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1031 7TH AVE S.PDF111111111111 6934 1031 7TH AVE S of ED�Dti City of Edmonds ;•'. 4•i'v} Development Services Department Planning Division Phone: 425.771.0220 ./a,. 1890 Fax: 425.771.0221 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 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). PLEASE PRINT CLEARLY Owner/Applicant: 9CROP-6 £ U gU1.CGA l3y?-L-L Name 10Si -7�m nvet,-, .s . Street Address [-_1�1aotjnS wA• qP-na.o City State Zip q�'S-- -21 3L - 911 7 Telep o e Signature C'- 1� - OC') Date Applicant Representative: Name Street Address City State Zip Telephone Signature Date d:reception/jana/CACLHandout.doc Revised 4/1012000 CA FILE NO. C4 Critical Areas Checklist --------------------------------- Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: /4 31 7 T0+ 4Te-. ' &- Mom, a s LX3 A ctRK2.1c 2. Property Tax Account Number: (0 19 L� - Op L-1 - C©a - ©©© -7 i 3. Approximate Site Size (acres or square feet): 91_CJC9© SCE F-,-r- (Pp?2.04. ISM k6o �1 4. Is this site currently developed? -IL yes; no. If yes; how is site developed? 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 l0-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 l0-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: *.2 en ; Approx. Depth: Q 7. Site contains areas of seasonal standing water: N Q ; Approx. Depth: What season(s) of the year? �j IR. 8. Site is in the floodway ►j d floodplain Q Q of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? v-"N i) Flows are seasonal? Vjjq (What time of year? 1.9 /►p ) 10. Site is primarily: forested : meadow : shrubs : mixed urban landscaped (lawn,shrubs etc) Yts� 11. Obvious wetland is present on site: DETERMINATION ft�_chLdwq P" IWOM DA Zone F N.W. 1/4, SEC. 25 T.27N.9 R.3 E.W.M. 153 _ ? -`_[I M rn to INI\� In� I` _n I 3'�?-t��-TN n lo• A If2 N 1n 1n P M.ln. Q 3O V N I Ih j r O I4 I Q . O I � 3:`�� 'viQ �� `0 s1 v• .o ,vSD •u,.o j � h i' r i r• 8. � � O� W m � � � P �O� ALDER` - ALDER ALDER "CK6 „4 Y 161� r„'MI ; y,ie`eO �I �'.Y O d t O ovqh�OJ N O 4aStir r r r r m ao_— tS l a: H: I� to,� M° y(^9S 1in141 M• 4L�{ d 41 WALNUT WALNUT WALNUT 500 ` � ' � 1o°N � f S ~ I r M o � v $ . 50 � 506 n N � c a h � � N � � db � o 5 is 051 I I 5G'1 503 IN n pp a� oo w a, 1_ 5ll N N M�M ►'1 P So(o 6e7 ' IY \ \ n M a` k o. M IS ri15 �n •e n h h N 519 N v Ip n i n r ►� �� h o� a i!i 516 520 521 :CEDAR 'ST. -DAR tDA :Q b to h H Sze 523 5,l9 612 "SAS m o o ,m 538 627 DR ,F $33 u, � ,� 548 8 537 M in ' 556 601 622 in �r gg I N 41 ib ' MMf6m 612 0tr 6/7 621. 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FIR ST. c a 1103 N FIR Pt. 1105 1114 1100 9wew, � o o llor � 0 02 I09 M 1109 2 Roc* o 0 11H 1113 N h fill 1114 tits 701B Ms121 1//8 0 I/25 1123 h 11115 1124 1123 Lgo°E` r 1121 1120 1121 710 = 112(22 v 1129 /136 112I. : 112li 1131 1124 HU 1136 H11 1125 c pFi• ELM a W 1131, 1 /26 1133 1- 11 !/32 .. //a/ r �� 1 a'r. 1140 1139 1137 1130 ►141 1140 <' 1137 i1311 113z F � a SEA 1►40 Q 1151 1142 1134 lisp 1/40 //4r vl 1142 1143 11n 1161 1146 r 1141 1136 1143 - `� > ✓/� WAY 1148 PARK %N9 IN6 1 o o 1149 a 1159 1152 1153 /54 T 1139 G h m 1158 d 0 I161 / tlt�w�euo vgre P57 1f47. 1160 ' -- --- .; ELM 3T. EL ST. - a „-220 .. N zol qp PARK - Uj M - �� ^/ P t` v O O� b pp 00 M W b�/J b°'ti° ° 1` n 14 i`' r ie r211 to 004 �► 1210 1221 ? i 2014r Etl y ` 21 o t. 12r4'15 ELM Z/9 gyp_ ?-WZ a . �Ij,� ! Y 1 J 3 13 l it \�• "�(11+i Div•," H 1216 h I , 7 122t r221 too/ N� h N M v�i I010 M-1 1010 IDOS N tNi� M H h In H Ov �p� I 5 13_:QO_�.. �ppQ_�o0r'I.'. tA Ito ity - � ram, `. C��_jc�►�_ �:I:� ��IL,�`.� _ _. ^_---__-.__ N o _ - two Lfv&l6 1 L 6 �o5.IL f � LIG Wt cA,Lcs ' (03. 4 _� i �� , 5' 103. 5 � _ 1 p 3. 5 / ,.... ► o z., i I Ifil a 1 z-6 5 :::��"� s_;w1aS CTR. ,~� � :; �t11�U ✓I' CiY7 0 - EDt"ANDS , ter,tIltl' -45 Cu vt,, . PLANNING DATA NAME: Mtt,15S& ' RIC,4ARb f3l T-LL_- , SITE ADDRESS: 1 V31 -71-4 M E, S. DATE: 6 — 3 - 00 - ZONING: RS — (o PLAN CHK#: 00 ` 310, PROJECT DESCRIPTION: A'DD IT10N W% UEGk I,, Gp\je-R-V___iD Pt'.1 tz r_LL c c C' 0 D �-G CORNER LOT N.d, (Yes/No) FLAG LOT NU.b. (Yes/No) SETBACKS: Required Setbacks: Front: ZO' Left Side: 51 Right Side: S� Rear: 15� Actual Setbacks: as, Front: 2WX Left Side: Right Side: 5 5 Rear: (00 Street map checked for additional setback required? (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N) LOT COVERAGE: Maximum Allowed: 35`10 2 (025 Actual: I(P-TT 11Z73 12$. 5 BUILDING HEIGHT: 164. e-1G Maximum Allowed: 25� Actual Height: 23 - � I (025 Datum Point: Datum Elevation: , A.D.U. CREATED?: Nb. 1273 ? 600 SUBDIVISION: Nb. CRITICAL AREAS #:_ 00 — b9, 2yla �FO SEPA DETERMINATION: I x tG' � So' LOT AREA: 7 500 S-F, rr,Po�c1.�2 16 Xro =0pl OTHER: Plan Review By:— c:V i1es\peeni1kAP1Mauao« �E ` APPLICATION for The City of Edmonds si-R t""` � SIDE SEWER PERMIT EASEMENT No . .......................................... NEW CONSTRUCTION REPAIRS 106-07700 OWNER........ ------------------------------------------------------------------- CONTRACTOR----------------...............-----.........---------------------......-------------------------- PERMIT No....................... ADDRESS.-..1.03.1-..r..--- Tth..Av'nlie-s-------------------------------------------------- LEGAL DESCRIPTION: LOT No.---------------------------------------------- BLOCK No............................................. NAMEOF ADDITION......................................................................................................................................... • s . DYE TESTED ON SEWER JULY* 1972 Approved: DATE................................................ BY--------......------------............................-----......----- City of Edmonds Permit No: Z- 3 RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: A. Address or Vicinity of Construction: �4'.i�-3 ()6� --,5 B. Type of Work (be specific): C. Contractor: �Ct rTr✓`�*- ,GC_ Mailing Address: 86 % ..--s -,,rl ,. State License #:ZT19 J - D. Building Permit # (if applicable): 60-11 � Contact: 144� L�Ct^ it) S, Phone: 19 -2-5_ &t3 Liability Insurance: GCS Bond: $ Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ EUC (PUD, GTE, PSE, CHAMBERS, OVWD) ❑ Multi -Family •P[�� Single Family ❑ Other INSPECTOR- F. PAVEMENT: ❑ YES ❑ NO G. SIZE OF CUT X H. Charge: $ CONCRETE CUT: ❑ YES ❑ NO IDEMNITY: Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERJALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the required training in their possession. Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City - approved material prior to the end of the workday — NO EXCEPTIONS. Three sets of construction drawings of proposed work are required with the permit application. I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE THE PINK COP E PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS Signature: Date: i i " .2 C- C (Contractor or Agent) CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS COMMUNITY DEVELOPMENT CODE. (, FINAL APPROVAL OF PERMITTED WORK: t T INSPECTOR'SSIGNATUR DATE: For inspection requirements see Engineering Information Handout. ^~� : DATE RECEI ED ✓ t 1' r FERMITI'�fPIRES U .a r l ��� �� USE PERMIT 20071,q ZONE CITY OF EDMONDS NUMBER �(- _ .,' CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS ; •1 r/ y V OWNER NAME/NAME OF SINESS p , t a 1 /�/� PLAT NAME/SUBDIIVVISION NO. LOT NO. LID NO. LID FEE $ MAILING ADDRESS 1 STREET MAP PUBLIC RIGHT OF WAY PER OFFICIAL S RW Per approved ❑ me Required ❑ EXISTING PROPOSED se ParmR Req'd ❑ Street Use Inspection Required ❑ Sidewalk Required ❑ P CITY ZIP TELEPHONE a ( �/ / / REQUIRED DEDICATION FT Underground Wiring ea 1� METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED N E t YES ❑ NO X _ W REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z Z ADDRES� y iEA/ / t Z -� L. . i 4'j a ZIP + r ��� TELEPHONE f 1 r� 01�? 11 I� �T v U� � NAME ENGINEERING REVI WEB/DATE ADDRESS `r/� �l r� 66 FIRE REVIEWED BY DATE w S LL ITY ZIP i T LEPHONFr VARIANCE OR CU SHORELINE OR ADB# INSPECTION RE 'D BOND POSTED STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY In �/► 1 �-rr I �v 410 - ' �` ""� YES NO SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED �PROPOSED 1 `� '� PROPERTY TAX ACCOUNT PARCEL /N�Oc'.. EXP'L3•�1 �r ❑ NEW RESIDENTIAL K PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT UR SIDE REAR YC] COMMERCIAL COMPLIANCE OR ❑ 6-aj / m G'.)YO 2-91 1 j I I K5 I 9 r� I I y 6"j zj �(11 Z ADDITION ❑ CHANGE OF USE S PARKING LOT AREA PLA NING REVIEWED BY DATE ❑ REMODEL ❑ APARTMENT ❑ SIGN REO'D PROVIDED �/�{ fr. �/"ir"/' er�''j"7,�'• �`� •- UtJ. FENCE ❑ REPAIR ❑ GRADING CYDS ❑ ( X FT) REMARKS r MIA,It` �ETB iCKu MAI , ❑ DEMOLISH ❑ TANK ❑ OTHER ❑GARAGE ❑ RETAINING WALL ❑ RENEWAL CARPORT (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHEC ED BY TYPE OF CONSTRUCTION CODE GROUPANT, a'� NUMBER OF NUMBER OF DWELLING I CRITICAL AREAS —^ 1 � SPECIAL INSPECTOR AREA 14J . I I.:?_ 1 OCCUPANT � LOAD % STORIES UNITS NUMBERC UW " REQUIRED ❑ YES . ^< 1 6s* I Z.L 0 DESCRIBF %A-0v rn o"Kl": , A , �� -, iTW 5 ( �O 1, -riQ� REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D o Pq 1 1� m (� 'Pry)hA 1 L ' �tS.t r ^C o.r i r'.. �r...I. �-• sy. � VIA1ii VALUATION FEE PLAN CHECK FEE HEAT SOURCE GLAZING %y O�� LOT SLOPE % j. O� l BUILDING R AN CHECK NO: VESTED DATE PLUMBING 1 MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL f DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. STATE SURCHARGE t - PERMIT APPLICATION: 180 DAYS i PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION H 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE �y w W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF I•:{';✓�1:. r" J i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND pxf'E /I,f: �� ¢ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY . a REC T = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT 1S ..`• ( 1� t• SJ30, c DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE O NOR LIMIT IN ANY WAYTHECITY'SABILITY TOENFORCE ANYORDINANCEPROVISION.• = RECEIPT / / , TOTAL AMOUNT DUE ! _ %' i, 4 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the Building Official or h(s/her Deputy: and Fees are paid, and TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknbwledged in space provided. WORKMEN'S COMPENSAT N INSURANCE AND RCW 18.27. OF CIALS SIGNATURE DATE WNE Rt ENT) D E GNED r v , IvMf11`4� (425) �J I .� ( , / 771-0220. RELEASED BY _ DATE ATTENTION..... IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR TRUCTURE UNTIL 771'0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- oFMINAL - FILE YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR