23711 104TH AVE W.PDF23711 104TH AVE W
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ADDRESS: U)
TAX ACCOUNT/PARCEL NUMBER: —
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICALAREAS: "-Q-Dn DETERMINATION: E] Conditional Waiver E] Study Required Y�aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): 1--VOU —
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: o bi-lo
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S),#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
OTHER:
LID
LOT: BLOCK:
LATEMP\DS'Ps\Fonns\Street File Checklistdoc
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STREET FILE PLANNING DATA
SINGLE FAMILY RESIDENTIAL
STREETFILE
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Name:
t /06
Site Address:
tdqf� Ave. W
Plan Check #:
Project Description: �� r ex I ez;.N' "' ci/e-ck or% esk _s,cle- c-C Netz deck *%S
"ce.a 4c> 6e: 9-,,�,e. 'e, jZ 0/"
Reduced Site Plan Provided: (9/ NO)
Zoning: Reno —
Map Page: 0(D:1
I Corner Lot: (YES
Flag Lot: (YES
Critical Areas Determination #: CA-W - Tf
0 Study Required
1,21waiver
SEPA Determination: E7 -
X eN,
,P3 Exempt
El Needed (for 500 cubic yards of grading or site within 200 feet of Puget Sound or Lake Ballinger) -AIIA
0 Fee 0 Checklist 0 APO List with notarized form
Re,Xired Setbacks
Street: (\,.f)
Side: �IV)
Side:
Rear:(
E 16"
Actual Setbacks
Street: (,)
Side: (/V)l q1
Side: +
Rear:
Detached Structures:
Rockeries: Noc\e, a—Vl"4>r\
El Fences/Trellises:
El Bay Windows/Projecting Modulation:
Stairs/Deck: Ile- re.F,�S,
Height
Datum Point: NIA
Datum Elevation: NIA
Maximum Height Allowed: Actual Height:
tic> QnZ,-nAe-
Other
Parking Required:
Parking Provided: +
Lot Area: 570() ip
Maximum Lot Coverage: 35% Proposed:
A/6 Q
e-
Lot Coverage Calculations: ftfk
-%
ADU Created: (YES 0
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES A9
Comments
we1-,VA- c--.Ac�S nA ,e&ded Vc- Ak �z, -..4 -,s �c. \oe,
.b� k�,e ciot okr-k t+ r-e�-a,�ed.
Planning Data Form 04-11-06.doc
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Zone &,a?— Cornerb& Flag go
Setback Reguired Actual
Front (W) -- 29L S31+
S i d e s (N, (4 -L 1 i—, v,, 7-a _C* -
Rear �E)
Other
Height _A/d, C,6)�to
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"Nothing in Uiis permit approval proem shaU be.
interpreted 05 &110wingor permittuMi the
maintenance of any cuffently existin$ fflegaL
nonconforming or unpalmItted bufldin& StMCW"
or site conditio'n which is outside the soope of the
permjt application. regard Ims of whether such
bu&ft, stmeture or condition is &vwnvn the
site plan or drawing. Such buildillt, structm or
condition may be the subject of a sepwite
inforcement action."
�pp,ROVED gy PLAIIIIING
I
STREET FILER+ESUB;
OCT 05 2006
BUILDING DEPARTMENT
CITY OF EDMONDS
RECEIVED RECEIVED
--JUN 2 6 21D06 0 C T -, 5 2006
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS BUILDING DEPT.
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STREET FILE FlESUS
ICT 05 2006
-SUI�DING DEPARTMENT
C17Y OF EDMONDS
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#P20 CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1.. Site Address/ Location: V-*-7
2. Property Mix Account Number: '2-n r.)-3,?) b� .0 0
3. Approxhinate Site Size (acres or square feet):
4. Is. this site currently developed? -,)(yes; no.
If yes; how is site developed?.. 4,�-Wtq_ Avu 2 0
5. the general site topography. Check all that apoly.
Tlat: less than 5-feletelevation change over entire site..
Rolling: slopes on site
generally less than,15% (a vertical "rise of 10-feetover a horizontal
distance j.
of,66-feetfi
10�46et
1-filly: slopes present. on site of more, th 4%4�
aM
"M V �J
over a horizontal distance of 33'fo 66-feet).
fv�
ep: grades of greater. than 30% present on sit al Jv
Ste V c
ja
�o
distance of less than 33-feet).
Other (please d
escribe).
6. Site contains areas of year-round �standing water: A*porox.' Depth:
7.1' Site contains areas of seasonal Standirig -water: Ap Dep#i:
prox
What se ason(s) of the year?
8. Site is, in -the flo, o-dway floodplaiii ofawwatbr' course.
9. Site contains a creek or an area where water flows across the grounds surfaceT Flows are year-round?'
Flows.are seasonal? (What time of yL
10. Site is primarily: forested meadow
.,shrubs mixed-.
urban landscaped (lawn, shrubs etc)
'11. Obvious wetland is present on site:
2.
3.
4.
S.
For City Staff Use Only
Plan Check Number, if applicable? Q QQCo - Q
SiteisZoned?..
SCS mapped soil type(s)? 1-4- - Ev QcftyfA�v 6&� 0 40 RX _--�Jooes'
Critical Areas inventory or C.,&. map indicates Critical Area on site? MD -
Site within designated earth subsidence landslide hazard area? Alo.
DETERMINATION
Reviewed
NO
WAIVER
#F20
- %:. 1 0 7
City. of Edmonds
Development Services Department
P'a, 7e
Pho
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a .
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 av i t
CIM ar
WON
r
appirrinm U
�)(-10 r Air -1 Ps);01�
Date Received: (a 17,67 /0 �p
City Receipt#: Reif Y
Critical Areas File M
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 o'n'this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in cohjunction with this Checklist to assistant staff
in completing their prelirminary assessment of the site.
The undersignedltpplicant, and his/her/its heirs, and assigns, in consideration on the p f the'applicition agrees
yocessing o
to release, indemniff, defend and hold the City,of Edmonds harmless. from any and all damages, including reasonable
attorney�'s.--fees-.- "?-r,*Tirgj� from- any - ad�on. or ir,&P.0,en-bap in 'Wh6le-P '�arf i mon J �q I -,e.;, �Mi ing-inp, cunrat
bts
incomplete information furnished by the applicant, his/her/its age- 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 a's listed1below.
SiGNATuRE oF APPLicANT/AGENT jAZ"�� DATE
Property Owner's Authorizadon,
By MY signature, I cer* that I have authorized the. above Applicant/Agerit to apply for the subject land use application,
and grant my permi�-sion 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 4s application.
SIGNATURE OF OWNER
Owner/AppHcant:
Name
f
-3,-711 q L
Street Address
city §tAte Zip
Telephone: te)Ka -i5,-��7 -5
Email address (optional):--ft 11
Applicant Representative:
Name -
Street Address
City State
Telephone:
Email Address (optional):
zip