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23622 84TH AVE W
ADDRESS: . I-
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TAX ACCOUNT/PARCEL NUMBER: -/4 � 33 00) (Do,?- 0 o
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
"'�R*aiver
CRITICAL AREAS:— 9(K DETERMINATION: ElConditional Waiver E] Study Required C
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: (0/��
SEWER LID FEE S:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT:
LID #:
BLOCK:
LATEMP\DST's\Forms\Street File Checklist.doc
FILE NO.
titical Areas Checkliso
------ --- ------------------------------------
Site Information (soil s/topography/hydrology/vegetation)
I . Site Address/Location: --Z-36:1 31 - R 4i t/7 /4 1,, e. tc/ - " Eei-,4 vkleh,,
2. Property Tax Account Number: 6 33 o0i oox e,�
Approximate Site Size (acres or square feet): 00 4
4. Is this site currently developed? L,-' yes; _ no.
If yes; how is site developed? S�n le _�a .; �q 1,.,, Les- e
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 I 0-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 3 0% present on site (a vertical rise of I 0-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:
7. Site contains areas of seasonal standing water: —;Approx. Depth: Y1
What season(s) of the year?
8. Site is in the floodway ij,& floodplain n,,,b 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)
11. Obvious wetland is present on site:
----------------------- -------------------------------- For City -Staff, Use Only -------- i6ff-B ---------------------------------------
.1. Site, is Zoned?
rnapped,spil..type(s) tj,� &0,Cj0VL- j Z 3
a. Weiland inventory or C.A. map indicates wetland present on site?
4. Critical Areas inventory. or.C.A. map indicates.Critical Area.on site?.. No,
5. Si,..,
te.wi in. designated earth. subsidence. landslide. hazard - area?,.. (\4�,
.6. Site.designated on the Envirounientally Sensitive Areas Map.?
]DET'V RMINATION
^cn_chk,doc; Rev 10/03/97
0 0 RECIE'lVED
City,of Edmonds JUL 2 9 1998
'CRITICAL AREAS CHECKLIST
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 a development
permit 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).
An applicant, or his/her 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Ailh G,Le_-e
Name
�2_3 - R Y f/,, /I v e_ kl,
Street Address
,E a - 9-1/9,60
city State Zip
� A- 5- /7 7
Telephone
Signature
71�, �kl
Date
c:recepdon\jana\cac1.doc
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
(over)
0 9
PLANNING DAT
NAME: � c
SITEADDRESS: Q(RZZ-- Kyk4"-"-6ATE:
ZONING: as-/ —PLANCHK#:
PROJECT DESCRIPTION:
CORNERLOT " .(Yes/No) FLAG LOT Yo —(Yes/No)
SETBACKS:
Required Setbacks:
Front: -7 (t Left Side: '7 1/t- Right Side: 7 �z Rear:
Actual Setbacks:.- 157
Front: 66' Left Side: Right Side: Rear:
Street map checked for additional setback required? Vtg- wb,--_(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed:— —Actual:
BUILDING HEIGHT:
Maximum Allowed:— 7- 5 Actual Height:
Datum Point: Met-14-6- —Datum Elevation:
A.D.U. CREATED?: A4�
SUBDIVISION:
CRITICAL AREAS #: 7 � 2, 6 0 — 1--,,9 1 vm
SEPA DETERMINATION:
LOT AREA: 3,
OTHER:
Plan Review By: �_�Dtd
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CITY _0F,1EDM0Nb$Z. �ZON PER1141T
E NUMBER
CONSTRUCTION PERMIT lkFPLICATI0N::::
JOB SUITE/APT #
ADDRESS:
OWNER NAME/NAME OF BUSINESS
LEGAL PESCRIPTION CHECK SUBDIVISION.NO. LID NO.
W MAILING ADDRESS
,? 4�"
Z LAJ
0 :PUBLIC:AIGHTOF eR OFFICIAL STREET MAP. TESCP Approved 9__
CITY zip TELEPHONE NUMBER RW Permit Required A1,0
�E.ISTIN
ebmow)s 602 40 4Z� 3bS REQUIRED DEDICATION Sir.., Use Permi�Req*d JkV
I I PROPOSED inspection Required
NAME Sidewalk Required
01 it METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIR
C,V1eV_KW4_ L/OtosT INC
Lu ADDRESS 7. YES El NO
P-C VI t5lj 'bil REMARKS
Q
cc CITY ZIP ITELEPHONE NUMBER.
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NAME
4;"ZjZN4A\<_ 1�00$'�
cc ADDRESS '4.
0 NGINEEf1ING �EMO DATED
p4wvt; REVVYVED BY
lejo / �,e er e',#
cr CITY ZIP I!TgLEPVNE NUMBER i. -
I ( IRE MEMO DATED % REVIEWED BY
Z
0
U LL
STATE LICENSE NUMBER EXPIRATION DATE
C'�j JEP t
VARIANCE OR COU ADB'# E#
Legal Description of Property - include alf dasements
jl�� SEPA REVIEW SIGN AREA HEIGHT
Z fz_-� SOW COMPLETE EXEMPT ALLOWED I PRqegSE0- ALLOWED POSED
PRO
EX�-
LN4. 0 'D- 0 1 4� 1 1 F-r wf L 5C ---T
o LOT COVERAGE REQUIRED SETBACKS (FE) PROPOSED SETBACKS (Fr.)
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W ALLOWED PROPOSED FRONT sibE REAR FRONT UR SIDE REAR
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(9 7f -7
_j Property
To Account ZLf___�;� —00 1 00 LOT ARE;�, _FLANNIN9.�IEW BY DATE
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2, / f
Qel No. —1
REMARKS
FINEW RESIDENTIAL PLUMBINGfMECH
91DDITION COMPLIANCE OR
COMMERCIAL CAANGE OF USE
FIREMODEL APT :. BLDG.
[:1,SIGN
HECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT
GRADING FENCE x —FT) GRqff,,
REPAIR _CYDS. V_/I 97-
WOODSTOVE SWIM POOL TECIAL INSPECTOR SEOMO� 0(
DOEMOLISH INSERT. HOT TUB/SPA 0 OCCUPANT
REQUIRED LOAD
_'bARAGE RETAINING WALLJ YES
L-Vi � ROCKERY; RENEWAL REMARKS
Z
0 (TYPE OF USE. BUSINESS.OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 108
to
NUMBER NUMBEri OF. CRIT16AL AlleelL I W91h, 1217
W C
0 OF DWELLING AREAS.
LIM
[13 STORIES L UNITS T"NUMBER
0
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
Of FINAL INSPECTION REQUIRED
VALUATION FEE
*,Doe
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
% PLUMBING
Fman Check No. q9 MECHANICAL
This Permit covers work to be- done on private property ONLY. GRADINGIFILL
Any construction on the pub . lic domain (curbs, sidewfilks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE IM
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: I Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spodse, heirs, assigns and ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
'Lnu harmles's the City of Edmonds, Washington, jts officials,
2 employees, and agents from any and all claims for damage!E�bf
M whatever nature, arising directly or Indirectly from the issuance
4
x of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
0
modify, waive or reduce any requirement of 4ny,city ordinance
0
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision." ISO#
I hereby acknowledge tha ' I I have read this application; that'the
information given is correct;,and that I am the owner, ot, the duly ATTENTION APPLICATION APPROVAL
authorized agent of the -owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- 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 Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Injiurauce aria RCW 18.27. acknowledged.in space provided.
INSPECTION
�SSIGNA R VVNER OR AGENT) ATE SIGNED DEPARTMENT
OFF�3 NA /DATF4
7W CITY OF
EDMONDS
L CALL FOR RELEASED BY- DJTE
ATTENTION INSPECTION
.IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — InAspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109 PINK — Owner, GOLD — Asses3or