542 HOLLY DR.PDF11111111111111
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542 HOLLY DR
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WOLIC WORKS DEPART=:':;C1iECKL1O
BUILDING PER4IT REVIEW
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Street Right -of -Way Existing REQD
Access Easements Existing REQD
Utility Easement Existing K)C:>�� (E-- REQD
LDt per Subdivision Assessor Map
Site Plan Checked for Accuracy 1-7
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive.Area
Environmental Checklist Reqd. Ni
Flood Hazard Zone
U Shoreline Management Area
Z Slope, Soil, Vegetation
Stream, Creek, Drainage Basin 1--_
'Exi
sting Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Approval
Board of Adjustment Approval Reqd.
Review By: Date:
�U_�A /zs
Existing Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
-Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
bepr-ic ianK vesign Approvea
Septic Tank Permit Reqd.
Sanitary Sewer Availability
Drawing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By: Date:
Size
Date:
VVWYYVVkVV
Date:
Permit No.
Proi. .
File No.
Address
: TOpen Ditch Existing__�_ Reqd.
:E7.. Culvert Reqd. Size
P� Catch Basin Rcqd. Indicate on Site Plan
0 0 Shoulder drailial',e maintaiji' collection 'on swal
Open e. opcn rLaiof f
Culvcy
P� C_ _
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Sjjoulc
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1�.u-ihole rcqd. indicate on Site Plan
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Soil Conditions and Grouiid Water Field Clieckcd-
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Review by 11.1 te
idStreet P'�ving, Reqd.
Curb and Gutter Reqd._
Sidewalk Reqd.
Curb Cut for Driveway M�qd.
;)4 Right -of -Way Construction Permit Reqd.
H Bond Reqd. for Pu1)lic Irrproverrents
Street Nam, Sign Reqd._
Other SiViing Rcqd.
Pre Permit Site Inspection ma -de on
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BY: SS,.TER.
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w WATER
STREET
ENGINEERING
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Special Requiruio;its listed in memo to Com=ity Developulel'it De'partmnt,
Building Division
-BY Date
c) All iten�s filled in on Building Permit Application
BY Date
P-4 Drawings Stamped and Notations 1,1ade
BY Date
< JjApproved by Public 1%lorks DeparOwnt:*
Kevised: 1V 10-1977
The City of Edmonds
OmwER ............ R.i.(.:.har-d ... arcm .............................
"'-ES`9 -------- 542 .. Holly --- Brive -----------------------
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APPLICATION
for
SWE SEWER PERMT
NEW CONSTRUCTION [] REPAIRS E]
EASEMENT No . ..........................................
-.- .................... CONTRACTOR ......... .................................................................................... PERMIT No . ......................
------------------------- LEGAL DESCRIPTION: LOT No . ................................. ............ BLA)CK No . ..............
NAME OF ADDITION
DYE TESTED ON SEWER
JULY, 1972
APProved:
DATE
By-------------------------------- ---------------- _
PLANNING DATA
NAME:— ��'
SITE ADDRESS:—§p Al—k DATE: Z�411& - .
ZONING: C6 - (.p -PLANCHK#: �Fg,/o .
PROJECT DESCRIPTION:
CORNER LOT____LD_(Yes/No)
SETBACKS:
FLAG LOT FJb —(Yes/No)
Required Setbacks:
Front: c-PO Left Side: Right Side: :5— Rear A —
Actual Setbacks:
Front:- Left Side: Right Side: Rear: .9
- 0
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed: Actual:
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?: - L12
SUBDIVISION:
CRITICAL AREAS#:. q2 - *
SEPA DETERMINATION:
LOT AR
OTHER:
Plan Review By:
C.0\fjjd%pe1Mjg%ApjandU&c
MAR 2 7 1998 CA FILE NO.
r.rit; 21 Arp2c rhPrV1;ct
PER JIT QOUNTEFi
Site Information (soils/topography/hydrology/vegetation)
I . Site Address/Location: 1,5��I-)- 1�1011V di'll"l—,
2. Property Tax Account Number: 2-S-_2 17-C,
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? y yes;_ no.
If yes; how is site developed? <5- X�-s ,
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 ri.se f -feet over a
horizontal dist,,.nce of 66--feet).
Hilly: slopes present on site of more than 15% and less than 3 % (FQePJW of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% 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 standina water: /4,1
:n Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway /-,"a floodplain /i/ 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 --------- ------------------ ---------------------------
1. Si te is Zoned?
.......... ...
SCS mapped soil type(si?
3. Wetland inventory,61'.C.A.inap indicates.wetland present on site.? —�X
:4. 'Critical Areas Inventory or C.A. map indicates Critical Area on site?
�5� Site within. designated earth subsidende: landslide hazardareal
6. Site designated on the. Environmentally Sensitive Areas Ma'l
P.
City of Edmonds.
N�W 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
E�monds prior to his/her submittal of a development
permit 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 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.
Please submit a vicinity map alone, 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checldist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
Street Address
City State
Telephone
Signature
Date
Zip
Applicant Representative:
Name
7z�
�le 2
Street Address
city State Zip
Telephone
Signature
Date
c:recepfion\jana\cac1.doc
(over)
k'V E -C
CA FILE NO.
MAR 2 7 1998
Critical Areas Checklist
P E R 17"' QQ U NT E Ei
Site Information (soil s/topography/hydrology/vegetation)
I Site Address/Location:
2. Property Tax Account Number: — 2--S�2 7c,
3. Approximate Site Size (acres or square feet): Fr
4. Is this site currently developed? I/ yes; —no.
If yes; how is site developed? 'T X,-s "
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 I 0-feet over a
�.orizontal 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 3 0% 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: Ila
112 _; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 1,,6? floodplain 141 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:
---- -------- w ---- — ---------------------- 7 ---------- -- For.C-ity.Staff Use Only ----------- ------------ ---------- - --------- I ------
Site is Zoned?
SCS mapped soiltype(s)? &1,a/nd Am �gAi
Wetland inventory or C.A. map indicates wetland present on site?
icad Areas inventory or C.A. map indicates Critical Area on site?
:4* Crit'
Sitt -with-in: designated:earth subsidefice Iah dslide hazard area?
6: Site designated. on the Environ.mentall� ��nsitive Area]s Map?
D.ErtgRMINATION
ftachUm Rev tom/97
City of Edmonds
'W�W CIRJTICAL 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 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 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.
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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
Street Address
city State Zip
Telephone
Signature
Date
Applicant Representative:
De-A-1 A/ /' C 111-1'7 041, t
Name
Street Address
City State Zip
�/ �2 ---- �7.21,1
Telephone
Signature
Date
c:rccept1on\jana\cac1.doc
(over)
-t ZIC. 180)
April 9, 1998.
Dennis M. Day
4470 73rd Place S.W.
Mukilteo, WA 98275
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 77 . 1-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning /Building * Parks and Recreation e Engineering * Wastewater Treatment Plant
Subject: Determination regarding Critical Areas Checklist # 98-94
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO. BE NOTED: -
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
millo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 40
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination -
* Architectural Design Board
Thank you.
Sharla Graham
Acting Planning Secretary
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MECHANICAL
GRADINGIFILL
This Permit covers work to be done orf private property ONLY.
Any construction on thepublic domain (curbs, sidewelks,,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
PermItApplication: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 -Days
STORM DRAINAGE FEE
FNG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, Its officials,
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amages of
employees, and agents from any and all claims ford ,
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whatever nature, arising directly or indirectly from the Issuance
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of this permit. issuance. of this permit shall not be deemed to.
PLAN CHECK DEPOSIT
modify waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
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
authorized agent of the owner. I agree to comply with, city and THIS PERMIT T his application is not a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES .
THE signed by the Building Official or his/her
ed there�iyjno person will be employed in violation of the Labor ONLY
WORK NOTED Deputy; and fees are paid, and receipt is
Code oythq'State of Washington relatirWorkmen. s Compensa-
acknowledged in space provided.
tion Ingurence aria RCW 18.27. INSPECTION
T) S DEPARTMENT
SIGNAT JOWNER ORA ENj
PRY DATE
YIGN�D
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 JRl`GINAL — File hLLOWC Inspector,
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION W9 PINK — Owner GOLD`— Assessor
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