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21110 PIONEER
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CITY of EDMONDS
For Inspection Call 771-3202
Address of Construction:
S 10 E
ST
FILE
S E-W E R PERMIT
PERMIT NO.
EDMONDS
Property Legal Descripti'on (Include all easements): X,
Owner and/or Builder: /2e- Js ttr,"w _S X,4� 'Zt�' to C -'74'
Contractor & License No: 4.:--
Single Family Residence
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No '-A/ Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-80,0-424-5555) 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 cer4tify that 1-have read and shall comply Nate
with the items listed on the back.
Permit Fee: issued By: /V"
Trunk Charge: Date -Issued:
Assessment Fee: Receipt No.:
Partial. Inspection:
Comments
Final Inspection Approved:
Rejected:
eason
SP. B!J Date Initial
HOLLAND
Date Initial
PERMIT MUST B.E POSTED ON JOB SITE
Wh.ite Copy File Green Copy - Inspector
Date —5—itial
Buff Copy - Applicant
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS Fj LID NO - ------------------ ASMT. NO - ------------------
OWNER ..... -------- -E -- �� r\cx- -------------- PERMIT NO. .76�25
CONTRACTOR
EDMONDS
R
Re
,:AT�
JOB ADDRESS D L--.Lcv� ------ Coti�i� ----- Cn --- -------- LEGAL DESCRIPTION: LOT NO - ----- 4 ---------------------------- BLOCK NO..
[T- FATMENT-PLANT
..................................... ........................ ----------------------------------------------------------------------------------------
� NQRT-t-� am—
PWW-0001-11175 (REV.11/78)
.D ------ E!& ----------------- ......................
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X�om.$T TO G"COMC -
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Approved: 33,j
DATEByj ...........................................
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STREET MLE
FILE# N/A
DETERMINATION OF NONSIGNIFICANCE STREET
Description of proposal
Deck Addition
Proponent Harry Fass
Location of proposal, including street address, if any
21110 Pioneer Way, Edmonds, WA 98026
Lead Agency Edmonds'Planning Division
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 (EIS) is not required under RCW
43.21C.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.
X 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
Responsible Official John Bissell
Position/Title Code Enforcement Tech. Phone 771-3202
Address 250 5th Ave. N., Edmonds WA 98020
Date April 19, 1991 Signaturl ' - IL
X You may appeal this determination of nonsignificance
to- Hearing Examiner
at 250 5th Ave. North, Edmonds, WA 98020
no later than 5:00 p.m. April 29, 1991
by filing a written appeal citing reasons.
You should be prepared to make specific factual objections. Contact
John Bissell to read or ask about the procedures for
SEPA appeals.
There is no agency appeal.
FILE
Compl:ete this checklist for nonproject proposals, even though questions may be answered "does
not apply". IN ADDITION, 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 n should be read as "proposal," "proposer," and "affected geographic
area." respectively. 4 — �, —*. 0. V
A. BACKGROUND
1. Name of proposed project, if applicable:
2. Name of applicant:
APR
PERMIT Co p -TE.,l
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3. Address and phone number of applicant and contact person: ;�r-7 (.J J J
-7
4. Date checklist prepared:
5. Agency requesting checklist:
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1,—. 2, . , /V 0 — g, -- e�-'
6. Proposed timing or schedule (including phasing, if applicable):
7. Do , you have any plans for future additions, expansion, or further activity related
to or connected with this proposal? If yes, explain.
1111d
8. List any environmental information you know about that has been prepared, or
will be prepared, directly related to this proposal.
A/ o �//
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.
A
10. List any government approvals or permits that will be needed for your
proposal, if known.
C r-.ell 1/g�, " 1) - - I 0�
,j , , - - 211ve", �- .. x - - �,'. - �-, i.,
11. Give brief, complete description of your proposal, including the proposed uses
and the 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. (Lead agencies may modify this form
to include additional specific information on project description.)
4
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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 the range or boundaries of the
site(s). Provide a 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.
TO COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat, rolling, hilly,( -steep
S -o'pes� mountainous, other
I
b. What is the steepest slope on the site (approximate percent slope)?
*'-'-" 'A
c. What general typ4s 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.
d. Are there surface indications or history of unstable soils in the immediate
vicinity? If so, describe.
/I/ C)
e. Describe the purpose, type, and approximate quantities of any filling or
grading proposed. Indicate source of fill.
f. Could erosion occur as a result of clearing, construction, or use? If so,
generally describe.
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9. About what percent of the site will be covered with impervious surfaces after
project construction (for example, asphalt or buildings)?
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duce or control erosion, or other impacts to the earth,
h. Proposed mxe-a-Vs-u?-/eJs-et,o' Ke--"'c��-4
if any:
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.
b. Are there any off -site sources of emissions or odor that may affect your
proposal? If so, generally describe.
c. Proposed measures to reduce or control emissions or other impacts to air, if
any:
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.
2) Will the project require any work over, in or adjacent to (within 200 feet) the
described waters? If yes, please describe and attach available plans.
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 fill material.
/�/ �--;) � �' C.
4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.
5) Does the proposal lie within a 100-year floodplain? If so, note location on the
site plan.
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.
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.
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.
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.
2) Could waste materials enter ground or surface waters? if so, generally describe.
d. Proposed measures to reduce or control surfaces ground, and runoff water
impacts, if any:
4. Plants
a. Check or circle types of vegetation found on the site:
--deciduous tree: alder, maple, aspen. other
---,,6v-!ergreen tree: fir, cedar, pine, other
,��hrubs
:Z4ra s s
pasture
crop or grain
wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
water plants: water lily, eelgrass. milfoil. other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
c- List threatened or endangered species known to be on or near the site.
d- Proposed landscaping, use of native plants, or other measures to preserve or
enhance vegetation on the site, if any:
" , -; - j -
5. Animals
a. 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, songbirds, other: ............................
mammals: deer, bear. elk, beaver, other:
fish: bass, salmon, trout, herring, shellfi;�:*;t*�;;: ...
b. List any threatened or endangered species known to be on or near the site.
c. Is the site part of a migration route? If so, explain.
d. Proposed measures to preserve or enhance wildlife, if any:
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.
b. Would your project affect the potential use of solar energy by adjacent
properties? If so, generally describe.
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:
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.
1) Describe special emergency services that might be required.
2) Proposed measures to reduce or control environmental health hazards, if any:
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
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.
3) Proposed measures to reduce or control noise impacts, if any:
8. Land and Shoreline Use
a. What is the current use of the site and adjacent properties?
Il
A.. - 0_��l
b. Has the site been used for agriculture? If so, describe.
c. Describe any structures on the site.
4/ �,. --,,.,I -c
d. Will any structures be demolished? If so, what?
e. What is the current comprehensive plan designation of the site?
h. Has any part of the site been classified as an fienvironmentally sensitive"
area? If so. specify.
i. Approximately how many people would reside or work in the completed project?
j. Approximately how many people would the completed project displace?
k. Proposed measures to avoid or
reduce displacelent impacts, if any:
I. Proposed measures to ensure the proposal i patible with -existing and
projected land uses and plans, if any:
14--N 41 id
7,v
9. Housing U-�
a. Approximately how many units would be provided, if any? Indicate whether high,
middle, or low-income housing.
b. Approximately how many units, if any, would be eliminated? Indicate whether
high, middle, or low-income housing.
C. Proposed measures to reduce or control housing impacts, if any:
10'.. Aesthetics
a. What is the tallest height of any proposed structure(s), not including
antennas; what is the principal exterior building material(s) proposed?
b. What views in the immedia te vicinity would be altered or obstructed?
c. Proposed measures to reduce or control aesthetic impacts, if any:
4
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11. Light and Glare
a. What type of light or glare will the proposal produce? What time of day would
it mainly occur?
b. Could light or glare from the finished project be a safety hazard or interfere
with views?
c. What existing Off -site sources -of light or glare may affect your proposal?
d. Proposed measures to reduce or control light and glare impacts, if any:
12. Recreation
a. What designated and informal recreational Opportunities are in the immediate
vicinity?
b. Would the proposed Project displace any existing recreational uses? if so,
describe.
c- Proposed measures to reduce or control impacts on recreation, including
recreation opportunities to be provided by the project or applicant, if any:
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.
lu'fo
b. Generally describe any landmarks or evidence of historic, archaeological,
scientific, or cultural importance known to be on or next to the site.
C.. Proposed measures to reduce or control impacts, if any:
14. Transportation
a. Identify public streets and highways serving the site, and describe proposed
access to the existing street system. Show on site plans, i any,
b. Is site currently served by public transit? If not, what is the app
distance to the nearest transit stop? roximate
C. How many parking spaces would the completed project have? How man would the
project eliminate? y
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).
/;�ro
e. Will the project use (or occur in the immediate vicinity of) water, rail, or
air transportation? If so, generally describe.
f. Now many vehicular trips per day would be generated by the completed project?
If known, indicate when peak volumes would occur.
g. Proposed measures to reduce or control transportation impacts, if any:
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15. Public Services 7-i"
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.
b. Proposed measures to reduce or control direct impacts on public services, if
any.
16. Utilities
c
a.—C' 1 ti.1 i ties. currently--ava i labl e -at �the_s )ite:
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t cre use service., t
t,,,ry. se�y c 0 er.
t I Sys te�
f _�honeJ'i�ni a se s m 0
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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.
r I
C. SIGNATURE
The above answers are.true and complete to the best of my knowledge. I understand
that the lea o�n the t k 'ts decision.
d agency is _�,tn o ma e i
/ relying
Signature: .....
.....................
Date Submitted: .....
...................
D. Supplemental Sheet for Nonp oje
ct "Acti ns (Rezones, Code Changes, Annexations, etc'.) Do
not use this sheet for project actions.
Because these questions are very general, it may be helpful to read them in conjunction with
the -list of the elements of the environment.
When answering these questions, be aware of the extent the proposal, or the types of
activities likely to result from the proposal, would.affect the item at a greater intensity or
at a faster rate than if the proposal were not implemented. Respond briefly and in gen&al
terms.
L How would the proposal be likely to increase discharge to water; emissions to
air; production, storage, or release of toxic or hazardous substances; or
production of noise?
Proposed measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine
life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. Now would the proposal be likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
4. How would the proposal be likely to use or affect environmentally sensitive areas
or areas designated (or eligible or under study) for governmental protection; such
as parks, wilderness, wild and scenic rivers, threatened or endangered species
habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would -the proposal be likely to affect land and shoreline use, including
whether it would allow or encourage land or shoreline uses incompatible with
existing plans?
Proposed measures to avoid or reduce shoreline and land use impacts are:
6. How would the proposal be likely to increase demands on transportation or public
services and utilities?
Proposed measures to reduce or respond to such demand(s) are:
7. Identify, if possible, whether the proposal may conflict with local, state, or
federal laws or requirements for the protection of the environment.
ENVCHK3/PFORMS
CITY OF EDMONDS SSET INFORMATION SHEET
FILEA
STREI:
12�NEW ASSET NO.
ADDITION ADDITION TO ASSET NO.
RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION D E�VR N 0
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
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B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
PROJECT NUMBER
PROJECT COMPLETION DATE
COST /eq
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
)ZDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
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BISIN
LEGAL DESCRIPTION CHECKI SUBDIVISION NO.
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CITY JTELEPHONE NUMBER SEE ENGINEERING MEMO DATED
NAME
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ADDFfESS
CITY TELEPHONE NUMBER
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STATE LICENSE NUMBER
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Legal Descriplion of Property - Include all easements
(show below or attach four copies)
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RESIDENTIAL
F] PLUMBING
ADDIALTER
1 1:1 COMMERCIAL
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SIGN
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EXCAVATE
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INSERT [:1 APT. BLDG El RENEWAL
NUMBER OF STORIES NUMkH:HU1-
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
METER SIZE
REMARKS
SUPPLY SIZE
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SIGN AREA I COMPENV. REVIEW
ALLOWED I PROPOSED LETE i EXEMPT
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0 YES ONO
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHAN ICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
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successors In interest, agrees to Indemnify, defend and hold
to
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harmless the City of Edmonds, Washington, Its officials,
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employees, and agents from any and ill claims for damages of
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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
waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
x
01
nor limit In any way the City's ability to enforce any ordinance
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
ad 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
tiqn Insurance..
INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
q -
CITY OF
yaou
EDMONDS
ATTENTION
111.3202
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AV,/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTU
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
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CODE
HEIGHT
1 1? 17—
OCCUPANCY
OCCUPANT
GROUP R_3
LOAD
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'141 X
VALUATION
FEE
6 � 1 ��02
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
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
,PINK — Owner GOLD — Assessor
. 1 �777
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SITE P-AN, SCALE1 JL
STANDARD DRAINAGE PLAN
T USE* INFILTRATION SYSTEM
INFILTRATIO N SysTEM
NOTEI DO NO
ON SLOPES OVER 15 PERCENT (15
PAGE p OF 2
FOOT RISE P ER 100 FEET HORIZONTAL)
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DATE : / — /_:�_ — 65�11
MEMO TO: Building Division
Planning Department
FRO14: Engineering Division
Public Works Department
S UBJECT:
After reviet-i of the subject Building Permit application, we have the following
coraments
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. Oriveway slope not to exceed 14'.
5 . —Back-aa_'Cer val ve requ i red i f downs ta i rs PI umbing is below elevation of
upstream manhole.
6. Water and sewer lines to be separated by 10 -foot minimum.
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