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CA FILE NO. �0
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Locatio n: W11- AY. JX� FW,9,012W-5.
2. Property Tax Account Number: t5_7 .- 000 - Q/ -7 - 006 3
3. Approximate Site Size (acres or square feet): _3466 -5,r APR I I 1(%A)qs
4. Is this site currently developed? -4yes; _ no. WWI COUNTER
If yes; how is site developed? A-e _S,� d
-o
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 I 0-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: jL75 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)
11. Obvious wetland is present on site: IJ6
-For City Staff Use Only
.I::. Sit 'Zoned?
1 e is
mapped
2"i -§CS: soil type(s)?
Sit loam
-3:".:..'.,`M Wetland inventory or C.A. map indicates wetland present on site?
M6
4.1-..:. �'Critical Areas inventory or C.A. map indicates Critical Area on site?
within designated earth subsidence'laindslide hazard area?
d
i e esignated on the E
nvironme'nWly Sensitive Areas Map?
btTtRMINATION
�TUDY REQUIRED CONDITIONAL WAIVER
..'WAIVER
.Reviewed by -
Planner Date
Rzv 0 1/04/94
690 -199-
City of E&mon&
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/h i er 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant: -
LM CLk S. Loa -
Name
do V - -76? 71 AuL a).
Street Address
City, State, ZIP hone
61UO77-5
*Sinature Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature
Date
f.777
STR-11:;.�, I FILE
4,11,01,
APPROVED BY PLANNING
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A&6�WO)
�A FILE NO. r,� - -7
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
R 6 C
2. Property Tax Account Number: I t5_7 000 - ol-I 006 3
APR I 1 11.9 9 6
3. Approximate Site Size (acres or square feet): 3'qzy) -.54" kl� pERMIT COUNTER
4. Is this site currently developed? __4yes; no.
If yes; how is site developed?- A-c S,� d
-o ,
5. Describe the general site topography. Check all that apply.
V'_ . 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: jL' 6 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)
11. . Obvious wetland is present on site:
For City Staff Use Only
4:�::':i- :Site is Zoned?
67.
2.::.... .§tS:mapped soil type(s)? '3;2- ftiL�,A
Wetland inventory or C. A. map indicates wetland present on site?
-.::::.CnticaIAreas inventory or C.A. map indicates Critical Area on site?
Site Within designated earth subsidence'- landslide hazard area?
designated on the Environmentally Sensitive Areas Map?
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
R e'vi" e-
ed by:
.ew
Planner Date
PcV01/04t94
41 9 0 - 19 C, -
City of Edmon&
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 pro - perty. 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Y) CLOA, VA _Ly
Name
'-�o 9// - -7,q -4 A)L it).
Street Address
zt'�z q oA&
City, State, ZIP _ ,&,,Yhone
Sf nature Date
Applicant Representative:
Name
Street Address
City, State, ZIP
Signature
Phone
Date
PLANNING DATA
D&r-f (,tr / 6e r k" r
SITE ADDRESS: Z-0911 - 7L Ave DATE:
ZONING: P-s- k PLAN CHK#: 19� -
PROJECT DESCRIPTION: 2.1' '2 7' a-AA�'h a,- N V, ZA-0- kkm"�b— I �IUA. 6
SETBACKS:
Required Setbacks: z 2.09 fi�
7g"', Front: 25' LeftSide: 7�� RightSide: '7'5' Rear: 7 V2-'
Actual Setbacks:
Front: A)A (WO Left Side: Right Side: 47 ' Rear: 2- 3 1
CORNERLOT &S (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED t-3 (Y/N)
LOT COVERAGE: j9&776
Maximum Allowed: '3517. Actual: 3� - Z_ 2 1%
BUILDING HEIGHT:
Maximum Allowed: a5' —Actual Height: i Lp
Datum Point: N.t- o�,wA Datum Elevation:
SUBDIVISION:
CRITICAL AREAS#: 9b - 73 -
SEPA DETERMINATION: A)6p- 4,W-A
LOT AREA: pX 105, � pooa
OTHER: nc,��4u_- 641, 15to �jzw :, 7,1 - t 7 � 31- 71' 111-4 7 0
0�4 4— iz,� itnae,,z -Av h ,o., k— —
Plan Review By:
-;K VV L D
CITY OF EDMOND%JD 51EQ LE
C * OMMUNITY SERVICES DEPAR 4 1991
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. * Owner: Washington Natural Gas Company B. 9 Contractor:
Z
0
W
U
W
0
�1.
Name
915 Mercer Street
lailin Address
OR WA 98111
Permit No. 9
Issue Date
Name
Mailing Address
City State Zip City State Zip
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 20911 78 Avenue West
Type of Work to be Done: Repair Leak T. 90 06966 014
D. * Work in Connection With: 0 Sub or Plat El Single Family El City Projects
0 Commercial 0 Multifamily Ix Utility
E. 0 Pavement Cut: 0 Y FK1 N F. 0 Size of Cut: - X - No Cuts
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its d 'pariments or employees,. including or not limited'to the defense
court ',
of any legal proceedings including defense costs, ��sts, and attorneylfees by reason of granting this permit.
Ir c'
THE CONTRACTOR IS RESPONSIBLE FOR WOkRKMANS,HIP AND I MATERIALS FOR, A.PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ,
Estimated restoration fees will be held until the final street patch is comple'ted-b� City forces, at which time a debit or credit will be
processed for issuance to the applicant. r
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and, at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material'prior to'end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature:. A4 6AUx&" Date: April 15, 1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work .
APPROVED BY: BW
Time Authorized: Void after VfV_A\-V1_ days.
I -
Special Conditions:
RELE ASED BA� Datill 2-
PERMIT FEE:
Restoration Fee: R
Receipt No til J j+ 1141
v 1W4W§*1 116M
Fund I I I Fee:
Street cut bimensio x
INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Lng. Div. MarCh 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Iiispection by P. W.:
Work Disapproved By: —
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
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NattnA Gasw-S�MF
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WNG to window
existing
proposed
W/o 0 1+ -
Addendum to:
City of Edmonds
Permit Application
Engineering Aide: Kerry Walsh
4X��Ss Washington -Natural Gas
622-6767 x2761
.&V W
�'10 e-e-ul's>
a depth unknown
s/Key:
sa itary sewer
wa er
water valve
hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
APPLICATION
for
The City of Edmonds SEDE SEWER PERYaT
EET- F I U E DE Pj INSIDE REPAIRS E]
C)
7--
CARDNo . ......................................
EASEMENT No . ......................................
-------------------------- CONTRACTOR ....... . . ........ .. PERMIT No.
OWNER. - - -- ----------- STREET
HOUSE No . ....... ... No. BLOCK No . ...............................................
rolz ......... .... 6w) AVENUE LOT -17 ---------------------------------------------------------
................................... .................................
-a Ate NAME ADD. ..... . ....... z
B.P.
SEWER WORK ORDER ISSUED ..........................................
DATE
By
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 Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), in . cluding, but not limited to,
the 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 City of Edmonds nor its
employees or officers shall be liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS Call PRospect 6-1107 24 hours (plus No
Saturday, Sunday and Holidays) be- 913
-CITY HALL — WATER -SEWER DEPARTMENT fore work is ready for inspection.
SIDE SEWER PERMIT
ADDRESS ........................ .........................................................................................................
........ 241 ... 226d..PUCQ ... 0.1
OWNER ...................... ... !Umm-rd ................................... CONT RACTOR ............... �.&TIWt.-St.-AUbin .......................
Permission is granted ....... ................... 9 19 ....... (alpr ........................ days, to REPAIR or CONNECT a side sewer
With City Sewers in' ace WV application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners jDf� the, property may obtain a pertnit to construct sewer inside property line. A licensed Side Sewer Contraotor
ns
must be employed to construct side sewer in street area. Do not eover any portion of sewer before it has been i pected
NOTE No. 2—Obtain 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 least 30 inches coverage at property line and 12 inches inside property line; minimum grade of
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 responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 6—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.
EMMM
ff�l
M
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
9WNER NAME �4AME,O�.BU§INESS ADDRESS
(k LEGAL DESCRIPTI
:ITY ZIP TELEPHONENUMBER
D (_�(;a
NAME
ADDRESS
CITY zip
TELEPHONE NUMBER
STATE.LICENSE NUMBER EXPI,�ATION DATE
L C
Legal Description of Property - include all easements
A*
-7-
0 "i'Q r, L1
TaxAccount cco- cl 17 - cocz
Parcel No. .)� -I .>
PERMIT
NUMBER 9G0311
- -?"" ert- "j. t _... 'ASU
P PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 13
RW Permit Required 13
EXISTING REQUIRED DEDICATION -
Street Use Permit Req*d 0
Inspection Required 0
PROPOSE
Sidewalk Required C3
IRE"I'MARKS
METER SIZE
LINE SIZE
I NO. OF FIXTURES
PRV REOUI D
C3
EINEW
F0 -
LJ:�k RESIDENTIAL
I"
PLUMBING
1.42!WDITION
COMMERCIAL
MECHANICAL
REMODEL
APT. BLDG.
SIGN
GRADING
FENCE
REPAIR CYDS.'
I
F]DEMOLIsH WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
RETAINING WALL/
EGARAGE
1C ROCKERY
RENEWAL
(TYPE OF USE. 13USINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
LI
OWEL NG
CRITICAL
'TIC
R
FAREAS
NUMBER 96 3_
UM R
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
C� kj\
HEAT SOURCE: GLAZING I
1�_s %
SIGN AREA
$EPA RE IEW
ADS NO.
ALLOWED
PROPOSED
COMPLETE
EXEMPT
V111
I
SHORELINE
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS - FEET
HEIGHT
1
LOT COVERAGE
FRONT SIDE
REAR at
-T�; ,
3'��
_/Ary AeIIAZ- —
sla� felll�14 6�_
1 1 14 - /�j I I I
SPECIAL INSPECTOR OCCUPANT
REQUIRED I LOAD
0 YES
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No.
MECHANICAL 50,�.jj�j
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewpike,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
2
harmless the City of Edmonds, Washington, Its officials,
5
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
nor I.imit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance and RCW 18.27.
INSPECTION
SIGNATURE (OWNER OR A ENT) DATE SIGNED
DEPARTMENT
e.
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-024r.0
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
A ////
10247
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APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged In space provided.
I RELEASEQ BY: DA
5�
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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