19016 83RD AVE W.PDF111111111111
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19016 83RD AVE W
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 shoutd
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, sip 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 gla
I along with the signed
�opy —0f this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate colunm belwv).
Owner/Applicant:
.-AV-Lec
Name
(0
Street Address
CICITICY16L) Wash, C15D-zi(a - 60/5
City State Zip
(42-5) -7
Telephone
Signaitire
Da
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signative
Date
creception\janakad.doc
(over)
CITY Copy CA rILENO. 'ql - S3
Critical Areas Checklist
---------------- --------------------------- ---------
Site Information (soils/topography/hydrology/vegetation�'
I . Site Address/Location: 1q, 0 1 & �531-6-j A-ve �J,-Z,.$)-7 c-1 go 2-
2. Property Tax Account Number: 'VtZ,5,w� 4 91 (e QQ4 op 1 00 -
3. . Approximate Site Size (acres or square feet):
4. Is this site currently developed? X yes; —no. lot
I A I
If yes; how is site developed? Q LC -rc,111 I CLU--o-A I I r-�rj 168 / R .-tb
5. Describe the general site topography. Check all that apply. OP411tvt _',
VFlat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15% (a vertical -rise -of 1 0-feet-over a
horizontal disItance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% a vertical rise of
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
06er (please describe):
6. Site contains areas of year-r ound standing water: Approx. Depth:
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) _X
11. Obvious wetland is present on site: 0
bETkP-M1NAT16N4
PLANNING DATA
NAM E: 41rz /Z
SITE ADDRESS:Jqolb 5���ATE:
ZONING: & - I
.—PLAN CHK#:—
PROJECT DESCRIPTION:
CORNER LOT � _(Yes/No)
SETBACKS:
FLAG LOT
(YesINo)
Required Setbacks:
Front: Left Side: A� Right Side:- /0 Rear:
Actual Setbacks: , AP
W19k, -7'5Rear:
Fron Side: ' Rlj�t Side:A'.
Street map checked for additional setback required?
,(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED 4-7 (Y/N)
LOT COVERAGE:
122 /�"
Maximum Allowed:--z � 4 /-;7X0-ActuaI:---
BUILDING HEIGHT: 751� 7
Maximum Allowed: Actual Height:
Datum Point: Datum Elevation: 407)
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION: N
90 - 10
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
STREET �Er IT
Permit Number: 9,-) -,,) e
Issue Date:___7 11�2-� 7-�-
A. Address or Vicinity of Construction: 1901683 Avenue West
B. Type of Work (be specific): Install New ServIce
C. Contractor: —Washington Natural Gas Co iy Contact: Frank Swan
Mailing Address: 815 Mercer Street, Phone: 224-2278
State License #: Seattle, WA 98111 Liability Insurance: Bond:$
D. Building Pen -nit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision [I City Project J2 Utility (PUD, GTE, WNG, CABLE, WATERF
F� Multi-Farriily El Single Family El Other
INSPECTOR: INSPECTOR: �wlc"n-t
F. Pavement or Concrete Cut U Yes E]No G. Size of Cut: 2 x 4 H. Charge
APPLICANT TO READ AV)(D SIGN
INDEMNITY. Applicant understands and by his signature to this application, agreesi—oh'A the City ofEdinonds harrnlessftont injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforcen, that may be made against the City of Edmonds, or any of its deparlments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA7ERIALS FOR A PERIOD OF ONE YEAR FOLLOWINq, THE FINAL INSPEC77ON
A AD A CCEPTA NCE OF THE WORK. ES 77MA TED RESTORA 77ON FEES WILL BE HELD t]Ai77L THE FINAL STREET PA TCH IS CdMPLE TED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departil
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes. 771-0220
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 statetqgnt�r and understand the permit requirements and the pink copy of the permit will be available
on site at all times Jor-J4��ction ' puf0oAe§..
c4
Signature: Date: September 14, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY- JSVV R1014T OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER KW Z4 DAYS DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: V A RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
COMMENTS; orn
DATE:
RECEIPT NO:
ISSUED BY:
)R TO PERMIT IRSIJANCR
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 13 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
t�ng. uiv. juiy iva:)
Addendum to city of Edmonds
Right of Way
Permit Application
Submitted by: �tl" AQ[)
Engineering Aide
Washington Natural Gas
622-6767 x2761
-AV LJ-3 pager q(__9 - �(,ob(o
Z,
'2�� W.4-
WNG to window
water main depth
unknown
1� 11 gas main
-g- gas
-ss- sewer
-E�- water hydrant
C) water valve
815 Mercer St. (P.O. Box 1869), Seattie, WA 98111 (206) 622-6767
APPLICATION
The City of Edmo STREET FILE for
nds SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS
ci
OWNER -119 NJ.9/�:l ....... . / .. ltf 4,c�-:y
-------------------- * ------- *** ..........
ADDRESS IW-1`6 ..... ....... ....... ......................................
I
(:�A4
: Z - F-: --
LYM PL4,4T
No. ..........................................
J- 'j-" j 3
CONTRACTOR j 0 c, I--
. . .......................... ............................... ................... ....... PERMIT No . .......
LEGAL DESCRIPTION: LOT No. ............................
...... BLOCK No . ........ V --------------------------------
NAME OF ADDITION ........ Ig -t)i
............ 3
...........
c
Approved:
......... BY
DATE . ................................ ..... ........... ........... . .................................
NOTICE:
NbwarrantyOT -a. c c. u rd
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e City of �Edm.qnds does not . warrant the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform'ation shown on
tF�e -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
empto-yee-s o-r officle-rs -sh-al-1 be 1--ia-b-Ife for the
information given on this map(s), nor for
ation provided based
any one represent
upon . said map(s).
CITY OF EDMONDS
C][VXC CENTER — WATFX-SLWEU DEPAP
.nW
'NT Call PP-sPect 6-1107 when wft
is "y fer I-pe-Uon. (No Inspe.-
SIDE SEWER PERM -IT MOB Saiurday, Sunday or hou"..) N2 1809
ADDRESS ................ 19 16
......... .... 8_3rd ... Axeljqg ... Kp;qj�
OWNER......... .... Ta ley. ----------------------------------------------------------------------------------------------------------------
........... ................................ CONT"CTOR .......... R se .1 1
P"llission Is granted __-March 20 ... ........ oh-ps.o.n ........................
With City ----------------- -------- * ------------ for ...
days, to REPAIR or CONNECT a side sewer
Sewers in accordance with application on file and governing ordinances.
.................
ATTENTION IS CA.LLE, TO TIM FOLLOWING:
NOTE NO. I —The . Owners of the Property May obWn a permit to con
be employed to construct side sewer in street ares, Do notstruct sewer Inside Property line A licensed Side Sewer Contractor taust
NOTE NO. 2—Obtain full Information cover any Portion Of sewer before It has been Inspected.
NOTE No. regarding Ordinance 11.16.030 arid Regulations governing side sewers
3--TOP Of side sewer must have at least 30 Inches coverage at Property line and 12 inches inside p when you get permit.
Cyo bends In grade sharper than % will be Permitted. roperty. line; minim
due um grade Of 2%.
NOTE No. 4—TreaChes fintstreet must be water settled and surface Of street restored to Original condition.
NOTE No. failure 0 Improper work which may develop within one Year of completion.
5-1t 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 ap-
PUrtenances except to insert the pipe Into the Wye. Contractors shall be responsible for
CA FILS NO.
Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1 . Site Address/Locatilon: 1q,01(c, 53L-6) A-ve- L/3e-3'J-
2. Property Tax Account Number: qA�/,re� 4 9 1 oD4 0'0 1 cQ
3. Approximate Site Size (acres or square feet):
4. Is this site currently deve loped? X yes; —no.
If yes; how is site developed? )0QUL
5. Describe the general site topography. Check all that apply. -*,
V— Flat: less than 5-feet elevation change over entire 19819,11ces
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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: gr-.tdes of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-r ound standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodwav 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) X
11. Obvious wetland is present on site: N D
City of Edmonds
"q,W CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map - along with the signed
�opy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factu'al, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
-,�W,re-&40
Name
Street Address
F -p
ryluylat5 Wash. cwzk'�' - 60IF5
City State Zip
-7
Telephone
Signat6e
Da�e
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
c:rccepdon\jana\czc1.doc
(over)
I - �)
12 C. 1 S9
February 21, 1999
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Meredith & Jay Hueter
1901683 rd Ave. West
Edmonds, WA 98026-6018
Subject: Determination regarding Critical Areas Checklist # 99-33
Dear Applicant:
BARBARA FAHEY
MAYOR
Enclosed please find ' a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS.- YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
mo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determirfation
* Architectural Design Board
Thank you.
Sharla Graham
Planning Secretary
C:Reception\Jana\CRLTR.doc
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING 4DDRESS
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CITY ZIP TELEPHONE
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PROPERTY TS
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GARAGE RETAINING WALL
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NUMBER
NUMBER OF
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STORIES Z_
UNITS
NUMBE R
DESCRIBE WORK TO BE DONE
9N
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PERMIT
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NUMBER
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ADDRESS
C1 412
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1 LEGAL DE§CRIPTION C"HECK
I SUBDIVISION NO.
I LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
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AW Permit Req.11ed
0
EXISTING — REQUIRED DEDICATION
Street Use Permit Rcq'd
0
inspection Required
0
PROPOSED
Sid ... Ik Required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
ESO NO
REMARKS
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FIRE MEIA0 DATED REVIEWED BY
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ADB#
SHORELINE #
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED S(T'BAlkS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR S E REAR
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LOT AREA
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SPECIAL INSPECTORT /*
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REMARKS
PROGRESS INSPE9TIONS
CO OCCUPANT
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k I AIZ VALUATION FEE
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AA441 ti i-l-A-) fll2i�" PLAN CHECK FEE
HE�T�SOUFICr - -1 v GLAZING 9% 1 LOT SLOPE '% — BUILDING
PLArPCHECK No- 7 _"'��ED DATE PLUMBING
THIS PERMIT AUTHORIZES ONLY THE WOR . K NOTED. THIS PERMIT COVERS WORK TO MECHANICAL
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL 1 !6-
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cr STATE SURCHARGE
W
Q. PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS STORM DRAINAGE FEES
in
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
cc EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
4
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
0 FROM IHE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
_1
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE PLAN CHECK DEPOSIT q )34
z NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." —in
— TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT: AND I HAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- APPLICATION APPROVAL
rION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL This application is not a permit until signed by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. receipt is acknowledged in space provided.
YGNATURE (OWNER OR AGENT) DATE SIGNED (425) F,F C S gVRE DillkTE
I A O"M
171") e r t i j i'dirr,,ii 771-0220 � 1- —9
RELEASED BY
ATANTIO14
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED UBC SECTION 109 PINK OWNER - 601 1) - ASSESSOR
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