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TAX ACCOUNT/PARCEL NUMBER: 2_
BUILDING PERMIT (NEW
COVENANTS (RECORDED) FOR-
CRIT . ICAL AREAS fe�_ff DETERMINATION: F] Conditional Waiver Study RequiredK;Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE S: LID #:
SHORT PLAT FILE: LOT: BLOCK -
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE ENCROACHMENT PERMIT #:
FOR:�
WATER METER TAP CARD DATED:
OTHEK-
L1TEMP0Srs\Fbrnu\Suw File Cf=kliadoc
I —T 77—
SrNUMOE
BUILDING DEPAR NT Applicant Fill ONR
inside Heavy Lines u
7ERMIT APPLIC 5-�2
ME OF BUSINESS) LOT AREA S'.DIjtSION NO.
IN NIAE A.
Is PRO
ILI 'T F,. 0*1
PEF
Cl"W EET 9111 dn"-'->
XISTIN STR
�.�-'p E CCMp. PLAN ST. RIVI &D Fy. It
0 CITY Z
REMARKS M
A..' M TP W
hl;o ICHECKED By '3'
ADDRESS Z
STREET AND/OR UTILITY WORK PERMIT -1-- W
TELEPHONE NUMBER REO'D. C1 -'ES PNO 0 YES VINO
CITY
UNDERGROUND -71,10
WIRING REO'O. vES
NAM
vERIFIT 0
k
TYPE CONNEITION
SANITARY SFVIER No
0 ADDRESS
OYES
Ul SE,,rIC SYSTEM
.1
I- ea- -NUMBrR API By CITY ENG. N 0
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Z REMARKS
0 ITY LICENSE NUMBER
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I-
LeqnI DoscriptiOn Of Property iShOW Below or Attach Four CoOos) <
3:
REMARKS
Z SIGN AREA ENV. VIEW All
0
ALLOWED PROPOSED COMPLETE L
U
0
W
RCMARKS
< Y DATZ
0 VARIANCE OR CU
W
.j
Loy COVERAGE
YARDS r OEA
SIDE R
FRor1T
GAS FIRE ZONE TYPEYNSTRU ON CODE I
LINE j
SIGN 15 )CT,:CUPANC OCCUPANT
REA
A UP LOAD
AD RETAINING ROUIR
W .L
AILL. YE N CATED IN THE (I
F. 'C [01 T IS SITE :S L I HE
'S T
CAVAy- X FT) P— CH 0 AL TAX
ALTER Ox F
n FILL 6 EDMONDS. I- C L
REPAIR. PR -MOVE 0 01M. s OULD 6E CODED 31.04�
INSP. �ARKS Z
NUMBER OF' STORIES NU.85R OF W
OWEL-ING
BE K
MATURE OF WOR TO
A 0
VALUATION FEE
Z
176 PLAN CHECK 3,66 W
I, OpOSED USE NO.
Z .3 6 0
0
2 -1
I- OT PLAR 5RME7,:iff But DING SETBACKS, BUILDING
,I G STREETS)
ABUTTI >
PLUMBING W
U
W 'LINE
HEAT & GAS LINE
0 t
FENCE Z
SIGN
0
RETAINING WALL U
SWIMMING POOL
Nad this applic3tion; that I in- TOTAL AMOUNT DUE:
I hereby acknowledge that I ha% he owner. or the duly author- TION APPLICATION APPROVAL
formation given is correct: -and that I ant t'
ed agent Of the Own". I agTeP, to c,)Mp,,y with city and state 12ws 'egu- ATTEN This application is not a Permit
ating construction; �nd in doing the work authorized .�.ereby. no person
411becmployed in,iol,,tjonofthe L,bcI,Code ofthe StatII,or\Vashingto THIS PERMIT by the Building Official or
elating to Workmen's COMPells3tiOn Insurance. "--zrS un I signe fees are paid. and
ONLY THE nis DII and
)EMOLITIONS and FILL ipt is 'a&novvIedged in space pro-
E- Permit Lim!' �Ps 6C" npleted in 90 WORK NOTED rCCe
ITS without cond;tion ' P,,mit. whic% shall be cor ths.) vid,d
BUILD G shall be coir?leted in six MO INSPECTION DIRECTOR'S GNA
Its NII — --I-- RTMENT
St 'NATURE I NE 0 AG I MIT) GNED DEPA -
CITY OF
7 EDMONDS DATE
775-2525
VOTE: Applicanr Subject to riall C77eck Fee " OR[ INAL.. File YELL6w. inspect
This Permit coverS Work to be done on private property ONLY. - owner
Any coliStrUtticr, on tne public domain (curbs, idew,,Iks, d,sv--Y-, GOLD - Assessor PINK
marquees, c1c.) will rotuir, separate permission.
CA FILE NO.
Oritical Areas Checklist*
Site Information (soils/topography/hydrology/vegetation),
1. Site Address/Location: X,�" A N') T
2. Property Tax Account Number: -70
3. Approximate Site Size (acres or square feet)-
4. Is this site currently developed? y' yes; no.
If yes; how is site developed? '2"!,J C/,i L2
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: Xj 0 Approx. Depth:
7. Site contains areas of seasonal standing water: �j n ;Approx. Depth:
What season(s) of the year? \1i, ) (f)
8. Site is in the floodway K ) - ( ) 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 (lawn,shrubs etc)
11. Obvious wetland is present on site:
-For City Staff Use Only
Site is Zoned?
2..'.:.:* SCS'mapped soil type(sr A urLR,_4W,9 0 /Z t3� 4AX-V 4W.11DIK - 2- - 6
_::.....Wetland inventory or C.A. map indicates wetland present on site?
-3.
Areas inventory or C.A. map indicates Critical Area on site?
A' des'gnated'earth subside c6.1andslide hazard area?
iewi in I n
designated'on the Enivironmentally Sensitive Areas Map?
.DETERMINATION,
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
R ew y::- . . ....
6 - d . b
D -a
Rev 0 1/04194
& 9 0 . 19 O�
City of Edmon&
Critical Areas 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 s taff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should -beeasily available from
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign land date it,
and submitit 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.
Witha signed copy ofthis form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan,topography map,etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of thesite.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out theappropriate column below).
Street Address
I
Applicant Representative:
5,0
Narne
VX
Street Address
,:770
i`,--1 F)
City, State, ZIP Phone
'7q 1-3
"A
8ignatur-e Date
CA FILE NO. (o
leritical Areas Checkliso
Site Information (soils/topography/hydrology/vegetation)
� /, '. �p:
1. Site Address/Location: t�72,-L"� "� r,-- t \� T i -
-2� c�2' �Z -70
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? t,� yes, no.
If yes; how is site developed? L2-
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! rise of I 04eet 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 I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: X_j () —; Approx. Depth:
7. Site contains areas of seasonal standing water: �J D _;Approx. Depth:
What season(s) of the year? �" ) r:,)-
8. Site is in the floodway X P) floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows ar ' e year-
round? kj-0 Flows are seasonal? 7— (What time of year?
10. Site is primarily: forested ;meadow _;shrubs mixed
urban landscaped (lawn,shriubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
�Site'is Zoned?
2- 6 X,
2..:::*;.. .'CS'mapped soil type(s)?
-3:'-:. W6fland inventory or C.A. map indicates wetland present on site?
4..�,� :�.:�C.ritical Areas inventory or C.A. map indicates Critical Area on site?
.:,:Site Within designated'earth subsidence� landslide hazard area?
�'-.1:::'Site' desi . gnate . d on the En*vironm . entally Sensitive Areas Map?
.DETERMINATION
CONDITIONAL WAIVER
i.STUDY REQUIRED
WAIVER
R view Y:
e tA b
Da
Rcv 0 1/04194
9 0 19
City of Edmon&
CriticalAreas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for theCity of Edmondsprior
to his/her submittal of a development
permit to the City.
The purpose of the Checklist isto enable
City s taff 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/her 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
orplot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunctionmith this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Street Address
City, St9/e,'XP P - hone
Applicant Representative:
'A
Narne
Street Address
C-'P t�'-
//
':77
i I �"
Cit , State, ZIP - --1
Phone
�ignature
Date
The City of Edmonds Side Sewer Drawing EASEMENT NO - ---------
NEW CONSTRUCTION [:] REPAIRS El LID NO - ------ ----------- - ASMT. NO - ---------
OWNER ---- ---------------------------------- CONTRACTOR --- Ej�� --- --- FQk- 1� 0.
S7?-!5' Ise --------- QA -.v ---- y ------------------------- PERMIT N --------------------
JOB ADDRESS ----- . ......................... ------- L&Vl-e- LEGAL DESCRIPTION: LOT NO. .- ---------------------------------- BLOCK NO. - ----------------------------------
........... ................................................ ............... .................... ................................................................
NAMEOF ADDITION .................................... ..................................................................................
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A-
c" -+,, o Lcc cA e
eUJCA.4q
Approvtd:
PWW-0001-11t75 (REV.11/78) DATE.�*- 9-0 ------------ By ................
0 0
PLANNING DATA
NAM E:- 3 eL-Ar'k- 6y"41"
SITE ADDRESS: 5Z- 5' 3mo-W4 DATE': it - ? - 14
ZONING: As- 6 —PLAN CHK#:
PROJECT DESCRIPTION: 4114(0.�- 6y, 7 C440ft
V
CORNERLOT 14-1010, (Yes/No)
SETBACKS:
Required Setbacks:
Front: 7-& Left Side: Right Side:. Rear:
Actual Setbacks:
Front: C I Left Side: Right Side: YS" Rear: 3X"
Street map checked for additional setback required?—....y —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: 3 Actual:
Maximum Allowed: ( ?. -3 eT
BUILDING HEIGHT:
Maximum Allowed: 15- _Actual Height:
Datum Point: Al y_r±vw'e- Datum Elevation: 10'. 7 f-
.r
SUBDIVISION:
CRITICAL AREAS#:. CA' - 74( - ( �4'5�"
SEPA DETERMINATION:
LOT AREA: 2 3 0
OTHER:
Plan Review By: I- 4-i4, lZM_
OeL -400S&
MBLIC LISTO
M IT U) I
L; A-
RT R E ET--
-7 1
Strcct Pul V1 i 11--oLc-Way KxistinF RMT)
inn% lkrftr
Access Easements Fxistin5 NAn
)"n L
utilitv F.'asciTiont 17.xistina 1!5m ITY N&
Lot Per Si ib d i v i s i on__ Plat Assessor I 'no
-7 Site Plan (1ed:od for AccUrICA
u
110vi'C": by
I
C�:
0
i ng I - "ater :�Inin
I*,*atcr "ain Fell �,-Cd
(C-q
1!%,(! ra! i L J'criuired (.Ner Fire co(.-!
Pctect or (1,Cc'; ,:c-, r 11ired
flz
c
Soptic I'mul,
Sani. ta ry Avai I ahj. 1 i 1\
"0
Side !",
)cl..,Cr i va-11a
I r I%%,- i -1
Samit,.1 Mn -er Cormectioll Fco Pooldred
,mu
Ditcli 4,-t4j,,
('111vort Peon
C"Itch Dzl-,ill Pe(mire(I
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N,111,11olc requil-CO,
Soil �C,10—ujl(-11,1,ater FICId
I C .,0.
), a te
!�izc
"ro i
1., i. rc,('
Si. ze
nrl;catc oil !7ite plan
Cd s
Indicate 01) Site
Date
: L
AIL
Stre lavilw RC(IIII rod
-in 'c(� r
Curb and C' i 'L t c ollire(I
Sidm mR, I'Collircd
D-i rlb nu t for Privewav Rlcqui rcd
C,
P-j I I t - 0 Construction lj t Rccc ldrod
Eond Pcouired II)Jic Jj�jj)rovcj--,,ent.,;
'I -me Sim IRc(iiired
Othor
S'te In,-,noctiGn rna(lc on
17 )ilc octiGn rmlc on,
C
scwer
U
CT
Water
Strect
-71
�Tlgijl cc 1.111
Pecuircr.mits listcd in m(-,,o to Puihlin,,� Y�--Pnrtmicjlt
Date
C_.S (I j I,(! JIC I j .ion
_t
P,
Patc
Sta;-Ipcd and ".1:0tation." �!'-Icc
Da t
A')-'prCx'c(l by Pulhhc R-�partlllcnt
APPLICATION
for
The City of Edmonds SME SEWER PERMT
NEW CONSTRUCTION 0 REPAIRS 0 EASEMENT No . ..........................................
104-04550-
OWNER............ Emilt.:T ...... Frieke .......................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS -------- 525-Seamcat ... Larle ........................................... ........... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
E
0
0
LRL-�
IJA
ov,
NAMEOF ADDITION.. ..................................................................................................................
DYE TESTED W SEUER
JULY, 1972
Approved:
DATE....................... ........................ By ......................................................................
CITY OF EDMONbs
USE
ZONE PERMIT
NUMBER !960?95
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT #
ADDRESS
uj
Z
'
0
OWNER NAME/NAME OF BUSINESS
ji�-)Viwad Orayn . Jr
LEGAL DESCRIPTIONMECKI
SUBDIVISION NO
LID NO.
MAILING ADDRESS I
.
5,�,5 5,0,d I -A 0 Y) � 1,j A C4�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
PROPOSED
TESCP Approved 13
RW Permit Required 0
Street Use Permit Req'd 0
Inspection Required 0
Sidewalk Required 13
cc
CITY ZIP
Fdmood,6 99d.? 01
TELEPHONE NUMBER
??q-31rbl
UUJ
Z
occ
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 0
W
<
ADDRESS
62A r Si
ARKS
cc
W
W
CITY ZIP
NE NUMBER
FAmpy)(15 qlg_01? 19
3 C/
NAME
0 w mo r
ADDRESS
cc
-ENGINEERING MEMO DATED REVIEWED BY
0
C ITY ZIP
TELEPHONE NUMBER
Z
8
rIMMEMO DAI ED REVIEWED BY
W
STATE LICENSE NUII�BER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADB NO.
ALLOWED,, PROPOSED
COMPLE XEMPT
Legal Description bf Property'- include all e�itements
Z
L
rc
_j
w-,
1�., T 14) P 1� I R(7 63
EXP
SHORELINE N
A -A P, Q'I'ci "' F T e
I ropr 8e. F-r
SIA) C1 Y 7het) F
7ARIANCE OR CU
PLANNING REVIEW BY
DATE
11 - 7- �6
1 h e a - Iq 1177 FT The'17 W 50 Fr 7ht'17 9
r -r Po t3
SETBACKS — FEET
FRONT SIDE REAR
HEIGHT
ILOT COVERAGE
Z
Z
<
Property
Tax Account
Parcel No. R 51)17 0 3 - `� - /01� __ 61
REMARKS
CL
NEW' RESIDENTIAL PLUMBINGIMECH
COMPLIANCE OR
a
TM�ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. 0 SIGN
CHECKED BY
TYPE OF CONSTRUCTION ICODE
OCCUPANT
GROUP
'GRADING . FENCE x
REPAIR CYDS. FT)
Z
WOODSTOVE SWIM POOL
DEMOLISH INSERT
0 HOT TUB/SPA
GARAGE. RETAINING WALL/
C ROCKERY RENEWAL
SPECIAL INSPECTOR
REQUIRED
0 Y E'S'
fREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER-.UI3C 108
Z
0
Ir
(TYPEO USE. �41ESS OR ACTIVITY) EXPLAIN:
A e-S
_j
9
WS
0
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
T %0_1417182
,W
STORIES .1 UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
ition fo P_xis�irjj i- rd
FINAL INSPECTION
REQUIRED
VALUATION"'
FEE
CHECK FEE
3_3
BUILDING
HEAT SOURCE:
AM
GLAZING
IN)
PLUMBING
Plan Check No.
A0 C--Z—F
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
P ermit Limit: I Year - Provided Work Is Started Within 180 Days'..
STORM DRAINAGE FEE
"Applicant, on behalf of his or her.spouse, heirs, as.sibirls,iiind
ENG. INSPECTION FEE
Lu
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its,.-bfficials
I
I
0
x,
employees, and agents from any and all claims for damages of
whatever nature, 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."
PLAN CHECK DEPOSIT
Z?OZ3
TOTAL AMOUNT DUE,f
Al(twd
X,
I hereby acknowledge that I have read this application; that the
information.given is correct; and that I am the owner, or the duty, �fT`ENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply With city,and' THIS PERMIT
state laws regulating construction; and In doing The W&k'a'uthorIz- AUTHORIZES This application is not a permit until
ed thereby. no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the S�tate of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. - INSPECTION acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF OFFICIAL'S SIG FIE DATE
EDMONDS // / -? -
CALL R RFfF-A,;;;n BY. DIIITE
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 YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109 PINK — Owner GOLD — Assessor
W--Ikb-
1>
17-
Zt'-&(/ 2-4
vi
PROJECT ADDRESS:
5 2 5 SEAMONT LANE RECEIVE
EDMONDS. 104A 416020 NOV - 4 199E
OYNINER-
SANDRA 4 KAY OKAM PERMIT COUNTI
525 SEAMIONT LANE
EDMONDS. b%A q6020
114-94161
DES1,9NERo
HANSON PES*N
KRISTIN HANSON
652 ALPER STREET
60MONIPS.104A cI8020
(206) '114-11241
SCOPE OF PROJECT --
ADDITION TO EXISITING OARAOE:
12* X 24'SHEP DORMERS.
TAXNO 252'705-2-105-0004
&AL DESCRIPTION -
SEC, 25. Tr4P 21, R6 05.
5AAP 21 q FT N 4 254 FT E OF
514 CORN ER NP4 1/4 THEN E 50 FT
THEN N 1 1 *lFT THEN Y4 50 FT THEN S 1 11 FT
TO Pos.
ZONEw FtS &
LOT COVERACM
LQT_,x=_ q5&O SOFT
EXISITNCy LOT CeOVERACEE: 1005 90 FT 1 q.51
PROPOSE17
LOT COVERA&E: 1505 SOFT 1q.5
ALLOAARLP ne3yr-RAMP: 35%
SLAZINCy- NO HEATE12 AREA ADDED TO
HEATIN& ENVELOPE.
GRAVINC71- NONE
-DC.+ u -A% ?6? 1 Alt- i S 'A" av% C a, (C's -
HEISHT CALCUL&
CORNER A: I oor
B. 101'
r_: 10(7
0: 102'
403' 4 - 100.15' MAX