23214 97TH AVE W.PDFiiiiiiiiiiii
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23214(97TH AVE W
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TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: AW -009 1 DETERMINATION: 0 Conditional Waiver E] Study Required NA aiver
AW
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA'
I
SCALED PLOT PLAN DATED: k I I k
SEWER LID FEE $:
I
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMpv)srs\Fomis\Street File Checklist.doc
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"Nothjji�jj�ET� v
vJLE
ppr I . process shall be
bd as allowing or permitting the
=nance I tury
.Y UULLMJ�i existinj -i11e-j@7,—
nonconformin 7 or unpermitt�ed buildi ig, structur(
or site conditi'n which is outside the, wpe ofthe
9, ermit applilion, regal'dless of whet ier such
yilding, strudure or condition is sho vn on the
site &n or dn wing. Such building, cture or
condition may De the subject of a sepaatq
enfbreement adion."
APPFOVED BY PLANNINP
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DEVELOPMENT SER'
ICES CTR.
CITY OF EDMI
�NDS
one
Comer
Flag
etbacks
1�2�
Actual
Front
3-7
Sides
(q((M,l
Rear
ire
Other
lHeWht
ry
37'
"? 77-4,4ve W
41. 1 q -it
PLANNING DATA 10
SINGLE FAMILY RESIDENTIAL
STREET FI�E
Name: on
Date:
Site Address:
Plan Check
?- 00 7- 06 ?
Project Description: WV1 ps-
Of L w 54,c;1 1 r .5- do o It,, o
Reduced Site Plan Provided: (YES NO)
zoning: xl� -
Map Page: 5LI
Corner Lot: (YES � fN� =Flag
Lot: (YES
Critical Areas Determination #: C J 'FCO-7 p09
El Study Required
0-waiver
SEPA Determination:
R�-Exempt
El Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist 0 APO List with notarized form
Required Setbacks
Street: 2S--
Side: S—
Side:
Actual Setbacks
Street:
3-7
eA S' (11
Side:
�ear:
Detached Structures:
Rockeries:
El Fences[Trellises:
E]_-13ay-3 indows/Projecting Modulation:
rs�/Dk.
Stairs/Deck:
Height
Datum Point:
Datum Elevation:
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided:
Lot Area: /v 1 -2- 5f
Maximum Lot Coverage: 35% Proposed: 1 6
Lot Coverage Calculations: rj 2- 0
ADU Created: (YES / U)
Subdivision: nPA
Legal Nonconforming Land Use Determination Issued: (YES NO)
Comments
Plan Review By:PA.6��
ill
Planning Data form 04-11-06.doc
4,D C. 1% () NJ
#P20
.0
City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: Q5.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Appli cationfor 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
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
C%MW arMUM nRosoil
IT
ArFUUA
Date Received: C91 1 DW f-
City R eceipt #: 51 +to -T-
Critical Areas File #: 4&tCCH — 009
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
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 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 assistant staff
in completing their preliminary assessment of the site.
The undersign edftpplicant, and his/her/its h-e;s7a"73"as"s"igns, 'in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or inftaction based in whole or part upon false, misleading, inaccurate or
incomplete information famished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
.knowledge and that I am authorized to file fis application on the behalf of the owner as listed below.
o7siGNATuRE oF APPLicANTIAGENT DATE- L 11'3 0 �7
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application
SIGNATURE OF OV44ER DATE
—� �OO 7
Owner/Applicant:
40[JOLJ
Name
2-�;'Zl�(
Street Address
F,A,u vloe�r
city State Zip
Applicant Representative:
a4rz.cl 31L-7- OuA-
Name
AJr—
Street Address
0004pl,v u(?-14 ?e0 7
City State Zip
Telephone: :?,4f2- �5Y?,, - =Sd,,�f - Telephone: 4&-f ZU <-oN"K
Email address (optional):
Email Address (optional): C
#P20 CA File No: �11200'7- CM
Critical Areas Checklist
Site Inforniation (soils/ topography/ hy
drology/vegetation)
1. Site Address/ Location:
2. Property T4xAccount Number: eD55&%
ob()-LWSoL4
3. Approximate Site Size (acres or square feet): 7) 2-
4. is this site currently developed? -Zyes; _ no.
If yes; how is. site developed?.-- IA4,e, 0 k)
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 th 15% espyMffi 306t)
over a horizontal distance of 33 to jve� tVj
V
Steep: grades of greater than 30% present on site # v ti all hisif t tibTROR M, InA
ff, c
distance of less than.33-feet). kit, I
Other (please describe):
6. Site contains areas of year-round standing water: &D ; Approx. Depth:
7. Site contains areas of seasonal standing water: M6 Approx. Depth:
What season(s) of the year? 1V1'4
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 (lawn, shrubs etc) 4----
11. Obvious wetland is present on -site: 6,16
1. Plan Check
2. Site is Zoned?
3.
—For City Staff Use Only
ber, if applicable? ?o D '7 — 06
SCS mapped soil type(s)?
4. Critical Areas inventory or C.A. map indicates Critical Area on site? —&I �2 V z
5. Site within designated earth subsidence landslide hazard area? Arb
DETERMINATION
WAIVER
OV E DA,1
I SCO
CITY OF EDMONDS
121 STH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20070494
SIDE SEWE R PERMIT (I -Single Family)
Permit Number: ENG20070494 Expiation Date: 11/27/2007
Job Address: 23314 97TH AVE W, EDMONDS
FISCHER PLUMBING FISCHER PLUMBING
1115 NW 51ST 1115 NW 51 ST
SEATTLE, WA 98107 SEATTLE, WA 98107
206-783-4129
LICENSE #: FISCHPCI 3 1 RI EXP: 2/22/2008
Y
N
JOB DESCRIPTION
IREPAIR N PROPOSE TO REUSE LATERAL LID NUM BER.
CRI`NDER PUMP N I PROPOSE TO REUSE SIDE SEWER
SIDESEWERREPAIR
EAS EMENTINFOICNIATION
• I PROIECT CROSSES OTHER PRIVATE PROPERTY
• VERIFICATION OF RECORDED EASEMENTS COMPLETE
IA'DEMA7TY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
CALL DIAIA-DIG (1 -800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HO UR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOT A PERNUTUNTIL SIGNED BYTHE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Th
ffflEyflu
r-� FILE COPY �/INSPECWR COPY F-1 APPLICANTCOPY
27
STATUS: ISSUED
ENG20070494
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10'separation between the sanitary side sewer and the water service line.
0 ESanitary Side Sewer Inspection
PARTIAL INSPECTION
PARTIAL INSPECTION
FINA L INSPECTION APPROVED
DATE: INITIAL:
DATE: INITIAL:
DATE: INITIAL:
NOTES:.
NOTES:
City of Edmonds
Plumbing & Mechanical, Tank & Demolish
Permit Application Form C
Site Address:— <7 7 4,, F,
Suite#: XTax Parcel #:_ _ _ -
Business/Tenant Name (if a
V, EQA
A 10
'*"X PROPERTY OWNER:
Mailing Address:
City:
Phone: (_)
7'�7 L,4,
State: 6�1 Zip:
FAX: (_)
E-Mail:
CONTRACTOR: ±�_ 5-
-7'
Mailing Address: _Z
City: State: M_;;1L Zip:
Phone: FAX: (,7.&1b) E-Mail:
er: City Business License No: OZZC)4
State License Numb Exp: Dat
MECHANICAL
PLUMBING
Fixture Type
Fixtures
Total
Fixture Type
Fixtures
Total
Gas Furnace/Fi replace:
Water closet
BTUs Location
Sink
Gas logs/direct vent fireplace
Lavatory
BTUs Location
Tub/Shower
Air Handler BTU Location
Dishwasher
a Electric
Hose Bib
a Other
Gas water heater w/expansion tank
Boilers _BTUs Location
BTUs Location
Hydronic Heating
Expansion Tank
Vents, Single Duct #
Floor Drain
Other:
Pressure reduction valve
Water Service Line —ft
Gas Piping ft
Other:
# of Outlets
DEMOLITION ._:sqft
Gas Outlets
TANK _gallons
a AC Unit a Furnace
0 Fill Material
0 Water Heater 0 Boiler
0 Pump, Rinse & Cap
0 Dryer 0 Stove/Range
0 Removal
0 Fireplace 0 BBQ
Critical Area Chklst
0 Other Gas Outlet
___F
0 Study Reg. 0 Waiver
I I
L:\TEMP\BUILDING\WEBchecklists\MECH.PLUMB.APP.doc 8/31/06