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23027 94TH AVE W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:2p-,Kz�( 6-4000
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:— M' I Zq DETERMINATION: 0 Conditional Waiver []Study Required N/Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):2pQP,-)Q&t&
PLANNING DATA CHECKLIST DATED: q I I Q D5
SCALED PLOT PLAN DATED: SAM
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT ff:
WATER METER TAP CARD DATED:
OTHER:
LID #:
LOT: BLOCK:
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APPHOVED AS NOTED
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Date: T/14
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RECEIVED
APPROVED BY PLANNING AUG 2 9 2005
"A"rR ET F...
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01,16 E PERMIT COUNTER
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PLANNING DATA
NAME: K-OL7Mq PrrV_,e4-Ma1vj DATE: Q61 /I (P /,�,OoFF
surEADDRESS: f 9ea?C)2_+ lq47H AVe, VV PLAN CHK#: 05r — 4-0_T
PROJECT DESCRIPTION: P-7uAld dccle-& 4uvimorY7
REDUCED SITE PLAN PROVIDED?: ( Des No)
MAP PAGE:_0�59 CORNER LOT:. FLAG LOT: fft�Lt&
ZONING: 'CRITICAL AREAS DETERMINATION#: 2-9
U Study Required -
Waiver
UConditional Waiver
SEPA DETERMINATION: enAtfwyn
Ll Fee I
U Checklist
U APO list w/ notarized form
U(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
a Ex-m t
os '71��A
SETBACKS: 0 vl� -
Required Setbacks: +
F 61ym
+� -4. W914 Side: Reer-
Street: I e:
Actual Setbacks:
Street: 6eft-Side- I/ S i d e: Reaf-
(K Street map checked for additional setback required? (Yes I No I
DETACHED STRUCTURES: (-P_y-f-C"HV15
ROCKERIES: N 04-C, C7 Vt0VVV1 On 0 f+r-,- F layx
10 (EC�E�TRELLI ' SES: e�Kirrbr)�-
U, BAY WINDOWS I PROJECTING MODULATION
U STAIRS I DECKS:
N Qvirl 4_5V10VVV1 0,Y) -e;li_�rl Flo -In.
PARKING: Required: I- Actual:
1DX10
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LOTAREA: (P[;T(o '0
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LOTCOVEIRAUE. —,.,
Calculations: V'r," I f-/
�317-0
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C.0 vr�� el
BUILDING HEIGHT:
Datum Point: 6e&A_'�
Datum Elevation-,
10 0. 00
Maximum Allowed:
—Actual Height: 11Q-1
A.D.U. CREATED?: DOC- ��ttMfM
C-2VIDWA.
SUBDIVISION: .1-11
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED:
OTHER:,ef� bufl-1- CnA --,.* aAnn"f_�uy� i
Plan Review By: Q LAI-�
Ne%vBPP lafui IngData Form -DOC
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City. of Edmonds
Development Services fflffiax@�
Planning Division
Phone: 425.771.0220 2 `)) 2005
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
befilled out by any person preparing a Development
Permit Application. for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
det.ermine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to c6mplete the Checklist should be easil
-Y
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: 0 9 12, ci 11,0 0 L�r
)City Receipt#: 2,-4-1 1F 5" . .
Critical Areas File M 0 6 - +-2.4- lag
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant: S_ -8- 05
A property owner, or his/her authorized 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
permit application.
Please submit a vicinity map, along with.the signed copy
of this. form. to- assist City staff in fmoling and locatin the
9
specific piece of property described on thisform.. in
addition, , the applic ant, shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this.Checklist to assistant staff
in completing their preliminary assessment of the,site.
The undersign ed applicant, and his/her/its heirs, and assigns, �in con
sideration on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, 4ncluding r . easonable
attorney's fees,.arising from any action or infraction based in whole or part upon false, misleading, miaccurate . or
incomplete information fumishedby the applicant, his/her/its agents or employees..
By my signature, I cer* that the information and
knowledge and that I am authorized to file this applic
SIGNATURE OF APPLICANVAGENT
herewith submitted, are itrue and correct to the best of MY
the behalf of the owner as listed. below.
DATE <
Property Owner's Authorization
By my signature, I cer* that I have. authorized,t�h�bov),Appl
and grant my permission for thepublic officialsand
purposes of inspection and posyng atten4pa Is
,��o is application.
SIGNATURE OF 0WNEi'_4_--\a,,
it./Agent to apply for the subject land use application,
City of Edmonds to enter the subject property for the
I
DATE -,7
uwne /Appucaot: Applicant 4�presentative:
NAme Name
Vd Nil
J, YA
Stree Ad ss Street Addr
city State Zip city State Zip
Telephone: 6� Telephone.
Email address (optional): Email Address (optional):
r . ___ -IN,
MWC
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: 0 4)rw,
CA File No: OS
, IN
2. Property Tax Account Number: 2:1 0 33 to 00 (D 7 00 c:� ( e -Z-7 0
1-7
3. Approxunate Site Size (acres or square feet).
4. Is this site.currently deveIoped?,\,/ves; no.
If yes; how is site developed?.
5. D�s� the general site.topography. Check all that apply.
Flat:. lessIthan 5-feet elevation' change over entire site..
R�iling: slopes on site generally less.than 15% (aVertical 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: 0
;Approx. Depth --
Depth:
7. Site contains areas of seasonal standing water: Approx.
What season(s) of the year?
8. Site is in the floodway �Z> floodp*lain of a 'water course.
9. Site contains a creek or an area where water flows across the grounds surface?. Flows are year-round?
Y-\ Flows are seasonal? (What time of year?
meadow shrubs mixed
10. Site is primarily: forested
urban.landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use 0 fily
1. Plan Check Number, if applicable? NOVIf, QfMl -
2. Site is Zoned?
3. SCS mapped soil type(s)? 15-.AjAV�-W0c)6(_uyi,1Ayi 16m d
4. Critical Areas inventory or C.A. map indicates Critical Area. on site? Npn& 5MWY1-
5. Site within designated earth subsidence landslide hazard area?* IQLA-� �30 i I d rl
O�f� Gf a I -f-o M a V-� -f� rl A 1 C4 0-e/V- VM I mat� uyt�-
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed bv. -Id AAA,-, DIVAN� Date: ID C1 j9'_j-