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ADDRESS: e---7K.Z�
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver 0 Study Required 0 Waiver
DISCRETIONARY PERMIT X
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER).
PLANNING DATA CHECKLIST DATED: 10 / ( I / () -7-
SCALED PLOT PLAN DATED: /P—q"T
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSTsTonns\Street File Checklist.doc
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STREET FILE
PLANNING DATA STREET=FILE
SINGLE FAMILY RESIDENTIAL
Name:
Date:
Site Ad6r /S:
Plan Check #: ;?,Oa
Project Description:
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Reduced Site Plan Provide< 7(YE)S NO)
Zoning: ps — <3
Map Page: 0�5 Corner Lot: (YES
Flag Lot: (YES 140
Critical Areas Determination #:
El Study Required
��Waiver
SE�A Determination:
>K�empt
Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist El APO List with notarized form
Required SetbaCk5
Street: f
Side. 07-s�
Side: 7-51
Rear:
Actual 5etbacks
Street:
Side:
Side:
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El Detach7JAructures:
El . Ro cke e,
El Fe es/Trellises:
El y Windows/ Projecting Modulation:
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Stairs/Deck:
Height
Da�p�in . 4-4-4:AJ C-5 A/24
Datum Elevation:
Maximum Height Allowed:
Actual Height:
7. Other
Parking Required:
2.-,.
Parking Provided:
LotArea:
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations: goo
ADU Created: (YESO-o�)) ?&4-e�4-i4 A--L>"
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES / NO)
Comments
Plan Review By:
Planning Data Form G4-11-06.doc
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address: � 3 4 / 9- 101 St- Li
Edmonds, Washington q IV 0 9-0
Legal Description:
Assessor's Parcel Number: 0 0 q L-1 16 ::� 0 () 0 003 00
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code (ECDC) and understand that an accessory
dwelling unit as defined in ECDC Section 21.05.015 is prohibited until an Accessory
Dwelling Unit Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all
the criteria in Chapter 20.21 are met, and all the necessary items are submitted,
including an affidavit of occupancy and a covenant to be riled with the Snohomish
County regarding the regulations imposed on Accessory Dwelling Units.
Property Owner Signature:
Property Owner Name (printed): V14k,4Z---T
Date: I;L,260 9
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that V-Av-,Ae k 7— 1
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
Notary's pressure seals must be smudged. Dated: A, Qoo 9,
Signature of
..... . Notary Public:,.Q-��"�-
Residing at:
My Appointment
7 3-,\ Qo. Expires:
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THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
ADUstatementdoc