24314 92ND AVE W.PDFiiiiiiiiiiii
9020
24314 92ND AVE W
IMPERVIOUS SURFACE CALCS
EXISTING
RESIDENCE: 1662 SQ. FT.
EXISTING
FRONT PATIO: 105 SQ. FT.
EXISTING
DECK: 397 SQ. FT.
EXISTING
REAR PATIO: 303 SQ. FT.
EXISTING
CARPORT: 600 SQ. FT.
EXISTING
DRIVEWAY: 832 SQ. FT.
PROPOSED
ADD'N TO GARAGE SLAB:
HEIGHT CALCS
A = +99
8 = +98
C = +96.5
D = +104
AVG. GRADE = 991<
ACTUAL 121.7'
MAXIMUM 124.,4�5S
F-t
Ld
z
c%4
0)
23.8
48.2 SQ. FT.
LOT COVERAGE:
2415.2 SQ. FT. (26.4%)
LOT AREA:
9152 SQ. FT.
+105
D
+104
Nw
104'
C14
NORTH
SCALE: 1" = 20'-0"
ZONE P-S -'F
SETBACKS:
FRONT �2-5
SIDE
REAR- I-S71
OTHER
HEIGHT 7-/-� '
PAT`10 EXISTING
105
. SO FT RESIDENCE
— I
1662 SQ. FT.
EX'G
DECK
397 SQ. FT.
I LINCOVID
00
10
EX'G CARPORT
30.0 600 SQ. FT.
0 Ld *SEE NOTE
X> M
Ld — CN
Of
in IZ417-1;;—I�'7 77 77,
B
%+98
24.0
.1+99
c
+96.5
EX'G
PATIO
303
SQ. FT
LINCOV
A
- — — — — 4+99
Of,
+100
SITE PLAN
DATUM PT. +100 E- )ca60A FOR
TOP OF SS SEP -- 7 2egi AL & JUDY LINDEN
MANHOLE COVER 24313 92ND AVE. W.
DEVELOPMENT SERVICES CT.9. EDMONDS, WA
'"*TREET Fil F CITY OF EDMONDS
S 11610im
+104 104'
*PROPOSED ADD'N
1 ST STORY 48.2 SQ. FT. ADD'N SLAB
2ND STORY 516 SQ. FT. I
rr�� Fcf � %y w Tf�))
PLANNING DATA
NAME:
SITE ADDRESS:
PROJECT DESCRIPTION:
991
REDUCED SITE PLAN PROVIDED?( oYes LNo) X
0
MAP PAGE: CORNER LOT: LYes 14g) FLAG LOT:
ZONING: CRITICAL AREAS DETERMINATION #:
LJ Study Required:
M
UConditional Waiver
XS PA DETER ATION: �IJZA
PA ET
Fee
e ist
list w/ notarized form
(NeedeXfor 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake, Ballinger)
E m
xempt
SETBACKS: ,
Required Setbacks:
Street- 12-6 Left Side: Right Side: -7 G7 Rear:
Actual Setbacks- Aei-.1f7 , I
Street: 'M. q ' Left Side: 57.2-�Rlght Side: 1q. S Rear: 1;7-q
M-reet map checked for additional setback required? (Yes &<o DIDNA)
,,r,U �DETACHED STRUCTURES:
ROCKER
OC
S SfTREILLISES:
A INDOWS / PROJECTING MODULATION:
0
S ST I S C
TAIRS DECKS:
A
PARKING: Required:_2- Actual:
LOT AREA:
LOT COVEFU%T. -qt 15-2-
Calculations: (,2- 60C> 2� -ilaE� — 7
BUILDING HEIGHT:
Datum Point:_qn___' e� W a,1kP1e_ C_ V vl- Datum Elevation: 00
A Actual Height:
Maximum Allowed: �7
A.D.U. CREATEDF-*Qo I es)
SUBDIVISION: ateVt (ot-.;.e a(_, I �q S,-rjaC_a
I
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: ()Les oNo
OTHER:
Plan Review
NewEIPPlanningDataForm.DOC
i
CA File No:
.Cribcal Areas Checklist
Site Information (soils/�qp''
ography/hydrology/veg
etation),
1. -A
_506,A-4dress/Loc don: NK. (�Jl &9\,�
I— --P:rop4�i-VT��'Accou-n-'t'Nui��:, 004�(, '3SoL CA, c)o S'd
irry-"
4 no.
------------------ :__ —7—
yes,�� 0 issi aevl ef d
�e ppe ?
5. Describe -the general site topography. Check all that apply.
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).
A
pre on a. vertic rise of 10-feet
s _opes se#t ' site of mpre.than15% and les's dian3O.%--( al
over a,horilzontal di�tince 'of 33 to 66-feet).
Steep: -grades' of-- greater than 30% present on site (a vertical rise of 10-feet over a horizontal
Other (please describe)-
6. 'Site ct�� areas of year-round standing v%�ater: N-N2) Ap'
prox. Depth:1
. .............. .................... . . ..
7. -Site contains areas of seasonal standing water: Approk.'Dep'th:
VYF r seasonts) or me year f
Site is in the flboqway flood lain, course.,
p of a water
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
meadow
;shrubs mixed
i.irban tandka'ped (laWnshrubs �tc) -------- —
Obvious wetland is present on site:
7.,
W-
� Mi q§ M. 2
VM467W4
ina
ft "10M
7- 7A
_4 P:
e th
VIA,
j4pr, .,nispiridkabe�QUM 4M
U_:
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Aoii tW bMd
gna MM. b g ence MdMiq ar, e-a:
Y.-
Critical Areas IdiSt. rd"13.19.2001
FILE:
LIJ � 0 (2 0 1 Z, a 3 tcA�-- , d4ke, (
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
-C. 1b7
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 from obsei dU fAF LW Ita available at
City Hall (Critical areAdnventories, aps, or soil
surveys). 10 2001
PERMIT- C00VTER
Date Received:
City Receipt #:
Critical Areas File #: "A -0
Critical Areas Checklist Fee:- $45.00
Date Mailed to ADDlicant: 9-4 1,--o t
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 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.
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 ham -Jess 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/her/its 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 A DATE k
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 officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF DATE w
PLEASE PRINT CLEARLY
Owner/A pl cant:
p i
eLCN, AR-(N
Name
1��Va
Street Address
City State zip
Applica.nt�Representative:
Name
\sib 2-
Street Address
s"y'0�v" ,
city State zip
-Le) C:� W),
Telephone: 20fo S4-2- Telephone: X C " -1
Email address (optional): Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
CA File No: LA— D(O
Critical Areas Checklist I . I
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: Dik 2) k --� cv�p!�- NIC, (,J, Fe\, �* Wi4, Rq)o-�-o
2. Property Tax Account Number. 00 A- G 13r:�o ?- C-Ilk 00 S 03
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Y- Yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
VI"'- Flat:' less than'5-feet elevation chang - e 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 mpre-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 horiz o*ntaI
distance of less than 33-feet).
Other (please describe):
6. Site conbdm areas of year-round standing waier: '00 Approx. Depth:
7. Site contains areas of seasonal standing water: k-�Jb - Approx. Depth:
What season(s) of the year?
8. Site is in the floodway —
floodplain — of a water course.
9. 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?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site:
/,tb L.L
Critical Areas Checklist.doct3.19.2001
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
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 fbe Checklist should be easily
available from observadU PiVLWJta available at
City Hall (Critical areAbeventories, aps, or soil
surveys). 102001
PERM/T COUIVIER
W� F/0,
0 1 - -�,Cy 3 tcj�- - d4",
Date Received:
City Receipt #:
Critical Area's File #: 610r-0( -10(10
Critical Areas.Checklist Fee:. $45.00
Date. Mailed to ADDlicant: '6- L-t) i I
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 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.
The undersigned applicant, and his/hff/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/her/its 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 APPLICANVAGENT DATE f 0 k
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 officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER, L
DATE
PLEASE PRINT CLEARLY
Owner/Applicant: A plicant.--Revresentadve:
J
r
Name Name
Street Address Street Address
axx*,"s *�� RR)0�-o —
City State zip
Telephone:aUo SLA-2-
Email address (optional):
city State zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doe/3.19.2001
RECEIVED , 110
CITY OF E DMONDS
CONSIPUCTIOMPERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAIL NG ADDRESS
Lu I
z
�: � kw,
0
CITY Zip TELEPHONE
-,yW1oj
NAME
ADDRESS
x
L)
cc
CITY ZIP TELEPHONE
C�vzx-t-k\
C�svoz
NAME
VOILAV— GVVLr
a: ADDRESS
0
L)
4 v;,b )ao C S
cc
l z TELEPHONE
'- CITY ZIP
0 V, 5 o
STATE LICENSE NUMBER EXPIRATION DATE CH
k.- c 0
PROPERTY TAX ACCOUNT PARCEL NO.
Lu
0 NEW CeIRESIDENTIAL /MECH
UM111
�PL
Mo"ADDITION COMMERCIAL Ej COMPLIANCE OR
CHANGE OFUSE
�REMODEL APARTMENT �'SIGN
REPAIR GRADING FENCE X
CYDS ( FT)
DEMOLISH TANK OTHER
'y
z GARAGE R ETA' NING WALL RENEWAL
CARPORT ROC KERY
P: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
cc
U
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
GO UNITS NUMBER
o STORIES C;�. I I
DESCRIBE WORK TO BE DONE
HEAT SOURQE GLAZING 91,1,,%
0 0
I �J SLOPE
PLAN CHECK NO: VESTED DATE
01 - -IL61 21)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES;'ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAfURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
�E�MliEXPiRES
USE PERMIT
ZONE NUMBERc,?4��/' e�7X�
JOB SUITE/APT#
ADDRESS.
61 z A I d Kc
PLAT NAME/SUBDIVI SION NO. LOT NO. LID NO.
LID FEE $
TIESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED Inspe4 tion Requlred
Sidewalk Required
REQUIRED DEDICATION— FT Underground
r ng requ re
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NO 0
YES 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
r-IN& IA15;0. 9&,W4�)
ENGINEERING
FIRE REVIEWED BY
DATE
M
uj
z
z
a
z
Ui
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
BOND
REQ'D
POSTED
0 YES NO
SEPA REVIEW
SIGN AREA
HEIGHT
C OMPLETE EXEMPT
I
ALLOWED PROPOSED
ALLOWED PROPOSED
I �
EXP
-2- is 2 2
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSEDSETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONTUU SIDE REAR
z
z
PARM NG
LOT AREA
PLANNING I
REI'l I PROVIDED
f.5
REIM,ARKS
CHECKEDBY ITYPEOF
SPECIAL INSPECTOR JARV
REQUIREDC:]YES I tr:;--e
OCCUPANT
C�T�- GROUP
OCCUPANT
A. . ��i LOAD
INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'
f
VALUATION
FEE
PLAN CHECK FEE
601Y
BUILDING
-70 3
-4.24
PLUMBING
I p%
_1Tj
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEE/
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT JRECJIPt,�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON, REL,4TING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 1
DATE SIGNED
oes/n Iri
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
RECEIPT
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
.(425)
EXT 1333
771-0221
FAX
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy; and Fees are paid. and
receipt is acknowledged in space provided.
=FrIALS SIGNATURE DATE
BY
I
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
111111 lill lill
15487
24314 92ND AVE W
UNIPFAVIOUS SURRAWE C"AIX'S
Exiqing Residence: 9 10 SQ, FT. 19-5-0
I.-I'xistingBack Covered Dc& 260 SQ� FT
Existitig Back.Paljo: 270 SQ, FT. 1?-5-o
F-��x i st i n g ('3T a r a g e: I () 0 0 S Q. FT. 19,94
Existing Shed: 240 SQ. FT. /'7-5-0
F'xisting DriveNvay 1660 SQ� F'L /O/J-O -
HE JGHT (Alk's
A = + 106'
B = + 1, 05.75'
10S.17f
.D 10C
locaolt7l;
A VE C) R ADE - +0010!*
ACTUAL=- 12259--
MAXIMUM �- 4-1-*44%
IV57-
LOT COVERAG f-':
2410SQ.1--T, (20.37'k,b)
LOTAREA,
11,830 SQ. FT,
I'llk Wyc
7, Pff- r, -L7' I 7�Y �Lil Dr,
MAR 2 7 2002
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
NORTH
SCALf'i: I" �1 20'.01'
ZONE
?-5
SETBACKS:
FRONT--
714�
SIDE
-7-5
REAR
051
OTHER
HEIGHT
173,0 1
t e)�G
40 OWNER/CONTRAcToR IS RESPONSIBLE FOR
c EROSION CONTROL AND DRAIINGE
ADD GUTTERS/DC WNSpOUTS 10%75
H3LOCKS 6
AND SPLAS — - v F
FAG
OAL%
< t1unc
E wvqTHIN
IFY
C1101A
+%o6 C&�K 5
CC��Qjjjft'El) (I �ut 5r/-o L cs
rr P VE AS NO
Jr.
IbS.0' ,-,,,BYY NGINEERINIG
t 86��
L
L
'APRO)"OSE0 AI)D'N'
I S'T* STM Y ---. 498 SO. F 1. Date:
2ND STORY-: 653,So. F-7 —41 �,
DATUM �PT. - lot),
'rop OF S's cl'-wo SITE PLAN
I AT&LINDAGIBI-F-A
VIA-NHOLF C.OVER
APPROVED BY PLANNING
v TH E'F T Fit
243, 14 Q2 N 1) A Vf-,' W
1AA10NDS', W,,v
PLANNING DATA
NAME:
SITE ADDI
PROJECT
REDUCED SITE PLAN PROVIDED?: (fij / No
MAP PAGE: 00 4 CORNER LOT: (Yes
LAN CHK#: Cq- - / 1/,
i I.C11" rk., �0,4,_A irm
FLAG LOT: ffe—SA0
ZONING: P-5-9 - CRITICAL AREAS DETERMINATION #: 07- - bt
L3 Study Required:
L&Walver
Ll Conditional Waiver
SEPA DETERMINATION:
Ll Fee
Ll Checklist
Ll APO list wl notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Bal linger)
EI'Exempt
SETBACKS:
Required Setbacks:
Street: 7-5' Left Side: 7. 5 Right Side: 7, 5" Rear: 19
Actual Setbacks: 16
Street: 5-5' -Left Side: 131. 9" Right Side: 2-91. Rear: '77
Street map chocked for additional setback required? (Yes WZ)tpm) ." 'Y' 6j,
DETACHED STRUCTURES: �h., f-P" -
ROCKERIES:
FENCES/TRELLISES:
BAY WINDOWS / PROJECTING MODULATION: �,ppe, k,, A t_—
STAIRS/ DECKS:
PARKING: Required: 2- Actual: 2- �,,, (fp-,-7
LOT AREA: 11.1;. f fj q'� J - - - , - . -
LOT COVEKAUL: 910, 3— . �� 410 7- u 9 5.. & 1�
Calculations: w3n 1 23
BUILDING HEIGHT: #'A- 6v 6N_,-
Datum Point: 4b di S6.1. S19W-C, A� W. Datum Elevation: 106'
Maximum Allowed: Actual Height: 2.1-
_"A.D.U. CREATED?: (No / Yes)
Flo,*
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED:
OTHER: 11,"� 1.4- PA,"eA PL,, 51-1( jtaW "J�
�j
Plan Review
It 930
NewBPP1annjngDataForm. DOC
n-0 ,
Critical Areas Checklist CA File No: (19
Site Informati6ii?(so'ils/topogr�phy/hydr,ology*/vegetation)
V�Jk P414�
1. Site Address/ Location: 11ILV311t ckl
2. Property Tax Account Number: 2-90 3-a C (00 Lt 0 2. C� 02)
3. Approximate Site Size (acres or square feet):
4. Is this site currentlydeveloped? Y'
yes; — no.
If yes; how is site developed? -'- M\&
5. Desc'ribe the gene ral site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally lets than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more than 15% an d less than 30 5/c a vertical r' ise of (0-feet
over a horizontal distance of 33' '10
to I reet over talo
Steep: grades of greater than 30%. presenrt#�i ;KrOc4a Oe 'oO aTonz
distance of less than 33-feet).- - 0
Other (please describe): V107A"'U
6. Site contains area's of year-round standing water: t,,)O Approx. Depth:
7. Site contains areas of seasonal -standing water: t-) 0 Approx. Depth:
What season(s) of the year?
8. Site is 'ffi the floodway tit
fl'odplain
0 of a water course.
9. 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?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawnshrubs -etc)- /10
11. Obvious wetland *i's present on site: �-J
Critical Areas Cheiklist.dod-3.19.2001
I
A
I
City of Edmonds
Development Services Department
Planning,�Division
Phone: 425.771,.020
Pax: 425.771.0221
The Critical Areas Checklist contained on this fo * rM is to
be filled out by any person preparing a Deveilo'p�me'nt
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 ito complete the Checklist should be easily
W
... UW*ap!n
as
s s
APPUCAMN PIC D$GmL,,�.
Date ReceiVed:
9ty Receipt #: 4
Critical Area� File #:
,britical"Are'iith `� 14
ecklist Fee: 5.00
Date Mailed to ADDlicant:
A,pr0perty.q,wner,,_or his/her authorized re resentative,
p.
must fill out the -checklist, sign and date it, and submit it
to the -City. The City wiltreview the checklist,': make a
precursory site visit, and Make a. determination of the
subsequ6nt steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form io assist City staff in finding and locating the
sppcific piece of property described on this fbrm�. In
addition, fhe 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.
The undersigned applicant, and his/her/its heirs, and assigns, i ' n consideration on the processing ofthe 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 basedin whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted ate 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 APPLICANVAGENT
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 officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posfing atterl4ant to this applic
gtiorl-
SIGNATURE OF
Owner/Applicant:
Name
,2A3 I �- OA- — NvT- �_3
Street Address
G
City State Zip
Telephone: ')LCX�
Email address (optional):
DATE I I&
/o__
Applicant Representative:
Fmr,1v,-_ G;M\,kir
Name
- ksblfo -
Street Address
city. State Zip
Telephone: -:W� 2,bG'L I
Email Address (optional):
Critical Areas Checklist.doe/3.19.2001 -)
2—
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E.RECEIV ED
01
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONISTRUCTIO'N PEAMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAMEINAME OF BUSINES§
PLAT NAME/SUBDIVISION NO. LOT NO.
LIE) NO.
S-ty"Viz— <i*%\A
LID FEE $
uj
MAILING ADDRES Is
TIESCP Appmved
0
PUBLIC RIGHT OFWAY PER OFFICIAL STREET MAP
RW Pemft Required
EXISTING PROPOSE6� 7
t
Street Use Perinh Req'd. D
Inspection,Required
CITY ZIP
TELEPHONE.
Ck b012.0
lo (1.- 15 41—
i
REQUIRED�OPICATION WTI. FT
Sidewalk Required
Underground
Wiring
required
NAME
',ME TER E.'
L SIZE _i
NO.
NO. FIX RES
PRV REQUIRED
YES 0 NO
K,
1W
f-
'ADDRESS
REM�AKS
OW ERJCONTRACTOJ�#SPONSIAE FOR E��D"CONTR OLJORAINAGE
X
z
MT1,6firl-log
W
CITY ZIP
TELEPHONE
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.NAME
4
F\V� QN\ k.-�kTsk c:W!aV%6kj
ENGINEERflr REVIEWED/DATE
ADDRESS 7 1
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19
01
D.
0 sees
11, . I
FIRE: REVIe)kED BY DATE
11-2 Z fT
0
CITY zip,
Ctb2-q%
TELEPHONE
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^R[AhiCE PR dl��
�HORFLINEORADB#
INSPECTION
REO'D
BOND
IPOSTED
STATE LICENSE NUMBER EXPIRAf16N DATE'
CHECKED By -
N: k C) \0 <�%
OW, s ..
YES Q�96
SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PRPPOSEP.
ALLOWED I PROPOS . ED
EXP
2 22,11
pq
E] NEW ReRESIDENTIAL L.VMBING MECH
LOT COVERAQE -
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT . SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT. UR SIDE REAR
COMPLIANCE OR
&r'AQDITI9N 0 COMMERCIAL CHANGE OF USE
3 5; -7- 3
.3 �* 79
S7
f-
z
z
PA KING
REO'D PROVID ED 1
LOT AREA
PLANNING REVIEWED BY DATE
ED REMODEL APARTMENT 0 SIGN
:3
11
2. 2. J
I
0 REPAIR FENCE
0 CYOS 0 X FT)
4;. S40
V
0 DEMOLISH TANK (3 OTHER
z
GARAGE RETAINING WALL RENEWAL
CARPORT ROCKERY
77TWOE.OF tj�E. BUSINESSPRA
CHE&ED-By
TYPE OF CONSTRUCTION
OCCUPANT''
IL
J i
AL
GROU P
I
NUMBER
OF
i]
NUMBER OF'
DWELLING 4
I ITICA
-CR Lj It
AREAS
SPECIAL INSPECTOR JAREA
-
OCCUPANT
(5r 40 0
0
STORIES
UNITS
N
REQUIRED [— 1. 1
_] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ1p
-to
A4.
,:ANT
VALUATION
:FEE
PLAN CHECK FEE
HEJT SQURCE LOPE 41
S
BUILDING
eto
V
PLAN CHECK NO; ESTEDPATE :PLVMPI G
ME�HANICAL
"WORKTO
THIS PERMIT AUTHORIZES ONLY THE tORKNOTED. THIS . PERMIT C&�,Rt
!Z BE DONE. ON PRIVATE r PROPERTY JNLY. ANY CONSTRUCTION r ON T 66BUC1
�
DOM . AIN (CURBS, SIDEWALK$, 0 . RIVEWAYS,MARQUEES, ETC.) WILL REQUIRE G.RADING/FILL.
SEPARATE PERMISSION.
STATE SURCHAR
uj PERMIT APPLICATIO N 180 DAYS - -
PERMIT LIMIT. 1. YEAR - PROVIDED.WORK IS STARTEDWITHIN 180 DAYS FEES .... .......
ENG.
SEE BACK OF PINK PERMIT FOR. MORE INFORMATION q
'APPLICANT ON BEHALF 00 HIS ORLHER SPOUSE. HEIRS, ASSIGNS AND SU CESORS ENG, INSPECTION FEE
C
'IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OFL LANDSCAPING
2 EDMONDS, WASHINGTON, ITSO&FICIALS, EMPLOYEES, ANDAGENTS FROM ANY AND
INSPECTION FEE
LYORINDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT 9� . . RECEIPT
FROM THE ISSUANCE 00 THIS PERMIT. ISS ANCE OF THIS PERMIT SH#LI_ NOT BE P�A N CHECK DEPOSIT
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY�ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'.
RECEIPT
TAL AMOUNT DUE�-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRVC- This application is not a permit unld signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY,,,146 PERSON WILL BE EMPLOYED. Building Official or his/her Deputy: and Fees are paid. and
eODE OF THE STAT receipt is acknowle
IN VIOLATION OF THE LABOFLr E 00 WASHINGTON RELATING TO POR INSPECTION dged in space provided.
OMPENS*1Pq.WN9bfANCE AND RCW 18.27.
OFF1 LS SIGI�LATURE4, DATE
ED
SIGN�LIRE (OWN A T —JDATE SIdN -'(425)
LUJ 6
4
.771-0220. '"MISED
BY
ATTENTION EXT333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
-022
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERfIFI-
0 ORIGINAL- FILE YELLOW - INSPECTdR
,ATE OF CCUPANCY HAS BEEN GRANTED. UBC SECTION. 109
FAX, PINK -OWNER GOLD -.ASSESSOR