23816 101ST AVE W.PDF1.111111111
105
23816 101 ST AVE W
PLANNING DATA
NAME: _WtArcY.-4^4m DATE: 111,71-20.7-
SITE ADDRESS: Q 2 3 81 01 - W, PLAN CHK#:_ 0 2— - - 0 7
PROJECT DESCRIPTION: 4stA 789 " mAji-e- rvjv—,0&4
REDUCED SITE PLAN PROVIDED?��/ N�o)
MAP PAGE: 003 CORNER LOT: (Yes FLAG LOT: (Yes
CA -
ZONING: CRITICAL AREAS DETERMINATION #: 02- `5
ID Studv Reaulred: -
Ef Waiver
13 Conditional Waiver
N a
SEPA DETERMINATION: tJ-�- IT
REET AM
U Fee
Checklist
L3 APO list w/ notarized form
U(Needed for soo cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
Exempt
SETBACKS:
Reguired Setbacks:
Street: 2-5' Left Side: -7 5' Right Side: Rear: 15--
Actual Setbacks: '4. -cz_—
Street: 31' Left Side: I I I Right Side: a' Rear:
Street map checked.for additional setbaci required? (Yes / No
DETACHED STRUCTURES: !V6-c
ROCKERIES: 0—
U FENCEsrrRELLISES: WC sj�"
El BAY WINDOWS I PROJECTING MODULATION:
USTAIRS / DECKS: t,—t - 1 4.,tM
4-
PARKING: Required: 2- Actual:. 2 1 f�
1170
LOT AREA: 2
LOT COVERAGE
Calculations: 14
BUILDING HEIGHT:
Datum Point: Xd&m ok k4, g6k (;P
Datum Elevation: C
Maximum Allowed: Actual Height: 5, �Z 5,
A.D.U. CREATED?: (M2LYes
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes I
OTHER:
Plan Review B)r
C/
NewBPPlanningDataForrn.D0C
PROI
STEVE & ANGIE ZAMBERLIN
23816. 101sT AVE WEST
EDMONDS 98020
206 542 8824
TAX No 006 15 800 000 700
I EGAL DESCRIET-ION.
WOODHAVEN BLK 00
LOT 7.
T27 R 03 S 36SW
SCOPE OF PR9J-ECT-
SINGLE STORY ADDITION OF 788. SQ FT.
DINING ROOM, MASTER BEI) AND BATH.
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hydrolog /vegetation)
1. Site Address/ Location: �Z '*&I (A 1mv 4VEF
2. Property Tax Account Number 00 4P 10r7 0 e 4 �) 004 7 '74 P t- .2
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _kyes; no.
If yes; how is site developed? - W,/O
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 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- 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: Approx. Depth:
7. Site contains areas of seasonal standing water: AIQ Approx. Depth:
What season(s) of the year?
8. Site is in the floodway NO floodplain AJO' of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
AIL02 -Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc) Y.
1-1. Obvious wetland is present on site:
G:\Share\Library\Planning\Forms\Public Handouts\ Critical Areas Checklist Doc/1-16-2001
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.02�6
Fax: 425.7,71.0221.,
DATED RECEIVED:
CITY RECEIPT #:!i3!
Critical Areas File M
,..Critical Areas Checklist Fee: $45.00
N
'DATE MAILED f0 APPLICA 'T:..
.CRITICAL ARtAS 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/or 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.
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).
PLEASE PRINT CLEARLY
Owner/Applicant.
I
---A��TV\IeIPAQ6(e
Name 9
Z*e I (a
Street Address
012' 'UJA- JX0ZV
City State Zip
Telephone: �06&- '7q2.-- SIZ-t
Signature
Ap , plicant Representative:
I.. ': ,
LIA�
,Name
Street Address
"MQ�49e2' WA 1962.0
City State Zip
07 #**'
Telephone: 4&&-,7
WA�iv� Aawn^r\ , *
Signature Date: 1.10.040 (
G:\Share\Library\Planning\Forms\Public Handouts\ Critical Areas Checklist Doc/1-16-2001
E RECEIVED
-'PERMIT EXPIRES
N
C17Y 0FEDM0`N'DS
USE PERMIT
E
Z9N 5
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUTIVAPT#
ADDRESS 21 �2 1�/ ve�
1 15 , —. W
OMER NAME/NAME
F BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
4'�Ffr_Vr- ILMOIF, :ZA 11 F�f� JZ L
LID FEE $
15
MAILING ADDRESS
'61
TESC
to
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
POPMAPF=
RW a
EXISTING PROPOSED
Street Use Pannit Recrd
Inspection Required
Sidewalk Required
UnderWound
CITY IP
ITELIEPHONE
R-EQUIRED DEDICATION FT
I
_jWlft9
required
NAME
METER SIZE
LI NE SIZE
NO. OF FIXTU R;S
PRV REQUIRED
YES 13 NO 0
ADDRESS
REMARKS
z
U01- A LQF_k, '�_f
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
ouy� 169Z
TELEPHONE
llt4
I N 5 jk-(l I OPS f-EQ6.j 9Q V-905 10 N nZ r 10 A L.
NAME
A -142 T,
1VV,0yj PiAviisf(h
ENGINEERING REVIEWED/DATE
it
ADDRESS
4VE- 17F.
FIRE REVIEWED BY DATE
C17Y
E,
r7
STATE LICENSE NUMBER
------ 'BY
VARIANCE OR CU
SHORELINE OR ADB*
INSPECTION
REO'D
IPSOND
OSTED
AJ S"_g- o ji
YES GrOO
SEPA REVIEW
COMP IIETE EXEMPT
N AREA
ALLOWED PROP OSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
0 (P goo wo
,
,
7.5'
EXP
NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
ADDIT161(" COMMERCIAL 0 COMPLIANCE OR
35-2
7-5 � 7 5' 5'
33' 2[f
z
CHANGE OF USE
PARKING
REOD PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL 0 APARTMENT
0 SIGN
IL
REPAIR 0 GRADING _% . FENCE
CYDS 11
Z 1 2-
9,14701
REMARKS V
1 _ X FT)
/
0 DEMOLIS4' TANK OTHER
c3 GARAQ 0 RETAINING WALL
CARPO;� ROCKERY RENEWAL
(TYPE OF USE. BUSINESS 00 ACTIVITY) EXPLAIN:
CHECKEO BY
TYPE OF CVS WON
IC
OCCUPANT
GROUP -2
NUMBER
NUMBER OF
CRITICALW
SPECIAL INSPECTOR
REQUIRED
AREA iiIa
ftD
OCCUPANT
LOAD
OF
STORIES
DWELLING
UNITS
AREAS
NUMB—( A,'/gZ.
DEgCRiBE WORK TO BE DONE
REMARKS*
ADD 21 10 - LE, 1A A 5, F,) E D 0)A TV
PROGRESS INSPE CTIONS PER UBC 108/FINAL INSPECTION RECVD
P I IQ6 gr-ma-DEL,�
K I T-C A F, f4,1
I
f
(Mm-,t tic -up 4- IC4-11 w
0 144
:�. "., " /
A
$
Description
as
FEE
Description
FEE
Plah'Check
HEAT SOURCE GLAZ G % LOT SLOPE %
I L Building
V.ESTED DATE
PLAN CHECK NO P 9m Wn
;7--
Mechanical
THIS PERMIT AUTHORIZES ONLY*THE WORK NOTED. THIS PERMIT COVERS WORK TO .
BE DONE ON PRIVATE PROPERTY ONCE ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEESp ETC.) WILL REG grading Recording Fee
UIR
t: SEPARATE PERMISSION.
PERMIT APPLICATION: 4r En City Surcharge
ISODAYS
CL PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Endr. Inspection
Y 6
SEE BACK OF PINK PERMIT FOR MORE INFORMATION State Surcharge
I*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Dep�sit
U C C E S OR S
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E C IT Y 0 F
AN Y D
WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt #
IEDMONDS,
ALL AIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
No IR Y
E I�
FR69MLTHE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
L NOT BE
9 DEEMED TO MODIFY: WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount Due
RDI CE
JF
0 NOR umrr. IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION"
'ROVISION.
dAN
Landscapelnsp. Receipt # q1f)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION;'THAT THE INFORMATION
R 10
0 M T
GIVEN IS CORRECT.. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED -AGENT OF
AGENT OF APPLICATION APPROVAL
C S UC
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application Is not a permit until signed by the
R MPLOY CALL
TION; AND & DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE. EMPLOYED
. Building Offl.11al or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ovdeoged In space
Aracelpt is ackn
WORKMENS COMPENSA71ON INSURANCE AND RCYV 18.27. provided.,
SIrRE DATE SIGNED IGNATURE DATE
OM '1 (425)
/t/;1"ER
Sr 6JAJ AM IQ
771-0220
RELEASED BY
ATTENTION Off 1.333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE -UNTIL L 9113k�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- .771-0221
Z
ORIGINAL - FI(E YELLOW - II&SPECTOR
CATE OF OCCUPANCY:HAS BEEN GRANTED. UBC SECTION 109 . .
10/01 FAX PINK OWNER GOLD - ASSESSOR
q
Permit No: 2602-0014
City of Edmonds, k ('J-z Lo
RIGHT OF -WAY CONSTRUCTION PERMIT Issue Date:
A., Address or Vicinity of Construction: -2- -� 951 �e 0 F_ UJF.1�5'_r
B. Type of Work (be specific): ?A�F, rP_QM e Q 6 F_
)F STF-tET
TL2 P R OF-aLlY U M E Z Q E T-- M 11'4 -
C. Contractor: Contact: Y_ R 15 11 W AAW ez 0 tJ
Mailing Addressl 2,0 2-, (d e-j AV E- &�i Phone. 42fl...JU -71al
�J 0 A 0 rl 1 "74 qe) 2-'70
State License #: Liab nsurance: Bond:$ 6,910
D. Building Permit # (if applicable):- We'r Permit # (if'applicable):
E. F-1 Commer"cial Subdivision F� City Project E] EUC (PLJD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family Other
INSPECTOR- W(ClUileu- 61JLI�ega
F. PAVEMENT: E] YES WNQ G. SIZE OF CUT x H. Charg�: $
CONCRETE CUT:. YES RNO.,
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACT& IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A ?ERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND I A CCEPTANCE'OF THEWORK. ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH IS
COMPLETED BY CITY FOR I CES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic control - and h public safety shall be in accordance wiih City regulations as required by the City Engineer. Every
flagger must be traint'ed as required by (WAC) 296-155-305 and must have prtification verifying completion of the
reqt,iiked training in their possession.
at a
eord'fice 'w ith �Cit" rcbdes-�,,�'All�*stfeet.�'eutz; trericfi�- iibrk' sl�all - be' patched- with asphalt or City
e ion i y
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
IIIAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUIREMARV AND ACKNOWLEDGE
THA T I MUST MAK��THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Pate: 'oe-E r4l
r
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
A I Pp I roved b�- 26� Right-of-way Fee:
Time Authorized: Void AfteriO,100r,_ 5 W/"Ibt-T, Disruption Fee/Fuind 111:
Special Conditions: IV—,Z PA'� Restoration Fee:
&59- Me�gpk L lif Rih*l,1 Total Fee:
lqll) g-
Receipt No:
Issued by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK. a2 6w I 4W�
INSPECfOR'S SIGNATURE DATE:1 I 1010 Z,
For. inspection requirements see Engineering Information Handout.
NO WORK SI-IALL 13EGIN PRIOR TO PERMIT ISSUANCE