24128 76TH AVE W.PDF111111111111
6465
24128 76TH AVE W
C-4
0-
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
11
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required gWa`iver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DA'
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERM[IT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fomis\Street File Checklist.doc
DATE RECEIVED
I,
PERMIT EXPIRES
io
L:
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB 11 SUITE/APT#
OWNER NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
6e,n,&a. d6i aOS
CC
W
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW POU.it Required
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3:
qiQ7
OF
14-V?,41za_1
EXISTING OSE
Street Permit Roq'd
Inspection Required
CITY ZIP
I TELEPHONE
Sidewalk Required
/::7 V
0 --77s9
REQUIRED DEDICATION FT
Underground
Wiring required
NAME
METER SIZE LINE
SIZE
NO. OF FIXTURES
PRV REQUIRED
11 If
4L
1-7 __z
YE NO 13
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CC
ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP
TELEPHONE
64h&V i
NAME It
GINEERII�G REVIEWED BY DATE
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ADDRESS\ T I
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-573 doS7
FIRE �-REVIEWED BY DATE
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CITY TELEI�_HONE
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0 It
VARIANCE OR CU�
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SHORELINE OR AD�#'j
I
I IN�PECTION
BOND
POSTED
STATE LICI�PeNWBE ExPiAATION DATE CHECKED BY
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1*0YES
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fiZNO
$
"SEPA-REVIEW*
COMPLETE E X T
�SIGN AREAV
ALLOWED. I IROPOSED-
HEIGHT
.:,ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL -NO.
�t Lf 7'1
06) 4-4 OMOD902
Exp
NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSE
BEQUIRED-BETB
D PMftT&-904E
ROPOStp SETBACKS (FT.)
t
COMPIL ANCE OR
ADDITION COMMERCIAL
35 1511/0
0..
a5 A5$ L, 71"'
CHANGEOFUSE
PARKING
T AREA
PWN!NG REVIEWED
BY DATE
MULTIFAMILY:,
REMODEL SIG . N.
PRTVIDED
La
1773
I 1441-,
'9151c; 4Y
CL
FENCE
El REPAIR CYDS X' FT)
R�MARKS
0 - -f-fer*
DEMOLISH T;NK E], OTHER ,
C �Icr
GARAGE RETAINING WALL:`, FIRE SPRINKLER
O'ROCKERY
CARPORT
(TYPE OF USE, BUSINESS OR ACTIVITY]I EXPLAn,':,'�,. e,l
0
CHECKED BY,
ITY LICTION -
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OCCU P T
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IA
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611-19J)L
NUMBER
OF
NUMBER OF
DWELLING
I
CRITICAL
AREAS
SPECIAL INSPECTION
JAREA
OCCUPAN
LOAD
0
STORIES I?
UNITS
NUMBER' 1(�'9
- - -
REQUIRED
[:] YES
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DES�PBIE WOR6 T9 �E 0ONj, ;24
41!!.S 51 Alel rWh I U/
REMARKS
PROGRESS,INSPECTIONS PERIUBC108/FINAL INSPECTION REO'D
/51—AZZA?, -71
VALUATION
$
Of
Descriptioni
r-,FEE
Description
FEE
Plan (�he Ck State Surcharge 1_11�62_
9WING % !4� 11 5SLOPE %
11�_�
H�
4 arge
, V/C> Buildind.?,elrmit City Surch
�BOURCE
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. _ . .
I
PLAMCK N9- VESTED DATE �P Ing Base Fee
-lumb
f
Mechanical
ZZ2
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
i Grading
:I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t= SEPARATE PERMISSION.
Engr. Review
CC
ILI PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspedon
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
4 214'�5_ 7
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt #
I �Vl
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE qf WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIO�,�RANCE AND RCW 7. /
I ------ OF11 S TUFE ATE
SIGN (OWNE'OR DATE SIGNED (425)
f-, ze, oel, 771 -0220
RELIJISED BY DATE
ATTENTIdP( EXT 11333
& &k&
LAW
"i IT IS UNI L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INZECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - Fit E - YEI I OW AN SPOOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
09/03 PRFq.q 14ARn voijARE MAKING 4 r—C)PIES
S IT E PLAN
Tax Account Parcel #:
00491100000902
105
HEIGHT CALC.- 104
102.58' A '03. 81+ 103.58. S"
102.58',�D� += 412.53V4 - 103.08'+(2
1
{MAX. 8 06. HT.) = 128.08'
�CTUAL 8LOG. HT.) = 127.6'
27.6'.c 128.08'
LOT COVERA&E 103
LOT SIZE = 11,772.5 S.F.
BUILDING AREA V6�.); 1,811 S.F.
WALK, PA 87 S.F.
= Z,098 5.F. Z)R ZZ.176
CONTACT
6ENNADIY KUTASHVILI
9107 9TH AVENUE SE
EVERETT, WA 98208
TEL. 425-290-7792
CEL 425-387-9908
z
N
qual
3
-7
Other d. 5 —to - --rw7,-eo-L—v -Je7j c-,,T,l
Height 7-1--
85.0' G
Datum Point
fo
i
sw� I
RECEIVER'
JU-N 2 9 2004
10'
85.0'
---------------------------------
F--�
PROPSED .
RESIDENCE
PERMIT COUNTER
APPROVED BY PLA ING
Ll 76TH AVE W N 0 R —
MT 1 ri
MCC I rILC
[A
Zone CornerYO Flag Ao
-----------------------
Setback 25'8.S.B.L.
b
06
11
PLANNING DATA,
�Lc Je
NAME - 4TSEP v-rq �1 v DATE: S,'(1jj01Y
SITE ADDRESS: a q I N 7 6 Tl A Ve. PLANCHK#: Oq-?,�6
PROJECT DESCRIPTION: A/5FR
REDUCED SITE PLAN PROVIDED?:& No
MAP PAGE: oo6. - CORNER LOT: &/_�Oj FLAG LOT: ge�s
ZONING:- CRITICAL AREAS DETERMINATION #:O�, -q3
L1 Study Required:
Waiver'
ld�Conditional Waiver
SEPA DETERMINATION:
Q Fee
Ll Checklist'
L3 APO list w/ notarized form
L3 (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
AExempt
SETBACKS: Al
Reciul!�pd Setbacks: /'
Streett: d
_2�5Lteft Side: 7 kpgW Si 6: lZber: 7 4�
Actual Setbacks: E Al
54 t._j 57 �_L'bft Side: 5*9 Side: — Lio R",r:_
Street map checked for additional setback. required? r(Yeb'N/ No I DNA)
DETACHED STRUCTURES: — A/ jed—icoco-uIN
0 ROCKERIES: A114 0-�
561t/T�\ lo*-feel To
Q FENCES/TRELLISES: &,-14
OK TeaAf To
L3 BAY V�INDOWS /PROJECTING MODULATION:
L1 STAIRS/DECKS: A1114 OK
PARKING: Required: �_Actual:
LOTAREA: 11,?7L 0/
LOT COVERAGE 0
Calculations:
BUILDING HEIGHT:
Datum Point: Datum Elevation:
Maximum Allowed: —Actual Height: A q 17"
A-D.U. CREATED?: No Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: ffei6Eg�
OTHER: —
Plan Review Bv. K55 eeMv
NewBPPlanningDataFomLD0C
APPROVED AS NOTED
BY ENGVEERING 0
DRAINAGE PLAN I I ��� -_
Date:
Tax Account Parcel #: RIG [IT -OF -WAY C014STRUCTION PERMIT
00491100000902 . . AND INSPECTION REQUIRED
CONTACT
GENNADIY KUTASHVILI
9107 9TH AVENUE SE
EVERETT, WA 98208
TEL. 425-290-7792
CEL. 425-387-9908
HEIGHT CALCULATIONS
102.58' (A) + 103.58'(B) + 103.58'(C) +
102.58'(D) = 412.3274 = 103.08'+ 251
(MAX. BLDG. HT.) = 128.08'
(ACTUAL BLDG. HT.) = 127.6'
127.6'< 128.08'
LOT COVERAGE
LOT SIZE = 11,772.5 S.F.
BUILDING AREA (+O.H.) 1,811 S.F
DRIVE. WALK. PATIO = 827 S.F.
TOTAL = 2,638 S.F. OR 22.41 %
INVERT ELEVATIONS
DRIVEWAY DRAIN OUTFALL - 100.5
UPPER CATCH BASIN:
INLET - 98.75
OUTLET 176,'71
CONTROL CATCH. BASIN:
INLET - 98.50
OUTLET - 9848 q 9 -S-D
STORM SYSTEM - 98.33
SCALE
III = 20'
FOOTING DRAINS
To 13E TIED IN
rNote: The) existing
sewer lateral needs to
V
bbe TVd by the City's
Public Works Departme�nt
4 , t
to determine the condition
a ,.,4 i 8 sa 1 ry
nd size of the sanitary
sewVin.
A rAB,,.E TIGHTLINE
MATERIAL
SDR 35
SCH 40
14-12
FS 0 JJANCO
104
103.751
INI
102.5-4
v"Tit19
RF
.CEIVED
mAY 17 2005
WIMIT COUNTER
85.0'
107
a-iii�'EIV-C�,�NTRACTORISRESPOiqSiP',.=- I
FOR EFIOSIWMNT_ROL AND DAMAGE
I&B.S.B.L.
- - - - - - - - - - - - - - - - - -
4-105.5
104.5
177
B C
'�103.75
PROPOSED-
)I�SIDENCE W)
N, C6
11 !J: v
103.75
----------------------- : . . . . -
MAIN DRAINAGE LINE : MAIN SEWER
.......................... a ......................... a .......................... of .................. 0. 0: ... a ..........
M.
R - 1,1111170MIDN"WAS
STANDARD
OWNER:/l
DETENTION SYSTEM W
(5000 SF OR LESS)
)DDRE�,S: _ il .
It A C4
ORKSHEET
CALC BY:
PHONE
DAT E:
FPIP-=
[ORIFICE Ay
IMPERVIOUS SUFACE AREA
PIPE DIA_
LENGTH
P'65'M",q'AM_',SHALL NOT BE CONNECTED TO DETENTION SYSTEM
r—COCKING LIC (TYP.)
RIM ELEV.-' - --7-A I- DETENTION PIPE LENGTH
FINISHED
GRACE
TIGHTLINE_ I
0.5% TO 1 0% SLOPE
UPPER CAT Ch BASIN
ELEV
91, f0:14
ROM CONTROL CB
IfA ELEV
F6" Mir.. cleararoa
Measved from topol
Conc. box or iiset
TO C"Ty CONVEYANCE
ELEV.
'---OUTLET
ONTROL
`,,�CRIFICE
_2*X2'X12* DEEP CON-ROL CATCH BAS!N
(4- -6- QUARRY SPALLS OR EQUAL) `� IN 6�,,
.IN &'COVER
FROM CCNTROLCB
R-.'PRAP OUTLET
SHALL BE PERPENOICIULAR
TO SPREADER TRENCH
PERF, PIPE SHALL BE
LEVEL 8 CAPPED ATENDS
NOTES
I
SPREADER TRENCH
RIM ELEV
INV. ELEV
CITY STORM
CONVEYANCE
SYSTEM
PREADER TRENCH
SHALL BE A WIN
CIF 10'LONG AND
PERPENDICULAR
TO CONTROL CB.
CONTROLCB 00
TRENCH SHALL BE LINED
WITH MIRAF I &ON TOP
WASHED DRAIN ROCK
1 CAL t_ E- N-G,.NEE IR NG D V* S;O.N 7 1 _02"20 EX T 1 _K61 2 4 H0(_ R S iN AOVAN--_:E� ;�:OR A - G." T Ll-%�= ANG DETE N -!CN
BEFORE BAC�',='_PtS kND FDR ::JIAL INSPE-C-10-NIS
2 ::c�e,at on a id ma.r*e - a -ice of :: -3nage s...-stems o- :),.,..a-.e res::Cnz_in:Iri- c" -t-e p(:pe-.
e V-_rage p pe -ie:: c :-a s r-s -.c al c,.-i ::,00er : raz;:�-
le'a!e-iaI az�cirnula!ed -i * -n L S'� be " is arz: re
T-a oj-; c-* L�c.,ro C* '!Ce -.Ls. be ,ez:-. --per a. 3 'mes
El
EP 2 9 2004
BUILDING DEPT
ED B
5-1136-
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I
Critical Areas C.heck'list CA File No: 0a -A a)
Site Informflon (soils/ topography/ hydrology/ vegetation)
` Z 761y�� �
1. Site Address/ Location: - Y 0
2. Property Tax Account Number*: jp jq 62 0 19
3. Approximate Site Size (acres or square feet): 2 4�
4. Is this site currently developed? yes; _ no.
If yes; how is site developed? 5 e- aecV 6 92�?=4 e
1
5. Describe the general site topography. Check all that apply.
Flat. less than 5-fee.t 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 legs than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: IVO ; Approx. Depth:
7. Site contains areas of seasonal standing water: A10 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IVO floodplain of a water course.
9. Site contkins a creek or an area where water flows across the grounds surface? Flows are year-round?
/1/0 Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed X'
urban landscaped. 0i",shrubs etc)
11. Obvious wetland is present on site:
U
WN I'M;
i#73. 7
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Y
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ea.on,si
tic-' e! p., 4-
Irt V1 al 0a. SWVZIW;�E F.- �57
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W;4.
Q 05
IMMUMUeDI wtm r
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Critical Areas Checklist.doc/3.19.2001
-.1. 1 0'
City oAdmonds
Development Services Department
Planning Division
Phone:
Fax: 425-771.0221..,
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 shq�flj)be easily
available from observations of the s#�"data available at
City Hall (Critical areasooA�Res, s, or soil
surveys).
Date, edel d:
Mc
City Receilt M
CritidalArea-s F"e;',#--
Cr�tical,Areas Checklist Fee: $45.00
Date Ma'ib�� -to Applic ant:
A property owner, or his/her authorized representative,
must.fill'6�t the checklist, sign and date it, ainid-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 '(q,g. site plan, -topography map, etc.) or
studies in -conjunction with this Checklist to assistant staff
m completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/heThts agents 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 as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public official and the staff of the rQ of Edmonds to enter the sub ectprooerty for the
n j
purposes of inspection and postin attenda;70 this applic#0'
g on./
SIGNATURE OF OWNER
O�vner Applicant:
9�EIVA'-'4z) / Y
Name
?1627 ql--� Ilve !�E,
Street Address
W'4 q 00
City State Zip
Telephone: 4Z -5-- 2- -7 7
Email address (optional):.
DATE e 57 V'?, C) 2— .
Appficant-Ripresentative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
117 C. 18,9,3
CITY OF EDMONDS
121 5TH AVENUE NORTH * EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wmci.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
June 1, 2005
MEMO TO:
Puget Sound Energy
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
GARY HAAKENSON
MAYOR
Please be advised that 24130 761h Avenue W has been retired from the Edmonds address
system. It has been replaced with 24128 761h Avenue W.
Occupancy: Residential
SFR Demolition to new SFR
Tax ID Number: 00491100000902
If you have any questions regarding this letter, please contact me at 425-771-0220 or
Harrison@ci.edmonds.wa.us. Please contact me if you wish to be removed from this list.
Respectfully,
Senior Permit Coordinator
Edmonds Building Department