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KOELLER RESIDENCE MAY 0 1 1996
16925 76TH AVE WEST
EDMONDS, WASHINGTON
PERMITCOUNTER
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RECEIVED
MAY 2 0 1996
PERMIT COUNTER
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110 - 210TH ST. S.W. • EDMONDS, WA 98026 • (425) 771-0235 • FAX (425) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
Inc. 1890
September 24,1997
CERTIFIED FINAL NOTICE
Gerald Koeller
16925 76th Ave. W.
Edmonds, WA 98026
Account #308050
Subject: Backflow Prevention Assembly Annual Testing
On August 1, 1997, you were notified by letter that your backflow prevention assembly
was due for annual testing.
On September 2, 1997, the second notice was sent which stated that you had 15 days to
take care of this matter. Failure to comply, according to the City of Edmonds -
Ordinance Chapter 7.20 and Washington State codes WAC 246-290-490, water service
to your premises will be discontinued if test results are not sent to me within 20 days
from the date of this letter.
Should you have any questions or concerns, please contact me at 771-0235, extension
644.
Sincerely,
Linda McMurphy
Water Quality Control
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan. Japan t
Gerald W. Koeller
16925 - 76th Avenue West
Edmonds, WA 98026
March 27, 1997
Mr. James Walker
City Engineer
City of Edmonds
250 - 5th Avenue North
Edmonds, WA 98020
Re: Remodel at 16925 - 76th Ave. W, Edmonds
Pursuant to my conversation with you on March 27, 1997, it is my understanding
that it is not necessary to put the utilities underground when doing my remodel at
16925 - 76th Ave. W, Edmonds.
Gerald W. Koeller
cc: City of Edmonds
Building Department
250 - 5th Ave. N.
Edmonds, WA 98020 '
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. `Site Address/Location: oi, 'vs hlz_ k jqF
2. Property Tax Account Number: ` 3A , b00.
3. Approximate Site Size (acres or square feet): ba G
4. Is this site currently developed?'____" yes; no.
If yes; how is site developed? S"l 11Ot
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 10-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 10-feet over a horizontal distance of 33 to 66-feet).
9
Steep:. grades of greater than 3096 present on site (a vertical rise of 10-feet over a �. Za
horizontal distance of less than 33-feet). t"`A`t ads '` -lie tztsP- ®
Other (please describe):
6. Site contains areas of year-round standing water: *40 ; Approx. Depth:
7. Site contains areas of.seasonal standing water: jun ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? �40 Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc) _
11. Obvious wetland is present on site:
r
----- —For City Staff Use Only -
1:Site is Zoned?
2 :: SCS mapped soil type(s)? 2�(699 c5 1,�wnx-
3::;:;>Wetland inventory or C.A. map indicates wetland present on site?,
4 ::.:.Critical Areas inventory or C.A. map indicates Critical Area on site?
:.:Site within designated earth subsidence landslide hazard area?
:»:Site designated on the Environmentally Sensitive Areas Map? � 5 - �.�f•4- CKr�t[ �tSj S il-'QF-'�
Rev 01/04/94
MAR 2
PENIT ® COUNre
5. a 6e f P
6lg0_199
City of Edmonds
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Street Address
E-0VV'oNgs
City, State, ZIP Phone
Signature
Date
Applicant Representative:
AV4 A
Name
Street Address
City, State, ZIP Phone
L-�L 5 2,6
Signature f Date
y OF.,EDAl
O
x N CJ
CITY OF EDMONDS
Fsr i $qo 250 5TH AVENUE NORTH, EDMONDS, WA 98020 (206) 771-0220
RCW 197-11-970 Determination ofNonsignificance (DNS)
DETERMINATION OF NONSIGNIFICANCE
Description of proposal: Demolish an existing garage (except for a concrete retaining wall) and construct a new
garage in its footprint which extends north an additional 8 feet and west an additional 5 feet and has a height of
22.25 feet. Connect the new garage to the house by enlarging the kitchen into the new garage area (City of
Edmonds Building Plan Check No. 9b-7.6�1.
Proponent: Gerald W. Koeller
Location of proposal, including street address if any: ,16925 - 76th Avenue W., Edmonds, Washington
Lead agency: CITY OF EDMONDS
The lead agency for this proposal has determined that it does not have a probable significant adverse impact on the
environment. An environmental impact statement is not required under RCW 43.21.030(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.
X 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: Jeffrey S. Wilson
Position/Title: Current Planning Supervisor, Department of Community Services - Planning Division
Phone: (206) 771-0220
Address: City of Edmonds, 250 5th Avenue North, Edmonds, WA 98020
Date: 3d G
XX You may appeal this determination to Robert C ave, Planning Manager, at 250 5th Avenue North,
Edmonds, WA 98020, no later than 1996, by filing a written appeal citing the
reasons..
You should be prepared to make specific factual objections. Contact Jeffrey S. Wilson to read or ask about the
procedures for SEPA appeals.
XX Posted on 5 31 1996, at the Edmonds Public Library, Edmonds Community Services
Building, and the. E monds Post Office.
XX Distribute to "Checked" Agencies on the reverse side of this form, along with a copy of the Checklist.
Page I oft
PC9676EN.DOC
5/30/96.SEPA
Mailed to the following along with the Environmental Checklist:
XX Environmental Review Section
Department of Ecology
P.O. Box 47703
Olympia, WA 98504-7703
XX Applicant: Gerald W. Koeller
16925 - 76th Ave. W.
Edmonds, WA 98026
XX Architect: Kathi St. Peter
8122 206th S.W.
Edmonds, WA 98026
pc: File No. PC-96-76
SEPA Notebook
Page 2 of 2
PC9676EN.DOC
5/30/96.SEPA
�F EDM
MEMORANDUM
Date: May 30, 1996
To: File No. PC-96-76
From: Meg Gruwell, Code Enforcement Officer..
Via: Jeffrey S. Wilson, Responsible Official
Subject: ENVIRONMENTAL DETERMINATION FOR •KOELLER GARAGE
DEMOLITION AND ADDITION; FILE NO. PC-96-76 (BUILDING PERMIT)
I have had the opportunity to visit the site, and review the environmental checklist, proposed plans, and
other information, which has been prepared for the project. A copy of these materials are filed in the
official file for this permit.
Based on my review of all available information and adopted policies of the City, I recommend that an
environmental determination of nonsignificance be issued for the project.
Should you have any questions concerning the information in this memorandum, please contact me.
Review by Responsible, Official
I concur:
I do not concur:
Comments:
3
Jeffrey S. Wilson Date
Attachments
pc: File No. Building Permit PC-96-76
City of Edmonds cQ Planning Division
PC9676CO.DOC
05/30ft.
CITY OF EDMONDS
ENVIRONMENTAL CHECKLIST
e90-1914..
Purpose of Checklist.
MAY Q 1 log,
PERMIT u
The State Environmental Policy Act (SEPA), chapter 43.21C RCW, requires all.governmental agencies to consider the
environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all
proposals with probable significant adverse impacts on the quality of the environment. Zile purpose of this checklist is to provide
information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it
:an be done) and to help the agency decide whether an EIS is required.
Nstructions for Applicants.
this environmental checklist asks'you to describe some basic information about your proposal. Governmental agencies use this
:hecklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer
:he questions briefly, with the most precise information known, or give the best description you can.
You must answer each question accurately and carefully, to the bast of your knowledge. In most cases, you should be able to
answer the questions from your own observations or project plans without the need to hire experts. If you really do not know the
answer, or if a question does not apply to your proposal, write "do not know" or does not apply". complete answers to the
Iuestions now may avoid unnecesnry delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. 'Answer these questions
if you can. If you have problems, the governmental agencies can assist you.
The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels
3f land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which
you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining .
if there may be si�_nificant adverse impact.
Use of checklist for nonproject proposals.
Complete this checklist for nonproject proposals, even though questions may be answered "does not apply." IN ADDITION,
:omplete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D).
For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as
'proposer," and "affected geographic area," respectively.
A. BACKGROUND
1. Name of proposed project, if applicable:
2. Name of applicant:
`�-
3. Address and phone number of applicant and contact person:
/,�-.4 2
-4-r- e- �
4. Date checklist prepared:
Page 1 of 22
:HK LT/ 10-2 5.93. Al ASP G R
5. Agency requesting checklist: City of Edmonds.
6. Proposed timing or schedule (including phasing, if applicable):
(STAFF COMMENTS)
7. Do you have any .plans for future additions, expansion, or further activity related to or connected with this
proposal? If yes, explain.
(STAFF COMMENTS)
8. List any environmental information you know about that has been prepared, or will be prepared, directly
related to this proposal.
(STAFF COMMENTS)
9. Do you know whether applications are pending; for governmental approvals of other proposals directly affecting
the property covered by your proposal? If yes, explain.
d
(STAFF COMN1ENTS)
10. List any government approvals or permits that will he needed for your proposal, if known.
(STAFF COMMENTS)
Page 2 of22
CHKLT/10.2S.93.MASfGR
I
11. Give brief, complete description of your proposal, including the proposed uses and size of the project and site.
There are several questions later in this checklist that ask you to describe certain aspens of your proposal. You
do not need to repeat those answers on this page. ,
/moo c=
— /�..- . 7
(STAFF COMMENTS)
12. Location of the proposal. Give sufficient information for a person to understand the precise location of your
Proper Project, including a street address, if any, and section, township, and range, if known. If a proposal
would occur over a range of area, provide range or boundaries of the site(s). Provide legal description, site
plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required
by the agency, you are -not required to duplicate maps or detailed plans submitted with any permit applications
related to this checklist.
(STAFF COMMENTS)
TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other:
_re--. ��
(STAFF COMMENTS)
b. What is the steepest slope on the site (approximate percent slope)?
/ol v
(STAFF COMMENTS) WAAI oA ,tTsr'a•,a.. 6A -1, s 6,11> Ia I7
c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you
know the classification of agricultural soils, specify them and note any prime farmland.
Page 3 of 22
CHKU11473-93,MASCER
1'
(STAFF COMMENTS) Le -A G-P
MvuwD. l 157-2SV i
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
O
(STAFF COMMENTS)
e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
of fill. , -
(STAFF COMMENTS)
f. Could erosion occur as a result of clearing, construction, or use' If so, generally describe.
(STAFF COMMENTS) PlAns Qww 464- 41., U,A't+tm rack wall oA�t fig" xS� conrn[f{
wa11 w11 rur+a� a+d he hca��xakdl ihb 44 '40 ore
CwTt 41:„ Pavu1.
g. About what percent of the site will he covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
2z U
p
(STAFF COMMENTS)
Page 4 of 33
C 1 UC LT/ 10-?3-93. M ASTER
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
(STAFF COMMENTS)
2. AIR
a. What types of emissions to the air would result from the proposal (i e., dust, automobile, odors,
industrial wood smoke) during construction and when the project is completed? If any, generally describe
and give approximate quantities if known.
(STAFF COMMENTS)
b. Are there any off -site sources of emissions or odor that may effect your proposal? If so, generally
describe.
(STAFF COMMENTS)
C. Proposed measures to educe or control emissions or other impacts to the, if any:
10
(STAFF COMMENTS)
3. WATER
a. Surface:
(1) Is there any surface water body on or in the immediate vicinity of the site (including year-round
and se:Lsonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names.
If appropriate, state what stream or river it flows into.
(STAFF COMMENTS)
Page 5 of 22
CHKLT/14 3.91. M A.Sf ER
(2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If
yes, please describe and attach available plans.
(STAFF COMMENTS)
(3) Estimate the amount of fill and dredge material that would be placed in or removed from surface
water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill
material.
(STAFF COMMENTS)
(4) Will the prop(md require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
(STAFF COMMENTS)
(5) Does the proposal lie within a I00-year lloodplain? If so, note location on the site plan.
(STAFF COMMENTS)
(0) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the
type of ww%te and anticipated volume of discharge.
(STAFF COMMENTS)
Page 6 of 22
CWLT/10.15-93MASTER '
b. Ground:
(1) Will ground water he withdrawn, or wilt water. be discharged to ground water? Give
general description, purpose, and approximate quantities if known.
(STAFF COMMENTS)
(2) Describe waste material that will be discharged into the ground from septic tanks or
other sources, if any (for example:' Domestic sewage; industrial, containing the
following chemicals...; agricultural; etc.). Describe the general size of the system, the
number of such systems, the number of houses to be served (if applicable), or the
number of animals or humans the system(s) are expected to serve.
(STAFF COMMENTS)
C. Water Runoff (including; stonn water):
(1) Describe the source of runoll' (including storm water) and method of collection and
disposal, if any (include quantities, if known). Where -Mll this water flow? Will this
water flow into other waters? 11'so, describe.
(STAFF COMN1ENTS)
(2) Could waste materials enter ground or surface waters? If so, generally describe.
(STAFF COMMENTS)
Page 7 of 22
CHKU/ 104ZS.93. M ASC E R
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
(STAFF COMMENTS)
4. Plants
a. Check or circle types of vegetation found on the site:
deciduous tree: alder, maple, aspen, other:
evergreen tree- fir, cedar, pine, other:
/ shrubs
grac5
pasture
crop or grain
wet sail plants: cattail, buttercup, bulrush, skunk cabbage, other:
water plants: eater lily, eelgrace, milfoil, other:
other types of vegetation:
(STAFF COMMENTS)
b. What kind and amount of ve; etation will be removed or altered?
(STAFF COMMENTS)
C. List threatened or endangered species known to he on or near the site.
"e '`�--
(STAFF COMMENTS)
d. Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the
site, if any:
Page & of 22
C KKLT/ 14Z5-9.7. M ASTER
(STAFF COMMENTS)
5. Animals
a. Check or circle any birds and animals which have hem observed on or near the site or are known to be on
or near the site:
bird.•. haw herim, a igi sclry;bir , other:
mammals: deer, bear, elk, beaver, other:
fish: bass, salmon, trout, herring, shellfish, other:
(STAFF COMMENTS)
b. List anv thre-itrned nr ondtrnrrw•arl cnw4ac L•n.%-- fn Iw — — ♦i..,
(STAFF COMMENTS)
C. IS the Site narl of n miorntian rrudr+' it cn a.•nh,:n
(STAFF COMMENTS)
d. Proposed measures to preserve or enhance wildlife, if any:
(STAFF COMMENTS)
6. Energy and Natural Resources
CMLT/10-:5-93.MASCER
Page 9 of 22
a. What kinds of energy (electric, natural gas, oil, Wood stove, solar) will be used to meet the completed
project's energy needs? Describe whether it «'ill be used for heating, manufacturing, etc.
Ile
(STAFF COMMENTS)
b. Would_ your project affect the potential use of solar energy by adjacent properties? If so, generally
describe.
0
(STAFF COMMENTS)
C. What kinds of energy conservation features are included in the plans of this proposal? List other
proposed measures to reduce or control energy impacts, if any:
(STAFF COMMENTS)
7. Environmental Heath
a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and
explosion, spill, or hazardous waste, that could occur as a result of this proposal? if so describe.
0
(STAFF COMMENTS)
Pane 10 of 22
CHMT/10425-93MASM
(1) Describe special emergency services that might be required.
(STAFF COMMENTS)
(2) Proposed measures to reduce or control environmental health hazards, if any:
(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic,
equipment, operation, other)?
(STAFF COMMENTS)
(2) What types and levels of noise would be created by or associated with the project on a short -tern or
a long-tenn basis (fir example: (raffic, construction,'operation, other)? Indicate what hours noise
would come from the site.
(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
(STAFF COMMENTS)
Page 11 of 22
9CLT/I4:3.93.MASTER -
8. Land and Shoreline Use
a. What is the current use of the site and adjacent properties?
(STAFF COMMENTS)
b. Has the site been used for agriculture? If so, describe.
v
(STAFF COMMENTS)
C. Describe any structures on the site.
(STAFF COMMENTS)
d. Will any structures he demolished? 7f so, .chat?
(STAFF COMMENTS)
e. What is the current zoning classiriaitiun of the site?
(STAFF COMMENTS) k4wtL
Page 12 of 22
CI KLT/10-25-91MASTER
f. What is the current )comprehensive plan designation of he site?
/L I/
(STAFF COMMENTS)
g. If applicable, what is the current shoreline master plan designation of the site?
(STAFF COMMENTS)
h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify.
(STAFF CO N1 M ENTS) ` ,k kc bury D� 3 a, jti c roe, r+ �G, �cn s d�v� 4rtJ %lg n
d s a S i�26.e .eft'nva,�. t.W
i. Approximately how many people would reside or work in the completed project?
O -
(STAFF COMMENTS)
J. Approximately how many people would the completed project displace?
A
(STAFF COMMENTS)
Page 13 of 22
k. Proposed measures to avoid or reduce displacement impacts, if any:
(STAFF COMMENTS)
I. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans,
if any:.
(STAFF COMMENTS)
9. Housing
a. Approximately how many units would he provided, if any? Indicate whether high, middle, or low-income
housing.
(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-
income housing.
M
(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
(STAFF COMMENTS)
OWLT/10- 5-93.MASTER
Page 14 of 22
10. Aesthetics
a. What is the tallest, height of any proposed structure(s), not including antennas; what is the principle
exterior building material(s) proposed?
(STAFF COMMENTS)
b. What views in the immediate vicinity would he altered or obstructed?
(STAFF COMMENTS)
C. Proposed mmsures to reduce or control aesthetic impacts, if any:
(STAFF COMMENTS)
11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
(STAFF COMMENTS)
h. Could light or glare from the finished prgiect he a safety hazard or interfere with views?
(STAFF COMMENTS)
Pagc 15 of 22
C► Kt.T/1425.93.MAsrrR
C. What existing off -site sources of light or glare may affect your proposal?.
(STAFF COMMENTS)
d. Proposed measures to reduce or control light and glare impacts, if any:
(STAFF COMMENTS)
12. Recreation
a. What designated and infornial recreational opportunities are in the immediate vicinity?
(STAFF COMMENTS)
h. Would the proposed project displace any existing recreation uses? If so, describe.
(STAFF CON1N1ENTS)
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the pru.ject or applicant, if any:
(STAFF COMMENTS)
Page 16 of 22
CI MLT/t4?S-9.1.M ASTER
13. Historic and Cultural Preservation
a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers
known to be on or next to the site? if so, generally describe.
a
(STAFF CONIMENTS)
h. Generally describe any Landmarks or evidence of historic, archaeological, scientific, or cultural
importance known to he on or neat to the site.
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
(STAFF COMMENTS)
14. Transportation
a. Identify public streets and highways serving; the site, and describe proposed access to the existing street
system. Show on site plans, if any.
(STAFF CONMENTS)
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop?
Pa.c 17 of 22
CI UCLT/163-93.MASI'ER
(STAFF COMMENTS)
C. How many parking spaces would the completed project have? How many would the project eliminate?
(STAFF COMMENTS)
d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not
including driveways? if so, generally describe (indicate whether public or private).
v
(STAFF COMMENTS)
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
(STAFF COMMENTS)
f. How many vehicular trips per day would he generated by the completed project? If known, indicate when
peak volumes would occur.
(STAFF COMMENTS)
Page 18 of 22
CI OCLT/163.93.M AST[R
g. Proposed measures to reduce or control transportation impacts, if any:
(STAFF COMMENTS)
15. Public Services
a. Would the project result in an increased need for public services (for example: fire protection, police
protection, health rare, schools, other)? If so, generally describe.
(STAFF ComMENTS)
b. Proposed measure to reduce or control direct impacts on public services, if any:
(STAFF COMMENTS)
16. Utilities
a. Circle-LALWes currently available at the site: electricity natur nt ,� refuse�serv-
y sever septic system, other:
(STAFF COMMENTS)
Page 19 of 22
:FOCLT/I0.2541 MASP@R
b. Describe the utilities that are proposed for the project, the utility .providing the service, and the general
construction activities on the site or in the immediate vicinity which might be needed.
(STAFF COMMENTS)
C. SIGNATURE
The above answers are true and
to make its decision. i
Signature of Proponent
Best of my knowledge. I understand .that the lead agency is relying on them
z
Date Submitted
CHK LT/14:5-9J.M ASTER
Page 20 or 22
D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS
(do not use this sheet for project cations)
$ecause these questions are very general, it may be helpful to nod them in conjunction with the list of the elements of the
environment.
When answering these questions, be aware of the extent the proposal, or the types of activities likely to result from the
proposal, would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond
briefly and in general terms.
1. How would the proposal be likely to increase discharge to water, emissions to air, production, storage, or release of
toxic or ha-rardous substances; or production of noise?
Proposal measures to avoid or reduce such incre ,;o; are:
Q
2. How would the proposal he likely to affect plants, animals, fish, or marine life?
ON
Proposed measures to protect or conserve plants, animals, lih, or marine life are:
3. How would the propo-W he likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
Pagc 21 of 22
C1I U /10-15-91MASTER
4. How would the proposal he likely to use or affect environmentally sensitive areas or areas designated (or eligible or
under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered
species habitat, historic or cultural sites,. wetlands, tloodplains, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal he likely to affect land and shoreline use, including; whether it would allow or encourage land
or shoreline uses incompatible with existing; plans'
AZ Zt:Z
Proposed measures to avoid or reduce shoreline and land use impacts are:
6. How would the proposal he likely to increase demands on transportation or puhlic services and utilities?
Proposed measurLw to reduce or respond to such dem:uid(s) are:
7. Identify,. if pos,Sible, whether the proposal may conflict with local, state, or federal laws or requirements for the
protection of the environment.
Page 22 of 22
CUKU/143-93.MASTER
CA FILE NO_ _ 9L-$C)
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
I { Ste Address/Ucation: _ i &J ZS %Uh A u , "
p 4erty Tax Account Number: J 131 - OOD + 1 Z I — I i O'L
3. Approximate Site Size (acres or square feet): 1 5.
4. Is this site currently developed? yes; no.
If yes; how is site developed? `t!sM M& � C�Fl►��
5. Describ the general site topography- Check` -all that apply.
Flat: less than 5-feet elevation change over entire site.
.wsr,
r
Rolling: slopes on site generally less than 15% (a vertical rise of 10-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 10-feet over a horizontal distance of 33 to 66-feet). .
Steep: grades of greater than 30% present on site (a vertibal 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. ,i/0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: k1V ; Approx. Depth:
What season(s) of the year?
-7-r
8. Site is .in the floodway 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 primarily:. forested ; meadow ; shrubs ; mixed ;
urban landscaped (lawn,shrubs etc) _
11. Obvious wetland is present on site: --
. 1
. � a � ,�.d'.•J ..:� .1;i7: Z•• .s Il •l,_ dSS•A .. .
APR.,18' 1996
COMMUNITY ativius
or
9a 19y
City of Edmonds ---
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 Citywill - ,
review the checklist, make a precursory site
visit, and malae a determination of the
subsequent steps necessary to complete a
development permit application.
*19
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). M
addition, the applicant shall include
other pertinent information (e.g. site
Plan, topography amp, etc-) or studies in
cogjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant: Applicant Representative:
sr Pax J
Name • .Name
lG 9 a !r 7472V w ., 81 Z2 bath 56t� J
Street Address Street Address
City, State, ZIP Phone v _" City, State,. ZIP:
- Phone
7v G 70 - s
Get
Si cure ','� Date Si tore}+, i} r
. Date t.
City of Edmonds
Critical Areas Determination
Applicant: Gerald Koeller Determination #: CA-96-80
Project Name: Permit Number:
Site Location: 16925 - 76th Avenue W. Property Tax Acct #: 5131 000 121 11 02
Project Description:
Non -Project Specific
Determination: Study Required:
During review and inspection of the subject site, it was found that the site appears to contain
and/or is adjacent to a Steep Slope Hazard Area pursuant to Chapter 20.1513 of the Edmonds
Community Development Code (ECDC). To determine if a Steep Slope Hazard Area does
exist, a topographic survey prepared by a Licensed Land Surveyor delineating Steep Slope
Hazard Areas must be completed. Any slope over 40 % with more than 20 feet of rise will be
classified as a Steep Slope Hazard Area. A 50 foot buffer is required from both the top and
toe of the slope. A 15 foot building setback is required from the 50 foot buffer.
For development of any kind which is proposed within the critical area, 50 foot buffer or 15
foot buffer setback, it must be shown that the development will not adversely impact the
Critical Area or its buffer, by doing one or possibly both of the following depending on the
outcome of the study:
For development proposals which will occur within the 50 foot buffer, but no closer
than 10 feet from the top or toe of the slope, the 50 foot buffer requirement may be
reduced to 10 feet if a study is completed by a licensed geologist or geotechnical
engineer which clearly demonstrates that the proposed buffer alteration will have no
adverse impact upon the site, the public or any private party. All Critical Area Studies
must be completed under a three party contract where the City hires the professional
required, and the applicant pays for the study (pursuant to ECDC Section 20.15B.150).
2. If development must occur within the critical area, buffer, and/or buffer setback, and is
not identified as an exception per ECDC Chapter 20.15B, a Reasonable Use Exception
and Variance must be obtained pursuant to ECDC 20.15B.180A and 20.15B.040C.
All proposed development of the subject lot must meet the requirements of Chapter 19.05
(Building Permits - Earth Subsidence and Landslide) .of the Edmonds Community
Development Code.
• If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on the site, they may submit their proposal to
the Planning Department for review. If the Planning Department finds that the proposed
development permit will not adversely impact a Critical Areas or its buffers, a conditional
waiver may be issued on a,project by project basis.
The site is also in an area designated on the Critical Areas inventory as Slopes with Erosion
Potential. All proposed development must have an erosion control plan approved by the City of
Edmonds Engineering Department.
Name
Date
2
4ti
eaac�n
3• fro .�� � ,�� ir,'� �' '
(1&125 7F
91 sq Fr 4 -re kra ,J
8 / waree.
0
i 3s. are
15, 500--50Fr, 51 rr ,
.e�r F:-eowr 4 e arz 26
�I c77e: 10'
F ewr MAX. le,'
rA"L, -0 5131 - 000 - 12 i - 110 2
MEADOWDALE BEACH
BLK 000-0-11 PTN TRS 121 & 122 DAF SAAP 642FT N 6 2OFT
E OF W 1/4 COR SEC 8-27-4 WH PT IS ON W LN TR 122 TH
S87 * 06 OOE 196.70FT TH N60* 20 OOE 135FT TH N87*
KOELLER RESIDENCE
16925 76TH AVE WEST
EDMONDS, WASHINGTON
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
660470
'
YJGL• M
• ,
ZMAILING'ADORESS
i1
C
• r • T'l if
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved;
%�!
CITY. ZIP .
'��
TELEPHONE NUMBER
EXISTING REQUIRED
11
DEDICATION
RW Permit Required O
Street Use Permit Req'd O
i i`*a
Inspection Required lY
"e
NAME
PROPOSED 13r
Sidewalk Required' t]
/ sC�
6I
METER SIZE
LINE SIZE
NO.OF FIXTURES
PRV REQUIRED
•'
~
w
ADDRESS ,,;•
YES 13 NO
t'..
REMARKS
CITY ZIP.
TELEPHONE NUMBER
NAME r. ,.i'..•
��.. T .k •
ADDRESS.:'.-'
ENGINEERING MEMO DATED
REVIEWED BY
~1 0-1 , 5'
CITY.' ZIP
TELEPHONE NUMBER
z
FIRE MEMO DATED
REVIEWED BY
8
STATE LICENSE NUMBER EXPIRATION DATE
1of!Property
SIGN AREA
SEPA REVIEW
ADS NO.
ALLOWED '
PROPOSED
EXEMPT
,,..•+�"'
".
'Legal ?Description = Include All easements
Z
`' ,. �v :':...• Ui+ � �. • /, f. .s'., r /. � '. %1�' / :C 1 4 1-4-2-
7COMPLETE
yNs
SHORELINE M
,;
O
....
EXP I si
L+,- tNH
a::. l F�i �� �• j/tm
VARIANCE OR CU
PLANNING REVIEW BY
DATE
W
o
F.,`!,l%Es'. '� .q'(,�; +',,7 .FT _ r-jN 4.� y 0 A` OCiII�
,
+ �f�►
SETBACKS — FEET
HEIGHT
LOT COVERAGE
O
r II
FRONT 44 SIDE I IU'
REA1
7 C.'
�rJ.
i
L•.'
�0,
Property'. '• :. :• ;. :.
.Tax Account . '
Parcel No'
REMARKS
Lll. RESIDENTIAL
JX
PLUMBING
INEW":.
'MECHANICAL
IM ADDITION: ;•
hJ COMMERCIAL
'APT: BLDG.
REMODEL
SIGN
GRADING FENCE
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
GROUP _.
.REPAIR CYOS. (_ x _FT)
_
TOVE SWIm POOL
HOUB PA
SPECIAL INSPECTOR
r
fJ
OAUP�ATDDEMOLISH
ODREQURED❑
WALL/
YES
CARPORT:'? .'; ROCKE YG RENEWAL
R MARKS
(TYPE OF USE;.BUSINESS OR ACTIVITY) EXPLAIN:
YPE
PROGRESS INSPECTIONS
PER UBC 305
' ,
O
.NUMBER`::.:•
OF'' "-•
NUMBER OF
DWELLING',
CRITICALuj
AREAS��
INUMBE
' 7
m
STORIES'•:":•'''
UNITS
a
'.DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
I
FINAL INSPECTION REQUIRED
VALUATION
FEE
.'
:. LA
PLAN CHECK FEE
.�
L
BUILDING
✓
HEAT SOURCE::: :`
;::
GLAZING nn I e/a
•.i.. 5
L !1
PLUMBING
/
MECHANICAL
GRADINGIFILL
This'.Permit covers.work to be done on private property ONLY.
constructior• in.the'publlc domain (curt:s, sidewalks,
driveways ;'marqubes,'etc.)•Will. require Separate permission.
STATE SURCHARGE
4.
Pemtlt Appllcation;180 Days .. .
Permit Limit:`1 Year ='Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
,.
- •behalf UNIs or er spotJse, half assigns and
successors:in nterest. agrees to Indemnify,' defend and hold
ENG1`INSPECTION FEE*. '
•
'Harmless; the City ' -of Edmonds, Washington, Its officials,
` QmpI* '' ,:anli agents from any and all claims for damages of
Whatever,nature, arising directly or Indirectly from the Issuance
PLAN CHECK DEPOSIT
otahi& permit. Issuance Of. this permit Shall not be deemed t0
o
x
.modify; Waive or reduce any, requirement of any city ordinance
r ill t•;i any waY.the:Clty'd ability to enforce any ordinance
TOTAL AMOUNT DUE
,CFO Z1S
•i:
I`'tieretiy'acknoWledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
,_
information givenas•correct; and that I am the owner, or the duly
authorized agent of..the owner: I agree comply with city and
'state lews;regulating construction; and in'doing the work authoriz•
;THIS PERMIT
AUTHORIZES
This application is not a permit.until
red;ttieretiy„ no'person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code`of:,the.State of, ashington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
s
tion••Insuranc'e and RCW 18.27.. •
INSPECTION
acknowledged in space provided.
,:„
j
SIGNATU E.!OWNER OR AGENT) GATE SIGN D
�'•�' Q/�
DEPARTMENT
CITY OF
OFF( ION DATE
' !)k '��C✓; /�.fG;GC:- c�V
EDMONDS
�-
:•
r: •aF� .
ENT!"''''
CALL FOR
INSPECTION
RELEASED BY: DATE
z Z
:-',, I,T-,IS UNLAWFUCTO USE OR OCCUPY A BUILDING OR STRUCTURE
°':UN,71L A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 Owwo
11
ORIGINAL — File YELLOW — Inspector
A,'•:.CERTIFICATE• OF. OCCUPANCY HAS BEEN GRANTED. UBC'
' ,,,CHAPTER; 3..
01f6 '
PINK — Owner GOLD — Assessor
TN
01
Le
z
z
4
1
,. .. .. 'E MONDS �
.. � '•' CITY'OF D
,.- .
USE
PERMIT
ZONE
6 0
� NUMBER � ��
s 2
R �
;.CONSTRUCTION
PERMIT APPLICATION
JOB SUITE/APTAt
OWNER.NAME/NAME OF BUSINESS.
ADDRESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
w
MAILING ADDRESS
4
3
O
f]
1 RIGHT F AY PER OFFICIAL STREET MAP.
PUBLIC G 0 W E O C
TESCP Approved ❑
CITY ZIP
'
TELEPHONE NUMBER
EXISTING REQUIRED DEDICATION
RW Permit Required ❑
Street Use Permit Req'd ❑
^ ..� rr ,
1')�rl/P f i'' YUo, ,'
Inspection Required " 01
..
NAME, : .' '.
PROPOSED -f
Sidewalk Required ❑
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED,,
a
ADDRESS `
YES ❑ NO O
U/
2 S /�
REMARKS
CITYZIP
TELEPHONE NUMBER
(.l j/ r „„/✓! 1 ,�, . tl ;'
w
z
60"vIUIn
' / «
b
NA%!�/V../�v(�J 4V•I•�7�/ li
C'. i�o/ Ivi k/•
o
ADDRESS .
O
ENGINEERING MEMO DATED REVIEWED BY
M LII h, 6 n�1 wt
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED T REVIEWED -BY
�
pZ
U
ti
'
STATE LICENSE NUMBER., , EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADS NO,
Legal Description of Property - include all easements
ALLOWED
PROPOSED
COMPLETE
EXEMPT
p
er'.G« 17'�f�
SHORELINE M
' afr7aJ/vim
.1.
gam, •(vA2.t.'_N f S O� tv 4
EXP
�
VARIANCE OR CU
PLANNING REVIEW BY
DATE
LU
15
. •../;Y� �.,y 7o Ff,..TH. A�,e'iO�f �O U�� /_.5 Fr 7N
SETBACKS -FEET
_
w
... ,
FRONT Z7 , SIDE /0' REAR Z SJHE�17GH�TLOTCOVERAGE
3y '7
z
�
. Prgpeny-: ::. ..
Tax Account
EMARKS
Pa�ieJel Na
LtQ NEW
LJO RESIDENTIAL
PLUMBING
�.
ADDITION .'`
COMMERCIAL
MECHANICAL
aREMODEL
APT, BLDG.,
SIGN
GRADING FENCE
CHECKED BY
TYPE OF COJ�tNSTRUCTION
CODE
OOCCCCUPPANT
REPAIR CYDs. x _FT)
C
DEM041SH '.. WOODS SWIM POOL
INSERT HOT TUB/SPA
i
SPECIAL
SPECIAL INSPECTOR
AEA
% 507•
OCCUPANT
REQUIRED
13 YES
LOAD
CTAINING WALL/
RE
RENEWAL
MARKS,
ARPORT• ROCKERY
z
O
(TYPE OF USE BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC WS
=
040
.
INUMBER
o
'v;:-',":' -'- ' ''' NUMBER OF
OF",•:r�:;.<%-......• DWELLING
/
CRITICAL
AREAS�'.9�p�
/
% j/ 1 I
C
.STORIES UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FiNAL INSPECTION
REQUIRED r
U l LO ` Fl t.-
VALUATION
f E£
°F'/ ,166 (,t,%
PLAN CHECK FEE
HEAT;sOURCE: 'i. . ' e'
Gal%
GLAZING
BUILDING
%
I
PLUMBING
'
s
-Plah-theck.No. �1fo--74
MECHANICAL
+
't7his:Permit covers work -to -be done on private property ONLY.
GRADINGMLL
,,..Any -construction 66 the public domain (curbs, sidewelks,
'd�i4eweys,.marguees;
±
G
a
eic.) Willrequire separate permission.
STATE SURCHARGE
�>
Permit A16 H n;186 Days —
pp] ..
Permit Llmit.'1 Year = Provlde-d Work is Started Within 180 Days .
STORM DRMNAGE FEE.
i
Applicant; on,behalf-of his or her spouse, heirs, assigns and
ENG. NSPECTIONFEE
d
Yn
successors in Interest; agrees to indemnify, defend and hold
W
:•harmless'. the; 'City ' of .Edmonds, Washington, its officials,
;
;
w'
a
,�employee§;.and':agents from' ny and.ali claims for damages of
+
whatever nature, ar(sinp directly or indirectly from the Issuance
=
of:this permit. issuance of: this permit shall not be deemed to
PLAN CHECK DEPOSIT.
{Ix
rmodify, waive -or reduce any requirement of any city ordinance
?
!
i
nor -limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
,provision
4''
;information
i hereby'acknowledge that 11have read this application; that the
given Incorrect; and that 1 am the owner, or the duly
ATTENTION
; ' •A�P�LICATI'QN A PflOk/ ►!L
thorized. agent of: the owner. i agree. to .comply with clay and
estate Iaws.regufating:oonstruction; and In doing the work authoriz-
THIS 'PERMIT
AUTHORIZES
This application is -not a :permit :uff it f
:thereby„no person Will be employed in violation of the Labor
ONLY THE
s(gned'byrthe:8uilding Ofticial.or his/her
,
Code of the State of Washington relating to Workmen's Compensa
WORK NOTED
Deputy; and lees are -paid, andreceipt ja
Ion Insurance 'an 18.27.- •
INSPECTION
acknowledged in space provided.
SIGNATU_ IE 1 NER:OR AGENT) ., DATE SIGNED
DEPARTMENT
ITY OF
F SIOCOF R13 DATE
'
y�
s', ; °
j,"•ATTENTION
CAL
INSPECTION
RELfA-S j&Y: DAT
C� 21 � Z
UNLAWFUL TO US OR'nCCIfAY A BUILDING OR STRUCTURE:
.?i UNTiL,.A (FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
�.J a�
� CAIGINAL - File FELLOW - Inspector
� � �
i'V"-A`+'.CEATIFICATE
: OF• -OCCUPANCY HAS BEEN GRANTED. USC
..a'
✓�/9L, PINK- Owner GOLD -Assessor
,/%r:
PLANNING DATA
SITE ADDRESS: 14,9 Z S - -7 6 - A,-e . U DATE: S/ ;7 /
ZONING: �-S - 12— PLAN CHK#: 9/ - 7G
PROJECT DESCRIPTION: Lkr-i,s w,a '�.2s� a a
Prrl"$A (fir' Ganf wh lam, o-
SETBACKS:
Required Setbacks:
Front: 2,5' Left Side: 10' Right Side: toRear: 25'
Actual Setbacks:
Front: 32-' Left Side: .IS' Right Side: M4Z)Rear:
CORNER LOT Nb (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: i L to * -7 / °
Maximum Allowed: Actual: i 3. sao
BUILDING HEIGHT:
Maximum Allowed: 25' Actual Height: LZ'iz
Datum Point: 614-� &a,a ,i, Datum Elevation:
SUBDIVISION:
CRITICAL AREAS #: 9/1 -_ &3
6,`k
SEPA DETERMINATION: SPA
LOT AREA: 13 5�
OTHER: av-y
k-N ih +I,( /gym -I S "' I kub )- i-lI b4 an A-04 h 26thjC� 5i�s'wrt�^c % kypj d k My� 3- n.x � i-- k—oC.
Plan Review By:
CA FILE NO. C' (� j
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: ��7`L ��(v �•'�i,
2. Property Taz Account Number: Sl 3J , 6C0 - VL1
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? - yes; no. f� 6
If yes; how is site developed?
5. Describe the general site topography. Check all that apply. MAY 0 1 1996
Flat: less than 5-feet elevation change over entire site. PERW COUNTER
Rolling: slopes on site generally less than 15% (a vertical rise of 10-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 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
2-a
horizontal distance of less than 33-feet). t"16'Tna
Other (please describe):
6. Site contains areas of year-round standing water: 1.W ; Approx. Depth:
7. Site contains areas of seasonal standing water: j410 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway f j o floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? )40 Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shr ubs etc) _
11. Obvious wetland is present on site:
.. I- -
---- �j — For City Staff Use Only -
1: '::::: Site is Zoned?#`n�°'�"
2. 'SCS mapped soil type(s)? /ty C- j97 �J �i J,/i/ 11�,f,F;• �Lkt� U�(� U/t�V�
3: <::" Wetland inventory or C.A. map indicates wetland present on site?. Z—
Critical Areas inventory or C.A. map indicates Critical Area on site?
5.:. <Site within designated earth subsidence landslide hazard area?
6 :`:' : < Site designated on the Environmentally Sensitive Areas Map? l/� S - S-rf�4- cHa FE)
Rev 01/04/94
Ego .19C,
City of Edmonds
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,
ftE
C8 VV
MAR 2 5 1996
M41T.COUNrE
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
_ eU i, %,\ �%, Aer
Name I
Street Address
C-�t.-QI N
City, State, ZIP Phone
Signature Date
Applicant Representative:
A��A
Name
l'1� v, 6�� W� r
Street Address
City,State, ZIP Phone
Signature Date
.The City of Edmonds
APPLICATION
for
SIDE SEWER PER T
NEW CONSTRUCTION REPAIRS E]
LYNN PLANT
0
EASEMENT No. 140,Ks-ay ......
OWNER ............C2. ................. CONTRACTOR -....... 5... PERMIT No.
ADDRESS F
2, 2 Es
... ............. . ez ......... .. ....... LEGAL DESCRIPTION: LOT No . ............................................. BLOCK No . ...... .....................................
, L
NAME OF ADDITION ............ .......
..................................
� 0
0
:7-/71 S A-,�, 6�1-V 7—
Approved:
DATE
BY
as SCHEDULE .
NO. F-137147 AMOUNT $ 16, 000. 00
DATE July 19, 1967 at 9:00 a.m. PREMIUM $ 90.00
I. INSURED
I-1:1:01A1 (411"NOrM, a widow.
2. TITI.,F T(VITI E, I�,ti'I'A'I'I�;, I.,I FN Olt 1 N'1'ERES`1' INSIJItI!;D BY THIS POLICY IS VESTED IN
The named insured.
3. ESTATE, LIEN OR INTEREST INSURED
Fee simple estate.
4. DESCRIPTION OF"I"1I1� 12EAh, INSTATE WITH REST'FaCT TU WHICH THIS POLICY IS ISSUED
.All that portion of Tracts 121 and 122, Meadowdale Beach, according
to plat thereof recorded in volume 5 of plats, page 38,.reeords of
Snohomish County, Washington, described as follows:
Beginning'at a point 6LQ.0 feet North and.20 feet East of the West
quarter corner of Section 8, Township 27 North, Range 4 East, W..M.,
which point is on the West line of said Tract 122, Meadowdale Beach;
thence South 87006' East 196.78 feet; thence North,OP201 East 135 feet;
thence.North 87006' West 196.78 feet; thence South 0020( West 135 feet
to point of beginning.
EXCEPT the'West 98 feet thereof.
SCIIEDULH/ i3
DEFECTS, LIENS, ENCUM BRANCES AND Q`�ER MATTERS AGAINST WHICH THE COMPANY
DOES NOT INSURE;'
SOECIAL EXCEPTIONS
-'' CITY OVEDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER— WATER -SEWER DEPARTMENT is ready for inspection. '(No Inspec-
tions Saturday, Sunday or' holidays.) Ii V O 2935.
SIDE SEWER PERMIT
ADDRESS........... 16925..-..__76th--Avenue ..West
OWNER ............... Hi-1dur...Gj.endem............----...-------- CONTRACTOR ------Superior Sewers
-----------------------------------------
Perinission is granted ............. April ......... 5-____ 19..68, for ........................ days to REPAIR or CONNECT..a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
-- NOTE No. 1—The owners of the property may obtain a permit to construct -'sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches Inside property line; minimum grade of 2q.
No bends In grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe into the wye.
Date: April 22,, 196R
r
t.
I iemo to:,, John E . Moran
Director of Public Works
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: All that portion of Tracts 121 and 122, Meadowdale Beach,
according to plat thereof recorded'in Volume 5 of plats, page 38, records of
Snohomish County,Wash., described as follows: Beginning at a point 642.0 ft.
North and 20 ft. East of the West 1/4 corner of Section 8, T27N, R4E, W.M.,
which point is on the West line of said Tract,122, Meadowdale Beach; th South
87006' East 196.89 feet; thence North 0020' East 135 ft.; thence North 87006,
West 196.78 feet; thence South 0020' West'135 feet to point of beginning.
Except the West 98 feet thereof.
Commonly Known as: 16925 - 76th West Owner: Hildur Gjendem
Z.F.F. Calculation:
( 27 ) Z.F.F. x ($5.50 )
( 1 ) Unit x ( $25.00 )
$ 300.00
Y
Connection Fee
$ 25.00 Trunk Charge
$ 10.00 Permit
$'335:00 TOTAL
STREET HLE
Date: April 2 ? 1968
teno to: John 7. 'loran
Director of Public Works
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: All that portion of Tracts 121 and 122, Meadowdale Beach,
according to plat thereof recorded in Volume 5 of plats, page 38, records of.
Snohomish County,Wash., described as follows: Beginning at a point 642.0 ft.
North and 20 ft. East of the West 1/4 corner of Section 8, T27N, R4E9 W.M.,
Which point is on the West line of said Tract 122, Meadowdale Beach; th South
870061 East 196.89 feet; thence North 00201 East 135 ft.; thence North 87006t
West 196.78 feet; thence South 00201 West.135 feet to point of beginning.
Except the West 98 feet thereof.
Commonly Known as: 16925 - 76th West Owner: Hildur Gjendem
Z.F.F. Calculation:
( 27 ) Z.F.F. x ($5.50 ) _ $ 300.00 Connection Fee
( 1 ).Knit x ( $25.00 ) _ $ 25.00 Trunk Charge
10.00 Permit
$ 335.00 TOTAL
STREET FILE
CITY OF E ®M O N D S LARRY S. NAUGHTEN
250 51h AVE. N. • EDMONDS. WASHINGTON 98020 • (206) 771.3202 MAYOR
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
January 22, 1988
June Friesendahl
16925 - 76th Ave. W.
Edmonds, WA. 98020
SUBJECT: DRAINAGE PROBLEM
Dear June:
I have been in contact with Mr. and Mrs. Horn regarding the runoff
problem mentioned in your letter to me. They have been very
cooperative and will have the problem resolved within the next few days.
After looking at the site, I feel that your comment about a berm on the
westerly side of the Horn's driveway is a good idea. The Horns were
anticipating having their contractor return to take.care of a few
things; they will approach him about the berm.
In any case, a berm (whether permanent or temporary at this time) will
be installed to direct the water into the Horn's catch basin.
Very truly yours,
�Vwl
JERRY W. HAUTH, P.E.
Hydraulics Engineer
JWH/sdt
FRIESEN/TXTST530
Alm
FA
PUBLIC WORKS PLANNING • PARKS AND RECREATION • ENGINEERING
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TO FROM _
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,, ��.. t,L,.S �' l ��-� �( G�� 1.....rU �„ �_ SIGNED C� �� •J ��1/(- . _ tt
.._�-L�+-.r.-'.';...W.•':?c.y,.?•�-,; ;`i..-.u.. w.. r_ .:�<., ...-_.-��&'..::aa<i.,�.'"._\:� «.�i:Je/1'�,���_-�-��•.-, o. .�i#tr...+:...;�--".u,::.�_n�: �:,Y«7--'.^r.' r-•s,-• y,�.�� �s..
RE 4S 468 F
NO REPLY NECESSARY REPLY REQUESTED - USE REVERSE SIDE
P.OLX PAK (50 SETS) 4P468 X carb®niess
STREET FILE_
__` _ J_- Dfate An'ri 1 22 1968
i'emo to: John ';ors n
Director of Public 47orks
From: Leif R. Larson
City Engineer t
Subject: Sewer Connection Charges
Legal Description: All that portion of Tracts 121 and 122, Meadowdale Beach,
according to plat thereof recorded in Volume 5 of plats, page 38, records of
Snohomish County,Wash., described as follows: Beginning at a point 642.0 ft.
North and 20 ft. East of the West 1/4 corner of Section 8, T27N, R4E, W.M.,
which point is on the West line of said Tract 122, Meadowdale. Beach; th South
87006' East 196.89 feet; thence North 0020' East 135 ft.; thence North 870061
West 196.78 feet; thence South.0°20' West 135 feet to point of beginning.
Except the West 98 feet thereof.
Commonly Known as: 16925 - 76th West 04rner: Hildur Gjendem
Z.F.F. Calculation:
( 27 ) Z.F.F. x ($5.50
( 1 ) Unit x ( $25.00 )
300.00 Connection Fee
$ 25.00 Trunk Charge
10.00 Permit
$ 335.00 TOTAL
j as • SCHEDULE A*
_NO.--=-- F=137-147 AMOUNT $ 169000.00
'DATE July 19, ,1967 at 9:00 a.m. PREMIUM $ 90.00
1. INSURED -
HILDUR GJENDEM, a widow.
2. TITLE TO THE ESTATE, LIEN OR INTEREST INSURED BY THIS POLICY IS VESTED IN'
The named insured.
3. ESTATE, LIEN OR INTEREST INSURED
Fee simple estate.
4. DESCRIPTION OF THE REAL ESTATE WITH RESPECT TO WHICH THIS POLICY IS ISSUED
All that portion of Tracts 121 and 122, Meadowdale Beach, according
to plat thereof recorded in volume 5 of plats, page 38, records of
Snohomish County, Washington', described as follows:
Beginning at a point 6Q.0 feet North and 20 feet East of the West
quarter corner of Section 8, Township 27 North, Range 4 East, W.M.,
which point is on the West line. -of said Tract 12.2, Meadowdale Beach;
thence South 87006' East 196.78 feet; thence North 0020' East 135 feet;
thence North 87006' West 196.78 feet; thence South 0020' West 135 feet
to point of beginning.
EXCEPT the West 98 feet thereof.
SCHEDULE B
DEFECTS, LIENS. ENCUMBRANCES AND OTHER MATTERS AGAINST WHICH THE COMPANY
DOES NOT INSURE:sy
STREET FILE]
1G4aS '7�� Nwom 6 vie
FILE# N/A
DETERMINATION OF NONSIGNIFICANCE
Description of proposal
Single Family Residence Addition
Proponent Gerald & Evelyn Koeller
Location of proposal, including street address, if any
16925 76th Ave. West, Edmonds, WA 98020
Lead Agency Edmonds Planning Division
The lead agency for this proposal has determined that it does:not have
a probable 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.
X 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 John Bissell
Position/Title
Code Enforcement Tech. Phone 771-3202
Address 250 5th Ave. N., Edmonds WA 98020
Date June, 4 1990 Signature
X You may appeal this determination of nonsignificance
to Hearing Examiner
at 250 5th Ave. North, Edmonds, WA 98020
no later than-5:00 p.m. June 14, 1990.
by filing a written appeal citing reasons.
You should be prepared to make specific factual objections. Contact
John Bissell to read or ask about the procedures for
SEPA appeals.
There is no agency appeal.
Complete this checklist for nonproject proposals, even though questions may be answered "does
not apply". IN ADDITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part 0).
For nonproject actions, the references in the checklist to the words "project," "applicant,"
and "property or site" should be read as "proposal," "proposer," and "affected geographic
area." respectively.
A.
1.
2.
3.
4.
BACKGROUND
Name of proposed project, if applicable:
Name of applicant:
Address and phone number of applicant and contact person:
/4 cr • ;20 G - 7y?— o Q-2 L/
Date checklist prepared:
5 - ;2 - 96
5. Agency requesting checklist: �� ~7- L d
6. Proposed timing or schedule (including phasing, if applicable):
7. Do you have any plans for future additions, expansion, or further activity related
to or connected with this proposal? If yes, explain. ,
0
8. List any environmental information you know about that has been prepared, or
will be prepared, directly related to this proposal.
9. Do you know whether applications are pending for governmental approvals of
other proposals directly affecting the property covered by your proposal? If yes,
explain. /
U
10. List any government approvals or permits that will be needed for your
proposal, if known. /
11. Give brief, complete description of your proposal, including the proposed uses
and the size of the project and site. There are several questions later in this
checklist that ask you to describe certain aspects of your proposal. You'do not
need to repeat those answers on this page. (Lead agencies may modify this form
to include additional specific information on project description.)
P= .i / S l /,✓ � ��� /.✓L/`?J��f /-ice i�/�'c o,/✓%
12. Location of the proposal. Give sufficient information for a person to
understand the precise location of your proposed project, including a street
address, if any, and section, township, and range, if known. If a proposal
would occur over a range of area, provide the range or boundaries of the
site(s). Provide a legal description, site plan, vicinity map, and topographic
map, if reasonably available. While you should submit any plans required by the.
agency, you are not required to duplicate maps or detailed plans submitted with
any permit applications related to this checklist.
/G y2 5 -76 •—� w
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE_ -ONLY
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat, rolling, hilly, steep
slopes, mountainous, other `
b. What is the /s'teepest slope on the site (approximate percent slope)?
%Ul a
c. What general types of soils are found on the site (for example, clay, sand,
gravel, peat, muck)? If you know the classification of agricultural soils, specify
them and note any prime farmland. �o
d. Are there surface indications or history of unstable soils in the immediate
vicinity? If so, describe. /
0
e. Describe the purpose, type, and approximate quantities of any filling or
grading proposed. Indicate source of fill.
f. Could erosion occur as a result of clearing, construction, or use? If so,
generally describe. /
n lv
g. About what percent of the site will be covered with impervious surfaces after
project construction (for example, asphalt or buildings)?
;2 tJ v
h. Proposed measures to reduce or control erosion, or other impacts to the earth,
if any:
2. Air
a. What types of emissions to the air would result from the proposal (i.e., dust,
automobile, odors, industrial wood smoke) during construction and when the project
is completed? If any, generally describe and give approximate quantities if known.
:✓/�4
b. Are there any off -site sources of emissions or odor that may affect your
proposal? If so, generally describe.
c. Proposed measures to reduce or control emissions or other impacts to air, if
any:
3. Water
a. Surface:
1) is there any surface water body on or in the immediate vicinity of the site
(including year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If
yes, describe type and provide names. If appropriate, state what stream or river it
flows into.
2) Will the project require any work over, in or adjacent to (within 200 feet) the
described waters? If yes, please describe and attach available plans.
//q
3) Estimate the amount of fill and dredge material that would be placed in or removed
from.surface water or wetlands and indicate the area of the site that would be
affected. Indicate the source of fill material.
-/�
4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.
/,///"0
5) Does the proposal lie within a 100-year floodplain? If so, note location on the
site plan.
�v
6) Does the proposal involve any discharges of waste materials to surface waters? If
so, describe the type //of waste and anticipated volume of discharge.
,t,
b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground water? Give
general description, purpose, and approximate quantities if known.
2) Describe waste material that will be discharged into the ground from septic tanks
or other sources, if any (for example: Domestic sewage; industrial, containing the
following chemicals...; agricultural; etc.). Describe the general size of the system,
the number of such systems, the number of houses to be served (if applicable), or the
number of animals or humans the system(s) are expected to serve.
N/r
c. Water Runoff (including storm water):
1) Describe the source of runoff (including storm water) and method of collection and
disposal, if any (include quantities, if known). Where will this water flow? Will
this water flow into other waters? If so, describe.
2) Could waste materials enter ground or surface waters? If so, generally describe.
d. Proposed measures to reduce or control surface, ground, and runoff water
impacts, if any: -
,al'41
4. Plants
a. Check or circle types of vegetation found on the site:
_ deciduous tree: alder, maple, aspen, other
evergreen tree: fir, cedar, pine, other
l shrubs
, 1grass
_ pasture
_ crop or grain
wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
—_ water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
/" Al 14L
c. List threatened or endangered species known to be on or near the site.
d. Proposed landscaping, use of native plants, or other measures to preserve or
enhance vegetation on the site, if any:
5. Animals
a. Circle any birds and animals which have been observed on or near the site or
are known to be on or near the site:
birds: awk heron, eagle, songbird other : .............................
mammals: deer, bear, elk, beaver, other: .................................
fish: bass, salmon, trout, herring, shellfish, other: ....................
b. List any threatened or endangered species known to be on or near the site.
,(O-Z X-_
c. Is the site part of a migration route? If so, explain.
d. Proposed measures to preserve or enhance wildlife, if any:
6. Energy and Natural Resources
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used
to meet the completed project's energy needs? Describe whether it will be used for
heating, manufacturing, etc.
b. Would your project affect the potential use of solar energy by adjacent
properties? If so, generally describe.
it./ 6
c. What kinds of energy conservation features are included in the plans of this
proposal? List other proposed measures to reduce or control energy impacts, if
any: ®,✓.� tv�.✓'�� .✓1'
7. Environmental Health
a. Are there any environmental health hazards, including exposure to toxic
chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur
as a result of this proposal? If so, describe.
1" lu .
1) Describe special emergency services that might be required.
1 //�
2) Proposed measures to reduce or control environmental health hazards, if any:
b. Noise
1) What types of noise exist in the area which may affect your project (for exa-.:)le:
traffic, equipment, operation, other)?
." /-J .4t
2) What types and levels of noise would be created by or associated with the prc•,ect
on a short-term or a long-term basis (for example: traffic, construction, operation,
other)? Indicate what hours noise would come from the site.
N� �
•
•
3) Proposed measures to reduce or control noise impacts, if any:
M/7
8. Land and Shoreline Use
a. What is the current use of the site and adjacent properties?
b. Has the site been used for agriculture? If so, describe.
Z
c. Describe any structures on the site.
d. Will any structures be demolished? If so, what?
tiL O .
e. What is the current comprehensive plan designation of the site?
h. Has any part of the site been classified as an "environmentally sensitive"
area? If so, specify.
i. Approximately how many people would reside or work in the completed project?
j. Approximately how many people would the completed project displace?
k. Proposed measures to avoid or reduce displacement impacts, if any:
1. Proposed measures to ensure the proposal is compatible with existing and
projected land uses and plans, if any: /p
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high,
middle, or low-income housing.
b. Approximately how many units, if any, would be eliminated? Indicate whether
high, middle, or low-income housing. /
c. Proposed measures to reduce or control housing impacts, if any: �/�
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including
antennas; what is the principal exterior building material(s) proposed?
b. What views in the immediate vicinity would be altered or obstructed?
c. Proposed measures to reduce or control aesthetic impacts, if any:
11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would
it mainly occur?
b. Could light or glare from the finished project be a safety hazard or interfere
with views?
c. What existing off -site sources of light or glare may affect your proposal?
"J/�
d. Proposed measures to reduce or control light and glare impacts, if any:
12. Recreation
a. What designated and informal recreational opportunities are in the immediate
vicinity?
b. Would the proposed project displace any existing recreational uses? If so,
describe. Q
c. Proposed measures to reduce or control impacts on recreation, including
recreation opportunities to be provided by the project or applicant, if any:
M j/-9
13. Historic and Cultural Preservation
a. Are there any places or objects listed on, or proposed for, national, state, or
local preservation registers known to be on or next to the site? If so, generally
describe.
b. Generally describe any landmarks or evidence of historic, archaeological,
scientific, or cultural importance known to be on or next to the site.
c. Proposed measures to reduce or control impacts, if any: M/d
14. Transportation
a. Identify public streets and highways serving the site, and describe proposed
access to the existing street system. Show on site plans, if any.
b. Is site currently served by public transit? If not, what is the approximate
distance to the nearest transit stop?
c. How many parking spaces would the completed project have? How many would the
project eliminate? /t///�
d. Will the proposal require any new roads or streets, or improvements to existing
roads or streets, not including driveways? If so, generally describe (indicate
whether public or private). /
e. Will the project use (or occur in the immediate vicinity of) water, rail, or
air transportation? If so, generally describe.
f. How many vehicular trips per day would be generated by the completed project?
If known, indicate when peak volumes would occur.
g. Proposed measures to reduce or control transportation impacts, if any:
15. Public Services
a. Would the project result in an increased need for public services (for example:
fire protection, police protection, health care, schools, other)? If so, generally
describe.
G
b. Proposed measures to reduce or control direct impacts on public services, if
any. /
16. Utilities
a. Circle currentl availab a site:
ate ectricit atural ga
,om
sea refuse servic a ep one sanitary sewer mer.
b. Describe the utilities that are proposed for the project, the utility providing
the service, and the general construction activities on the site or in the
immediate vicinity which might be needed.
0
C. SIGNATURE
The above answers are true and comp�iet the best of my knowledge. I understand
that t ad agency is rely n em to make its decision.
Signature• ..... ..........................................
Date Submitted:... ......�... S..r�>........................
D. Supplemental Sheet for Nonproject Actions (Rezones, Code Changes, Annexations, etc.) -- Do
not use this sheet for project actions.
Because these questions are very general, it may be helpful to read them in conjunction with
the list of the elements of the environment.
When answering these questions, be aware of the extent the proposal, or the types of
activities likely to result from the proposal, would affect the item at a greater intensity or
at a faster rate than if the proposal were not implemented. Respond briefly and in general
terms.
1. How would the proposal be likely to increase discharge to water; emissions to
air; production, storage, or release of toxic or hazardous substances; or
production of noise?
Proposed measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine
life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. How would the proposal be likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
4. How would the proposal be likely to use or affect environmentally sensitive areas
or areas designated (or eligible or under study) for governmental protection; such
as parks, wilderness, wild and scenic rivers, threatened or endangered species
habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal be likely to affect land and shoreline use, including
whether it would allow or encourage land or shoreline uses incompatible with
existing plans?
Proposed reasures to avoid or reduce shoreline and land use impacts are:
6. How would the proposal be likely to increase demands on transportation or public
services and utilities?
Proposed measures to reduce or respond to such demand(s) are:
7. Identify, if possible, whether the proposal may conflict with local, state, or
federal laws or requirements for the protection of the environment.
ENVCHK3/PFORMS
STREET FILE.
690_199
City of Edmonds
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,
ReciziVED
W 2 5 1996
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In #t
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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:.
_ e,r -V% 1�4L'y'
Name I
Street Address
r.0,,,, "� tjgI
-
City, State, ZIP Phone
Signature
3 -vs
Date
Applicant Representative:
k k
Name
Street Address
V_�,AU ' ` V ill 149 Is -L-olo
City, State, ZIP Phone
L'�V. )121&)13Q
Signature I Date
CA FILE NO. - Clj ( �j
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
I. Site Address./L.ocation:
2. Property Tiz Account Number: �—1 3 j , f,C:� . 0A — Lk AV«
3. Approximate Site Size (acres or square feet): 3 b� F 51996 •
4. Is this site currently developed? yes; no. � df� pr
If yes; how is site developed? 'Sf i Oft=
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 10-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 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 1
horizontal distance of less than 33-feet). t"`6'1'4ta '' Te tzts-P-
Other (please describe):
6., Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: �4e ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway o floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? �40 Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow _;shrubs ; mixed ;
urban landscaped (lawn,shr ubs etc) _
11. Obvious wetland is present on site:
�q For City Slats' Use Only —
1::Site is Zoned?
2.'' :' SCS mapped soil type(s)? .. L C=
3:.; Wetland inventory or C.A. map indicates wetland present on site?._
4:'' ''`Critical Areas inventory or C.A. map indicates Critical Area on site?
ZIP
5`;.:»Site within designated earth subsidence landslide hazard area?�
G:;Site'designated on the Environmentally Sensitive Areas Map?
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Rev 0004/94
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STREET FILE
rA"L- 5131- 600 - 121- I 10 2
MEADOWDALE BEACH
BLK 000-0-11 PTN TRS 121 & 122 DAF SAAP 642FT N 6 20FT
E OF W .1/4 COR SEC 8727-4 WH PT IS ON W LN TR 122 TH
S87 *-06 OOE 196.70FT TH N60* 20 OOE 135FT TH N87*
KOELLER RESIDENCE.
16925 76TH AVE WEST
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k4AX 122.5.
EDMONDS, WASHINGTON
MAY 0
PERMi d COUNTER
PERMITAPPLICATION REQUIREMENTSUWE
To: Applicant
From: Lyle Chrisman, Engineering Inspector
owner: 6eraLd S. 5veLln koeltPr Plan Check No. pc- 96-:6
Address:_ 69. 25 % ve We Ty- Date: M�6, q 6
After review of the subject permit application. the following requirements must be met:
1. Construction hours are:
WEEKDAYS — 7:00 A.M.-10:00 PALWEEKENDSniOLIDAYS —10:00 A.M.4:00 P.M.
2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Buildedowner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 1830.030d) ,
S. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
1830.SOG)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION
(ECDC 1830)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGiIILINES AND CATCH BASIN
. INSTALLATION. INSPECRONS ARE REQUIRED.PRIORTO BACKMMG. (ECDC 1830)
S. Repair or replace all defective c3dstiag cwk gatterand sidewalk adjaeeat to the property. Van intersection is hrvolved, a handicap tamp
maybe required. Connector:hall toed with the Cky Enghwering staffto detetmiae the extant of repair prior to issuance of the permit.
(ECDC 1&90)
;'. Driveway slope shall not exceed 14%without a waiver. Every attempt should be made to keep the slope below 14% Waiver granted to
a (' % (ECDC 18.80A60D) ,
10. Driveways mast be paved from ptnpertsr line to City RIGHT-OF-WAY. A sepantte permit is regttired. (ECDC IU0.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIORTO AND AFTBR POURING. (ECDC 1t330)
12. No burning of construction ref Ise without a pewit firm the Fine Department
13. Connection to City water system is required. There is a separate change for the water meta.
(ECDC 7.20)
t4. A back water valve is required ifdownsiahs plumbing is below the elevation of opsheeum tmamhole.. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 fat minimum. (®CDC 1&10)
16. boa to the City sanitary system is mquhe&,A separate permit is ngahv&
L__. Fees pall: Yes No ChwV (ECDC 1&10} i
17. Undagmumd wiring is required on aU new eotrtntctiorn. and for additions„ altaatiotns,. and repairs that oweed 50% of the total assessed
value of the structure. (ECDC 11390)
t8. A FINAL ENGINEERING INSPECTION IS REQUMED PRIOR TO THE BUILDING DlirlbiON-GRANTING OCCUPANCY
OFTHE BUILDING OR STRUCTURE. gUMC 1890) -