.20)
S. Water and sewer main Ifnes should be separated by 10 fed minhum- (8=1&10)
6. C011110Z= to the City =nItay system is requited. A pmkb
LID#— Few paw yet— No— amp. 0
QDMC luoy.
7. UndagroundwitiOg is requhW an all new consftuctlon, and foraddidons, aftesadmo, and repaks thatexceed 50% ofthe total assessed
valueaftheStrUctum (ECDC18-"
L A FINAL ENGINEERING INSl?ZCnON IS REQUIRW MOR TO THE BUILDING DIVMON GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE (ECDC I"
WTIREQRMor
Site Plan
Plepee Check After Doing Site Plan Ej Se tic and drainfield
, p
2'Praperty dimensions QSqwer lines
LLrExisting buildings L�6etbacks of proposed and
M,Kroposed building existing buildings
7 Easements aMain road with name
Job Name. Job Site Address:
ZxLess to proposed building
D4-ot size
al�levation of property
2S,odies of water
D,Floorplan
-2-7 o46
White - Customer Copy Canary - Office Copy Pink - Accounting Goldenrod - Production 0 1995 PermaBilt Industries FR#34 2M
%—A Plij,-
Critical Areas Checklist
Site Information (soiis/topography/hydrolou/*vegetation)
I. Site Addressl4cation: ZS701(a
2. PMerty Tax Aemm Number §Z
L4
000 - -DO() 7 JUL 2 4 996
3. AppmximateSite Sim (acras of upare fw): 15, o-0 PSMIT GOUNTErt
4. Is this site currently developed? __..,< yes; go.
If yes; how is site 4&doped?-- i-k�) 19 6 L,-O 6
S. Describe the gewt ift topogqhy.
Check all dw apply.
Flat: -less thaii 5 fed elevation chmp over ando site.
Rolling: sk4m an site generallY less than IS% (a vertical Ase of 10-feet -over a
horizDntai distanceof 6&fed).
Hill-r- 31" PrMM On sks Of mOft than 15% and less than 30% ( a vertical rise
Of 104ba over a botizoad distanceof 33 to 66-feet).
Steep: grades Of gre= thn 30% presew art site (a vertical rise of 10-fea over a
dim=Lof last= 334ca).
Ot1w Olease describe):
6. Sit* conWas areas of year-round staoft wow, N Z) Approx. Depth:
7. Site contains areas of seasonal standing Uster: 14,C Approx. Depth:
What Beason(s) of the YMO,
8. site is in the floodway � 0 floodplain of a water course.
9. Site Wntains a creek or an area where wsw non ac*vm the g=nds sunftce Flows are yem-
round7 . 4- Flows am seasolw? . '(What time of yao
10. Site Is primari1r. lbrested ; ineadow _:shrubs
urban Jandscaped 0awnArubsetc) mixed
11. Obvious wetiand is pmeAj on site: A)0
For Chy Staff use on If-
L Site is Zomed?
2. SCS=ppedSWl(yAS)? (0
3. Watiand invantM or C.A. map indizates watland VIMMt on site?
4..,. !',CfiticW Areas i4yamtozy or C.A. Mp ioditates Cti" Arm on lite?
tO withii dasip�ted e&M miWidence landslide ; haufd am?
'.ilte` aei� Oft -the EnvimmO41211Y Sermitive Am, Map? —Nt, OAS.'&
-�TMDY REQUIRED
CONDITIONAL WAIVER
WAIVER
fteyit�*� by,.-'
Date
KV414M