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1370 6TH PL S11111111111111 14734 1370 6TH PL S 0 • -t'k ADDRESS: TAX ACCOUNT/PARCEL NUMBER:CQ539 lop C of Do BUILDING PERMIT (NEW STRUCTURE): qt(j2.b2.CF COVENANTS (RECORDED) CRITICAL AREAS: DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: 9* Im DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMITS) #: O2 GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: LATEMP\DSTs\Forms\Street File Checklist.doc go AppUCATI(7 & BUILDING PERMIT CITY OF EDMONDS Building Department �.i A,,I. No. ;2- ---------72:- ------ Permit limit, one year the accom APPUCATION -1r, hereby made for a permit to construct the following work, in accordancz with - g pIWS and specifications. Two sets are submitted herewith for approval- parryin Off-St "I -, Parking ...................... alter iddn repair ... & ----- e76-...._...._ Fire zone .................. ----- - --- ... Const. type ................................ Use zone ... . .. . .................... .. x--"4 ........... Lot ........ J -------------- Bk --------------------- Acidnia'� F .................... Septic tank_.-_... ........................... ge. Area ...... ...... rear .... Z--O ................ side-...._. . IF front ..... ............... r. side .... --------------- 1. Tel. No.. Address.- AV-.--e -'C"( ........... t . ..... ............ Tel. No..... ........... ............ Address ............................. .......... I V--F ........................................................ b3r.................................................................. Address .................................................... Tel. No ............................. Remarks.........- .............................................. nd I agree to comply with III applicable Codes and State laws regulating this The above is a correct statement, a workdress ............................................ Date.5. Signed "Owner/AgeWe/-'r—'�- PERMIT for the above work is hereby r.ppraved, subject to the above conditions, and to compliance with the aP' proved plans and specifications, and Bj,,3ing Department notations tharm- 77� Valuation ------------ c/ ....... Permit fee ... ................. Rccd. t Building Department, By .......................................... .......... This Pennit does not cover P1147nNng, Sewer or Electrical installations, t .. .. r. .. . �n n ,arw.MH+.v+pw• mm f+Y, M"rWrl LJ OWh1CR MtG�A�I. A,.sU -f-LF4z4i pt%9k Oo 53r--+j 00o p �i (cl-ft-t C'LAGK E;OOTIA- E-A, ss'fkyl- D" 5 Pk kcr V F14, w hY mn yb.00' o° T' f�C 5 I t7Elh)GE 11 lo(a 54-ir?' 2 O Ly isrwfr M cw���CE1E PA o 2,6 sp sat -FT o t T� �i p rd GX. f'4k 54-F Z + DR Ot c. 1Dy_2y� przz E RTY L-► fJ cc O NE1,) LOGA'f10f.3 F(.;,IZ 5 MrrYGK ( MeL6c-a-T6V fo' N.w.� Nth Zone - o Cornerr Flamm_,., Setbacks Required Actual Front _ a n -=- -- es a� Rear Other - O. Ha t 2, 6 ' 4' 3' Gr — P R-O POS Ef D A g'OJ�'!-- © BY PLANNING �3�0 lcr� Q� 5c�r'N CrJKv►JAS W� 1 14 '( �i�TR�►,✓cF NC.. Date Approved: � � �gs2 BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $............................................. .... .�..7...�............... B-�- ._.,w.:._::_............ - L..... ........ SEWER WORK ORDER ISSUED ................................................ DATE............. kt: N #P20 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 be filled out by any person preparing a D Permit Application for the City,of his/her submittal of the applicatioy The purpose of the determine w e061 may be,reneeded fo c available from qbA City Hall(CIW surveys). -PC, `i OS a 5 q K Date Received: &(2ILO-6 City Receipt #: X US Y Q Critical Areas File #: 03.O Critical Areas Checklist Fee: $13 .00 Date Mailed to Applicant: owner, or his/her authorized representative, the checklist, sign and date it, and submit it The City will review the checklist, make a 6te visit, and make a determination of the steps necessary to complete a development Cn . oT- permit application. ;t i � Please submit a vicinity map, along with the signed copy s ould be easily of this form to assist City staff in fording and locating the site or data available at specific piece of property described on this form. In inventories, maps, or soil 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 file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT 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 posting atten". to this application. SIGNATURE OF OWNER DATE 10 OE - PLEASE PRINT CLEARLY Owner/Applicant: wAicmei. A�v -fepzt PcN� Name PLACE, one - Street Address 1547gVops �kx . clgda o City State Zip . Telephone: 1-7 3. 4 Email address (optional): Applicant Representative: . Name Street Address City State Zip Telephone:, Email Address (optional): #P20 05Ag Critical Areas Checklist CA File No: Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: L D &rk P1_ S Wf* 2. Property Tax Account Number: OCR S 30 l 60006 t 00 3. 4. Approximate Site Size (acres or square feet+, Is this site currently develope If yes; how is site developed? 5. Describe the general site topography. Check all that'ly. Flat: less than 5-feet elevation char e over eft Rolling: Hilly: slopes on site generally less than 15% (a vertical 1Eise.,9f,10-feet gyer".i horizontal distance of 66-feet). 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: Approx. Depth: 7. Site contains areas of seasonal standing water: NO ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway MO 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 rimarily: forested meadow ; shrubs nixed ; ur an landscaped (lawn, shru s etc) 11. Obvious wetland is present on site: For City Staff Use Only 1. Plan Check Number, if applicable? 05. Z-15 2. Site is Zoned? FL 5 • (D . 3. SCS mapped soil type(s)? Vt: Ed-CireAt arol v-f-lll .Sa rA d v I o U M o - 0 •i' s l,oms 81 tottJ V-t'� aroaf t I i1 5a rl Av I D a vn 4. Critical Areas inventory or C.A. map indicates Critical Area on site? N OYIf, _h 0W Yi. 5. Site within designated earth subsidence landslide hazard area? N O , ejL4fjAfV1Q o f -H(j 611 +D M a V-f, -fi n a I d-e,+ A-_M i rl att'rn� . DETERMINATION STUDY REQUIRED WAIVER Reviewed bv: Date: o to I W4 I 9r) 01J