19327 84TH AVE W.PDF111111111111
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19327 84TH AVE W
. ! Critical Areas Checklist CA File No: g,;�_41
Site Information (soils/ topogr aphy/ hydrology/ vegetation)
1. Site Address/ Location: -/93 27 Ave- W ., F,-A v"cAct s VJA, 0 �Z,6'
2. Property Ta . xAccountNiimber: -�Z70`//goo ypb.goo
3. Approximate Site Size (acres or square feet): )-J', 000 S2 4�-f-
4. Is this site currently developed? Zyes; — no.
If yes; how is site developed? Lc 1PCtr%1L,:1�Z
%j f -
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 orf-site 0' more tha&1.5% and fe�_
f ' ' ' ss 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: &L?.- Approx. Depth:
7. Site contains areas of seasonal standing wat . er: U0 Approx. Depth:
What season(s) of the ye air
8. Site is in the floodway K) 0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the ground ' s surface? Flows are year-round?
�j 0 Flows are seasonal? tjc) (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site: AJ D
4. Critical Areas inventory or C.A. map indicates Ciiii,calAreA on site?
5. Site within designated earth subsidence landstd�e"l�az'a"r'd"'a'ie'zi?:
DETERMINATION
RE D/1 WAIVER
TU
Review6d by.
Date.
Critical Areas Checklist.doc/3.19.2001
E , D 0
City of Edmonds
Development Services Department
Planning Division
hone: 425.771.0220
/17 1�
Fax: 425.77.1.00221
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
deten-nine 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).
Date Received: - 14 - zoey-�
City Receipt #: IfO 12.;'7 1-
Critical Areas'File'#: --7 00Z - pc)4-1
Critical*eas Checklist Fee: $45.00
Date Mailed to ADDlicant: j5-,;z,(3—CrZ,
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
pf 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 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 furnished 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 file this application on the behalf of the owner as listed below.
"o,
SIGNATURE OF APPLICANVAGENT DATE 9 - 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,���;�
DATE 3— 5— OZ
PLEASE PRINT CLEARLY
Owner/Applicant:
P kc- r 1,e. v
Name
Z7,3a 7 g t-1 rl A,,
Street Address
r -
CA A.1 CJ A Ck- S Jlu A
City State Zip
Telephone: 77/-5-620
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email address (optional): Q_L 1-40 ppr=iZ %(2 i4,) .'I Email Address (optional):
0 cvvt
Critical Areas Chccklist.doc/3.19.2001
8 9 0 - 1 9 C� -
City of Edmonds
-OF-WAY CONSTRUCTION
RIGHT
PERMIT /&
Permit Number: F'�� , z �J
Issue Date: (; -11_3
A. Address or Vicinity of Construction: 19327 84 Av* W. (9316866
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Nat'l. Gas Co.
MailingAddress: 815 Mercer St, $sattle, Wa.
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 9?A-297A
Liability Insurance: _ Bond: $
Side Sewer Permit # (if applicable):
E. Commercial Subdivision 0 City Project fiXUtility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family R Other
INSPECTOR: INSPECTOR: t.--
F. Pavement or Concrete Cut 0 Yes Mo G. Size of Cut: x H. Charge$
APPLICANT TO READ AND StG,N
INDEMNITY. Applicant understands and by his signature to this application, agrees 1� the City of Edmonds harmlessfirpm damages, or
the City of Edmonds, or a,309 !IV or enip oy-
claims of any jUnd or description whatsoever, foreseen or unforeen, that may be made 4 Ox
e5��,Jncluding or not limited to the defense of any legal proceedings including defe0se costs, and attorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WOR13fA NSHIP A ArD MA TERIA L:� FOR 6A "'PERIOD OF ONE YEA R FOLD ING, 7HE FINAL INSPEC77ON
AND ACCEPTANCE OF 77LE WORK ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREEII� A T91h IS D BY
CITY FORCES, A T WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED _T
C �LE
FOFJI§Z�k�E_V'O THE APPLICANT. (r — P-MP
Construction drawing of proposed work required with permit application.
J.
A 24 hour notice is required for inspection; Please.call the Engineering Departryi (77,:1,-
.;K
Work is to be inspected during progress and at completion. 'M
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 regulati6ns as required by,the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the c�id of the working day;"
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
_balfe: May 27, 1993
Signature:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
_P
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 11
Addendum to City of Edmonds
Right of Way
Permit Application
by: Guyla Connors
Engineering Ai de
Washington Natural Gas
521-5248
CE�17_A L,\j \Kj
q--�) k(_Pff:A�-
WNG to window
Water main depth
unknown
gas main
NJO C�LrF_��
1`34 "'S-F 4��W
815 M=cr St. MO. Box 1869). Scank. WA 98111 (206) 622-6767
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sewer
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water hydrant
0
water valve
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2 - i ig T2 R_ E � il-E TNIFILE
PUBIJC WCRKS - ENGINEERING
ACTION REPORT
M 2816
SUSPENSE DATE:
Date: Time:--/ C2,f 2��t'_File #
Attachments: =Yes
SUBJECT: =No
PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE r--j
OTHER:
RECEIVED BY'-
RntITF in
HIM
IMMIam
MEM
'EM
MMMM���==
All Concerned Notitled
Actj,t�n Completed/File
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NOTICE:
.NJ'n w a rr a n
I
.:d "' Y.
A
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 'Edmonds 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 -m a p (s) , including, but not limited to,
th'e lociation of any sewe r 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
h-a-11 be !..*,Ia-b.-11-.e for the
ernp[o-yee-s o-r office,rs,s r
information given* on this map(s), nor for
any one representation provided based
upon . said map(s).
Tke City of Edmond%M.W
APPLICATION
fax for'
SIEDE SEWER PERAUT
NEW CONSTRUCTION g]--' REPAIRS 0
.................................................
OWNER ........ 15�&I.e_Al ....... &
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ADDRESS..... L?3.,71.7 .... 4 ........... ......................................
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EASEMENT No . ............................
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CONTRACTOR ..... 139Z ....... ....................... PERMIT
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ...................... :� ..........
THE SOUTH 801 OF THE EAST 180' OF THE WEST,2001 OF THE
NAMEOF ADDITION .........................................................................................................................................
NORTHWEaT QUARTER OF THE SOUTHWEST QUARTER OF THE SOUTH-
EAST QUARTER OF SECTION 18,TOWNSHIP 27 NORTH,RANPE 4
EAST,,W.M.; EXCEPT THE WEST 101 THEREOF.CONVEYED T THE
CITY OF EDMONDS*
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Approved:
DATE .... ...... 2 ............. By .......... ... .........
.. ... .. ...... ---- -----------
C -OF EDMONDS SIDE'' S,,fWER,-'!PER!M11T
ITY'
IWATER-SEWER DEPARTMENT
'PIP,
'1107 for _�slde, .§ewer inspedtlons� �REJI.ORE, covering a Y, i it on, 'of tfi6� -constr 1=v
;(Call 176- n p� i uct
Insp . ectiozv wlll,�b6 pi6vidbd'wlthl . m-2�4ho�u'rs-�aft�i request
No Isat., !Sun.,,.!or Y, Inspections:T,
ho I i d1a
-7'
"OCAtION-OF 'CONSTRUXTION.*-....� ........... : ..... .................................................... ......... .........................
AD,DRESSI� 1 32 ....8 4T I.. _: WK
d�
-PROPERTY.; LEGAL DESCRIPTION.Min
.............. ............... ')0(l 1 4-, *N f
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a r ;e r� iV
t1,,je_Sf_ quarbtar-,'o Se�i:!: JS Towpshij��,`27 liorth Ran,96 4' '�'ast, 34- M; EXCept t
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . Z.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................
c6live) to th e, SVEN' HELLE MR',
ND/OR,�BUILDER ....................................................... . .................. 4 ..................
............ ................................. ....... ........ �PWNER A .... . ...............................
x 13bb- 'B '921 A
'm, .41 - f,24006,� W484'�
10614TRA'G'T�,OR S''NAME4ADDR-ESS ................. 7.-W-k1i
................................... ........... ..... ............................ ............ ......... ............ ....................
exver
..... -side sbWei to the At� sanitary s
granthd ................. ... M ...... ...... I ........ for repair �and/or �c�4��eetidn. ofa
sy4em. twaccordance with --.City - of Edmonds -,ordinanees..,,�
7
TE'Vd� 1" -The �owners, of, �tfie4'roperty'may iobtaltll,a:.,,i;��rnit'�io.,--c"6n'st"fuct IseNver �lnside,-proj ert,y*jln�. ..,A licensed s i ci�e Sewer Co�iractor must W,employed' to -construct
lnAtreet,'&rea;'-Do,mot cover �ady�pdrtlori -6f,sewei.,�b�'fbre it'.)has.-bee. inspected;
TE No.,',2—A1lh work per ormed -in: city -righ -of ay f:,Right-i
_W Df-,Way �P�rnait:-IobteLiiral�le from the:City Enginealr"s office.
1!4?TE, No.; ��—_,Olitain full-Aniormatidn reg&rding-,Ordinanc�e,'11;16tO3o iand,',Jieguia.�ions. _,�overniing,.sIde sewers �when you ket �permlt'.
a _perty`fin�; minimurri
side'sewer'must hav6' Cleast Mi '6 � s� o r and n
in he cov.erageat.�:pr pe ty line, 12A ches.;fn.fde pro grade.%of 2 No bends An grade
�haxperthan..*_ -�be!.peMitted:.
Will
NOTE'Ro;?5-. Mrbnches.ln�street m�st-',be water 'settled,iand,,su rface &�,'st�eetxestdred- to'origin'ai-conjition., Conti ap-tors..shal I be responsible for,; idilurie, due' to improper .
h'�may, develop %within.one year,.': of. c6mpletioh. -
,,NOTE No. work than W.J�rov�ided for lw the permit, or-,to'do:any work,o'n the� main gewer',or �its-tappurtenances, except.Ao in-
pe
into the-wye.
C.
:.DISAPPkOV%6'�� �M, Date ........... ]�Y; .............
_: ....... .... W,,By. i.. �i Date ...................................
.............
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A-P f "et,
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M.............................................. .- ...................................... ............ .................................. ...... I ......... - --- - -------------- ...... .......... ........ ............. .......
-_B�� Si�nedl�y- 6wrler"'Of-2 k �irm Perf rmin�.' onpti�#c�tion PRIOR To..,R�q, tion
rmit,Copies -,MU ST'_ 0 u,es.t For: lnisp�b
�iereby,'_ 6itify,",that,,th,e,side*:s6wer�installation,;con8trutie"dki- nder,this,p�rmit
U
:(bwne*r*'6*f*"C*on*t'rac*t'i*ng**Fi*im',*�*il*6r'i'br*min'g,*'--'(j*o�*�st'�*u'ctlo'� j.;:,
.vl�s.,Inst-'aJled,�in,,,�,,adeordance,.,witht,��ilL nc6s,ibf,, the-Cit
gqvernin,gr-,okd.iha y, pPMdmoxi.ds.:�,
40 _.G ...............
atod .tlus ....... Aa � f
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