15524 72ND AVE W.PDF1111111111115585
15524 72ND AVE W
City of Edmonds
f RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. �-
>isue Date- 9�3
A. Address or Vicinity of Construction: 15524 72nd Ave. W.
GTE to place,.operate,..and maintain a buried service
f p B. Type of Work (be specific): wi re f rom exi sti n4 pol e # 6455 1 ocated at `M . 515
h c•. 1.89 72nd Ave. W. then west to a residence at 15524 72nd Ave. W. GTE to' plow
150 ft., push no driveway and On RnAd- R.A.W. 5 ft:.
GTE Northwest Incorporated
C. Contractor: 9112r W_ rasine Rd. Contact: Jerry Scott;.425/774-5921 or 425/488-1628
Mailing Address:Everett, WA 98204-1440 Phone: Rose Brown, Permit Coord., 425/356-4027
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):. Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ;j L'tilfity (PUD, GTE, W_NG, CA'BLE,�WATER)
❑ Multi -Family ❑ Single Family ❑ Other `� GTE W.O.# 2850-9P001DB 642310
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: ❑ Yes NNo G. Size of Cut: , x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold 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 or 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 MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE� rHELD UNTIL. THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR 1 SUANCE TO THE APPLICANT.
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS. {
I have read a bove st en and understand the permit requirements and'the pink copy of the permit will be
available o s ' at all t me fo inspectrposes.
Signature: Date: 2-13-98
S on Manageral o tractororAgent) Access Design
CAL IAL-A-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:�,� TIME AUTHORIZED: VOID AFTER ' 1-0 DAYS
1
SPECIAL CONDITIONS:
RIGHT OF WAY FEE:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
T OTAL FEE: kff 0
R ECEIPT. NO.: ..
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
9
s
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL --•BY: Date:
PERMIT SUBMITTED BY
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ROAD BORES
OVERHEAD LINES
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STREET FILE FILE # - -
SWA
DETERMINATION OF NONSIGNIFICANCE
Description of proposal. Single Family Residence - - Re -engineer and build part
of existing foundation; add 2nd story addition, new enclosed garage
and entry foyer where a carport exists.
Proponent Rick Eaks
'Location of proposal, including street address, if any
15524 - 72nd Ave. W.
Lead agency City of Edmonds
The lead agency for this proposal has determined that it does not have a prob-
able significant adverse impact on the environment. An environmental impact
statement (EIS) is not required under RCW 43.21C.030(2)(c). This decision was
made after review of a completed environmental checklist and other information
on file with the lead agency. This information is available to the public on
request.
There is no comment period for this DNS.
This DNS is issued under 197-11-340(2); the lead agency will not act on
this proposal for 15 days from the date below. Comments must be submitted
by -- - - -
Responsible official Bruce G. Finke
Position/title Associate City Planner
Address 250 - 5th Ave. N.
Date October 16., 1984
Phone 771-3202.
Signature
= You may appeal this determination of nonsignificance
to Planning Director
at 250 - 5th Ave. N.
no later than 5:00 p.m. October 30, 1984
by written notice of appeal
You should be prepared to make specific factual objections. Contact
Bruce G. Finke to read or ask about the procedures for SEPA appeals.
0 There is no agency appeal.
,_
OCT 81984
ENVIRONMENTAL CHECKLIST
Introduction: The State Environmental Policy Act of
1971, Chapter 43.21C, RCW, requires all state and local
governmental agencies to consider environmental values
both for their own actions and when licensing private
proposals. The Act also requires that an Environmental
Impact Statement (EIS) be prepared for all major actions
significantly affecting the quality of the environment.
The purpose of this checklist is to help the agencies
involved determine whether or not a proposal is such a
major action.
Please answer the following questions as completely as
you can with the information available to you. Where
explanations of your answers are required, or where you
believe an explanation would be helpful to government
decision makers, include your explanation in the space
provided, or use additional pages. You should include
references to any reports or studies of which you are
aware and which are relevant to the answers you provide.
Complete answers to those questions now will help all
agencies involved undertake the required environmental
review without unnecessary delay.
The following questions apply to your total proposal,
not just to the permit for which you are currently
applying or the proposal for which approval is sought.
Your answers should include the impacts that will be
caused by your proposal when it is completed, even
though completion may not occur until sometime in the
future. This will allow all agencies involved to complete
their environmental review now, without duplicating
paperwork in the future.
NOTE: This is a standard form being used by all state
and local agencies in the State of Washington for various
types of proposals. Many of the questions may not apply
to your proposal. If a question does not apply, just
answer it "not applicable" (N/A) and continue on to the
next question.
ENVIRONMENTAL CHECKLIST OCT 81984
A. BACKGROUND
1. Name of Proponent
2. Address and Phone Number of Proponent 7&-J42_7
5_5_2_4--72 n4 AVt
3. Date Checklist Submitted 199
4. Agency Requiring Checklist U/L )A/ .
5. Name of -Proposal, if applicable Bl f/ awwl goe-e-rn IT
6. Nature and Brief Description of Proposal (including but not limited to
its size, general design elements, and other factors that will give an
accurate understanding of its scope and nature:
7.
C6
111
Location of Proposal (describe the physical setting of the proposal, as /
well as the extent of the land area affected by any environmental im-
pacts, including any other information needed to give an accurate under-
standing of the environmental setting of the proposal):
01C ivy 1.0A Ti U(T/0A) wlcL Ld t-E ®L6 « OAJ 6X/5T//V
4/4
J 5 /VD /l/p71d X "� J'(11WOWAWIM r PIffit c a9 TEO .
O�PTff s/o E DF LO% 5ueEj A ]` 54-6 AhiG �JOW/V ", Fvi2E ST
8. Estimated Date for Completion of the Proposal /--Eg 1 / /q g 3
9. List of all Permits,'Licenses, or Government Approvals Required for all
Proposal (federal, state, and local — including rezones):
Ui4_,V /k)i A wrn /T tv e>F �/XaAjoPeY01 1T
o% El7/YroN S �1 r ��—TE
Au- ( 0Airgai nle s Tn LI (05ni Oro
10. Do you have any plans for future additions, expansions, or further
activity related to or connected with this proposal? If yes, explain.
11. Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain.
Al L,4
12. Attach any other application form that has been.completed regarding the
proposal; if none has been completed, but is expected to be filed at
some future date, describe the nature of such application form:
72, ,?_V_ t-RM / r- TO 6 d dT/3//y tl9
-1-
B.
XT '81984
ENVIRONMENTAL IMPACTS (Explanations of all "yes" and "maybe" answers are required).
YES MAYBE NO
Earth. Will the proposal result in:
a. Unstable earth conditions or in changes
in geologic substructures?
b. Disruptions, displacements, compaction
or overcovering of the soil?
c. Change in topography or ground surface
relief features?
d. The destruction, covering or modifica-
tion of any unique geologic or physical
features?
e. Any increase in wind or water erosion
of soils, either on or off the site?
f. Changes in deposition or erosion of
beach sands, or changes in siltation,
deposition or erosion which may modify
the channel or a river or stream or the
bed of the ocean or any bay, inlet or
lake?
Explanation:
2. Air. Will the proposal result in:
a. Air emissions or deterioration of
ambient air quality?
b. The creation of objectionable odors?
c. Alteration of air movement, moisture
or temperature, or any change in climate,
either locally or regionally?
Explanation:
3. Water. Will the proposal result in:
a. Changes in currents, or the course
or direction of water movements, in either
marine or fresh waters?
b. Changes in absorption rates, drainage
patterns, or the rate and amount of sur-
face water runoff?
-2-
4.
OCT 8' 1984
YES MAYBE NO
c. Alterations to the course or flow
/
of flood waters?
d. Change in the amount of surface water
in any water body?
e. Discharge into surface waters, or in
any alteration of surface water quality,
including but not limited to temperature,
/
dissolved oxygen or turbidity?
f. Alteration of the direction or rate
of flow of ground waters?
g. Change in the quantity of ground
waters, either through direct additions
or withdrawals, or through interception
/
of an aquifer by cuts or excavations?
h. Deterioration in ground water quality,
either through direct injection, or through
the seepage of leachate, phosphates, deter-
gents, waterborne virus or bacteria, or
other substances into the ground waters?
i. Reduction in the amount of water
otherwise available for public water
/-
supplies?
Explanation: %• A001TIMAL I(P0 stf+ RoorAr2 .A
Flora. Will the proposal result in:
a. Change in the diversity of species,
or numbers of any species of flora (in-
cluding trees, shrubs, grass, crops,
microflora and aquatic plants)?
b. Reduction of the numbers of any
unique, rare or endangered species
of flora?
c. Introduction of new species of
flora into an area, or in a barrier
to the normal replenishment of exist-
- ing species?
d. Recution in acreage of any agri-
cultural crop?
Explanation:
-3-
5.
B
OCT 8'1984
YES MAYBE
Fauna. WIll the proposal result in:
a. Changes in the diversity of species,
or numbers of any species of fauna (birds,
land animals including reptiles, fish and
shellfish, benthic organisms, insects or
microfauna)?
b. Reduction of the numbers of any
unique, rare or endangered species
of fauna?
c. Introduction of new species of
fauna into an area, or result in a
barrier to the migration or movement
of fauna?
d. Deterioration to existing fish or
wildlife habitat?
Explanation:
Noise. Will the proposal increase
existing noise levels?
Explanation:
NO
7. Light and Glare. Will the.proposal
produce new ight or glare?
Explanation: Angiyori or- at 5-nooms -to howsc wiL1✓ U5E
fYIL�iLl a(� 1-it)n)G T64l4nJ 1721u 1AJA'L_ dQU I t
a
a
Land Use. Will the proposal result
in the alteration of the present or
planned land use of an area?
Explanation:
Natural Resources. Will the proposal
result in:
a. Increase in the rate ofuse of any
natural resource?
b. Depletion of any nonrenewable
natural resource?
Explanation:
-4-
OCT 1984
YES MAYBE NO
10. Risk of Upset. Does the proposal involve
a risk of an explosion or release of hazard-
ous substances (including, but not limited
to, oil, pesticides, chemicals or radiation)
in the event of an accident or upset condi-
tions?
Explanation:
Population. Will the proposal alter the
ocation, distribution, density, or growth
rate of the human population of an area?
Explanation:
12. Housing. Will the proposal affect existing
housing, or create a demand for additional
housing?
Explanation:
13.
Transportation/Circulation. Will the pro-
posal result in:
a. Generation of additional vehicular
movement?
b. Effects on existing parking facili-
ties, or demand for new parking?
c. Impact upon existing transportation
systems?
d. Alterations to present patterns of
circulation or movement of people and/or
goods?
e. Alterations to waterborne, rail or
air traffic?
f. Increase in traffic hazards to motor
vehicles, bicyclists or pedestrians?
Explanation:
-5-
UCT . 8, 1984
YES MAYBE' NO
14. Public Services. Will the proposal have
an effect upon, or result in a need for
new or altered governmental services in
any of the following areas:
a. Fire protection?
b. Police protection?
c. Schools?
d. Parks or other recreational
facilities?
e. Maintenance of public facilities,
including roads?
f. Other governmental services?
Explanation:
15. Energy. Will the proposal result in:
a. Use of substantial amounts of fuel
or energy?
b. Demand upon existing sources of
energy, or require the development
of new sources of energy?
Explanation:
16. Utilities. Will the proposal result in
a needfor new systems or alterations to
the following utilities:
a. Power or natural gas?
b. Communications systems?
c. Water?
d. Sewer or septic tanks?
e. Storm water drainage?
f. Solid waste and disposal?
Explanation:
�1�
10
17.
Human Health. Will the proposal result
in the creation of any health hazard or
potential health hazard (excluding
mental health)?
Explanation:
bCT - 8'1984
YES MAYBE NO
18. Aesthetics. Will the proposal result
in the obstruction of any scenic vista
or view open to the public, or will the
proposal result in the creation of an
aesthetically offensive site open to /
public view?
Explanation:
19.
20.
Recreation. Will the proposal result
in an impact upon the quality or quan-
tity of existing recreational oppor-
tunities?
Explanation:
Archeological/Historical. Will the
proposal result in an alteration of
a significant archeological or his-
torical site, structure, object or
building?
Explanation:
C. SIGNATURE
I, the undersigned, state that to the best of my knowledge the above information is
true and complete. It is understood that the lead agency may withdraw any declaration
or non -significance that it might issue in reliance upon this checklist should there
be any willful misrepresentation or willful lack of full disclosure on my part.
PROPONENT:
f�'rEry /- -
-7-
CITY OF E D M O N D S LARRY S. NAUGHTEN
250 5th AVE. N. • EDMONDS, WASHINGTON 98020 • (206) 771.3202 MAYOR
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
March 4, 1986
Rick Eaks
15524 72nd Ave. W.
Edmonds, WA 98020
PERMIT: 850089
Dear Mr. Eaks:
Within the last year you have obtained a permit from the
City of Edmonds Building Division. Our records show that
your permit has expired and not received a final evaluation
and approval from our offices. As part of the City
Ordinance and Building Code, all permits issued must be
inspected for final approval by the Building Division.
If your work was contracted, you may not have been aware of
your responsibility to schedule a final inspection. Please
cal-1 771-3202 extension 257 to schedule a final inspection
if your work is complete.
If your work is not yet completed, please call the Building
Division to update the status of your permit.
Thank you for your assistance.
annine L. Graf
Permit Coordinator
LAST INSPECTION DATE: 08/14/85
3 /0 86 / Z os 61�/1 6ai C?icb ZP-15
Lvi// `j�� LI�s lo�rstc�r Cain.
71)
PUBLIC WORKS • PLANNING PARKS AND RECREATION •
ENGINEERING
RECEIVED
CITY of EDMONDS SIDE SEWER PERMIT
For Inspection Call 771-3202 MAY ,'' 99�5 HERMIT NO. 07329
PUBLIC. WORKS''
Address of Construction: DT&- 4 r12�d ,UV ��dYI S UUG. �3d9 '
Property Legal Description (Include all easements): LYNNWOOD LINE
Owner and/or Builder: -K;ch3,rd 7=&kS
Contractor & License No:
Single Family Residence V-11
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. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No v-" Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
Ar
I cer ifs that I have read and shall comply ;� Date
with e' items listed on the back.
Permit Fee: 3 D,O G Issued By -
Trunk Charge: 2S(OD Date Issued:
Assessment Fee: Receipt No.:
Partial Inspection:
Comments Date Initial
Final Inspection Approved: �I
d-
to Ini al
oRejected:
Reason Date -Initial
a
** PERMIT MUST BE POSTED ON JOB SITE **
a
White Copy - File Green Copy - Inspector Buff Copy - Applicant
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ...........................................
(f m. CONK -
NEW CONSTRUCTION El REPAIRS ❑ LID NO. 9,10— ------- -ASMT. NO.._..._-.-_.--___
OWNER RI�NAi3Q # TC<HIN-..EAKS---------------- CONTRACTOR----------------------------------------------------------------------------------- PERMIT NO. 7..- % —5
JOB ADDRESS .- - ---------- AYE.=_-\iV.t ----- LEGAL DESCRIPTION: LOT NO- --------------------------- ------ BLOCK N
LYNNWOOD LINE
CA. 1-61
PWW-0001-11/75 (REV-11/78)
NAMEOF ADDITION----------------------------------------------------------------------------------------------------------------------
15 5 24 72.No A-q. W.
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Approved: / / fj fj
DATE 1 it _!_ 95--_---- BYa4
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ST-Dr-ET FILE
1-11.
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CITY OF EDMONDS
PUBLIC WORKS - EWINEERING ?
ACTION REPORT 7!1
- N.
SUSPENSE DATE:
Date: �� Time: File N
Attachments: =Yes';-,
CI IR.1 Ff.T Y7 M ' I A t� iT f� ?— ; J i^ n 'e J -
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REQUESTOR:
NAME:ill
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ADDRESS:
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PHONE:
REQUEST RECEIVED BY:
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TELEPHONE
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CONTACT
'OTHER:
IN OFFICE r--j
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RECEIVED BY:
ROUTE TO:
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ACTION: A
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All Concerned Notified44—
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'ACtion Completed/File
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