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CA FILE NO..
Critical Areas Checklist
Site Information (so'l;ls/topography/hydrology/vegetation)
1. Site Address/Location: Qiec� E(Avy(co,8s P6(,\Z6/ L-0 t
2. Property Tax Account Number: 000 — C)Q(o — 0008
3. Approximate Site Size (acres or square feet): 0.
4. Is this site currently developed? yes; — no.
If yes; how is site developed? V�o,,Lse-
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: n 0 ; Approx. Depth: --
7. Site contains areas of seasonal standing water: _V) C', Approx. Depth:
What season(s) of the year?
8. Site is in the floodway (,x(-) — floodplain T) C) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 00, Flows are seasonal? — (What ti 'me of year?
10. Site is primarily: forested meadow ixed
_; shrubs mi
urban landscaped Qawn,shrubs etc) e)u.%,- L(_ii,)dsc_&pec1 VxC)niE!_�
11. Obvious wedand is present on site: -n 0
aylrL .
Rcv0l/04(94
890.194-
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 Deyelopment Permit
Application for the City of Edmondspnor
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. 17he 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 Critica ' I Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant-.
Nam
a1605- P/ kla
Street Addrew
1,JP 990Z(g 676-R5.3
City, State, ZIP Phone
Applicant Representative:
Nam
117601 A) k)
Street Addrew
�Ieaelelbjp --5-q6-2298
City, State, ZIP . . Phone
# q
Date Signature Date
y-i
C I T Y f EDMONDS SIDE SEWER PERMIT
For Inspection Call 771-3202 STREET FILE PERMIT NO. 07639
EDMONDS
. ky REATMENT PLANT
Address of Construction: os FT
Property Legal Description (Include all easements)
Owner and/or Builder: ec"-�-3 6()A ++L) -S -TV\ C-
Contractor & License No: 'S 'g-d-L'3
Single Family Residence RECE, VEJ)
Mu.lti-Fami - ly (No. of. Units JAN 2 9 1987
Commercial (No. of fixture Units PUBL'C WORKS.,
Invasion into City Right -of -Way: No Yes (If Yes, Right-o'f-Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes,easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I C6-rtify tRat/�l a e read and shall comply Date
with the iteWi.isted on the back.
Pe'rmit Fee: issued By:
Trunk Charge: Date Issued:
Assessment.Fee: Receipt No.:
Partial Inspection:
Comments, Date Initial
Qr7
Final Inspection Approved:
Date Initial
00
Rejected:
-5-a t -e"� -1 n i -ti a 1
Reason
PERMIT MUST BE POSTED ON JOB SITE
Wh.ite Copy File Green Copy - Ins,pector Buff Copy Applicant AL
%� 4�
The City of Edmonds Side Sewer Drawing EASEMENT NO. - ......................................... - .
NEW CONSTRUCTION % REPAIRS 0 LID NO - ------------------ ASMT. NO - ------------------
OWNER ----- "-Qt--,ss ------ lt4r - ------------------ CONTRACTOR PERMIT NO.
JOB ADDRESS -2.1.0-0.5 ------- -------- LEGAL DESCRIPTION: LOT NO . ...... 6 --------------------------- BLOCK N ------- f-DM(-)T4DS ---------
(19 --- 9
TREATMENT PLANT
................................................................................................... ----------------------- - .....
NAME OF ADDITION PLAU ------- OS Z- Exe-.P�,- -o.<)r-> --------------------------------------------
P \,AIA:l
I OP
1.5,0p.
8,0P
4:' T.T.
2W
'CUP13 WhAF- I
-Pl 0 1-4 c F- R \pj &,y
Approved:
PWW-0001 -11175 (REV. 11/78)
DATE��.O
.�..198.7... By
I- - - ------------------------
CITY OF EDMONDS
ASSET INFORMATION SHEET
VNEW
1-1 ADDITION
El RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION ZI
7 e 0,V
SERIAL NO.
LOCATION
DE T NO
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
0
*PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE- OF PROJECT
ACCOUNTING ONLY
JXDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO. -
itnp
INITIA
DEPARTMENT FILE
CITY OF EDMONDS BUILD114G.,
250 STH AVENUE NORTH, EDMONDS, `WA 98020 (206) 771-0220
IF
RCW 197-11-970 Determination of Nonsignificance (DNS) "ry
Cz= CITY1
DETERMINATION OF NONSIGNILFICANCE -
Description of proposal: Second -story addition to single family residence totaling approximately 900
square feet, with no change in the footprint of the existing building.
(City of Edmonds Building Plan Check No. 94-85STREETFILE
Proponent: MaryJo and Jeffrey M. Sakoi
Location of proposal, including street address if any: 21005 Pioneer Way, Edmonds, Washington
Lead agency: CITY OF EDMONDS
The lead agency for this proposal has determined that it does not, have a probable significant adverse impact on the
environment. An environmental impact statement is not required under RCW 43.21.030(2)(c). This decision was
made after review of a completed environmental checklist and other information on file with the lead agency. This
information is available to the public on request.
XX There is no comment period for this DNS.
This DNS is issued under 197-11-340(2); the lead agency will not act on this proposal for 15
days from the date below. Comments must be submitted by .1994.
Responsible Official: Jeff
Ley S. Wilson
Positioriffitle: Current Planning Supervisor, Department of Community Services - Planning Division
Phone: 771-0220
Address: City of Edmonds, 250 5th Avenue North, E4mon&, WA 98020
Date: Eb, f-t Signature-.�_��
XX You may appeal this determination to Robe Chave, Planning Manager, at 250 5th Avenue
North, Edmonds, WA 98020, no later than QV Iq 1994, by filing a written appeal
citing the reasons.
You should be prepared to make specific factual objections. Contact Jeffrgy S. Wilson to read or ask about the
procedures for SEPA appeals.
XX Posted on R"�v 1994, at the Edmonds Public Library, Edmonds Community
Services Building, and the Edmonds Post Office.
XX Distribute to "Checked" Agencies on the reverse side of this form, along with a copy of the
Checklist.
Page I of 2
Mailed to the following along with the Environmental Checklist:
xx Department of Ecology
Environmental Review Section
P.O. Box 47703
Olympia, WA 98504-7703
x x Maryjo and Jeffrey, Sakoi i(Applicant)
2 1005 Pioneer Way
Edmonds, WA 98026
xx Ron D. Johnson
19601 23rd Avenue N.W.
Seattle, WA 98177
JEWLI =t5.1 %W
Critical Areas Determination # CA-94-67
Environmental Checklist
PC: Building Plan Check No. 94-85
SEPA Notebook
Robert Chave, Planning Manager
Page 2 of
((PUB fj)IZN/(((DATR))PWA
MEMORANDUM
CITY OF EDMONDS
PLANNING DIVISION
250 STH AVENUE NORTH, EDMONDS, WASHINGTON 98020
TO: BUILDING DEPT. PLAN CHECK NO. 94-85
FROM: Ann Bullis, Code Enforcement Technician.r.\/C1___1
<_Z��
k .
DATE: MAY 2,1994
SUBJECT: ENVIRONMENTAL DETERMINATION FOR A SECOND -STORY
ADDITION FOR A SINGLE FAMILY DWELLING AT 21005 PIONEER
WAY, EDMONDS, WASHINGTON
I have had the opportunity to visit the subject site, review the environmental checklist, and Critical
Areas Determination, a copy of which are filed in the official file for this permit. The proposed
project will not create a significant impact on the environment as the proposed second -story
addition will be constructed within the footprint of the existing building. There is no tree removal
proposed, nor any grading. The project should have an insignificant impact on the racoons and
songbirds noted to be occasionally seen on site.
Based on my review of all available information and adopted policies o f the City, I recommend
that a determination of nonsiznificance, be issued.
Review by Responsible Official:
Iconcur
I do not concur
Comments:
-T/q "k
Jeffirey S. Wilson, AICP Date
Responsible Official
- Attachments
PC: FILE NO. 94-85
Robert Chave, Planning Manager
Page 3 of 2
'y go - 199 -
Purpose of Checklist:
CITY OF EDMONDS REE C
ENVIRONMENTAL CHECKLIST APR2.5 191911
PERNONT 00! tprat-r
The State Environmental Policy Act (SEPA), chapter 43.21C RCW, requires all governmental agencies to consider the
environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be prepared for all
proposals with probable significant adverse impacts on the quality of the environment. The purpose of this checklist is to provide
information to help you and the agency identify impacts from your proposal (and to reduce or avoid impacts from the proposal, if it
can be done) and to help the agency decide whether an EIS is required.
Instructions for Applicants:
This environmental checklist asks you to describe some basic information about your proposal. Governmental agencies use this
checklist to determine whether the environmental impacts of your proposal are significant, requiring preparation of an EIS. Answer
the.questions briefly, with the most precise information known, or give the best description you can.
You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should be able to
Z
answer the questions from your own observations or prqlect plans without the need to hire experts. If you really do not know the
answer, or if a question does not apply to your proposal, write "do not know" or does not apply". complete answers to the
questions now may avoid unnecessary delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer these questions
if you can. If you have problems, the governmental agencies can assist you.
The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on different parcels
of land. Attach any additional information that will help describe your proposal or its environmental effects. The agency to which
you submit this checklist may ask you to explain your answers or provide additional information reasonably related to determining
if there may be signific'ant adverse impact.
Z
Use of checklistfor nonproject proposals:
Complete this checklist for nonprqleci propo%als, even though questions may be answered *does not apply." IN ADDITION,
Z
complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D).
For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as
.proposer," and "affected geographic area," respectively.
A. BACKGROUND
1. Name of proposed'prqiect, if applicable: Jj.J . A
2. Name of applicant: ()Jov1,,J Tr, 4 Tjffrc-k�l MCI -VC- 5-QkC.L'-
3. Address and phone number of applicant and contact person:
CILOW ' 01ONTO i T�Ae,4 M -WCOL' (C--K�1-15�) A Yelti V-J kcil b�Jchnson (5q�.-2?801
I C, Q 9 P 4. P er IkkA "i .23"'-L Ak;CQU-)
4. Date checklist prepared: 4 1119 �
Pa.-e I of 22
C1 IKLT/I 0-25 -93.M ASTER
5. Agency requesting checklist: City of Edmonds.
6. Proposed timing or schedule (including phasing, if applicable):
UfAMN "AMOMIM&F
(STAFF COMMENTS)
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this
proposal? If yes, explain.
06
(STAFF COMMENTS)
8. List any environmental information you know about that has been prepared, or will be prepared, directly
related to this proposal.
H&Ye- Vkak V" Kk-- n-,Ob�WA -x- Gf-fh'Cat arpzct.-'�'
an
(STAFF COMMENTS)
9. Do you know whether, applications are pending for governmental approvals of other proposals directly affecting
the property covered by your proposal? If yes, explain.
"e arn ai-wrp—
(STAFF COMMENTS)
10. List any government approvals or permits that will be needed for your proposal, if known.
(STAFF COMMENTS)
Page 2 of 22
CHKLT11 0-25-93.M ASTER
11. Give brief, complete description of your proposal, including the proposed uses and size of the project and site.
There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You
do not need to repeat those answers on this page.
k)q- (7f& I() a6d a z"- ft� Cis( ty-k JrinQ h�-,foe p f--eCvc
C1. . KCUV�C-�- V, V1
CL cc, 11:5 1 -5 �- c'
(STAFF COMMENTS)
12. Location of the proposal. Give sufficient information for a person to understand the precise location of your
proposed project, including a street address, if any, and section, township, and range, if known. If a proposal
would occur over a range of area, provide range or boundaries of the site(s). Provide legal description, site
plan� vicinity map, and topographic map, if reasonably available. While you should submit any plans required
by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications
related to this checklist.
Our
q P, 6, 21.
(STAFF COMMENTS)
TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description or the site (circle one): Flat, "I hilly, steep slopes, mountainous, other:
ftlo hoe iCk pollfrt_ 40tl5t :s / 't5 fhz hez(.-Ic- 9,4 -1he Vrj -d/-s
-'7nere f-10 Z lin-5 a, rv,- eua U hcult In hin d /hoa
(STAFF COMMENTS)
b. What is the steepest slope on the site (approximate percent slope)? Ltp
(STAFF COMMENTS)
C. What general types of.soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you
know the classification of agricultural soils, specify them and note any prime farmland.
Page 3 of 22
C1 1KLT/1 0-15-93.M ASTER
-67ravd.(H. --5--LndLi iogim
(STAFF COMMENTS)
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
(STAFF COMMENTS)
e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
of rill.
Nona- Ry-opc5q&
-b O'e�� V
(STAFF COMMENTS)
f. Could erosion occur asa result of clearing, construction, or use? If so, generally describe.
K0 dVV'wqqq'C- voi\� ba, -MMe -M Jne- 1&t ek-S a resvl-kv C�
J tj
--'hot-
(STAFF COMMENTS)
g About what percent of the site will be covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
ni cpv-e,(ed
IL tAJM -AOA- 0��(MqR- CIUC- b tkC-
oiLTAsmwJimn. IV,,t o.ufrenk- C'A, -Yy\la�' �)t
hq Ae �Anmo- , HYWe\,,od-U t cykhL*� 30"Zo
P to
(STAFF COMMENTS)
Pap 4 of 22
ClIKU/10-25-91MASTER
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
MOY161- �2yQqo-,Wd (Ai JLQ Vo Ae, -"Okure- 4 �Vt,--Pct
(STAFF COMMENTS)
2. AIR
a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors,
industrial wood smoke) during construction and when the project is completed? If any, generally describe
and give approximate quantities if known.
ej rL- -2yd-
(STAFF COMMENTS)
h. Are there any off -site sources of emissions or odor that may effect your proposal? If so, generally
describe.
(STAFF COMMENTS)
C. Proposed measure; to reduce or control emissiows or other impacts to the, if any:
(STAFF COMMENTS)
3. WATER
a. Surface:
(1) Is there any surface water body on or in the immediate vicinity of the site (including year-round
and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names.
If appropriate, state what stream or river it flows into'.
(STAFF COMMENTS) '
Page S of 22
CIIKLT/10-25-93.MA.STER
(2) Will the prqiect require any work over, in, or adjacent to (within 200 feet) the described waters? If
yes, please describe and attach available plans.
Wo K/A
bnec; ct p1p
(STAFF COMMENTS)
(3) Estimate the amount of rill and dredge material that would be placed in or removed from surface
water or wetlands; and indicate the area of the site that would be affected. Indicate the source of rill
material.
Mone. / N LA
\"bce� -nm-
(STAFF COMMENTS)
(4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
(STAFF COMMENTS)
(5) Does the proposal lie within a 100-yearnoodplain? If so, note location on the site plan.
(STAFF COMMENTS)
(6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the
type of waste and anticipated volume of discharge.
(STAFF COMMENTS)
Pap� 6 of 22
CliKLT/10-25-93.MASTER
b. Ground:
(1) Will ground water he withdrawn, or will water. be discharged to ground water? Give
general description, purpose, and approximate quantities if known.
(STAFF COMMENTS)
(2) Describe waste material that will be discharged into the ground from septic tanks or
other sources, if any (for example: Domestic sewage; industrial, containing the
following chernicalsi...; agricultural; etc.). Describe the general size of the system, the
number of such systems, the number of houses to be served (if applicable), or the
number of animals or humans the system(s) are expected to serve.
we- have- a--Wplaz� .6ml )�j
L
fnyc� tile
(STAFF COMMENTS)
C. Water Runoff (including storm water):
(1) Describe the source or runoff (including storm water) and method or collection and
disposal, ir any (include quantities, ir known). Where will this water flow? Will this
,-%v.tterno,vintot)ther,.v.iter.%? ir.so,descrihe.
No acki0lonal
0-L-k(te-01 'yun-OK dMALS, ip-iatvl f-y-c"rit- 10-r OA&
,'rl tu C, t hi d ra(wq2 gy-a les.
(STAFF COMMENTS)
(2) Could waste materials enter ground or surface water,%? If so, generally describe.
(STAFF COMMENTS)
Pa�-c 7 of 22
CUKU/10-25-93MASTER
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
-wona, pyt�j?�d Akk Ac� -Ae- n\nhual-0- rd- 46. py'ocej
'N
(STAFF COMMENTS)
4. Plants
a. Check or circle types of vegetation found on the site: J(AndsCaKd V\tme-4
deciduous tree:<�� maple, aspen, other: 'jhVaVV.% MLkDk--
evergreen tree:( 311 (ee:da?, pine, other: cLjpj'nL. 4 bjo�--ck
shrubs '�i,olecd -6,Y- lunscapad, �Xny VIA I I —A Lir V�bufflktlm C-4c
1. J,
j
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, hulriLsh, skunk cabbage, other:
water plants: water lily, eelgrass, milfoil, other:
other types of vegetation:
(STAFF COMMENTS)
b. What kind and amount of vegetation will he removed or altered?
�jo n a- - D.0 ry m nvcd b y- a Vi ro �k t--Y\
(STAFF COMMENTS)
C. List threatened or endangered species known to be on or near the site.
(STAFF COMMENTS)
d. Proposed landscaping,. use of native plants, or other materials to preserve or enhance vegetation. on the
site, if any:
Pige 8 of 22
CHKLT/10-25-93.MA.VTER
(STAFF COMMENTS)
5. Animals
W Win, F01110 0
a. Check or circle any birds and animals which have been observed on or near the site or are known to be on
or near the site:
birds: hawk, heron, eagle, 414
�n�ghir other: iuvir"d -tr- E-Afflfms V11 (clMa-Ama.
mammals: deer, bear, elk, beaver, other:
fish:. bass, salmon, trout, herring, shellfish, other:
(STAFF COMMENTS)
b. List my threatened or endangered species known to be on or near the site.
. t'b na-,
(STAFF COMMENTS)
C. Is the site part or a migration route? If so, explain.
tl�o —
MA thIn E C' VY\ I -A I JA
(STAFF COMMENTS)
d. Proposed measures to preserve or enhance wildlife, if any:
. �;nfia -
(STAFF COMMENTS)
6. Energy and Natural Resources
Page 9 of 22
C1 IKLT/ 10-25-93A ASTER
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) ' will be used to meet the completed
project's energy needs? Describe whether it will he used for heating, manufacturing, etc.
Oluryenf- Viaahng �-,. yiniumf qq5 w3k YmcLin naluad
:J
Q-C;OrIC 1(4 UM d- �6y � Lq�t +1 liq i a lk-,
(STAFF COMMENTS)
b. Would your project affect the potential use of solar energy by actiacent properties? If so, generally
describe.
(STAFF COMMENTS)
C. What kinds of energy conservation features are included in the plans of this proposal? List other
proposed me;Lsures to reduce or control energy impact,;, if any:
Meng,
(STAFF COMMENTS)
7. Environmental Health
a. Are there any environmental health hwzrds, including exposure to toxic chemicals, risk of * fire and
explosion, spill, or hayardows waste, that could occur as a result of this proposal? If so describe.
N
(STAFF COMMENTS)
Page 10 of 22
CHKU/10-25-93MASTER
(1) Describe special emergency services that might he required.
(STAFF COMMENTS)
(2) Proposed measures to reduce or control environmental health ha7ards, if any:
(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may af fect your prqject (for example: traffic,
equipment, operation, other)?
(STAFF COMMENTS)
(2) - What types -and levels of noise would he created by or associated with the project on a short-term or
a long-term basis (for example: traffic, construction, operation, other)? Indicate what hours noise
would come from the site.
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(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
(STAFF COMMENTS)
Pige I I ol'22
C1 1K LT/ I 0-25-93A A.vr[:R
8. Land and Shoreline Use
a. What is the current use of the site and a4jacent properties?
(STAFF COMMENTS)
b. Has the site been used for agriculture9 If so, describe.
No nc+- +ha+- T'w) niiyirer�-
(STAFF COM N1 ENTS)
C. Describe any structures on the site.
Our- ex.1st-09 . I&- lsfpw- Y-Omb)Gir 64ackua-
qaocy CL.rd
0
(STAFF COMMENTS)
d. Will any structures he demolished? If so, what?
(STAFF COMMENTS)
e. What is the current YA)ning classification of the site?
(STAFF COMMENTS)
CIIKLT/10-25-93.MASTER
Page 12 of 22
f. What is the current comprehensive plan designation of the site?
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(STAFF COM N1 ENTS)
g. If applicable, what is the current shoreline master plan designation of the site?
- Wof-
--N-0c;e's -Ylp�
(STAFF COMMENTS)
h. Has any part of' the site been classified as -.in "environmentally sensitive" area? If so, specify.
-X9, S 0, 1's t., n k i A 6 i, Q 11 G e CL a : 5 1 z --k V -v "! C', z C, f -, ey.
(STAFF COMMENTS)
i. Approximately how many p6)ple would reside or work in the completed proJect?
-OjMr �C,Y'nl :Z 6�vdks
Hovo fLJ1,i t rA A rA (i (A K, n
(STAFF COMMENTS)
Approximately how many people would the completed pn)Ject displace?
(STAFF COMMENTS)
Pa�-C 13 of 2)
ClIKU110-15-91MASTER
k. Proposed measures to avoid or reduce displacement impacts, if any:
tQ 144
(STAFF COMMENTS)
1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans,
if any:
I&W11 ri = irl &S nL --5jV1q)e— -ktM1JSJ re-5 � CieVVL,
(STAFF COMMENTS)
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
howsing.
ouy hcma— '5& yyi e cas-auy-(ey)A-�.�:( emst'5
(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-
income hotLsing.
(STAFF COMMENTS)
C. Proposed measures to reduce or control hotLsing impacts, if any:
na- 1-� I A
(STAFF COMMENTS)
Pige 14 of22
C1 IKLT/10-25-93.M ASTER
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is the principle
exterior building, material(s) proposed?
04VA4/iQ /q4
Y4 + cve,- +11C ex Ist-aNg
'huQ Y\t-, ?f wc f12 1�� ey VI 'I'cy- �M--, ayvi v�M ll(-,- fl,�nna
J
(STAFF COMMENTS)
b. What views in the immediate vicinity,%vould be altered or obstructed?
. - Mong,
(STAFF COMMENTS)
C. Proposed measures to reduce or control aesthetic impacts, il'any:
Mt-.00. N /A
(STAFF COMMENTS)
If. Light and Glare
a. What type of light or glarewill the proposal produce? What time of day would it mainly occur?
b IA
Ot, e S Y\ L-,r- a
(STAFF COMMENTS)
b. Could light or glare from the finished project be a safety ha7ard or interferewith views?
(STAFF COMMENTS)
Page 15 of 22
CI IK I.T/I 0�25-93. M A.WEIR
C. What existing off -site sources or light or glare may affect your*proposal?
Nona-
Q pal
(STAFF COMMENTS)
d. Proposed measures to reduce or control light and glare impacts, if any:
Nona.
POW
(STAFF COMMENTS)
12. Recreation
a. What designatedand inrornial recreational opport unit iL-; are in the immediate vicinity?
(STAFF COMMENTS)
b. Would the proposed proJect displace any existing recreation uses? If so, describe.
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be
provided by the pro.ject or applicant, il'any:
beCS nnt-'t ckppl�j
(STAFF COMMENTS)
Page 16 of 22
CUKU/10-2.5-91MASTER
13. Historic and Cultural Preservation
a. Are there any places or obJects listed on, or proposed for, national, state, or local preservation registers
known to be on or next to the site9 If so, generally describe.
(STAFF COMMENTS)
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural
importance known to he o*n or next to the site.
-Nonc,
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
Nkmv- h3 1A
(STAFF COMMENTS)
14. Transportation
a. Identify public streets and highways serving the site, and describe proposed access to the existing street
system. Show on site plans, if any.
WQ- k, ;,e- on h6vigar V�hq rad �iovt a I fl� I t
---M,C5 03W ---AL+ dk(AMV �-'-N'yo li�e CarreAi-
a
(STAFF COMMENTS)
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop?
tc� r) iAs S I-o 12
Page 17 of 22
C1 1K LT/1 0-2.5-93. M MaER
(STAFF COMMENTS)
C. How many parking spaces would the completed project have? How many would the project eliminate?
(STAFF COMMENTS)
d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not
including driveivays? If so, generally describe (indicate whether public or private).
No
(STAFF COMMENTS)
e. Will the- project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
KI
(STAFF COMMENTS)
f. How many vehicular trips per day would he generated by the completed project? If known, indicate when
peak volumes would occur.
ce'lf C(AMN &Ux�kk-C4 - 20( 3. No V1 C4 f rOYY\
-J
(STAFF COMMENTS)
Page IS of 22
C1 M LTI 10-25-93. M AS i'17R
g. Proposed measures to reduce or control transportation impacts, if any:-
�40nq_ "18
n6ocs. --Y1C'1rCuMV1
(STAFF COMMENTS)
15. Public Services
a. Would the project result in an increased need for public services (for example: fire protection,. police
protection, health care, schools, other)? If so, generally describe.
No
(STAFF COMMENTS)
b. Proposed measures to reduce or control direct impacts on public services, if any:
t'�Z)Ad 48
(STAFF COM NI ENTS)
16. Utilities
a. Circle s currently available at the site: �l Dtricit , 6 Eat u�jl ivait e �r Ce C—ep --h o n e
septic system, other:
(STAFF COMMENTS)
Pa.-e 19 of 22
OWLT/10-TO3.10ASTER
b. Describe the utilities that are proposed ffir the project, the utility providing the service, and the general
construction activities on the site or in the immediate vicinity which might be needed.
- N6 cha%os im q-< %�i v i'aq i AWWhe-s nairerAq nualb-LL-i -
(STAFF COMMENTS)
C. SIGNATURE
The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them
to make its decision.
Si -nature of Proponent
0
-*- 4 /2 5-ITA -
Date Submitted
K
Page 20 of 22
C1[KLT/10-25-93.MAS-rER J
V
CAFILENO..
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 9i(�-(*-, 0
'Tq 16 0, - 0 (-) 0 - 0 o (0 oc) 8
2. Property Tax Account Number: C)
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? __��_yes; 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.
X 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: f) C, ; Approx- Depth:
7. Site contains areas of seasonal standing water: f) C-1 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 1-\ c floodplain n L of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? n C, Flows are seasonal? — (What tii ne of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,sbrubs etc) e)u tr to
11. Obvious wetland is present on sit e: Y) 0
withiddesi&a Pail
Site desiknk6d 6n the Eji,�
bEirERMINATION"'.-
&AWL.
.. . ..... .
WA-i
'STUDY -REQ1JrRF�D.
CONPITTONAL WAIVER:�*.:.
V1 WAIVER
Re*viewed by
AR
Plarm*er Date
R-0110"4
-890-199-
City of Edmonds
Critical Areas Checklist
'Me 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.
Tbe 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 ftom
observations of the site or data available at
City Han (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 necessaryto 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 (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing thew preliminary
assessment of the site.
I have completed the attached Critica ' I Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill. out the appropriate column below).
Owner I Applicant:
Mar�To A, 24-Hrev
Nam
am5- Pluneer
Street Addrew
Applicant Representative:
,o�oln oroAns-cl? Cae-e 4 / /cc
Nam
-d
AJI
Shvet Ad&=
�5,Z6,elel
99,07-4, 676-1-�53
City, State, ZIP Phone - City, State, ZIP Phone
Date
gigakur� Date Signattme
-------------------
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9rREET FILE
C ITY OF EDMONDS "'ERS--0
E PERMIT
NUMBER C1�9
CONSTRUCTION PERMIT APPLICATION jos
I SUITE!APT a
ADDRESS
OWNER NAME NAME OF BUSINESS
GAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
(nor"I Z-0 A i
ul MAILING ADYHE55
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Appro ved 0
RW Permit Required 0
r
g i Dog %'o ',e e r W 0-
CITY ZIP TELEPHONE NUMBER
EXISTING REOUIRED DEDICATION —
PROPOSED
Street Use Permit Req'd 0
inspection Required 13
Sidewalk Required
cc
W
N. Ai EE�
LINE SIZE
NO. OF FIXTURES
PRV �EOUIRED
,NO
YES�d 9 16
ADDRESS -Z 3 REMARKS
I Cl V) `I,
Z
a:
W
w
cr ZIP TELEPHONE NUMBER
4 CITY
Z
0
Z
NAME
cc ADDRESS
0
ENGINEERING MEMO DATED REVIEWED BY
0 — NE NUMBER
< CITY ZIP TELEPHO
cc
0-
Z 4?q61Z(, 7 -4 L/
REVIEWED BY
FIRE MEMO DATED
W
0 -Edino-nds I(m-6)
DATE
STATE LICENSE NUMBER EXPIRATION
. . I
PR if!�'7-6 0?057
SIGN AREA
DROPOSED
SEPA REVIEW
COMPIETE EXEMPT
AD��
include all easements
ALLOWED
SHOR
Legal Description of Property -
4
Z 0�
EITP�h
I
2
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VARIANC
(�P)NJW.BY
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ezy
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LOT Of RAP(V
0/n
Z
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FRONT
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Z
4
Property
Tax Account _+4 80 - 000 - 00(c - ows
Parcel No.
Pul
Li
NEW
L0 RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
APT.BLDG.
SIGN
KIJI.REMODEL
GRADING
FENCE
FT)
CY
EIREPAIR — DS
( X_
WOODSTOVE
DDEIVIOLISH
SWIM POOL
INSERT
HOT TUB/SPA
GARAGE RETAINING WALL/
RENEWAL
CARPORT ROCKERY
TTYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
(e5j a 0 r% k I' at
NUMBER
CRITICAL
OF'
AREAS
STORIES
NUMBE R
DESCRIBE WORK TO BE DONE (ATTACH ILV I -PLAN)
A,z�, 2 141 rij ti f 5.4,
u), th
1 6 /5t i(,vel_
PE OF 5THUQIIY
,HECKED BY ITY N 01!21
I , , 27 L 9�;�
SPECIAL INSPECTOR OCCUPANT
REQUIRED 13 1 X' LOAD
PROGRESS INSPECTIONS PERUBC 305
FINAL INSPECTION REQUIRED
fflpfflmfflm� VALUATION
PLAN CHECK FEE
BUILDING
I'a
37/
HEAT SOURCE: GLAZING %
f) Reg)
Plan Check No. t
94
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewEllks
drivgways, marquees, etc.) will require separate permissio�.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENG, INSPECTION FEE
11 Applicant, on behalf of his or her spouse, heirs, assigns and
see�
S U ccessors in interest, agrees to indemnify, defend and hold
Lv' harmless the City of Edmonds, Washington, its officials,
JJ
S employees, and agents from any and all claims for damages of
cc whatever nature, arising directly or indirectly from the Issuance
4 not be deemed to
Issuance of this permit shall
PLAN CHECK DEPOSIT
of this permit.
modify, waive or reduce any ri equirement of any city ordinance
0
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
.provision."
mo��
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLiCATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
tion Insurance and RCW 18.27
INSPECTION
DEPARTMENT
OF it IA $1 NATURE DATE
SIGNATURE (OWryER OR AGENT) DATt: SIGNED
� 511t
CITY OF
EDMONDS
CALL FOR
ELEA DATE
7,
ATTffNT10N
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
� ORIGINAL — File YELLOW — Inspector
UNTIL A
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK — Owner GOLD — AssesVr
CHAPTER 3.
PRWECT 1071EW
PRa=P NI�Wt Pra7wr ADDRtSS:
AM
APPLICAT IPT DATE I
-Reviewed by:
(ifiitial/daFe-)
COMA�2m PLANNING WTR/SWR I
STREET
ENGNRNG
-fl-R-E BUILDING [777/7777
//T///77//
SINGLE FAMILY/MULTIPLE/W&ERCIAL (Circle One) ////// ///////// /////////
1 -�-i
S %am
7T/7-1///
////////
VARIANCE/SETBACK ADJ.
.77T7TR77-1117111
TRI111111
-
CONDITIONAL USE PERMIT
TfM7111
////7777
/F/-/-/-//-/77
.:ADB R=REM1MS CHEImm
MW ZONING REQUIREMENTS
7T/Tff
-T-3
ENVIRONMENTAL FEATURES
7
/P
6
777177
ACCESS SLOPE & VEHICLE ACCESS
r
DRhn#= PLAN (On Sitei
'77FIT-UT111117
P711111
7
//////. /////////
////////
STREET FILE
/////// 777717,777-17TT71-7
LEGAL DESCRIPTION V
1IN11111 -111117TITTrIT1711
QUIT CXAIM/DEDICATICNS /97
1111IT77TF1777T
10
EASEMENT - PUBLIC/PRIVATE
11
qMGMTE SEWER Ca4NECTION IF LID#
12
111117TI77TIT7171
PLAT/SUBDIVISICN REQUIREMENTS
13
RIGffr-OF-WAY CONSTRUCTION PERMIT REOD
P0
14
7777777TI-WIl
BOND REQD FOR PUBLIC IMPROVEKDM A0,0�� ////// /////////
7TT77777
7777777
15
SOILS CONDITIMS & GROUND 7T7Tff 7777777T
////// ///////// /////////
/ 111Uh
16
WATER FIETD CHECKED
71RII
STREET PAVING REQUIRED //////
7.77774
-,A1;fr
-77^
TFITITTR7
17
CURB AND GUTTER REQUIRED
7T17T777-
18
SIDEWALK REQUIRED -7
19
I / 7 7 7 7 7 TTF17TIT Tff ff 77 77
CURB CUr MR DRIVEWAY RMD
7TT17=
20
7TR11111
21
STREET NAME SIGN REQD
777T/7
7711//////
OTHER SIGNING REOD
22
SIDE SEWER AVAILABILITY
7 7 T1 TM
TF1 TT=
23
24
EaSTING WATER MAIN SIZE
777T/////
7777TI1111
25
WATER METER SIZE
VRTI/ 77TI7777
SERVICE LINE SIZE 7/777777
26
/////////
27
HYDRANT REQUIRED
771,171 7TI-111111
////// /////////
28
qr SIZE M(ISTING
777777 77TRIIII
7TFfMT
7M 7 7 7 7 7 7
CROSS CONNECTION INSPECTION REM
TTF1-1 7797
29
30
WATER METER CHARGE REM 77f[/////
77TMI171
FIRE LINE CHARGE REM SPRrNKLER /////////
1////////
//////////131
W/W//
/////////
32
STRELV CUP
T17711111
171711
OPEN DITCH EXISTING
7TrT=
33
34
REOD
V1711
CULVERT PBQD
TMR77 71///////
35
SIZE
777711111 7TM7111
36
777T/T
CATCH BASIN REOD Wfl/Mg
7T[TTF7T 7r/T=
37
-
11MICATED ON SITE PLAN ......................
.. .
38
Sf�UR FDIA��= �P"� HUMMON
39
SHALE OPEN RUNOFF
-ITF177TF
40
��ZREV333= By:
ING MaR. ----§TG-IMRING PUBLIC
PLANN MGR
WORKS MG4.
wk
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
ea(o o6S Ne's V1 Q,
MAILING ADDRE S
-7 z.,)
CITY TELEPHONq NUMBER
1Se_&tGe_ 779--2-30
NAME �� U VA
70DRESS
� � (, 0
CITY TTELEPHONE NUMBER
�Se ��44 u a-a-Ve
NAME
�S eA�,) Z) 6
ADD13 S
7 ��s , -,�-
CITY TELEPHONE NUMBER
Se.c_#(e- 1 7-�:i;-734,j
STATE LICENSE NUMBER
A:�; 6 C_D
Legal Description of Property - Include all easements
(show below or attach four copies)
NEW
RESIDENTIAL
PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
1:1 REPAIR
El RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
El OR FILL
FENCE
( x-FT)
PRE -MOVE INSPJ
SWIM
REMODEL
COMPLIANCE INSP.
POOL
WOOD STOV6
INSERT APT.BLDG
El RENEWAL
5 NUMBER OF STORIES NUMBER OF
DWELLING
1UNITS
NATURE OF WO KTO EDO E(ATTC
11 N A H PLOT PLAN)
W L
e-S &I -e-Al-T I
USE 'qIWPERMIT
ZONE 67
,/ NUMBER
JOB
ADDRESS QjCC,5 ep
6) 1 Z—&l
-.00,
PUBLIC RIGHT6FUY PER OFFICIAL STREET MAP.
EX REOUIREDDEDICATfON
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED toe'00"
STREET USE PERMIT REQUIRED 0
SEJA�ERINGAEMO DATED
RQJARKS
if
METER SIZE BUltDLOG SUPPLY SIZE FIXTURE UNITS
REMARKS
SIGN AR EA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT I SHORELINE#
VARIANCE OR CU IPLANNING REVIEW BY r
YARDS HEIGHJ I LOT COVEOFAGE
'7 -' I
FROM __5 ' SIDr7-' � rAR lzs
CHECKED By ITYPE OF CONSTRUCTION
REQUIRED
0 YES 0 NO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Perm * It covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
_�ermit
STATESURCHARGE
Application: 180 Days
ENERGY CODE
Permit Limit: I Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
,n successors In interest, agrees to Indemnity, defend and hold
funj harmless the City of Edmonds, Washington, its officials,
m employees,.and agents from any and all claims for damages of
< whatever nature, arising directly or Indirectly from the Issuance
X of this permit. Issuance of. this permit shall not be deemed to
PLAN CHECK DEPOSIT
a modify,. waive or reduce any requirement of any city ordinance
0
nor limit 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 In5u.rance..
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
SIG OURE WN ZROFQ�"
�;Vo 14 �j
DATE SIGNED
—� k, / I
OKI
GROUP
VALUATION
E-11
FEE
HEIGHT
OCCUPANT
LOAD
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged In space provided.
OFFICIAL'S SIGNATURE DATE
771-3202 RELEASED BY: DATE
ATTENTIQV�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEWMADE AND APPROVAL (DR JU[. ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 8 RECID
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78
cr
LU
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Z
0
Z
LU
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Uj
3:
0
Z
Z
Z
5
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July 24, 1986
mEMO TO: Building Division
FROM: Engineering Division
SUBJECT:
After review of the subject building permit application, we have the
following c=ents:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope.not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 1 0 foot minimum.
7) Builder/owner responsible for containing all temporary runoff and
erosion on site and may not impact neighboring properties.in any
I
BLDGREVW/T=RMS
,q
do
EN
Al v
.............
EWA'
HEj( o�iT