23920 84TH AVE W.PDF111111111111
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23920 84TH AVE W
ADDRESS: �23q2,n 04rti.- 4VC, N
TAX ACCOUNT/PARCEL#: 6 Ito 00) 0
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required Ej Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required El Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USEIENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
0 ..
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrolo y/vegetation)
1. Site Address/ Location:
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Property Tax Account Number:
Approximate Site Size (acres or squa. . re feet):
Is this site currently develop,�, �,es;
If yes; how is site developed? �!:2At_
Desc '
7e the general site: topography. Check all that apply.
Flat less than 5-feet elevation change over entire site.
% t. Rolling- slopes on si t generally less 6 ian 15 % (a vertical rise of . 1 O-feet. over . a horizontal
distance of 66-feet).
slopes present'on site of more than 15% and less than 30% (a vertical'rise of 10-feet
over - a horizontal distanc6. 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).
(please describe):
Site contains areas of year-round standing water: Approx.' Depth:.
Site contains areas of, seasonal standing water.: Approx. Depth-.
What season(s) of the year?
Site is in the floodway; floodplain, of a water course.
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?
Site is primarily: forested ID meadow shrubs mixed
-urban landscaped (lawri, shrubs etc)
Obvf6us wetlandjs present on 'site: W6
—I_
CA File No:
For City Staff Use 6dy
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? A lAglv,-A. �Vfo,�. A -A 4--Ptz,,, 2 417.
14. Critical Areas inventory or C.A. map indicates Critical. Area. on site? ' No
15. Site within designated earth subsidence landslide hazard area? N�
DETERMINATION
STUDY REOUIRED
WAIVER
ate: -117— 7 A� �-7
Reviewed
,�Oc. 1%9.1J
e #IP20
City. of Edmonds
Development Servicerbg991 V E
Planning.Division
Phone: 425.771.0220 SEP 19 2005
Fax: 425.771.02ZiEVELOPMENT SERVICES
CITY OF EDMONDS
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 fivin observations Of the site or data available at
City Hall (Critical areas inventories, maps, :or soil
surveys).
0
Date Received: OCA I 101 IWOL:�5-
City Receipt#:
Critical Areas File M
Critical Areas Checklist Fee: $135.00
Date Maildd 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 submiR a vicinity map, along witlithe signf4 copy
of thi's form to assist City staff in fmdingand"locating the
specific piece of property described on thys -form. In
addition, the applicant, shall include". other pertinent
information .(e.g. site plan, topograWAfiap, �ic) or
studies in conjunction . with this ChecIdNZo f assistant staff
in completing their preliminary assessment of the�siie.
The undersigned applicant, and his/her/its heirs and assigns, 'in consideration on the processing of the applicaed
J, �grees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, - including r hable
attorney's fees, arising from any action or infractio,n,�basedjn whole or part upon false, misleading, inaccurate or
incomplete information furnishedby the applicant, hislh�rhts agents or employees.
By. my signature, I cer* that the info I ation and exhibi erewith submitted are true and correct to the best of my
I
knowledge and that I am authorized to appli ati n n behalf of the owner as listed below.
e
SiGNATuRE oF APPLicANT/AGENT DATE
Property Ownerl's Authorization
By MY signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission f �rthe lic officials and the staff of the City of Edmonds' io' enter the subject property for the
)n a 0 s PISM!,
purposes of inspecti( ndi ajendant to this appli on.
SIGNATURE O.F OWNER DATE, CA -
PLEASE PRINT CLEARLY
Owner/ AppHcant-.
Name.
Street Address
city State Zip
Telephone:
Email address (optional):
APR cant e esent7e:
Name
C�l L ka k-
Street. Mdres�
City State zip
Telephone:
Email Address (optional):
CONFORS CM
2010%041f3 j PG
10104120 0 4-24�m J62,00
SWOMIV CO-1. , *INGION
Return Recorded Instrument To:
City of Edmonds
121 51h Avenue North, Edmonds WA 98020
ACCESSORY DWELLING UNIT STATEMENT
Property Address: 23920 84 1h Avenue West, Edmonds Washington
Assessor's Parcel Number: 00463301600105
Section 31 Township 27 Range 04 Quarter SW--HANBURY.S
SOUND VIEW TRS BLK 0 16 D-05 LOT I PER CITY OF ED PFN
Legal Description: S-05-129SP REC AFN 200605245002 & CORR PER AF14
200610130571 & 200810090152--BEING A PTN OF LOTS I & 2
OF EXST PLAT
Grantor(s): Margaret Henson
Grantee: City of Edmonds
Related Permit Numbers: BLD20100571
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 filed with the Snohomish County regarding the regulations
imposed on Accessory Dwelling Units.
OWNER/GRANTOR(S): Margaret Henson
SIGNATURE: 141-
DATED �is \C� day of N�,�4�C 2010
On this day personally appeared before me III OONS-or.-� -0b IN . . I described
�0 �,�,Vt6'me known to be the individua
therein and who executed the within and foregoing instrument, and acknowledged that he signed the same
as his free voluntary act and deed, for the use and purposes therein mentioned. Notary's pressure seal
must be smudged.
Signature of Notary Pu
Residin�
My Appointment Exp
- THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR -
Notary Public
State of Washington
PAIGE N HEWITT
My Appointment Expires May 15, 9013
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Aff,OV�.D' PLAN.Nli,,101
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STREET FILI
RECEIVED
AUG I 12010
DEVF-LOPMENT -SERVICES CTR.
CITY OF EDMONDS
4'? C. 18 9'3
Oil"
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
February 6, 2006
GARY HAAKENSON
MAYOR
STREET FILE
MEMO TO:
Edmonds School District
Edmonds Fire Department
Verizon Northwest
Edmonds Police Department
SNOCOM Police and Fire Dispatch
Edmonds Utility Billing
SNOPAC
Edmonds Public Works
Snohomish County E911
Edmonds Building/Street File
U.S. Post Office
Edmonds Address Files
Snohomish County Assessor's Office
Snohomish County Information Services
Lynnwood Disposal
Snohomish County P.U.D.
Comcast Cable
Puget Sound Energy
Waste Management Northwest
Please be advised that the attached addresses have been added to the Edmonds address
system: New: Lot 2 — 23922 841h Ave W, existing addresses of Lot 1 — 23920 8411, Ave W to
remain
Occupancy: R3 Tax ID Number. 004633-016-001-02
Subdivision: S-2005-0129 Lot #'s: Lot 1 (existing address) & 2 (new)
If you have any questions regarding this letter, please contact me at 425-771-0220 or
UlTibaugh@ci.edmonds.wa.us. Please contact me if you wish to be removed from this list.
Respectfully,
--e*Ul�ugh'
Permit Coordinator
Edmonds Building Department
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1-\Temp\DST's\N4aster Letters\New Address2/6/2006
Incorporated August 11, 1890 0
Sister City - Hekin.an, Japan
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