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23923 104TH AVE W
ADDRESS: Owe -
TAX ACCOUNT/PARCEL NUMBER.:— 1 q 9 S - OL0011
BUILDING PERMIT (NEW STRUCTURE): Go 0 00 qo(,n
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:— R-1-10 B DETERMINATION: [jConditional Waiver E]StudyRequired E]Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: q I ILO
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (
PLANNING DATA CHECKLIST DATED: q i cl (E
SCALED PLOT PLAN DATED: -"I 1101q5
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: Ll- BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
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TYPEE 1
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IFRAME & GRATE
RIM
299-00
IE=i,96,00
x
301.20'
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TRENCH W/ 6" PERF-.
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6" CLEANOUT
1*0 GRADE
k i IE=296.00
w
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EXISTING GRADE
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WASHED ROCK
BACKFILL
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PLANNING DATA
NAME:— 6251,
SITE ADDRESS: ODATE: AS
ZONING: P,� ;6 PLAN CHK#:—.
PROJECT DESCRIPTION:
CORNER LOT---I� (Yes/No) FLAG LOT (Yes/No)
SETBACKS:
Required Setbacks:
Front: - Z�6-7 "Left Side: Right Side: Rear:
Actual Setbacks:
Front:- 1-7 Left Side: Right Side: ;X Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (YIN)
LOT COVERAGE:
Maximum Allowed: (A�sd —Actual:- 69-740
BUILDING HEIGHT: �(Ie"2�, �6)Actual Height:
Maximum Allowed: /Aa
Datum Point: RKW WM. &5C UY Datum Elevation: 16D
A.D.U. CREATED?: N14
SUBDIVISION:
CRITICAL AREAS #:. 1� 10E
SEPA DETERMINATION:
LOT AREA: 00/90 & 4r4r., ��
OTHER:
OOJECT REVIEW CHECKLIST*
PROJECT NAME: PLAN CHECK #: Q
PROJECT ADDRESS: Ax, RECEIPT DATE:
P k,
BY: (initial/D
e).
JREVIEW�D
PLAN. IWATER
COMMENTS
FIRE
BLDG. ISEWER
ISTREE: ENG.
SetbacksNariance/Setback Adjustment
. .. .. ........
Conditional Use Permit
. . . . . . . . . . . . . . .
2
ADB Requirements
-3
Other Zoning Re uirements
4
Underground Wiring Required
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ve-5
5
Lot Slope 15%
'.. .......... .
SEPA Environmental Checklist/Hydraulics Permit
. . . . . . . . . . . .......... . . . . . . *
7
Tree Cutting Plan
.......................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............. ........... ........ ...... . . . . . . . . . . . . .
--8...
Plat/Subdivision Requirements
...... . . . . . . . . . . . . . . . . . . . .
9
Legal Description Verification
- - - - - - - - - - - - -
-�j 0
Quit Claim/Street Dedications
- - - - - - - - - - - - - - - -
"j/
Easements - Public/Private
Engineering Storm Drain Review Fee
. . . . . . . . . . . ........
................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A ........... .......... . . . . . . . . . . . . . . . . .
13
Engineering 2.2 Inspection Fee
--t4,7
Drainage Plan (On -Site)
.... ......
.. . ...............
Setback - Top of Bank, Stream, Water Courses
10 . . . . . . 4.1
- - - — - - - - - - - - - - - - -
16
Setback - Storm Drain Line
17
Open Ditch - Existing
18-
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
21
Catch Basin Required
. . . . . . . . . .
...... ... .
47
Driveway Slope & Vehicle Access
Sidewalk Required
. . . . . . . . . . .
Curb & Gutter Required
/V
::25::::-:
Curb Cut For Driveway Required
A,10
26
Street Paving Required
I . . . . . . . . . . . . . . .
AJ
Right -Of -Way Construction Permit Required
Street Name Sign Required
.................. . . . . . . . . . . . . . . . . . .
wX
Other Signing Required
Bond Required For Public Improvements
FE,MA Map Check/Water Table
..........
Side Sewer Availability
Calculate Sewer Connection Fee If No LID #
Create Street File
Existing Water Main Size
. . . . . . ......... . . . . . . .
Water Meter Size
3 7
Service Line Size
------
:38'
Water Meter Charge Required
Hydrant Required
Hydrant Size Existing
Fire Line Charge Requjred - Sprinkler
-42-
IStreet Cut
. . . . . . . . . .
jMiscellaneqgs.,f-�& JA
1
44
Reviewed By: 0
I IRE
9 al 4?�-YL8
PLANNING N E C E I VNMEERING PUBLIC WORKS
APR 15 1998
AI
EDMOND'S RK Ma % 01 Ir* w4l,= DFPT
R E C 0 R D OF C 0 N T A C T S
i
21
2
22
3,
23
4'
24
5
25
6
26
27
8
28
RW PERMIT # DATE ISSUED RECEIPT #
9
29
10
30
11
31
12
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT # DATE ISSUED RECEIPT #
14-.
PAID $ RECEIPT # DATE
34
5
35
36
17
37
METER SIZE PAID.$ DATE RECEIPT #
18
38
19
20
40
USE
CITY OF EDMONbs ZONE
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME/NAME OF BUSINESS I AUUHIZZI�
PERMIT
NUMBER
11?047c�_l
It
L6
LEGAL DESCRIPTION.CHECKI
SSDIVISjN NO
LID NO.
tu
MAILING ADDRESS
z
Sir,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
EXISTING —REQUIRED DEDICATION —
RW Permit Required 0
Street Use Permit Req'd 0
CITY ZIP
TELEPHONE NUMBER
+ L
PROPOSED
Inspection Requi red 0
Sidewalk Required 11
cc
NAME
METER SIZE
LINE SIZE
NO. OF FIXT RES
PRV REQUIRED
914
111;�@A) -5,
1
YESYNO 0
ADDRESS
AVE. A.
W
REMARKS
L)
cc
V 5x 97-
w
z
ZI
CITY P
NUMBER
UCI kVlf�"J6 �ee &'D
_`,:5 - 2 - 7 - (f 77o,-,
1-11-0 In 1 4,
ITELEPHONE
'360) 5'41 3 - CZ 4
NAME
�t 3,5 00 &1 V I U " S.
4- 0 IC
ADDRESS
cc
ENGINEERING)MEMO DATED )REVIEWED BY
TELEPHONE
z A,( I;"- 'Z
0
C CITY ZIP NUMBER
STATE LICENSE NUMBER np- EXPIRATION DATE
14 b K I A-J C C_ 1 99 1--� IM S�ZPJAW
YLegal Description of Property - include all easement� 71 "
L I La T C. 7-YL i - T- Q 91 C M sign.A) LL A
A--.c, i 48o &4 1 ('11
Property
Tal Account
x
ParQ No.
NEW
RESIDENTIAL
PLUM'BING(MECH
COMPLIANCE OR
ADDITION
COMMERCIAL
CHANGE OF USE
E]
APT. BLDG.
SIGN
REMODEL
G7&U
FENCE
REPAIR
CYDS
x _Fn
WOODSTOVE
SWIM POOL
DEMOLISH
INSERT
HOT TUB/SPA
RETAINING WALL/
CTARAGE
CARPORT
ROCKERY
RENEWAL
(TYPE OF USE, BUSINESS
OR ACTtytTY P-LA, L4�1
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
,b , _-, - - - , C , , , ,
91 � A 0�2 4 / /41 /W
VARIANCE OR CU
ADB#
SHORELINE It
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED
EXP
I
4 _4
1PROPOSED.
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
�
SPEeIAL 1148PECTOR I A OCCUPANT
REQUIRED 0 YES ps_�_ 1 LOAD
-1
REMARKS
I PROGRESS INSPECT IONS PER UBC 1'08'
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
P5 7
zff)
.
BUILDING
1 Z&
HEAT SOURCE:
G . LAZa,1G
%
PLUMBING
Plan Check No.
MECHANICAL
GRADING/FILL
This Permit covers work to be done on private'property ONLY.
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
0
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
(n
harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this per mit. Issuance of this permMsMill not be'd-eemed t 0
PLAN CHECK DEPOSIT
DUE
modify, waive or reduce any rei quiremdrit &V any ciiy brdinance
0 the City's ability to 66force bin;dordinance
nor limit in any way
TOTAL AMOUNT
provision."
ON
I—
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information -given is correct; and that I am the owner,,or the duly
au,thorized agent of the owner. I agree to comply with city,lghd
't THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authbri'z-
6' ., - I
no n,,wIII be -employed in violation of the Pbor
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
ed thereby, pers
Code of the State ofWaghlngton relating to Woekmen's Compensa-,
WORK NOTED
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
tion insurance ana RdW'1817�
INSPECTION
SIGNATUI)E (OWN R . OR AGE : NT) DATE.SIGNED-
DEPARTMENT
CITY OF
OFFICIA IGN DATE
3
t K: Ij
EDMONDS
CALL FOR
RF. r DATE
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 YELL6W"— Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
'el.11 olqv,
PINK — Owner GOLD — Assessor