19632 84TH AVE W.PDF111111111111
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19632 84TH AVE W
'4DC. I %9�
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
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).
Date Received: 0i
City Receipt #:
Critical Areas File #: CA -01 - its
Critical Areas Checklist Fee: $45.00
Date Mailed to ADDlicant:
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 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/hff/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edm�nds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infractio n 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 plication on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
— 7, ; � --, , /,,o � � DATE
Property Owner's Authorization I-001
By my signature, I certify that I have authorized 4 �ea/bove ApplicantJAgent 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 postng atten to i a plication.
SIGNATURE OF OWNER
DATE
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
/ 4�� _72-
Street Address
City State zip
Telephone:
Email address (optional):
Applicant Representative:
7-6,(-;,-, T�e T/711C
Name
g q /j-
Street Address
city State Zip
Telephone: ti ;t- —2-
Email Address (optional):
Critical Areas Checklist.doe/3.19.2001
Critical Areas Checklist CAFileNo: CA'01-n
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: _ 1 gya -3 2 S zy If -� +c,,e to f"W Zel'a 7 F 9,�
2. Property Tax Account Number:
�7C, dyl 06 �206 Ro e)
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Y, yes; _ no.
If yes; how is site developed? e X i zf� ol C
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 horizontal
distance. of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year? /V6
8. Site is in the floodway floodplain A/ A of a water course.
9. Site conta' a creek or an area where water flows(across the grounds surface? Flows are year-round?
T 6) Flows are seasonal? AV &4 (What time of year? zl�l A
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawnshrubs etc) ZeL 4.,j A,)
11. Obvious wetland is present on site: Xj A
Critical Areas Checklist.doc/3.19.2001
E RECEIVED
PERMIT EXPIRES
Wei
CITY OF EDMONDS
1
USE PERMIT
ZONE NUMBE22V 49� 7,g
CONSTRUCTION PERMIT APPLICATION
JOB SUITE�IAPT#
ADDRESS/��,?.,
2 g, &�/ 4 / I
OWNER NAME/NAME OF BUSINESS
PLAT NAME/tUBDIVISION NO.
LOT NO.
LID NO.
#'AJ
CC
ui
MAILING ADDRESS
LID F $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
1
TESCP Q
. P.. Req. 0
0
4
I q&3-2 SIj 4V
Street Use 09milt Req'd C)
CITY ZIP
TELEPHONE
EXISTING — PROPOSED
Inspection Required 0
Skimalk Required 0
07S
REQUIRED DEDICATION— FT
Underground
WIring required 0
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO C3
0
3
CC
W
ADDRESS.
REMARKS
z
OWNEFYCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
Ul
CITY ZIP
TELEPHONE
NAME
7 -A VIER r Vd4,(1 /;W7 600 V i�'a
ENGINEERING REVIEWED/DATE
ADDRESS
FIRE REVIEWED BY DATE
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CITY ZIP
" —
4.4, -r re,
TELEPHONE
ttj� - S f
S
7
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0
0
rL
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
IPBOND
OSTED
STATE LICENSE NUMBER EXPIRATION DATE
CIEQBY
711104
A)
a
E3 YES 0 NO
/ SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROP SED
ul
47,0011>0 906
EXP X_
I
7�
N/As I I A
NEW RESIDENTIAL PLUMBING If MECH
LOT COVERAGE
ALLOVIED ROTSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
f A
A
125'7V �151
I 1E)(j$_nN&,
z
F
CHANGE OF USE
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PARKfNG
REO'D I PROVIDED
LOT AREA
P DATE
REMODEL C:] APARTMENT
0 S16N
0 GRADING FENCE. -
REPAIR CYDS 0 X FT)
REMARKS
0 DEMOLISH 0 TANK
z
(3 GARAGE C3 ROETAINING WALL
CARPORT R CKERY C] RENEWAL
r-
Q.
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE OF CONSTRUCTION
COD�;
OCCUPANT
GROUP
NUMBER
OF
NUMBER OF
DWELLING
C RITICAYP
AREAS
ui
0
SPECIAL INSPECTOR -'kAPEA
OCCUPANT
0'
STORIES
UNITS
NU
REQUIRED C3 YES
LOAD
DESCRIBE WORK TO BE DONE
I .
R E MARKS
PROGRESS'MSPt CTIONS PERUBC 108/FINAL INSPECTION REO'D
5
6 /C
C, v C-,( C /,C- 1-d a C/0
r Wd
V, VIP 1701
VALUATION
FEE
AC L --I eh -1i C -
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NP: I VESTED DATE' PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT* 1 YEAR - PROVIDED WORK,S STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION.
ENG. INSPECTION FEE
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Lu
_j IN INTEREST, AGREES TO INDEMNIFY,-,DE,FEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALL CLAIMS FOR DAMAGEVF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
x FROM THE ISSUANCE OF ThIS PERMIT. ISSUANCE OF �HIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
a DE 7J
_j EMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION."
RECEIP
TOTAL AMOUNT DUE
Nwg
I HEREBY ACKNOWLEDGE THAT I HAVE 14EAD THIS APPLICATION: fHAf`fWffI&6RMATION
IS AND THAT I AM THE OWNER, APPLItATION APPROVAL
GIVEN CORRECT, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPQV. WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK.AOTH6AIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputyj and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE 00:WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged k space provided.
WORKMEN'S COI�#ENSA RANCE AND RCW 18.27. A
OF I IALS SIGNATURE
SIGG�NAER 0 DATE SIGN ED (425)
In(
VGE-
_0
-0 771
L A0220 DATE
'r
MSEDBY&
W.,
A-rtENTIO EXT 1333
OR OCCUPY A BUILDING OR STRUCTURE
IT IS UNLAWFUVUSE UNTIL
771 -0221 40AI-1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE W-1 qPF
FAX PINK -OWNER - GOLD-ASSESSOP
5/98
X
Lo-r AHREA
GL/ Ll o
C", c-
11wqz 77A X A c c P6,,.c c4
q7o
3 cl
SG
ZOME STREET FILE
CT- r--�nfofpj,
RECEIVED
OTHEki— AUG 2 8 2001
H!--- 1? H I NINC:, BUILDING DEPT.
V
07 *4
M
'Nortzage Processor
Nort
hwest Mortgage, Inc.
103111 Aurora Avenue North
Seattle, Washington 98133
Gentlemen:
DeceTber 16, 1',)69
This i�'; to certify tbat the, liouse at IM32 - 84th Avenue 'Je5t,
I
within the City of Edmonds, was connected October 20, 1965, on pernAt
number 1305 to the City of Edmond,,; sewerage. s;ster, according to the
City of rdmonds standards.
Yours very trul�"
CITY OF EDMONDS
RONALD L. WHALLY
Asst. Director of Publicolorks
RIM 1 j c
NOTICE:
-cy—
.N:o---w a rr a nt� ' ro r a cc -a
The information on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,�e City of �Edm.onds 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 information shown on
-map(s)., Including, but not limited to,
t
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 ";ty of Edmonds nor its
�'� I
empl-o-yee-s o-r offi-ce-rs -sh-a-11.1 be 1-`1a-b-1F.e for iffie
i n s ma p(s), nor for
information give' on thi
ion proVided based
any one representat'
upon . said map(s).
ale
APPLICATION
for
The City of Edmonds SIDE SEVi7jR PERAM
STR FILE
OUTSIDE E] INSIDE E] REPAIRS F1
If -
OWNERT.7-.!__=..: ....................................................
HOUSE No. -------------
3-Y
CARDNo . ......................................
EASEMENT No . ......................................
.................................... CONTRACTOR ..... ...... ----------_--------------- PERMIT No
STREET' -I
.................................... AVENUE LOT No . ................ I ............................................. BIOCK No.
NAMEADD . .......................................................... ----------------------------------------------------------------------
Ozv�-- L\ W,
0,
u
APPROVED
0 C T I P, 1965
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .......................... ..................
SEWER WORK ORDER ISSUED_ ....................................... DATE .....
7 ................. :.j ................................................
0 VED M ' ONDS
caji- PRospece'(1-1107 when work,'
CIVIG CENTER DEPARTMENT
Is - ready for hspectl6ij., (Noi,insp6c-� 0 130-5
ti.a. Sata I rday,'�unday or hql1days.),_ NKV
SIM-SEWER PERMIT
ADDRESS .............. ............................ 2.1.1.8.0 ..... ... 8.4.th .... Avenue ... W.e.s t ................... ............................. ..............
.. .. .. .... ............ .. .. .. ....
OWNER ................... Q4nn
. . . .................................................... CONTRACTOR.. .... ... 99PStrUCtion-
...........................................
Pert-nission Is granted 12 ............... 19.0... for ....................... A o REPAIIR or CONNECT a side sewer
days,
with City S.ewers-in accordance with application on file and governing ord I i-nances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A -licensed Side Sewer Contractor must
be I employed to construct side sewer In street area. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtaln 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 I , e"t.30 Inches coverage . at property line and 12 inches inside property line; minimum grade �f 2
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�_responslble 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 ap-
purtenances except- to Insert the pipe into the wye.