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HomeMy WebLinkAbout7019 172nd St Ne_BLD5154_2023 Permit Packet Coversheet Community and Economic Development City of Arlington • 18204 59th Avenue NE • Arlington, WA 98223 • Phone (360) 403-3551 Page 1 of 1 Permit Number: Permit Type: Address/Parcel: Completed (Month/Year): Land Use ˆ Notice of Decision ˆ Staff Report ˆ Application ˆ Narrative ˆ Legal Description ˆ Vicinity Map ˆ Site Plan ˆ Landscape Plan ˆ Complete Streets Checklist ˆ Traffic Impact Analysis ˆ Snohomish County Traffic Mitigation Offer ˆ WSDOT Traffic Offer Form ˆ Tree Survey ˆ Stormwater Drainage Report ˆ Geotech Report ˆ Critical Area Evaluation Form ˆ SEPA Checklist ˆ Public Notice Material ˆ Noticing and Related Documents ˆ Water / Sewer Availability Certificate ˆ Unanticipated Discovery Plan Form ˆ Aerial Photo of Site ˆ Proposed Building Materials ˆ Lighting Plans and Lighting Cut Sheets ˆ Color Elevations ˆ Design Matrix ˆ Plat Map ˆ Title Report ˆ Lot Closures ˆ Preliminary Civil Plans ˆ Archaeological Survey o Confidential Documents. Contact the City to obtain. ˆ Topography (Existing Conditions) ˆ CC&R’s ˆ Deeds / Easements / Conveyances /Dedications ˆ Developer’s Agreement ˆ Recorded Copies ˆ Bonding or Assignment of Funds o Confidential Documents. Contact the City to obtain. ˆ Letters and Project Documents ˆ Other: Civil ˆ Issued Permit ˆ Application ˆ Other Applications ˆ Construction Calculation Worksheet ˆ Approved Plans ˆ Review Comment Form ˆ Letters and Project Documents ˆ Other Agency Permits ˆ Reports: o Drainage Report Pg: o Stormwater Pg: o Geotech Pg: o All Other Reports ˆ SEPA and Noticing Materials ˆ Inspections ˆ As-Builts ˆ Other: Building ˆ Issued Permit ˆ Application ˆ Additional Applications ˆ Approved Plans ˆ Site Plan ˆ Letters and Project Documents ˆ Calculations ˆ Project Specification Manuals ˆ Reports ˆ Certificate of Occupancy ˆ Inspections ˆ Other: BLD5154 Residential Zoning Verification 7019 172nd St Ne February 2023 ✔ ✔ ✔ PTANumber: 31052300302200 Note: Diagrams may not be drawn to scale PTANumber: 31052300302200 Note: Diagrams may not be drawn to scale PTANumber: 31052300302200 Note: Diagrams may not be drawn to scale Environmental Health Division Rev021020rso 3020 Rucker Avenue, Suite 104  Everett, WA 98201-3900  fax: 425.339.5254  tel: 425.339.5250 CONSTRUCTION CLEARANCE REQUEST FOR A HEALTH DEPARTMENT CONSTRUCTION CLEARANCE AND/OR WATER SUPPLY COMMENT PROPERTY TAX ACCOUNT NUMBER: FOR PDS USE ONLY SITE ADDRESS: PDS PLAN CHECK #: SP # / Plat Name: PDS NAME: Expedited Review _______ OWNERS EMAIL: MAIL ADDRESS: CITY: STATE: ZIP: CONTACT PERSON: PHONE: CONTACT PERSON EMAIL: MAIL ADDRESS: CITY: STATE: ZIP: IS SEPTIC SYSTEM / DRAINFIELD: INSTALLED/EXISTING* PROPOSED NOT APPLICABLE *If installed/existing, approximate year of installation ______________________ Has a new onsite sewage disposal system application been made to the Snohomish County Health Department in conjunction with this proposed building project? __________ YES __________ NO INDICATE SOURCE OF WATER: INDIVIDUAL WATER SUPPLY PUBLIC WATER SYSTEM NOT APPLICABLE Has an individual water supply application been made to the Snohomish County Health Department in conjunction with this building project? __________ YES __________ NO Explain building project and its use (SFR, addition, shed, etc.): _____________________________________________________ Is plumbing for any structures: EXISTING PROPOSED BOTH EXISTING & PROPOSED Indicate total number of bedrooms before and after construction: BEFORE:_________ / AFTER:___________ MINIMUM PLOT PLAN REQUIREMENTS TO BE SUBMITTED WITH THIS APPLICATION DEPICTING THE FOLLOWING: 1. Scaled Drawing (max. 1” = 100’)5. Location of Existing/Proposed Water Well. 2.Dimensions of Property Lines.6. Location of Existing/Proposed Water Lines. 3.Dimensions of Existing and Proposed Structures and 7. Location of Septic System Components: their distances from Lot Lines. - Septic Tank and Primary Drainfield 4.Roads, Easements, Driveways, Parking and Pavement -Pump Tank, ATU, Sand Filter, etc. (if applicable) Areas.8. Location of Septic System 100% Reserve Area. SIGNATURE OF APPLICANT: ________________________________________ DATE: __________________________ FOR HEALTH DEPARTMENT USE ONLY WATER SUPPLY INFORMATION: (If Required By Building Department) Appears to be consistent with recommendations contained in "Guidelines for Determining Water Availability for New Buildings", issued April, 1993 as per Section 63 of Growth Management Act (GMA). Does not appear to be consistent with recommendations contained in "Guidelines for Determining Water Availability for New Buildings", issued April, 1993 as per Section 63 Growth Management Act (see attached sheet for deficiencies). ONSITE SEWAGE DISPOSAL SYSTEM: APPROVED DISAPPROVED BY:_______________________________ See Letter Dated __________ Initial and Date CONDITIONAL APPROVAL: Conditions To Be Typed On Building Permit DO NOT FINAL STRUCTURE WITHOUT PRIOR SNOHOMISH COUNTY HEALTH DEPARTMENT FINAL APPROVAL OTHER _____________________________________________________________________________________ _____________________________________________________________________________________ BUILDING CLEARANCE APPROVED: BASED UPON REVIEW OF THE ONSITE SEWAGE DISPOSAL SYSTEM INFORMATION AND, WHEN APPLICABLE, THE WATER SUPPLY INFORMATION. REVIEWING SANITARIAN: DATE: ____________________ Once the form is completed and signed, email the form and site plan to: SHD-EnvHlthQuestions@co.snohomish.wa.us SHD will reach out to you for payment.      !"#$%!() *!-) %$!*!+..// 0314 2&-( %$!*!5&-  6 678 9, %%*: ;"06%!0&<=&> ?@A?BC,D&- 6DF A&<3&/ &- #H(J&D KLKMNONMPQ 2&. Q//D. 89R/ A  3D/ %!0*/S-.& TUVTHOTWX\\YZ]] Z^TOZ]WYN_MN`V !aVZYTbZ !aVZY*c`VZ 7 8 7*!%$!% $0ZhNZaP_Z Z]WYN_MN`V ]]N^VZ\` Zh !"#$%!HK" !"!iMTNVBZTOMcZ_TYMbZVMT__Y`hTOj`Y]Z_MNWTV\aZOO *"           !" #$ %$ &#$,#-'#..-/#$$01 2%&,#'345,$$#-3$&4/$%36 #4#(-#/7- #,?@A@BBB@CADABDADEFG