6809 161ST PL SW.PDF1111111111
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6809 161 ST PL SW
9 0
ADDRESS: lz7
TAX ACCOUNTIPARCEL NUMBER: 6W
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:. j �?— �� DETERMINATION: 0 Conditional Waiver 0 Study Required/",Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNfNG 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: 4�
OTHER
LOT:
LID #:
BLOCK:
LATEMP\DS'l7s\Forms\Street File Checklist.doc
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.0. Fence shall not enclose or prevq
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RECEIVED
�AUG-27 2009-1.
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
01006 Edition IRC wfWAC Amendments
02006 Edition IBC wfWAC Amendments
02006 Edition UPC wlWAC AnmW,.nmU
and Appendices A, B, Q 1
02006 Editi-on IMC -vvfWAC Anmdnm&-
132006 Edition. IFGC w/WAC Antendmanu
02006 Edition lFC w,-VAC Amendmenu
[32006 Edition NIAQ WAC 51-13
02006 Edition WSEC WAC 5 1 - 11
U I Y OF EDMON-D-S-----7
BUILDINGDEPAF" --iMEN-0-
WORK
ADDRESS -J
CWNER
APPROVEDDATE._
BLDG. OFFICIAL:
PERMIT NUJIABER
RECEIVED
AUG 27 2009
DEVELOPMENT SERViCES CTR-
CITY OF EDMONDS
�.STREET FLE
0
HP20 r
CA Vile No:
Criffical Areas Che'ckfilst
Site Information (soils/ topography/ hydrology/ ve�retation)
1. Site Address/ Location:
2. Property Tax Account Number'.
3. Approxima te Si te Size (acres or square feet):
4. Is this site. currently developed? )�yes; no.
If yes; how is site developed? rrv%cle A.44., re ri
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 104eet. over a horizontal.
distance of 6&feet).
Hilly: slopes'present on site:of more thart 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 JO-.feet. over a horizontal,
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: kuoo Approk. Depth:
What season(s) of the year?
8. 'Site is in the floodway P%Q floodplain vx-" of a water course.
9. Site contains a creek or an area where water flows across'the grounds surface? Flows are year-round?�
r-crug- Flows are seasonal? (What.time of year?
Site is primarily: forested meadow shrubs !Le== -rrdxed
urban landscaped (lawn,'shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if ap
plicable?
2. Site is Zoned?
SCS mapped soil type(s)? ffikc� - F-VAr. LC
4. Critical Areas inventory or C.A. map indicates Critical Area on site? cyes
J -e-
5. -Site within designate� earth subsidence landslide hazard area? )W -
SITE DETERMINATION
-STUDY RE��ED WAIVER
Date:
Reviewed by. 'U
Critical Areas Chec.kiist.doc/2.5.2009
#P20
0 of Ed monds
ity
R"
Development Services Department
Planning Division
Phone: 425.771.0220
1" C)
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 should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Receive 7 7AVf
3t
City Receil
Critical Areas F�i�le:
Critical Areas Checklist Fee: $155.00
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 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 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 fit a plicati on the behalf of the owner as listed below.
SIGNATURE OF APPLIcANT/AGENT DATE q T'CA-11
Property Owner's Authorization U
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 a -7 T
SIGNATURE OF OWNER DATE (A-1 lu V
L-t2�!2nl -- i
PLEASE PRINT CLEARLY
OwneriApplicant:
— A-( C-,e
Name
— 62&9 1 (V
Street dd
Address
LL�Amh W
City State Zip
Telephone: 2f, --� -) L, 0 24 6)
Email address (optional):
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
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DATE: / AT19 0
MEMO TO: Permit Coordinator, Building Division
FROM:
ADDRESS:
OWNER:
Dan Smith, Engineering Inspector
After review of the subject building permit application, we have the
following comments:
1) Construction hours are: WEEKDAYS 7:00am to 10:00pm
WEEKENDS/HOLIDAYS 10:00am to 6:00pm
2) A Right -of -Way construction permit is required for any work on'
City property.
3) Connection to City water system required.
4) Connection to City sanitary sewer system required; obtain separate
permit.
5) Water and sewer lines to -be separated by 10 foot minimum.
6) Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7) Driveway slope not to exceed 14%.
8) Back water valve -required ffdownstairs plumbing -is below
elevation of upstream manhole.
9) Builder/Owner -responsible for containing all tempor&ry runoff and
erosion control on site. Construction may not impact neighboring
properties in any way. I
10) No burning of construction refuse without approval from Fire Dept.
11) Street to be kept clean of debris, dirt, mud, and construction
materials.- Contractor responsible for dust control.
12) Inspection required on drainage system, catch basin -installation,
driveways, and sidewalks. A final engineering inspection is
required prior -to the building division granting occupancy.-
CON
OWNER
MAILING
-- CITY OF EDMONDS
DHf%Tlf%Kl OCORAIT ADDII If% TinKII
FILE
ME PERMIT
ZONE eiLel NUMBER
A-5-20
JOB
�/N F BUSINESS AUUKLZ)Z:l 6goi9' 161-57-
LEGAL DESCRIPTION CHECK SUBDIVISION LID NO,
t1w F
RE6S
74(x
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, TESCP,,
L, r- ele
NAME
T11 C>
ADDRESS
Z) A/Z
CITY
NAME
cc ADDRESS
0
'MI CITY
STATE LICENSE NUMBE
14 0M i P-51V �e / 3 163
Legal Description of Property - inc
(show below or attach two copies)
ZOT
C 7
TELEPHONE NUMBER APPROVED BY
EX STING REQUIRED DEDICATION
I
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIREDkq,,--
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATEP REVIEW B
"v
TELEPHONE NUMBER 41A� Iki
ZE!-,7 REMARKS.
ZIZA eeYi221j�yr
An"
,AW,6� 1) —
TELEPHONE NUMBER
e all easements
DZNEW
R RESIDENTIAL
PLUMBING
ADD/ALTER
0 COMMERCIAL
ME CHANICAL
REPAIR
APT. BLDG.
SIGN
EXCAVATE
FENCE
DEMOLISH
OR FILL
L_ x _FT),
REMODEL
CARPORT
GARAGE
swim
POOL
WOOD STOVE/
r7 RETAINING WALL/
EJ
INSERT
" ROCKERY
RENEWAL
NUMBER OF STORIES NUMBEROF
DWELLING
TA(d UNITS t)h�
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) I
—<f ��10,ifXtE
METER SIZE IBUILDING SUPPLY SIZE I FIXTURE UNITS
cc
W
REMARKS
SIGN AREA
ENV. REVIEW
I ADB NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE #
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
HEIGHT
Lot COVERAGE
Z
FRONT SIDE
REAR
Z
5
REMARKS
0.
:;HECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
1 2
oj�� 'S1
SPECIAL INSPECTOR 7EA OCCUPANCY OCCUPANT
REQUIRED GROUR2 LOAD
OYES NO
REMARKS
PROGRESS INSPECTIONS PER UBC 3051
T#44"Iql, -Z�Wlz- A2�z llf6 140 6w4bV4
y
_T4�W_Le 771W /&Z))'
VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curts, sidewilks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year - Provided WorK is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors 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
a:
whatever nature, arising.directly or indirectly from the issuance
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
0 nor l.imit 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
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
SIGNATURE QWNER AGE
DATE SIGNED
"TE TION 771-3202
u
IT UNLAWLFILUIL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-87
—200 1016�
APPLICATION APPROVAL
i
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY: DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
REVIEW ammIST
P. PROJECT ADDRESS: Asr-
p ....PT :'DATE:
:Reviewed 7date)
by; (initial
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FIRE
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WORKS
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IGINEERING MGR., PUBMC�. WORKS MGR.�-.
C I T T 64 E D M Ff D. STREET FILE s, E S tl -E R'�. P-1 RA I T
For Inspection Call 771-3202 PERMIT. NO. 08007
Address of Constructi.on: ��Zyj PY I
Property Legal
Description (Include all easements)):
9 C')
Owner an,d/or.Builder:
S,
Contractor & License
No:, no /V [3/c 3
Singl:e Family
Residence
�YNNWOOD LINE
Multi -Family
(No. of Units
Commercial
(No. of fixture,Units
Invasion into
City Right -of -Way: No Yes
(If Yes, Right -of -Way
Construction
Permit required. Cal 1, One -Call -Center (1-800-424-5555)
before any
excavation.)
Cross other Private Property: No Yes (If
Yes, easement required,
attach legal
description and county easement number.)
PLEASE R D'T11
ITE LI-ST� "THE BACK
RECEIVED
i UK 1989
I�cert,jfy that
I haveread and shall comply
PUBLIC WORKS Date,
/with t�e items
listed on the back.
Permit Fee: 'Issued By:
Trunk Charge: c��, J I -Date Issued: Z;// 7t f
Assessment Fee: Receipt No.:
Partial Inspection:
Comments _-Na —te Initial
Final Inspection Approved:
'Date. Initial
00
- Rejected:
C) Reason _ffa t _e Initial
PERMIT MUST BE POSTED ON JOB SITE
White Copy File Green Copy Inspector Buff Copy Applicant
-# The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
4 NEW CONSTRUCTION Ff REPAIRS E] LID NO . .................. . ASMT. NO - ------------------
OWNER ------------------------------------------------------------------------------------------------ CONTRACTOR V\T-:7A --------- ------------------- PERMIT NO. C)-(6-QD-j
?(- - - LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ---------- ----------------
JOB ADDRESS --------- 1--(6 -----------------------------
is
QA t*vs b
rl
L
NAME OF ADDITION -
t�pvt-
---------------------- I ---------------------------------------- ------------------------------------------------------
�L �wl'\NOOD LINE
t cp � -5"- ?C, � - -'s -
PVWW.000 1 .11/75 (R EV. 11/78) DATE . .....
By--- - ------------------------------------------- -
v
PLANNING DATA
SINGLE FAMILY RESIDENTIAL
S ---]I
TREET FILE
Name: CA,-,e�c AA
Date: !i A�q
Site Address: c
0sog — I G I
Tax Parcel oo-7C,?rCxDC3cX:)qC0
Project Description: cl�, G 1 6, �n aec�.�
0,ip q,, klc�n cexl.� A;�
Plan Check #: W-,CyaC)0c105-8
Reduced Site Plan Provided: <9)N8') —Tzoning:
Map Page:
I Corner Lot: 0/ NO)
Flag Lot: (YES /,V
Critical Areas Determination #: OIRAacx"'52005�5
Study Required
Waiver
SEPA Determination: 4�Ker,,Oc
Exempt
Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist 0 APO List with notarized form
Required Setbacks
Street: Side: Side: Rear:
No p v--< An) : -,�AlNa 91%,
�p� i ax
X Actual Setbacks
Street:
Side:
Side:
Rear:
Detached Structures:
Rockeries: V-cc�rec-y 410C�DN cr-,
Fences/Trellises: ave ri=ke-r-y, G t-%
��� pe,)c., 4,co, 0,
El Bay Windows/ Projecting Modulation:
El Stairs/Deck:
Buildin Heh?ht
Datum Point: NIA
Datum Elevation:
Maximum Height Allowed:
Actual Height: 41' over rCCk--ery
G' 'm
Other
Parking Required:
Parking Provided: a�
Lot Area: No
Maximum Lot Coverage: 35% \Vroposed:
Lot Coverage Calculations: C
ADU Created: (YES
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES
Comments
Plan Review By:
Planning Data Form 07-14-09
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to., the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information g'iven
on map(s), nor for any one representation
provided based upon said map(s).
0
J,
-!Globe USDA FR,m Service A'Ia,icy r--r ua,a
9 GeoEye U S CeD og:czl Surve,! Dil � 7�! T,� t A',z
CITY OF EDMONDsSTREET FILE
0 1'- �NE W
El ADDITION
RETIREMENT
ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
Z�-
DEFT. NO.
2�
PURCHASE ORDER NO.
PURCHASE ORDER DATE
AI
191411
P R 0 J E C T N U M B E R k'11 ��, -1 ;S-�
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
2/'DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
Itnp INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
0
DEPARTMENT FILE