23507 92ND AVE W.PDF111111.111111
8998
23507 92ND AVE W
9
ADDRESS: q -;?- 1,4 Out Lo
TAX ACCOUNT/PARCEL NUMBER: LooqLp C)c)0,d-,00
BUILDING PERMIT (NEW
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:- [D
SEWER LID FEE $:
ID
0
X
DETERMINATION: [] Conditional Waiver [] Study Required n Waiver
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
SIDE SEWER PERMIT(S)
LATEMP\DS'Ps\Fon-ns\Street File Checklist.doc
0
PLANNING DATA
NAME: DATE: /10-17-03
SITE ADDRESS: 915�0-7 - q2-ool PLAN C
PROJECT DESCRIPTION- "'dft /
REDUCED SITE PLAN PROVIDED?: (Yes I No)
MAP PAGE: 095 CORNER LOT: (Yes 16 FLAG LOT: (Yes 4 WO
ZONING: R-S;-3 — CRITICAL AREAS DETERMINATION #: 03-1417
Ll Studv Reauired:
j;7',tSrWaiver
U Conditional Waiver
SEPA DETERMINATION:
UFee
Ll Checklist
Ll APO list w/ notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
t.L�Kxempt
SETBACKS:
Required Setbacks:
Street: 2,15- Left Side: Right Side:_ -7. 5 Rear: PG7
Actual Setbacks:
Street: 3& ' Left Side: Right Side:_/ Rear: -77f
ZBAYStre map cheZked for additional setback required? (Yes No
Stre
DETA HED STRUCTURES:
T
U U R KERIES:
C S/
LJ ENCEsrrRELLISES:
T
Y WI
WINDOWS / PROJECTING MODULATION:
ST I S/ C
STAIRS / DECKS:
PARKING: Required: Actual:
LOT AREA: �u? "0
LOT COVERAGE: *
Calculations: Lv�� 2-41-�—la
BUILDING HEIGHT:
Datum Point: Vvla-q-e-� kl4rp- Datum Elevation:
maximum Allowed: Actual Height:
111`�\ J&
A.D.U. CREATED?.*/[No / Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: ()Les le
OTHER:
Plan Review By: )(-�-
NewBPPlanningDataForrn.D0C
RECEIVED
PERMIT EXPIRES4 '46-5
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
JOB SUrTE/APT#
ADDRESS X.-L
CONSTRUCTION PERMIT APPUCATION
OWNER NAMENME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT No.
LID NO.
T-fWjeR:t AI-YDY
A.
_11R/
r AXADQ
LID FEE 111
'MAILING ADDRESS
c?
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
MOP Appond
RW Pon ROW&W
so" use Permit
plqt*w
Sklewalk Rsqubvd 0
CITY ZIP
TELEPHONE e-
C1 9 0
(A zoo-611.sr
REQUIRED DEDICATION Fr
Ur4wgrowld 13
WWII
NAME
M
LINE SIZE t
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
ADDRESS
�.AE,MAAKS
OWNER/CONTRACT"SPONSIBLE FOROPOSION CONTROL/DRAINAGE
CITY ZIP
T ELEPHONE
NAME
ENGINEERING. REVIEWEDPATE
LAC;ADDRESS
FIRE REVIEWED By DATE
LU
it
IE
I
CITY AP*
I
TELE AHE
I
. .
.
VARIANCE -OR CU
SHORELINE OR ADZ#
INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION BATE
CHECKED BY
-------------
13YES
$EPA REVIEW
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
. ALLOWED PROPOSED
9
PROPERTY TAX' ACCOUNT PARCEL NO.
00(441_10 2. co 14o in
0 NEW ar RESIDENTIAL PLUMBING MECH
COMMERCIAL COMPLIANCE OR
ff ADDITION 0 CHANGE OF USE
REMODEL 4AFrrMENT SIGN
El REPAIR .[3 GRADING FENCE
CYDS X
LOT 66VERAGE
ALLOWED PROPOSED
- !g -1Y
Z ;? v
REQUIRE . 0 SETBACKS (FT.)
FRONT SIDE REAR
-!5-75"
1 2
PROPOSED SETBACKS (Fr.)
FRONT L/RSIDE REAR
'PARKING
REQ`D PROVIDED
I LOT AREA
I PLANNING REVIEWED BY DATE
REMARKS
El DEMOLISH 0 TANK OTHER
Ei GARAG RETAINING.WALL
CARPORT [3 RENEWAL
0 ROCKERY
UWE OF USE. BUSINESS OR ACT�
A.)
CHECKED BY TYPE
OF CONSTRU ON
y;7
OCCUPANL.
GROUP
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL %ovot
AREAS q-7,
NUMBER
SPECIAL INSPECTOR
REQUIRED YES
JAREA:
OCCUPANT
LOAD
DESCRIBE WORK TO 13E DONE
AJV442 506-14S)IDAII
R E
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECfD
oo'A
A C HO U6L
VALUATION $
Descriptiori
FEE
Description
FEE
Plan Check
EAT RCE GLAZING% LOT SLOPE %
Building
FILAN CHECK NO: VESTED DATE Plumbing
pr f �
ec anical
THIS PER3111IT AUTHORIZES ONLY 71 rFD. THIS PERMIT COVERS WORK TO . .........
t: OE DONE ON PMVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC 0 Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVWAVS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERIMISSIOIL
Engr. Review City Surcharge
PERMiTAPPLICATIOW 1180DAYS
06 PERUFF LIMM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS Engr. lins0ection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION -
App . ucANr, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESO . R . S :Traffic Mitigation Plan Chk Deposit
uj IN INTEREST, AGREES TO INDEMNIFY, DEFENDAND HOLD HARMLESS THE CITY. OF
FI EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEESi AND AGENTS FROM ANY AND. Fire Review Receipt#
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY.
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS: PERMIT SHALL NOT BE
Fire inspection Total Amount Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE. CITVS ABILITY TO ENFORCEANY ORDINANCE PROVISION.
Landscapeinsp. Receipt #
'A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
G SC C
�%E ' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
TH7:WNEFL I FlE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUIC. This application Is not a p" until signed by the
TION: AND IN DOING THE WORK AMORIZED THEREW. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fen are paid. hnd
IN VIOLATION OF THE LABOR CODE OF THE STATE OF -WASHINGTON RELATING TO receipt Is acknowledged In space provided.
FOR INSPECTION
WORKMENS C?)"SATION INSURANCE AND RCW 18.27.
OFFICIALS IG URE DATE
KI R PENT) DATE SIGNED IA05)
1 WAr �F#
771-0220 0 REL By 4?1610&7 DATE
AT'ItNTION �M 133iC
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ra
A FINAL INSPECTION HAS 13EEN MADE AND APPROVAL OR A CERTIFI, 7711-0221 ORIGINA I L- FILE YELLOW� INSPE6OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
10/01
A�Pf-RV)ods -SURIFFAC-t C-41-cs.
GUTTERS/DOWNSPoUTS
PrZoPoSto.AoOMloo P, . 0-:;,r- oUTL,0L-, �W7571 TO CONNECT To EXIST. SyST.
9%1
V L Nq 3G5
H F i �4 1-4 T- e- A t c_Sj�.
1JUMIUAE
A, MATERK
SDR 35
SCH 40 APPROVED AS, No rED
C, N -12
F810 HANCOR BY ERIGINEFRING
Avc. 4aor- S, Z5' Date: //A ��-i
Ac—lux(- f-
A c- r U A� L AD. 13: A. q�'
L-1'2o
0 7' V.
r-7
3
L 0 p
A pFloxjED BY PLANNING
P
IT
11S
7
J3
)00
+
R�i 4iAT oF tj K
��C>-7 9-Z �j 0 AVL V1 P L
STREET FILE
R E C E: I V r-- 7)
OCT - 3 2003
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
ACCEPTABLE TIGHTLINE
A�PjAVjojs _S U A C_ 4- MATERIAL
SDR 35
PI2(_)PQSfQ AQ0)7_tqk> P�o>j:: pLrtL,0Z.-,.i4_7S_/ SCH 40
N 12
F819�4ANCOR
9_)-� X. rs D Q V L t_� V 365
CA Lc -S-
A. ci s
'UTTERSIDO"SOOUTS
C, TO ',"ONNECT TQ,EXIST..
Avt. 440t-, 9`8,25'
"Z
Ae-Tiu.Ni�
A �T-Lj AL Al).13: 11.1-3 A.
rx,
i-bi covuZjk� r -
C, Z)�
L=7
i- or A(Z LA,
fy
-PLANNING
APPROVIEQ BY
CTOR IS RESPONSIBLE FOR
C)WNEPJCONTRA
EROSION CONTROL AND DRAINkGE
oil
APPROVED-WS NOTED
BY'ENGINEERING
Alt Aej:,��
Date: -r 0 —r L,) N k�
J--� ��0-7 ct-Z ti 0 AVL W. PLO-F P L A,6
Zo
UK A 3 2003
CITY Cr%Dv
,EVELOPMEN'T SERVICES CTR.
CITY OF EDNIONDS
of ED& OL
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771-0220
I%C)Z Fax: 425.771.0221
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
&Ads&
Ci #HA f 1 aoillvir" MW il
Cdke
a mm, opt Amn^ki n in. uo--, no(%
r
Date Received:
City Receipt#: -
Critical Areas File #:
Critical. Areas Checklist Fee: =4484W--
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 * ed 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
attorney'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 certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OFAPPLIcANT/AGENT DATE 8-- 7 -
Property Owner's Authorizatio)(/�
By my signature, I certify that I ave 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 posti�% aapdant to this application. I/
SIGNATURE OF OWNER
Owner/Applicant:
-5—SFT—rW —� A . 6A.00`1�
Name
Z3 �-C-D'7 92-tJO A L/C to -
Street Address
1Z 0 M C),O 0 S CJ D, ao Z-0
city State zip
Telephone: Zo6 — Zcc, — 6 3
Email dress (optiona�l):
DATE -3
AppHcant Representative:
Name
Street Address 16VI
�') Ir i
city State Zip
Telephone:
Email Address (optional):
Inp
Critical Areas Checklis,t.doc/3.19.2001
Critical Areas Checklist CAFileNo: 03-ofl
Site Infomiation (soils/ topography/hydrology/ vegetation)
1. Site Address/ Location: Z3S-0'7 RZ W. - A Vi, t,-) � V-0�noP o:5�4� 0A 9 9gZc:)
2. Property Tax Account Number: 44-72 0-0*1 CZA oo -.-015
3. Approximate Site Size (acres or square feet): 0
4. Is this site currently developed? -Zyes; — no.
If yes; how is site developed? 5004ti- r—AlvLv tZEs.
5. Describe the general site topography. Check all that apply.
V"" Flat: less than 5-feef 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 than. 15% and less than 30% a vertical rise of 10-feet
over a horizontal distance of 33 to dMain -' 1, f, ;�'! -, -,-, - I I'm 0
etticaI rise of 10-feet over,4
Steep: grades of greater than 30% presen
distance of less than 33-feet).
. r%�!fj,
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: A / 114 Approx. Depth:
8.
9.
10.
11.
M
What season(s) of the year?
Site is in the floodway floodplain of a water course.
Site ontains a creek or an area where water flows across the grounds surface? Flows are year-round?
AZ A Flows are seasonal? (What time of year?
Site is primarily: forested ;meadow ;shrubs mixed
urban landscaped (lawnshrubs etc). I
LObvious wetland is present on site: A/, �4 -.
, 'i:g �h�
;-i. 'A
?
-A
ia
DY,
77
V
Wi 2-4 A
Critical Areas Checklist.doc/3.19.2001