18706 81ST AVE W.PDF111111111111
7355
18706 81 ST AVE W
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: ('670C" OW(-� ,\VE.
2. Property Tax Account Number: ( 0 q
3. Approximate Site Size (acres or square feet): IkOC19 so —FT,
4. Is this site currently developed? ?<, yes; — no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
,X, 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 horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: V 0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: ,U 0 Approx. Depth: -
What season(s) of the year?
8. Site is in the floodway �j 0
floodplain ,j 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
)JCI> Flows are seasonal? P ' (What time of year?
10. Site is primarily: forested eadow
m shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site: At 0
Critical Areas Check] ist.doc/3.19.2001
E
City of Edmonds
Development Services Department
Planning Division
;r Phone: 425.771.0220
/"C. I %9CJ Fax: 425.771.0221
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 the application 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
ne-.-Jed to . cornplete the Checkiist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received:
City Receipt#: 1 -7
Critical Areas File *: /I
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this furm to assist City staft' in finding and locaiing the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its; agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to filp4tis applicgiop on thg behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE 2- Z 0
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER)� DA FE
Owner/Applicant: Applicant Representative:
=df /V /0 - P,�Uoq- ) FPCD J,
Name Name
/670�p &AF �Vt, W, 1�07 L—L"QL-I'J 4-vf,
Street Address Street Address
1�0 D's. 2902-(.-S-82-1 .4A VILI LI-ell 2,7L
City State Zip City State Zip
Telephone: (,72--7137
Email address (optional):
Telephone: (1-1z�d 3-lb-SM-
Email Address (optional): _ 64&-*� e
67'K-- N
Critical Areas Checklist.doc/3.19.2001
Ell
A,�
t k I!e- 2.
4V3. qt,.
1/ " Y,
Ousr c.A&,
C, i, -%
Emn"r. oluvr-
.9— 1-1
LO
13S. 3 9
ri
SYmT. FV-Lc V4$04M P'PjW. L,%U) m
co
el 5
0 r 10 A
AP-LOWEt� Or. -I S.0'
ousr, wt6e
'A!
WP
r
pro f os c b
V-!
cvj�r, roe-"
C-
I
W09TM
I. -
co
w
Ln
LL
.a
cc
u
LE
LT
PLANNING DATA
NAME:
SITE ADDRESS: le-7oG
ZONING: in -PLAN CHK#: Ot -
PROJECT DESCRIPTION: ao:)i-ito
CORNER LOT _4��/No) FLAG LOT (Ye4i�
SETBACKS:
Required Setbacks:
Front: 2:E11 Left Side: 10 Right Side: QL Rear: I o
Actual Setbacks:
Front: a-& ' Left Side: 1 2. Right Side: q L4 -Rear: ZLI) IF)
Street map checked for additional setback required?— �Ye N o)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y&
LOT COVERAGE:
Maximum Allowed: DDA& _Actual:__�'I�
io
.Qoq
Hbcg '5r -C_-)AeAC--,q
BUILDING HEIGHT:
Maximum Allowed:—
Z, —Actual Height:
Datum Point: aturn Elevatign-",
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS#: - 01 - \�Po\rt",-,
SEPA DETERMINATION:
LOT AREA:
11 1 0.0/
OTHER:
Plan Review By:
c:Ti1es\perrnit\^p1andaLdoc
Z
City of Edmonds
2
-OF-WAY CONSTRUCTION
RIGHT
PERMIT -0 7
Permit Number:
STREET FILE Issue Pate: 3-d
A. Address or Vicinity of Construction: 18706 81 Ay. W. (1,93 01065 003)
9 B. Type of Work (be specific): ReRair Gas Leak
C5
C.. Contractor: Wa:shington Nat'l. Gas Co.
Mailing Address: 815 Mercer St. Seattle, Wn
98111
State License #:
I
D.. Building Permit # (if applicable):
Contact: FraaltkSiian
Phone: 224-227R
Liability Insurande: Bond: $
Side Sewer Permit # (if applicable):
E. El Commercial Subdivision E] City Project a Utility (PUD, GTE, WNG, CABLE, WATER)
F-1 Mu'lti-Family El Single Family Other
INSPECTOR: INSPECTOR: R4_AJ
F. Pavement or Concrete Cut : . El Yes :BNo G. Size of Cut: — x __'_ H. Charge$
APPLICANT TO READ AND. SIGN
ZINJDEMNIT�. *plicant understands and by his signature to this application, agrees 4;--oid,t.he City ofEdmonds harmIes�_*6.0j1dFs,>damages, or
claims �Yany kindor description whatsoever, foreseen or unforeen, that may be made 4%'J'1h'e City of Edmonds, or any yohs departments or employ-
ees, including or not, limited to the defense of any legal proceedings including defense costs-; �nd anomeyfees by reason of g�Zrnting this permit.
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMA NSHIP A AD MA TERIA LS FOR A PERIrD bF�ONEt YEA R FOLL 0 WING THE FINA L INSPEC17ON
AND ACCEPTANCE OF THE WORK ES71MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITYFORCES, AT WHICH 77MEA DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
..Construction drawing of proposed work required with permit application.
'�'---A- 24 hour notice is required for inspection; Please call the Engineering Departin
Work 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand th� permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature:
Date: Marnh 91, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
-.0
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
a I
m ,
FIELD INSPECTION NOTES
Comments:
Diagram:
I
(Fund III - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
r.ng. Lim jL
Gil
Street Right -of -Way Existing
REQD
Access Easements Existing Ont
�)�p REQD
Utility Easement Existing
REQD
Lot per Subdivision Plat
Assessor.Map
Site Plan Checked for.Accuracy
Z
Underground Wiring.R,�_d.
Check Accuracy ofLegal Description
Eqvirorm-entally Sensitive -Area
Envircrtmental Checklist Reqd.
Z,
Flood Hazard Zone
Shoreline Management Area
Z1r-
Slope, Soil, Vegetation
Stream,�Creek, Drainage Basin
'Existing Zoning Per Code
Amenities Design Board Approval Reqd.
ADB # Approval
Board of Adjustment Approval Reqd.
Review Bv:
Date:
Existing Water L'vlain Size
Water Main Reqd.
Service Line Reqd.
w-
Hydrant Size Existing
E__4
Hydrant Reqd. Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
Date:
Septic Tank -sign Approve
Date:
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proi.
Drawing No.
File No.
Side Sewer Availability
W
Sanitary Sewer Connection Fee Reqd.
Review BY:
Date:
Date
Addres s
Open 'Dit(I-i Existing_..���...��eqd.
Culvert Rcqd. Size
C4
Catch Basin Reqd. Indicate on Site Plan
0
Shoulder, drainal.;e mkiinta irt collection on swale open runoff
E-
Mm-diole rcqd.. Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
PC,,,ic!,." by w 1xite
Street Paving Reqd..
E-4
Curb and,Cutter Reqd.
Sidewalk Rcqd,.
Curb Cut for Drive�.,*Reqd.
'Rio -it -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inprovmments
Street Nam, Sign Reqd.
4
Other Si -iin-- qd.
gi RL.
*
Pre Pemit Site Inspection m.de on
BY: S B,E R
WATER.
STREET
ENGINE-ERIN
'G
Special Reqi-Lire-,-.-.?nLs listed in m.�m to Commmicy Developmnt Departrmnt,
Building Division
13Y Da te
0 All iters filled in on Building Peimdt Application
0� BY Date
PL4
Drawings Stanr)ed and Notations I-kide
BY —Da,te—
Approved by I'Vhlic 1-'Orks Departr)cnt
Revised: lv 10-1977
p �
Uj C:)
C,Y
>
0
z
Z 0
0
U
=00
> U
E190
EN
ow
0
00
0
E-4
0
Q-�
18
W �
9
ZRW
1*
00
0
z
PO
0
rA E0 cn
z
I.
0
rA
12, Z
0
r4
W
Z 1:W
z P4
0204
El
101
z
0
0
rT4
W
PQ
r4
M
Z rA
0>
0
9
P4
QM
El
z
0
04
U2
0
�T4
ME
14
z
Z
0
1a4
4
W 0
4 r.,
E- IT,
701 on
>: C�2 @I
z
0
U2
0
z
U2 z
z
0 a4 U
ow UZ,
0
0
z
C4 "
z 0
0 rX4
�_4
[-4
44
02
U Z
W
0
0
rA C-4 N
PL4
a4
,,, C-) Q
7_
C Y -
OF WMONDS Call PRospect 6- . 1107 when work
1e. -C FER WATER -SEWER DEPARTMENT
0�1.VJIA&11 !;ZG_11_ I
Is ready for Inspection. (No lnsper,-
NO
tions Saturday, Sunday or holidays.) 'A
"S" 2148'
K E,--�` EW R
S11 ER:PE-MIT
ADDRt'�g' j 8 70 6 81St Aveinue WEst
........................ .......... ........................................................................................................................................
.......................
bwxhli'. William.'.
Kn.owles .................................................. coNTRAcTOR_�__0.Wae_r .......................................
........................
............... la.01 for ............... Oays to REPAIR or CONNECT a side sewer
application oil file and governing ordinanem
-ATTENTION IS CALLED TO THE FOLLOWING:
NOTE, No'�: 1—The.owners. of the propefty,may obtain a, permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed. to -construct' side sewer in.stre.et area. Do not cover any portion' of sewer before- it has been Inspected.
r
4NOTE No.,�2_Obtaln full, Information egarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
J40;iE, No. 3,—T6p �of side- sewer must have -at least 30�inches coverage at property line and 12 inches Inside property line; minimum grade of 2%.
N9 bends in grade, sharper than % will be permitted.
N No. 4—Tienches 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 ma� 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'l . ts appur7
itenances except to insert the pipe Into the wye.
0
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Eclmonds does not warrant the
accuracy of anything set for.th on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tKe -map(s), including, but not limited to,
the lociation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yees or office-r-s shall be lialu-mle for.the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
DATE RECEbD
Cu
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
5TEPIAEN M, VJAIAC-.14 4 P-ILEW M. V�ELL4 lkk1-=M.
MAILING ADDRESS
I 18'70(p 811 -%t- AVE W
CITY ZIP TELEPHONE
et�moubg 1 4-1,5- - (P -7 -1 - 7% -3
NAME
Fe-e-b
ADDRESS
40-7 L-iNcoL-m AvIF
CITY ZIP TELEPHONE
Muv_tLyev q VL-i S- _,3 4- *8 - 3 9,is-
NAME
174C0.6 Z
ADDRESS
CITY ZIP TELEPHONE
- Y-42
STATE LICENSE NUMBER P I EXPIRATION DATE CHECKED 13Y
-T Y,
'. AOAA &, ;!no /M 0
PROPERTY TAX ACCOUNT PARCEL NO.
e>o -3 -7 1 -7 -3 0 <3 3 V 0
,7
C3 NEW Rr RESIDENTIAL- PLUMBINd/MIZCW'1
0 ADDITION COMMERCIAL 0 COMPLIANCE�OR
CHANGE OF,USE,,,,
REMODEL �'APA R ME NT
0: SIGN'
REPAIR ci GRADING FENCE
CYDS 0 X FT)
DEMOLISH TANK OTHER
oGARAGE RETAI NING WALL RENEWAL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
NUMBER NUMBER OF CRITICAL f (L)
0 F DWELLING AREAS
STORIES UNITS NUMBER'CMqT_
2_
DES
,.VEWORKTOBECONE
r
4�
S. F. At - I> t W AM, - kit b r
fAAAW f:"OR.
A
FPERMIT EXPIRES
USE PERMIT
ZONE
P5 1 L NUMBER C>ftof 6
JOB PT#
ADDRESS . -0 V, S _P
11T 06 11" 11 � S10
PLAT NAME/tUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Appmed 0�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pennit Required 0
Street Use Permit Req'd C)
EXISTING — PROPOSED Inspection Required 0
Sidewalk Required Q
REQUIRED DEDICATION— FT Underground
wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED/—;
YES z
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
IdMO&r A,,V,-W at's 1,
'ENGINEERING
R:VIEW D/DATE
1 ;6 r7
W
,.FiRE,'REVIEWED BY DATE Ui
EL
VARIANCEbR 6U'' 1� E,.OR:ADB# INSPECTION KBO N 0
T
RE P TED
YES% NO
IEW '§IGNAREA N HEIGHT
COMPLETE EXEMPT ALI��D PR7ED ALLOWED PROPOSED
EXP
IOT COVERAGE REQUIRED SETBACKS�IFr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SID9 'REAR. FRONT�:,L/R SIDF REAR
_2)5S/0 YO
PARKINPI.�,�_D] LOT AREA [�LANNING, REVIEWED BY DPfrE
RIP D., PROVIDE
REMARKS
CHECKED BY ITY �EOFr�STR CTION OCCUPAPA
GROUP
SPECIAL INSPECTOR JAREA01,0 q4 41 to OCCUPANT
REQUIRED 0 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER-UBC108/FINAL INSPECTION REO'D 0
171 liV.
A.
VALUATION
FEE
PLAN CHECK FEE;�
!9 Zx�
HEAT SOURCE GLAZING%VYj LOT SLOPE %
_q.S 16 ( ';&
��UILDING�_,�,
r Y
7--.
23 VESTED DATE
PLAN CHECK Nr) / _Z?
�IPLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
GRA ING
SEPARATE PERMISSION.
STATE 9R(_C`HVE
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
50
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT/
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
R CEIPT
TOTAL AMOUNT DUE
,,el I
e:z 6V
1
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
.
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
A
WORKME�;S COMPENSATION INSURANCE AND RCW 18.27.
Y
6_R.F�j DATE S17GD
(425)
OF CIALS S11 NATU�,h DATE
1""
A/
771-0220
SED By UA I Ef
�TTATIO'N-
EXT 1333
A 1 ,f.A
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
.4
4�
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE - YELLOW- INS4ECTOR
PINK - OWNER - GOLD - ASSESSOR
5/98