19009 83RD AVE W.PDF111111111111
7715
19009 83RD AVE W
CA File No. —qD
Critical Areas Checklist
Site Iriformation, (Soils/t hydrology/ vegetation).
1. Site Address Location: PZ "M /�'O/ 7
2. Property Tax Account NumVeiF�&.).�,? /c/o 0 0-5-0 e!:k) XoO 16 0 015-0 1_3oo
3. Approximate Site Size (acres or square feet): mo
4.. Is this site currentlydeveloped? _yes; P-no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: . less than 5-feet elevation change over entire site.
Rolhng:. slopes on site generally less than 15*% -(a vertical rise of 10-'feet over a horizontal
distance of 66-feet).
Hifly.-' slopes present on site of more than 15% and less than 30% (a vertical rise of 10-feet
overa. 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: A prox. Depth:
p
7. Site contains areas.of seasonal standing water: 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?
Flows are seasonal? (What time of year?
10. Site is primarily: forested - ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) ai
=612V
11. Obvious wetland is present on s . ite: /VO
--For City Staff Use'Only p--75-0(0)
1. Plan Check Number, if applicable?
2. Site is Zoned? P-6 - 10 -
3. SCS mapped soil type(s)? 5: Arjc1t4-"0ct V y10 AM JaM C[ Ct)M 12 1 f—, X, zi—g 1 1510 MG
4. Critical Areas inventory or C.A. map indicates Critical Area on site? Noyi-e, sYiown-
5. Site within designated earth subsidence landslide hazard area? ND. I�Wlch'n!2 lUal ID
%�j
M 61 Vc, fl n a I CAft&VM i n A 1� oyl
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by: al�Alv, Date: ff�- 0 1
Critical Areas Checklist.doc/4.22.2003
OV EDAf
City of Edmonds
Development Service�ga", -AVE
Planning Division
Phone:. 425.771.02M U N 2 12 .005
4- ..Qrj 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
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).
Da te Received: 0 G 12-1 1 " 0 15'
MCity Receipt#: -2,bc;8;q
Critical Areas File M"CA. 2-005 -090
Critical Areas Checklist Fee: $135.00
-Date-Mag" to Applicant:— =- C2 L,)�
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 f6rin to assist City staff in finding. and locating the
specific piece of property described. on this form. In
addition, the applicant shall include other. pertinent
information (e.g. . site plan, topography map, etc.) or
studies in conjunction with this Checklist t *0 assistant staff
in completing their. prelirminary 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 infi-action based * in whole or 'part upon false, misleading, inaccurate or
incomplete *'information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and. c6rrect.to.the best of my
knowledge and that I am authorized to fi! e behalf of the. owner as listed below.
SIGNATURE OF APPLIcANT/AGENT DATE
D&4-lae- e.
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 postin a dant toflus 4pplicaqon.
g tteft
SIGNATURE OF. OWNER
Owner/Applicant:
Name 0 9'
M604� 3
Street Address
-7
City State zip
Telephone: 72-'Z�F,57
Email address (optional):
tl—;7 ;? - / -
DATE - ,::, — - 06!57
Applicant Representative:
-/ . )zZ14/W`6-
Name
�qo� 7
Street Address
2F,-)1-10KAQJ
City Zip
Telephone: 2L57.--6 72- 26 -7
Email Address (optional): el-C
Critical Areas Checklist.doc/4.22.2003
Jw
N - C) STREET FILP
BUILDING DEPARTMENT
Applicant Fill
PERMIT
�ON -'F-5 - 'R, NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB �6)6 9 ZJ
ADDRESS -e.
NAME (OR NAME OF BUSINESS)
z
3:
0
C-0-
LEGAL LOT
PY'ES E:1 NO
I
PLAT NAME
SUBDIVISION NO.
1
MAILING ADDRESS I —
-5 W.
.
PUBLIC RIGHT OF WAY PER ORDINANCE NO
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
CITY
1,15dme9 U141
ELEPHONE NUMBER
2 74- -2-e2
NAME
U
W
U
M
DEFICIENCY OF RIGHT OF WAY
U
IL
ADDRESS
STREET/UTILITY WORK REQUIRED VYES El NO
-1 NO
PERMIT FOR WORK IN PUBLIC R/W �Wy ES E
UNDERGROUND WIRING REQUIRED ES ;�r_ 0
CONNECTION TO SANITARY SEWER ?:YES El NO
SEPTIC TANK PERMIT REQUIRED El YES �:NO
CITY
TELEPHON E NUMBER
NAME
0
F-
U
T
I-
Z
0
U
SEPTIC TANK PERMIT NO.
ADDRESS
SEE MEMO DATED
CITY
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
C H E C
Legal Description of Property (Show Below or Attach Four Copies)
e 4 7 Zle-
METER. SIZE
BUILDING SUPPLY SIZE
W
REWARKS r-)�
'elk
z
IL
I
D P&-72- (:��i 7Y C-6 0 6—
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
Z) 1161
SHORELINE
REMARKS
W
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS_ ILOT
12-� FRONT lb SIDE .2,67REAR
COVERAGE
GAS
NEW RESIDENTIAL E] LINE
L -RESIDE.T.A
NON TIA]L SIGN
ADD _ 1:1
RETAINING
DEMOLISH WALL
EXCAVATE FENCE
El ALTER FIOR FILL I— X—T)
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
ECIAL INSPECTOR JAREA
REQUIRED
0 YES [)�, 0
OCCUPANCY
GROUP
JZ-s
I
OCCUPANT
LOAD
PLAN CHECKED BY THIS SIT E IS'LOCATED IN TPLE CITY
REPAIR PRE -MOVE swim
INSP. POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
Z
0
I-
z
W
IL
W
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PLAN CHECK FE . E
VALUATION
FEE
PROPOSED USE
A; d
U
0
W
0
L
0
J
W
W
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
d
BUILDING
1>
PLUMBING
MECHANICAL
FENCE
z
0
SIGN
(A
W
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in in , terest, agrees to indemnify, defend and hold harmless
W.lNllillkloll, ils offi,i;lls.
RFrAINING WALL
0
Date 0,
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: C, 0 oci
After review of the subject building permit application, we have the
following comments:
Coordination of the location of any structure with respec't to.
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
The contractor is required to keep the abutting streets cleaned
of.dirt and debris caused by the construction.
/k7 The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works,.for any work within the
Public Right -of -Way or public easement.
rK ' Driveway slope not to exceed .14%.
7-
'7Z.r Connection to sanitary sewer required.
T_
-7
Septic Tank Permit required, submit design.
Fire hydrant required, submit d'esign.
Site drainage per code #-I'IILI. See,approved plans
LF
"bP
/_7 Curb /_7 Sidewalk Paving,required. —1 V
U_
/_7 Bond.required,for public impr.ovemen ts. Submit cost estimate.
/_7 Underground wiring required.
L-7 Approved.Engineering Plans required when applicable.
For Fr,-1 F. Herzberg-, P.E.
City Engineer
Department of Public Works
Rev. 7/78
N
'0 N T
ruE ------
HEIGHT
.2
941 - v
1g, YvIde
O,Q I Ile wNi
I
Laii—
/r
7-Tle.
-oe /e7 Isl
iy mm's
'G DIV.
EX.—�
------ EAIA�
;.;cQuriEc-:D
m2TIC TANIC
OTION
�4!
/0 1 IqlAi -
Q/
Oil*
L44
PUBLIC T,,1ORKS DEPARROU CHEC *-T /-/8- 7cl Date
BL�IDING PEmaT R=4
I q C-X-)C( - 9:57-QkAye-�W&.ess
Street Right-of-,r.Wa�*Existing 0 REQD
Access Easements Existing E—= REQD
Utility -Easement Existing "-N M" ewt REQD
Lot, Per. SL�bdivis ion Plat Assessor Map
Site Plan Checked for Accuracy
,,.Underground Wir' Reqd.
11,19
�Check Acduracy of'Legal Destfiption
Environny-,ntall�'Sensitive Area
E.nvirornental-Checklist Reqd.
Flood Hazard Zone
Shoreline Management, Area
Slope, Soil,,Vegetation —
Strewn, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.,, `,T-40 ADB # Approval
'Board of Adjustment �pproval Reqd.
A�eviqw.:By: Date: 1-1
"Exis Ing Wat6i: Main Size S T
Water Main Reqd. AIA
Service Line Reqd.
Hydrant Size Existing. -
El Hydrant Reqd. Per Fire Code A14 Size
I Detector C*heck Meter Reqd. AIA
Cross Connection.Inspection
Fire Department Cam-nents
Water Meter Charge Reqd.
Review by: Date:
S I
eptic Tanl,, Design Approved- Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Avail�Lbility \/C --5 Proj
Drawing 1\10. File No.
Side Sewer Availability
Sanitary Sm,7er Connection Fee Reqd.
Date:/ -
W Revie-w B)r:
Open Ditch Exi�tincv eqd.
R
C'ulvert Reqd.
Size.
C4 Catch Basin Reqd -Indicate on Site Plan
0
Shoulder drainage niaii-itain ColleCL:iojjL (X-1
swa e open ruioff
)v
rcqd.
Indicate on Site,Plan
Soil Conditions. and Groupd Water Field Cliecked
Re"YJ hy rx-, te
Mcreet Paving Reqd.
?)Curb and Gutter Reqd.
Sidewcalk Reqd.
Curb Cut for Drive%,-ay.Reqd'.
c.4 e, Right -of -Way Con,str-Liction Peri-nit Reqd.
Bond Reqd. for Public In-q)roven-.._-nts
Street Nari)e Sign Reqd._ PAZ
OLher Signij-iL- Reod.
all
Pre Peniit Site Thspection*uvide on
0
]),Y: SR_ �,1171R
IWATER .41P
SIREET
ENGINEE_PJ1,1,G
Special Requirdinan t:s listed i-n niojio to Con11U.-1ity'.Deve1_oPm,,nt Department-
Bui.].(Ling Division
> 13Y —Date
0 All itc-nns filled in on Building 11 t Application
1BY Date.
Drawiqc.,s Stain)ed and Notations 1�tide
By
JZ1 Date
N
'4 Approvecl by Public v7cwks DepzirurK�n.t'
Revised: IV 10-1977
-C7
�ivd 3
CY
CC�
0 ------------
N
I= HG�
QD
CN
oil
"J�'4
5.�
Ile
k Ul
2"19
o"
IF
W —;M;m MW
1 a —1i i R 0 SAME IQWWWP j
ZL Mn
Iff,41,
M-MMM S—W
a �ww
ff �-
R n� Amomm— NAM
MOW
woman
im!t I W"" — R—M-Maum
'WMMA. . _.. =&
— PT.
fto.�M 4
wl�
Out
oftwo-m—ml
ity 'of Edmonds Permit No:,�M3 —036Y
RIGHT-OF-WAY�C ONSTRUCTIONTERMIT IssueDate:
A. Address or Vicinity of Cobstruction: 10)039 R,3 L.")
B. Type of Work (be specifi6�7:Z�,,6A-o�,�t �We E
Lq_., � C C
B-3 oo Ct> 0_1 ck I '10 7 3 Lz)
C Coniractor 0,\-\ U L 00 Contact: ",3(41231d (�CL
Mailing Address: IZZ30 UoJJJ-/.SOcL�/��- �hone, (0 - 407,3 9
State License #: 11 L 01 �-1 C Liabili Insuranc6: Bond: $
ty
D. Building Permit if applicable) Side Sewer Perr�iit # (if applicable):'
I /_ tl
�,z j
Commercial Subdivision CityProject EUC(PUD,VERIZON,PSE,AT&T,OVWD)
Multi -Family [Nf�-Singl;e'Farfilly 0
INSPECTOR:
F. PAVEMENT CUT: YES NO G. SIZE OF, CUT X
CONCRETE CUT: El YES E] NO
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless ftom
i . nj . uri . es, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the" City of
Edmonds or any of its departments or employees, including but not limited to. the defense of any legal proceedings includihg defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE. YEAR FOLLOWfNG THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK ESTIMA TED RESTORA TION FEES 97LL BE HELD UNTIL THE FINAL STREET PA TCH IS
COMPLETED BY CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT KILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be',patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
* Three sets. of constr,uction'drawings of proposed work are required with the permit application.
I I - ' I * ' . I / - If
CALL DIAL -A -DIG (1-90.942415/555)?1 R-T0,11EGIOWING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MA KE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Date:' j C:;4 -.,;31
(Contractor or Agent)
FOR CITY USE ONLY
Approved by:. i-,� .,av
Right-of-way Fee:.AIAC-, F-0
1,zoey Disruption Fee/Rind 111:
Time Authorized: Void After 1114,e c H
Special Conditions: kcs=a 9 44ZOW M ii" A*n
A"A41N. <rr-6Aek- CQQJC4-A1#,&iry Total'Fee: 0, 2 Z 5'.', 0 a,
)11___1 I ��
S'Agoc* P9t,')r-,r f j: Receipt No: 7-7"7-
-APPe4ovc r4Airr_#c_ Aix -Issuedbye-
v.
A r Fi;,c re- b &',Cs i �Vg- j,4 r A,4 N C-4 j A�kj vr %1 40
Par-i-rPt*- 41- 4:;nD fri f6jAJ
kP_S.A0RE A4- V. 7fAnj-- 4(ogn 5VAr. 1Vr4'"_j0,AjjL,, Np SVQAJ,pAk�js
XPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERMITTED WORK. DATE4!���
Insp
ectol's Sig;rature
For' inspection requirements see, Engineering Inspection Information handout.
NO WOI1K SHALL IIIJAN IIIZIOIZ TO 11EIMIT ISSLJANCE
,DAMy Documents\Forms\Engrkmg\ROWpermit_.doc
. .........
a
N�
1 0
Z
D
N TO
SCALE
1-0211A
GV3HV
NNOM
avom
*> k2S
0
V
10n CT CIAI-N
-Pildhuck Contractors, Inc.
Job #106119304
14 Dec 03
Sheet 1 1,
J. Buss
National Barricade Co
Notes:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs
2. Alert affected residents
3. Channelizing devices are 28"
traffic cones.
4. Maintain a 10' driving lane on
pavement for n/b vehicles.
5. All signs are 48" x 48" B/O
unless otherwise specified.
6. Work zone is 100' s/o c/I 190 ST SW
& 12' e/o c/I 83 AVE W
00
C14
24,
Zt PAJING' C)
04
190 ST SW
;>W21-1A
W=ROAD
ORK
AHFAD
00 W20-1
CHANNELIZING DEVICE SPACING (FEET)
TAPER
TANGENT
20
20
LEGEND
WORK AREA
28" TRAFFIC CONE
EXISTING TRAFFIC FLOW
MZ SIGN LOCATION
PROTECTIVE VEHICLE
M3 OR WORK VEHICLE
0
NOTICE:
No warranty Of acc-u-r-a-c-y—,-
The -information on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.qnds does not . warrant the
accuracy of anything set forth on these
rnap(�_)- Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
tRe -map(s), including, but not limited to,
th-e location 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 "ity of Edmonds nor its
ernp-l-o-yee-s o-r office-rs -sh-a-1.1 be lla-b'Fe for the
information givei on this map(s), nor for
tation provided based
any one represen
upon said map(s).
K-1
I
W
The City of Edmonds Side Sewer Drawing EASEMENT NO . .. .........................................
NEW CONSTRUCTION REPAIRS r-1 LID NO . .................. ASMT. NO . ...........
OWNER ....... ......
------------------------------------- CONTRACTOR M ----- ................ PERMIT NO. ec72—=�2—
JOB ADDRESS \ - - ------------- ................... LEGAL DESCRIPTION: LOT NO - ----------- �4 ...................... BLOCX NO - ----- -4�-> -------------------------
..................................................................................................................................................................
NAMEOF ADDITION ------ . .......... m ........................................
FWVW-0001-11/75 (REV.11/78)
Approved:
DATE... ----------------- � By ---- ..... ------
CITY OF EDMONDS
-�PUBLIC WORKS DEPARTMENT
SIDE SEWER PERMIT
FOR INSPECTION CALAW Permit 4V.
775-2525 Ext. 220 Issue Date
* -----------
PERMIT MUST BE POSTED ON JOB SI
77onstruction
1. Address Of i;;�c 0
2. Property Legal Description (include all easements)
cr i 4 �
/�,v A J
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No. i:- 1- 7 �j /j,:
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of2
way Construction Permit Required Call Dial Dig (342-5344) before
excavation). ,
E-1 7. Cross other private property: Yes No Easement required
attach legal description and county easement number.
READ THE FOLLOWT.NG AND SIGN:
P4
P4
4 a. Property owners must obtain a permit to install side sewers on
>� their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
P4
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15
0 and maximum grade of 100% (450).
0
E-4 f. No turn in side s8wer greater than 45 (1/8,bend) is allowed
0
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
I certify'that I have read
and shall comply with the above
PERMIT DISAPPROVED BY: Date:
By: Date:
CONNECTION FEE:
P4 �3 APPROVED By:_40 --- Date:
0 __T_��
PERMIT MUST BE POSTED ON JOB SITE
lqloo
3TREET FILE
DATE
IM
OF�-
PHONE
MPORTANT MEBBAG
A.M.
TIME �N - P.M.
COOE NUMRFR --"' Z - ------- -
TELEPHONED
PLEASE LL
CAMETOSEEYOU
WILL ALLAG IN
WANTS TO SEE YOU
S
LRETURNE. YOUR CALL
SPECIAL ATTENTION
SIGNED -6--�V
LITHO IN U.S.A.
STOCK # WYWO-P REORDER FROM ASSOCIATED/RUGGLES 575-3960