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11791
23226 HUMBER LN
ADDRESS: t\QwOo� Vax\,�
TAX ACCOUNT/PARCEL NUMBER: MT-1 1300\008M
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR -
I
CRITICAL AREAS (AVIVET E RM IN AT 10 N: Ej Conditional Waiver Ej Study Required aiver
DISCRETIONARY PERMIT #'S: XV
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
-CZC/
PERMITS (OTHER):
gap_
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE S:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMFr(S).#:
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMMDS'PsTomiskStreet File Checklist.doc
0 PLANNING DATA
0 11 STREET:F:1:�K]
SINGLE FAMILY RESIDENTIAL
Name: Da te
Site Address: 'Z Plan Check ft: 0
Project Description: 400c (iA
Reduced Site Plan Provided: 6) NO) Zoning
3 —] Corn
Map Page: (95 er Lot: (YES
Flag Lot: (YES
Critical Areas Determination ff:
El Study Required
KWaiver
SEPA Determination:
V-Exempt
El Needed (for over 500 cubic yards of grading)
El Fee Cl Checklist Cl APO List with notarized form
Required tbacks
Street: _J Side-- 75- 1 Rear:
Actual Setbacks
Street: 3 Side: Side. �Rear:
Detached Structures:
Rockeries:
Fences[Trellises:
El Bay Windows/Projecting Modulation:
El Stairs/Deck:
61111dif I it
Datum Point: Datum (00
Elevation:
Maximum Height Allowed:
Actual Height: 12 —7 (10 7,
Other
Parking Required:
Parking Provided:
Lot Area: /'� 00 0
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations: o u-(e- dcl( �744 -- 4joe*_-Z
ADU Created: (YES
Subdivision: A10
Legal Nonconforming Land Use Determination Issued: (YES
comalents
ef_� M' C-q� C5
A -_ 015-
Plan Review By: '0 ��_ f1dnm)9 Odta form 04 -11 OGAOC
06�
is
#P20
Critical Areas Checklist
Site Information (soils/. topography/ hydrology/vegetation)
1.. Site Address/Location: Larve_
2. Property TaxAccount Number: 00�11-300/00?()Q
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _��es; no.
If yes; how is site developed? nm le u
5. Describe the general site topographqCheck all ffi�t apply -
Flat less than 5-feet elevation change over entire site.
CA . File No: CA11kTD_1 -5S
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet ov'
er 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: 60 Approx. Depth:
7. Site contains areas of seasonal standing water: /10 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 110 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Alb Flows are seasonal? (What time of year?
10. S* rimarilv: forested meadow shrubs mixed
—For City Staff Use drily M16P li�-a C612
1. Plan Check Number, if al
2. Site is Zoned? -
3. SCS mapped soil type(s)?
7
-7
4. Csitical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
STUDY REQUIRED WAIVER
W - 2�
R e v i e w e d b v. —1 a 0 Date: /n-.7
'tJC.. 1 %9"'
* #P20
City of Edmonds
Development Servi?.-es Department
Planning Division
Phone: 425.771.0220
h
Fax: 425.771.022
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 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
City Hall (Critical areas inventories, maps, or soil
surveys).
10 y kZ
Date -Received: 0, 4 1 %:5 1 1- 0 0 --V
City Receipt#: 9q!f 091-
Critical Areas File #: U--A- 07f- 6q.
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. 'Me 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 imp, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, 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
attomey'.s fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished 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 toAe this appliqLtioa on the behalf of the owner as listed below.
DATE '/
SIGNATURE oFAPPLIcANT/AGENT w'. 6ae��_�
Property Owner's Authorization
By my signature, I certify 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 posong attendant to this application.
SIGNATURE OF OWNER &01 DATE - -----
PLEASE PRINT CLEARLY
Owner/Applicant:
Var'l G ra-vc
iName
r,.,? a-d-c 4u
al -
Str t Address
city State Zip
Telephon"(,906
610 -40
Email address (optional): V
Applicant Representative:
Name
1720
Street Address
INty State Zip
Telephone:
Email Address (optional): t2L<,:�"?p
,4rZ1,>4,6?
A4 9:-7-
61TE. PATA
LOT ZONE = R�5-5
LOT AREA = 1A-, OrW
tVLPI* AREA-, UiisT, 40W-�E IIJ 19 es-
-MAWFLOOR AREA = 11%0 Sf. + Va 6F
NEW MAIN FLOOR AREA = 300 S.F.
T0rA_ REMOPELEP Sf ON MAIN FI-OOR = ;31 SF
r,1AQAr.f Qr-A Aal e� P
46
.... .. ....
HUM�ER'. LANE
4 5 P- 4 r;,- e I Al'�'
T L-4 M e'r, +I P0
Al. t1i I r- I`U", LAI tWL
�t6l% 6WERIA NOTE6,
Al. FaWATION PLAN &
510r,_r- 44 /YJ? F*Akj1K1rq
TOTAL MAIN FLOOR AREA W1 0ARA6f 01� 6F A�. FIR!5T FLOO, PLAN W1
LOT 6MRA6E = 4.,37b65 6F
WIWON 66hEPLLE.
A(,TUA_ LOT WrERA6E = 2,V 6F. (16. 4- 17.) 6 K!
A `R06F FMI*
k
IMPERVICL6 LOT C&ERA6E @ 50c, = 6,,�050 5F 04S
-ur, A5. ELEVATIONS & NOTES
RESIPEWE = 2,1316 PRIVFWAY = W 5F
WALK PATIO =*---06F
A6. ELEVArMS & Wf�E6
T0rA_ IMPERVIOJ6 5Lff1V,[ Sf < ffM.50 5.F. Or,,I
25_0" f RAT
(1,0roo) Al. DULPIWb e5WION, WkL
066LPANCY = R-3 6WON & NOTES
NO Of 6TORIE-5 = I
c
NAAX HE"T = i5-a, HAVE 12-J."-4- ft'�HT UrLCWLA--1-10� C -r 96.:51 A�3. PETALS ANP NOTES
A Ae,C- CALC-5
6CIL
F"T = 25--o" C q to,S 'A 1 '-0, 1Tve;F aq- T1 J14f) 606T, //q I q66
SIPE 14, 4- Ite 1 40
15-a" TOFAL 74, OARAOE ?AgAel� �601e* ililtl!s"S .+
'5% 2 1- 49% F-X 167% FA-irl �54 33
Aqc
KAR ArT tA p4t, 101,0 F� IV, 4 41/17, W111 0� a /V tt;q /v I, q 6z", 1011,
qq
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FLOOR LL. 40 P.5.f
WiNP LL. W P 6,F. - EW05WE D. e6 MPI
EARTHQLWE Wft V R 5 LOT 60vq, 6mr,) 3136-
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PARKINE7 6AR WArX HAVE 'X
C*A 'Z 00 ------ bi�___
(,"TRVIal TYPE
f/
*r)O*r-+Mff 13 ANP f 00TINO PRAIN5 TO �E TICIIT-LINE Q�.
T7
OWNER
TO 61ORM PRAIN. I - .. ....
7`7'
I I _Z:�_ I �11 >(1 I . I I ' I MM CRAVES
I +C) =. 5 '7
1006!7 'K IXU HUNMR LANE
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Ewa%06, _WHIWON
RDWEN(/�
VVINP PE61M 6RITERIA
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+
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1. M!% MW Sfff P ff5 M.PH. _Sc v +
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2, IMPORTAN611 F&JOR 1.0
OWNSPOUTS
Ex?oLr:AK z: fy GUTTERS/D
APPITIP TO CONNEcT TO EXIST SYST.
9� 9TE APPRE66
0
REMOWLEP AREA
2V.26 11WER LANE
6E1,5M1(/ PE61ON (ATERIA.- �)ITE P[DAN
EROVS, 1NA,5HI%T6N 95OW
Cf_19MI& IMP6RTftE FA/,,TOR.- I Id
55 lot
E
0 20' 30'
1BWI0W' A) -5s' 1.15
,MAPMP SPE6TRAL RET046E A6a
3.. 5PE(/TRAL K�Par_f 66F_Tli�ENTS: 5., 5p, 6M 02�3 -51 O�50 il,,= lot
C40F)
NTRACTOR IS RESPONSIBLE __"sh I
OWNER/C0 "Nothing in this Permit approval pro
4 riCISMI( , PES16N 6ArEOORY. V1 FOR EROSION CONTROL AND DAMAGE as anowine �f perini�tTg the
interpreted
mainten, arq of any ce, -ertly existing illegal,
5. T1WV,,-F6R6E-RE6I6TIWj SYSTEM: 'DMN(5 `�onconformi ,
r Rnp�_, tted 4uildin&
outside t
FM
or site conditil
he scope of the
k
permit application, reg- 1. ;�of whether atic
I ING Q t h a
APP VED P
6, PESft q building structure or ctucition is'shmmon
PASE 6HM: V (12 X t5ps/ R)M q
L or'drawing. 8%eb building, 8trudV=r-,,
0 may be the subject
of a sewate
.... .... ... ..
7 '506MI6 RW44 60WOENT.- 06) 'iM LEC)AL
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TY OF EDMONDS
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