21104 SHELL VALLEY RD.PDF11111111111111
13042
21104 SHELL
VALLEY RD
ADDRESS: 21 fi%/ is 0
- I .
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):_
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: (ff-- 76 �,� - DETERMINATION: []Conditional Waiver El Study Required J(Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
I
PLANNING DATA CHECKLIST DATED: '-
SCALED PLOT PLAN DATED: fq
SEWER LID FEE $: LID #:
SHORTPLAT
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATEI
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT:
BLOCK:
LATEMP\DS'Ps\Fomis\Street File Checklist.doc
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fon-ation gi%en is correct; and that i ..Ti the own Zate TION APPROVAL
owner. I aFe, to com
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�,ork authorized thereby, T
I his
01ibe employee. in vit:10'nn of the Labor Code of th� State of W"iingt,in THIS �EIIM" I
AUTHO91ZES until signed bythe Building Official or
relat,itz to Nvo-,kmen': C:o.npe7!s3tiar% Insurance. fees are paid, and
rr�cen,fW,10L�I'IONS and FIL, ONLY THE j-,;.,,.Dep.uty', and
NC)'(E: '—Ormit L11h:' Otte Yodr"7- rec ipt is acknowledged in space pro -
it condi-i 3nal us, perinr ;om leted in 90 WORK NOTED
vi d, ---A-
PERMITS vithOu in si. months.) sSt .
INSPECT—- TUPE
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DEPART
CITY OF
EDMC`NDS
775-2525
2YOTE: APP.`iC(Tr ��.,biccr to ph�4 Oteck 1,
ONLY. ORIGINAL - File YELLOW - Inspector
ca'lcr- v'-'J'k tv be dare or, mri'MA GTOPG"'
�nstruction on tir, i;uh!;c (t,,c*, �idei erivaN,.ys, GOLD - Assessor PINK Owner
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CA FILE IVO.
C*ical Areas Checklist 0
UP
Site Information (soil s/topography/hydro I o gy/v e getati on)
I. Site Address/Location:,��/oq-S/,/,�e/- ��"Y mlwav-,-
A
2. Property Tax Account Number: -000 -- e)3J-4100 9
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? V�_ yes; _ no.
If yes; how is site developed? _16�2m J�-_
5. Describe the general site topography. Check all that apply.
v---- Flat: less than 5-feet elevation change over entire site.
R
7
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
I 0-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):
Site contains areas of year-round standing water: llj��) ; Approx. Depth:
Site contains areas of seasonal standing water: AIZ) ;Approx. Depth: _
' What season(s) of the year?
8. Site is in the floodway �/p floodplain_ of a water course.
Z
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 ;rnixed
urban landscaped (lawn,shrubs etc) I,-'
11. Obvious wetland is present on site: -1&0
----------------------
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OETERMIN I A . TiON .
^ca_chk.doc; Rev 10/03/97
RECEIVED
AU6
City of Edmonds COMMUNITY SEAVICE�
BMW,
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
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 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 column below).
Owner/Applicant:
.5
1, , �,,) / A & 1- 5- L- W, A 97,r/-
Name
Street Address
Z��.OAIW '91TAR 40
City State Zip
4+12-5- ;)1-1:11f-lp;�5-
Telephone
Signature
8 // /Y�-
Date
c:rcception\jana\cac1.doc
Applicant Representative:
Name
Street Address
city State
Telephone
Signature
Date
Zip
(over)
0 0
PLANNING DAT
NAME:,�=v V
SITE ADDRESS:- c�-/M/N
ZONING: &- PLAN CHK#:
PROJECT DESCRIPTION:
CORNERLO (Yes/No) FLAG LOT .(Yes/No)
SETBACKS:
Required Setbacks: 0 //
Front:�7S Left Side:--7'/,p "' Right Side: Rear:
Actual Setbacks:
Front: - 1W Lewilele:- /0 Right Side: —Rear:-45'
Street map che�ked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed: ISOM 64Actual: 122Z� 46 5)
1 ,
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
An - q6-Z�&
CRITICAL AREAS #: L4
SEPA DETERMINATION:
LOT AREA:
OTHER:
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PR a , �Aawv%ll
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DEVELOpMENT SERVICES CYR-
CITY OF EDMONDS
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3T& OIL co- 16.5d
In STANDARD OIL CO EASEMENT A F N 1062266
EASEMINT2
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DEVELOPMENT SERVIC13 CTR.
CITY OF EDMSNDS
24 16.48' 19 N 6904414" W
2 5 V*32 0
ICOMMUNiTY ?.I.RK
10* ST00tv SIEWE't
EASEMENT
ectlair the
APPLICATION
The City of Edmonds for EASEMENT NO . ............................ ---------------
SIDE SEWER PERMIT
NEW CONSTRUCTION E REPAIRS E] LID NO - ------------------ - ASMT. NO - ------------------
OWNER ..... F-=t--, -- --------- A�4c ------------------------------- CONTRACTOR ---- ...... --------------- PERMIT NO.
JOB ADDRESS LEGAL DESCRIPTION: LOT NO . .......... --E��A -------------------- BLOCK NO - ------------------------------------
NAME OF ADDITION ........ - -------- .... =w .... 2 ---------
Approved-
.............
DATE . ..... c22 By '4�� . ............... �-41 ...... va
----------
PERMIT
covering any portion of the cOnstruction.N
call 1115-2525 for Bide sewer inspections RF'FORO liday ingpeetions.1
(Inspection will be provided within 24 hours after requat. No Set., Sun., Or 110
ADDREM L"A"ON OF CON19TRUCVON ......... .
pRopjaTy LWAL DESCBM"ON ---------------
40C
. .................. I ............ ............. - ---------
........... . .................. . ...... . .......... . .......... -4*;a-"Z7 .............
..........
... OWNER AND/OR BU"ER- ... .. ................... . ......................
----------- ..... . ...................... . ...... .
---------- *-"- ta NAME a ...... sewer t' *0 my awtary sawor
or COMMetion of
for repeAr and/
_,Lgdon Is granted ---------- Of ordixualcm
"%tan in seeordance W-4 rty line. A licensed Bid* Sewer contractor ,.at he employed to 0081shVat
ATTEIMON IS CAWZD To TEjE FOLLOWING: 1. Permit to construct sewer inside PrOW lengineer's Office.
r , of the property may obtain I rtion of sewer before it he"s been 'n'hmet&d* nable from the city
2400 , No. I —The OW11's] in street arelL. Do not cover any PO Mbt-Of-VV-y Permit ObW
side sewer ires an Invasion of g side sewer$ when YOU get P02"It- grade of 2%. NO hands in *"0*
jWrE No. 2—All work Performed in city right-of-W&Y requ 1.16.030 and Regulations govern'n' minlinum
information regarding Ordinance I coverage at property line and 12 ,,beg inside Property Hue-, . reponstwe for failure due to 1100010-
No' '—ObW' full wer must have at least 30 inches Itton. Contract_ shall be
No. 4.-Top of side se street restored to Original cond -
aha�per than % will be Pe Water settled and surface of W." or a. www---- --P, td 0
NOTE No. 5,-Trencheli in street must be one Year of completion. for in the permit or to do any work on' the M&tu
Wor)L which may develop Within is provided
-T+ in unlawful to alter or do any Other work tha'n
"rt the pipe
MAPPROVED 0 Data.— ------- — ........ By ----------------
APPROVED 0 Date—. './z ..... 72�� ................. 311y
A Bamwks: ....... .........................................
I ...............................
BY---------------- DzU ------- - -- --- --- ------- — ------ by ---------- ---
r-,PPniiest For InsPer3tiOn
--. ??3A(I(IA aOL
'10 .................................. . 9 ConSTXUFZUUIL X---
..... .....................
BY owner of Firm Performin
BOTIJ Permit Copies KU Be Sign on construc
'ted under tbis permit
certify that the side sewer installati
hereby
. ... ....................................
-T&n� tin' ' Performing Construction the City of Edmonds*
--- ----------- ---- ...........
was h1stalled in icecOrdance with all Overning ordinances of Dated . ........ .. . .. . ........... day Of - — -- r-1. --*"' other 19 .........
r.w— ut
YOU dig for: Water 0, C
0, TIPho" 0,
Cbeck BEFORE
............
I
APPLICATION
The City. of Edmonds for EASEMENT NO - ---------------------------- ...............
SIDE SEWER PERMIT
NEW CONSTRUCTION El REPAIRS F� LID NO - ------------------ - ASMT. NO . ..................
--------- ------------------------------------------- PERMIT NO. -602��
OWNER vi Tere%�, /-,Dn.c
. .......................... ......... .... ............................................... CONTRACTOR ---- n---
I
2 // 0 /
JOB ADDRESS ------------------------------------------------------ /- e- r -------- -------------------- LEGAL DESCRIPTION: LOT NO. ..q/ ------------------------------ BLOCK NO - ------------------------------------
..................................................................................................................................................................
NAMEOF ADDITION .......................................................................................................................
Approved:
DATE__/ 3 21-gez,�
...........................
...... By ...................................... ............ i iyyg
Asw� -^�,
tll'�-I—
bEq1NL'5-,- L-Q.T-3-L
lq#4
211,oq
s "rr%
E
1 m i: I 1--fLE
. . . . ......
. of EDAf
AM (!I Y OF EDMONL4?S
ENVIRONMENTAL CHECKLIST
St.
Purpose of Checklist.
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.
Instructionsfor 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, yo!i should be able to answer
the questions from your own observations or project 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 significant adverse impact.
Use of checklistfor nonproject proposals:
Complete this checklist for nonproject proposals, even though questions may be answered "does not apply." IN ADDITION,
complete the SUPPLENIENTAL SHEET FOR NONPROJECT ACTIONS (part D).
For nonproject actions, the references in the checklist to the words "project,11 "applicant," and "property or site" should be read as
"proposer," and "affected geographic area," respectively.
A. BACKGROUND
1. Name of proposed project, if applicable: 7-Q XS" 19/-- C-*-,(I-<-;-JAJ6
-.460-s�
2. Name of applicant:
3. Address and phone number of applicant and contact person:
CHXLT.D0C%1-N0V-93 Page 1 of 24
MAMR%PEA
4. Date checklist prepared: __±
5. Agency requesting checklist:
of Edmonds.
6. Pro"sed timing or schedule (including phasing, if applicable):
(STAFF COMMENTS)
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this
prqposal? If yes, explain.
(STAFF COMMENTS)
S. List any environmental -information you know about that has been prepared, or will be prepared, directly related
to this proposal.
(STAFF COMMENTS)_ �CM& *-9IDZV=H Aj 7V
�Aj
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.
(STAFF COMMENTS) UA
Page 2 of 24
CHUT.D001-NOV-93
MASnIMPEA
0
I-
66-1
10. List any government approvals or permits that will be needed for your proposal, if known.
11.
(STAFF COMMENTS)
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 paze.
(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. , 'MI A I
(STAFF COMMENTS)
Page 3 of 24
CfflMT.D=I-N0V-93
MASMR\SPEA
TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one)(5)olling, hilly, steep slopes, mountainous, other:
(STAFF COMMENTS)
b. What is the steepest slope on the site (approximate percent slope)?
-.44
(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.
f zt-'6156 - go I I, -
(STAFF COMMENTS)
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe.
(STAFF COMMENTS)
Page 4 of 24
CHUT.DMI-NOV-93
MASMMSPEA
e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source
Of fill.
(STAFF COMMENTS)
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
(STAFF COMMENTS)
g. About what percent of the site will be covered with impervious surfaces after project construction (for
example, asphalt or buildings)?
OF
(STAFF COMMENTS)
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
(STAFF COMMENTS)
2. AER
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.
(STAFF COMMENTS)
Page 5 of 24
CHUTMOLU-NOV-93
MASMSPRA
b. Are there any off -site sources of emissions or odor that may effect your proposal? If so, generally describe.
(STAFF COMMENTS)
C. Proposed measures to reduce or control emissions or other impacts to the, if any:
(STAFF COMMENTS) N 114
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)
(2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If
yes, please describe and attach av"able plans.
(STAFF COMMENTS)
(3) Estimate the amount of fill 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.
(STAFF COMMENTS)
Pap 6 of 24
CHKLT-DOMI-NOV-93
MASMR\SPEA
(4) Will the proposal require surface water withdrawals or diversions? Give general description,
purpose, and approximate quantities if known.
(STAFF COMMENTS)
(5) D oes the proposal lie within a 100-year floodplain? 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)
b. Ground:
(1) Will ground water be withdrawn, or will water be discharged to ground water? Give
general description, purpose, and approximate quantities if known.
(STAFF COMMENTS)
Page 7 of 24
CHKLMDOCU-NOV-93
MASrEMPEA
(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 chemicals ... ; 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.
(STAFF COMMENTS)
C. Water Runoff (including storm water):
(1) Describe the source of runoff (including storm water) and method of collection and
disposal, if any (include quantities, if known). Where will this water flow? Will this
water flow into other waters? If so, describe.
aAWA-f1m6
(STAFF COMMENTS)
(2) Could waste materials enter ground or surface waters? If so, generally describe.
(STAFF COMMENTS)
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any:
(STAFF COMMENTS)
Page 8 of 24
CHXLT.D=I-NOV-93
MASTEMSPEA
0
4. Plants
a. Check or circle types of vegetation found on the site:
deciduous tree: alder, maple, aspen, other:
evergreen tree: fir, cedar, pine, other:
shrubs
V-' grass
— pasture
— crop or grain
wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other:
— water plants: water lily, eelgrass, milfoil, other:
other types of vegetation:
(STAFF COMMENTS)
b. What kind and amount of vegetation will be removed or altered?
AZI �? -
(STAFF COMMENTS)
C. List threatened or endangered species known to be on or near the site.
(STAFF COMMENTS)
Page 9 of 24
CHKLT.DWI-NOV-93
MASMNSPEA
0 0
d.
Proposed landscaping, use of native plants, or other materials to preserve or enhance vegetation on the
site, if any:
(STAFF COMMENTS)
5. Animals
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:
v-**'— K'b'irds- hawk, heron, eagle, songbirds, other:
mammals: deer, bear, elk, beaver, other:
fish: bass, salmon, trout, herring, shellfish, other:
(STAFF COMMENTS)
b. List any threatened or endangered species known to be on or near the site.
(STAFF COMMENTS)
C. Is the site part of a migration route? If so, explain.
(STAFF COMMENTS)
Page 10 of 24
CHKLT.D=I-NOV-93
MASTERWEA
d. Proposed measures to preserve or enhance wildlife, if any:
AI�4y
(STAFF COMMENTS)
6. Energy and Natural Resources
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 be used for heating, manufacturing, etc.
(STAFF COMMENTS)
b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally
describe.
/V0
(STAFF COMMENTS)
C. What kinds of energy conservation features are included in the plans of this proposal? List other proposed
measures to reduce or control energy impacts, if any:
(STAFF COMMENTS)
Page I I of 24
CHUTMOCNI-NOV-93
MASMR%SPFA
0
4D
7. Environmental Health
a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and
explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so describe.
fl/
(STAFF COMMENTS)
(1) Describe special emergency services that might be required.
Alt) A) V
(STAFF COMMENTS)
(2) Proposed measures to reduce or control environmental health hazards, if any:
(STAFF COMMENTS)
b. Noise
(1) What types of noise exist in the area which may affect your project (for example: traffic,
equipment, operation, other)?
'�)O') E,
(STAFF COMMENTS)
Page 12 of 24
CHUTDC01-NOV-93
MASTEMPEA
0
(2) What types and levels of noise would be 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.
(STAFF COMMENTS)
(3) Proposed measures to reduce or control noise impacts, if any:
(STAFF COMMENTS)
8. Land and Shoreline Use
a. What is the current use of the site and adjacent properties?
b.
4L15_ 140 6AC-61
(STAFF COMMENTS)
Has the site been used for agriculture? If so, describe.
A/0
(STAFF COMMENTS)
CHUT.DOLM-NOV-93
MASIMSPEA
Page 13 of 24
C. Describe any structures on the site.
(STAFF COMMENTS)
d. Will any structures be demolished? If so, what?
(STAFF COMMENTS)
e. What is the current zoning classification of the site?
-5
(STAFF COMMENTS) ay"
__j��2Z
f. What is the current comprehensive plan designation of the site?
9�
(STAFF COMMENTS)
If applicable, what is the current shoreline master plan designation of the site?
(STAFF COMMENTS)
Page 14 of 24
CHKLT.DCC\I-NOV-93
MASTERWRA
0
h. Has any part of the site been classified as an it environmentally sensitive" area? If so, specify.
L
Approximateq now many people would reside or work in the completed project?
/A/ Mi /"'r
(STAFF COMMENTS)
j. Approximately how many people would the completed project displace?
(STAFF COMMENTS)
k. Proposed measures to avoid or reduce displacement impacts, if any:
/,///f
(STAFF COMMENTS)
1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if
any:
-7-D
(STAFF COMMENTS)
CHKLT.DCCI-NOV-93 Pap 15 of24
MASTERWEA
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income
housing.
,�Oye
(STAFF COMMENTS)
b. Approximately how many units, if any would be eliminated? Indicate whether high, middle, or low-
income housing.
(STAFF COMMENTS)
C. Proposed measures to reduce or control housing impacts, if any:
(STAFF COMMENTS)
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?
(STAFF COMMENTS)
Page 16 of 24
CHUT.D001-NOV-93
MASTERWEA
b. What views in the immediate vicinity would be altered or obstructed?
A/ 0/JZ—
(STAFF COMMENTS)
C. Proposed measures to reduce or control aesthetic impacts, if any:
(STAFF COMMENTS)
11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would it mainly occur?
A*
(STAFF COMMENTS)
b. Could light or glare from the finished project be a safety hazard or interfere with views?
AD
(STAFF COMMENTS)
C. What existing off -site sources of light or glare may affect your proposal?
(STAFF COMMENTS)
Page 17 of 24
CHKLTZMI-NOV-93
MASTERWEA
0 0
d. Proposed measures to reduce or control light and glare impacts, if any:
A1119
(STAFF COMMENTS)
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
A
(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 project or applicant, if any:
(STAFF COMMENTS)
Page 18 of 24
CHKLT.D=I-NOV-93
MASrERNSPEA
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 site? If so, generally describe.
YQ62 7- A 00
(STAFF COMMENTS)
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural
importance known to be on or next to the site.
(STAFF COMMENTS)
C. Proposed measures to reduce or control impacts, if any:
(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.
10Zd A/
(STAFF COMMENTS)
CHUTDWI-NOV-93 Page 19 of 24
MAM'ER\SPFA
0 0
b. Is site currently served by public transit? If no, what is the approximate distance to the nearest transit
stop? AJ 119
(STAFF COMMENTS)
C. How many parking spaces wou ld the completed project have? How many would the project eliminate?
Allh
(STAFF COMMENTS)
d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not
including driveways? If so, generally describe (indicate whether public or private).
Z2
(STAFF COMMENTS)
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so,
generally describe.
(STAFF COMMENTS)
Page 20 of 24
CHUT.DMI-NOV-93
MASMR\SPEA
f. How many vehicular trips per day would be generated by the completed project? If known, indicate when
peak volumes would occur.
(STAFF COMMENTS)
g. Proposed measures to reduce or control transportation impacts, if any:
(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.
(STAFF COMMENTS)
b. Proposed measures to reduce or control direct impacts on public services, if any:
(STAFF COMMENTS)
Page 21 of 24
CHXLT.D=I-NOV-93
MAVEMPEA
16. Utilities
a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone,
sanitary sewer, septic system, other:
(STAFF COMMENTS)
b. Describe the utilities that are proposed for the project, the utility providing the service, and the general
construction activities on the site or in the immediate vicinity which might be needed.
(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.
Signature of Proponent Date Submitted
Page 22 of 24
CHUTDC01-NOV-93
MASMMSPEA
vr- EDA,, 0
CITY OF EDMONDS
121 STH AVENUE NORTH, EDMONDS, WA 98020 (425) 771-0220
RCW 197-11-970 Determination of Nonsignificance (DNS)
DETERMINATION OF NONSIGNIFICANCE
Description of proposal: Construction of a new deck on property designated Environmentally Sensitive. Site
address 21104 Shell Valley Road, Edmonds. The property is zoned Single Family Residential —RS- (City of
Edmonds Plan Check-99-112).
Proponent: Leona Stein
21104 Shell Valley Road
Edmonds, WA 98026
Location of proposal, including street address if any: 21104 Shell Valley Road, Edmonds
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 14 days from
the date below. Comments must be submitted by:
Responsible Official: Jeffrey S. Wilson
Position/Title: Planning Supervisor, Department of Development Services - Planning Division
Phone: (425) 771-0220
Address: City of Edmonds, 121 5th Avenue North, Edmonds, WA 98020
Date: d (0? ?
xx You may appeal this determination to Robert Chave, Planning Manager, at 121 5th Avenue North,
Edmonds, WA 98020, no later than t4 nP '2— , 1999, by filing a written appeal citing the
reasons.
You should be prepared to make specific factual objections. Contact Jeffrey S. Wilson to read or ask about the
procedures for SEPA appeals.
xx Posted on -to a 1999, at the Edmonds Public Library, Edmonds Community Services
Building, and the Ed6nds Post Office.
xx Distribute to "Checked" Agencies on the reverse side of this form, along with a copy of the Checklist.
Mailed to the following along with the Environmental Checklist:
Page I of 2
PLCK 99-112.DNS.DOC
5/18/99.SEPA
0 a
XX Environmental Review Section P.O. Box 47703
Department of Ecology Olympia, WA 98504-7703
Attachments
pc: Plan Check 99-112
SEPA Notebook
Page 2 of 2
PLCK 99-112,DNS.DOC
5/18/99.SEPA
I N-q%%s Vicinity Map
Leona Stein
21104 Shell Valley Road
&Z71)
Attachment 1
0
S4e,LL �41LL67 /
. Ro,
AL
Ty
rp
Az
jjK%v C. -i
t;7
Ion
DEVELOPMENT S ERVICES CTfl-
CiTy OF EDMONDS
%�Y -21
0 0
0 V ED Af 0
Al �p
Date:
To:
From:
Via:
MEMORANDUM
May 18, 1999
21104 Shell Valley Road / Plan Check-99-112
Karissa Kawamoto, Planner
Jeffrey S. Wilson, Responsible Official
Subject: ENVIRONMENTAL DETERMINATION FOR A PROPOSED
DECK ADDITION ON A LOT DESIGNATED
ENVIRONMENTALLY SENSITIVE.
I have visited the subject site and reviewed both the building permit appiciation and
environmental checklist.
Based on my review of all available information and adopted policies of the City, I
recommend that an environmental determination of nonsignificance be issued for the
project.
Review by Responsible Official
I concur:
I do not concur:
Comments:
Je Kfrev S. Wilson Date
pc: Plan Check 99-112
City of Edmonds ca Planning Division
PLCK 99-112.SEPA.DOC
05/18/99.
PUBLIC WORKS DEPARTMENT' CHEY&ST
BUILDING PERMIT REVIEV
ST FT FILE 004PA(- 1-3 /- 7,:
2liz-1 %IL�Ik* e%o 12141/7,
(address) (date)
Street Right -of -Way Exist
__RE QD
Z
Access Easemmts Existing!!:�
I;EQ N tA—
"
p4
Utility Easement Existing
_
REQD
Lot Per Subdivision Plat
Assessor
Site Plan Checked for Accuracy
Underground 14iring Reqd.
Check Accuracy of Legal Description
-7
Z
Review by
Date
Existing Water Main Size
Water 14ain Required
Service Line Required 3;.Z
Hydrant Size Exist:*,-ng_
P4
Hydrant Reqd Per Fire Code
Size
Detector Check 116ter Reqd.
Cross Connection Inspection
Fire Departw-mt Conments
Water �hter Charge Reqd.'
Review by tZf,2������Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availabili<��_,e Proj.
Drawing No.
File No. 41200 eG:��
Side Sewer Availability 7P
Sanitary Sewer Connection Fee Reqd.
�3:
Review by
Date
Open Ditch Existing___,64eZ_-
Reqd.
Culvert Reqd. ��g_
-Size
F4
Catch Basin Reqd. &M4_
Indicate on Site Plan
0
Shoulder drainage maintain collection
on swale open runoff
1,tmhole reqd.
Indicate an Site Plan
Soil Conditions and Ground Water Field Checked
Review by�
Date
Revised: 1vl0-1977
Of
2 CARIGARAGE
DRIVEWAY
PRIVATE RD.
E.D *
0
3
OPPER >_
L-Li
3/ L.Li
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS WATERLINE NO,
21104 SHELL VALLEY ROAD 2001-0478
CONTRACTOR HOMEOWNER SCALE
UNKNOWN STEIN NTS
DATE INSPECTED INSPECTED BY DATE DRAWN DRAWN BY
6/21/01 UNKNOWN 7/5/06 J. BRONDER