558 4TH AVE S.PDFiiiiiiiiiiii
5091
558 4TH AVE S
ADDRESS: zr�
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Requi aiver
r;�Xw
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR: —
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: —
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: —
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED
OTHER:
,-4o
'�5-,7
LID
LOT: BLOCK:
LATEMP\DS'rs\Fonns\Street File Checklist.doc
Of
E.D*
0
4TH AVE S
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS
558 4TH AVE S
SCALE
HOMEOWNER CONTRACTOR
NOT GIVEN NOT GIVEN
DATE DRAWN PERMIT
11/21/05 IBY 1. ABILA NO. 2005-0573
NTS
ZONE: RS - 6
K af E L'
PROJECT ADDRESS:
�98 e AVE SOUTH LOT SIZE: 8,276 SQ. FT. 62' x 134.5' 174
EDMONDS 98020 �,Twtma
LOT COVERAGE: L4 11
EXISTING RESIDENCE/ GARAGE: 1,414[5,Q4t7..
QWNERS* TP
EXISTING DETACHED GARAGE: 480 SQ. FF.
SANDRA & BOB HAMA ADDITION 396 =17. ole
8316 OLYMPIC VIEW TOTAL: 2290 SQ. FT. 27.6%
EDMONDS 98026 c
IMPERVIOUS SINCE 1977: 396 SQ. Fr.
425-776-9378 ADD GUTTERS/DOWNSPOLffSo
.o.
004 0960010 1200 %,HEIGHT CALCULATIONS: AND SPLASHBLOCKS
LEGAL: cffYPARK ADD TO EDMOND DATUM: BASE OF TELEPHONE POLE @ SE CORNER.: 100.0'
BLK 001 D-00 BLK 1 LOT 12. A. 101.'
B. 101,
C. 100.1
SCOPE Q_F PROJECT: 100.1
ADDITION OF 396 SQ. FT. LIVING TO 402 4 100.51 + 25 ft 125.51 max.
EXISTING RESIDENCE. MAIN FLOOR 117.25'PROPOSED RIDGE
OF SINGLE LEVEL.
0
C SA
-to
0.7 tov
PPRI
pp
—NEW
�'Tr
7-�- al [ 11
Fr) BY pal
v-
3 . I T
u
V)
1 T
7A V M F0 t 91
RECEIVED
JUN - 3 2005
PERMIT COUNTER
#P20
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Ile 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. Ile information
needed to complete the Checklist should be easily
aledilalble "in observations of ihe site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
1� 1 721;
Date Received:- UVJ 1 .4 / 0
City Receipt#:
Critical Areas File#:
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
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 properiy described on this form. in
addition, the applicant shall include other pertinent
information .(e.g. site plan, topography map, etc.)' or
studies in conjimction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersign ed 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/her/its agents or employees.
By. my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to le dus a plica �on be f of the owner as listed below.
SIGNATURE OF APPLICANTIA�0=1 DATE !2_0
Property Owner9s 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 andjueIGg)attendant to this application.
SIGNATURE OF OWNEP, � 6?, Aef,�,,a DATE e
PLEASE PRINT CLEARLY
Owner/AppP cant:
-00F37 !� z2W Q rZA A
Name I
1� r� e) N"
Street Address
Q,
city State Zip
Telephone: -77 cc 1;-�5
Email address (optional):
Applicant Representative: .
0 A 1U 5 6 Q
Name
�. r� 2-
Street Address
<�JP/0�
City State zip
Telephone: �IL:CZ - 2
Email Address (optional):
L Aye-5—
A a<" r� -7 " -
0
#P20
CA File No . ......
Critical Areas Checklist
Site Information (soils/ topography/ h Y rolo_gy/ve�etation)
� P) I —
1.. Site Address/ Location: 6;7, 1 4�_
2. Property TaxAccount Number- CO I Q (2-00
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? uyle"s_
; no.
If yes; h9w is site developed?
5. Describe the general site topography. Check all that apply.
v"' 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: 0 ;Approx. Depth:
7. Site contains areas of seasonal standing water: ;Approx. Depth:
What season(s) of the year?
8. Site is in the flo odway V� 0 floodplain of a watercourse.
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 0 1 nly 162-
1. Plan Check Number, if applicable?
2. Site is Zoned? P- 5 (0
3. scs mapped soil tfpe(s)? J7:� r-:_Veq-CsW 0
jr-Av-01Y 6M�y Wam, O-el. 61opcb-
4. Critical Areas inventory or C.A. map indicates Critical Area on site?. M 0
5. Site within designated earffi subsidence landslide hazard axea?. N 0
DETERMINATION
Sl'fJDY REQUIRED X WAIVER
Reviewed bv-. Date: ['7,�D I-W h �0
0 0
PLANNING DATA
1 1 . � 4
NAME: He,, C- C-Ic- DATE: VOL-5
SITEADDRtSS: Ujj� 5::� PLAN CHK#:Cn=,PP--'1
PROJECT DESCRIPTRONT _<2_C!4j =�rQ
REDUCED SITE PLAN PROVIDED?:&D No)
MAP PAGE: 1!�2 9- CORNER LOT: (Yes fffip FLAG LOT: ff2i-6-4-)
ZONING:PZ)--k-'P CRITICAL AREAS DETERMINATION #:,p�--Tc(
LlStudv Reauired:
1)n Waiver
L3 Conditional Waiver
SEPA DETERMINATION:
0 Fee
Ll Checklist
LJ APO list w/ notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
'P, Exempt
SETBACKS:
Required Setbacks:
Street: 2-0 Left Side: Right Side: Rear:15
Actual Setbacks: z�,, pn e- C+
Street:c-6-7 -' Left Side: Right Side: R e a r:
Street map checked for additional setback required? (Yes No DNA)
Ll DETACHED STRUCTURES:
Ll ROCKERIES:
Ll FENCESfTRELLISES:
U. BAY WINDOWS PROJECTING MODULATION:
C)CL
Ll STAIRS6 Cb j- -
PARKING: Re%quir d-LZA=tual-�� Soc-'2�"P --� 4-
LOT AREA: 2 '--7 (0 �j r- 2 --1 & ==- 2-9 j
LOT COVl=KATjt::
Calculations: k "-),. /), 0 0 �A- A- u 10 +
BUILDING HEIGHT:6--'-r� I '-�)LAO ok� 0J- 'J�174 CIC
Datum Point: Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATEPIF �(N Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes �/
OTHER:
PlanReviewBy:
Newl3PPlanningDataForm. DOC
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No . ............................. ............
NEW CONSTRUCTION 0 REPAIRS 0
/Or) - c2AQOQ
OV#`NEf t .... WA.. e ................................................................. CONTRACTOR ............... . ......... ..................................
................................. PERMIT No . .......... ............ .
..........
ADDRESS ....... ....5 . ........ ....... .............. LEGAL DESCRIPTION: LOT No . ................... ........ ................. BLOCK No..—'
............... ........................
NAMEOF ADDITION --- ............. ................... ........... ..............................................................................
Jun a) Iq V
Dye, Te-34q-d On 5Lwq-r
Approved:
DATE................................................ By ..................................................... ................