21208 HIGHWAY 99.PDF11111111111111
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21208 HIGHWAY 99
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City of Edmon&
Critical Areas, Checklist
Ile 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 todetermine 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,
b
andsubmit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary to complete a
development -Permit application -
With a signedcopy of this form, the
applicant should also submit a -vicinity map
or plot plan for individual lots of the parcel
withenough detail that City staff can find
and identify the subject parcei(s). In
addition, the :applicant shall include
other Per-finent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in Completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill:out the appropnate column below).
Owner I Applicant:
Name
�U s-?�3 V�
Street Address
City, State, ZIP Phone
. . . . .. ........
Date
Applicant Representative:
Natne
Street Address
City, State, ZIP
Phone
Signature
Date
Cr' ' al Areas Checklist
Site Information (soils/topography/hydrology/veget:ation)
L Site AddresslLocation: e�214) 61 /.1
2. Property Tax Account Number: -ri�-& 7 -cjoo �2 15-kv;
3. Approximate Site Size (acres or square feet): /!,W ',,< 3 'X /,/6
4. Is this site currently developed? -X—yes; no. C L
If yes; how is site developed?
)AZ
5. Describe the general site topography- Check all that apply.
/I( Flat: less. than 5'-feet elevation change over entire site.
Rolling: slopes on site generall ertical rise of 10-feet -over a
y less than 1.5% (a v'
horizontal distance of 66-feet).
H il ly: slopespresent on site of more than 15% and less than 30% ( a vertical rise
of I 0-feet dyer 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-feety.
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas -of seasonal standing water: Approx. Depth:
What season(s) of the year? -
8. Site is in the floodway A0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? .- /1.0 Flows are seasonal? (What time of year?
10. Site is primarily: forested Meadow shrubs mixed
urban landscaped (lawn,shrubs etc) _V1 -
11. Obvious wetland is present on site: ki 0
—For City Staff Use Only--
1. Site is Zoned?
2. �CS mapped soil type(s)? Ileetvaoi U�l I,/ le-1
3. Wetland inventory or C.A-'map indicate's wetland present on site? A/b
4;.*-. :-,Critical Areas inventory or C.A. map indicates Critical Area on site? /f/0
5., within' designated earth subsidence landsl ide hazard area?
6. des';ignated on the Environmentally Sensitive Areas Map? 0
-DETF,RMNATION
-:'�tUDY REQUIRED
CONDI"HONAL WAIVER
V1 WAIVER
Reviewed by:_
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RETURN ADDRES&O
City of Edmonds, Ci ty C1 erk's Of f i ce
505-Bell Street
Edmonds, WA 98020
DECLARATION OF RESTRICTIVE COVENANT
THREE COMPARTMENT SINK/GREASE TRAP UTILIZATION
Reference #: Building Permit #970224
Grantor(s): (1) Jack Trogdon (2) Mohammad 1. Ali
arantee(s): City of Edmonds
Legal Description (abbreviated): Sec 29 Twn 27N
I - -Rni! 4E -tr 2
OR Lot —Block- Plat,
Assessor's Tax Parcel IDN(s): (1) 5807-000-007-02
Assessor's Tax Parcel 1D# not yet assigned
WHEREAS, - Jack Trogdon is the owner of the building on the
subject described real estate in the City of Edmonds, to wit:
Property Address: Happy Jacks Espresso Q 21208 HighwaV 99, Edmonds
Legal Description: Solners 5 Acre Tracts Block 000 D-02 all of Tract 7 lying West of street road I
less commencing at the Northwest corner of said lot then S 1 00*31 44E along West line of said lot
162.33 feet -to the Point of beginning then S 89*52 54E parallel with the North line of said lot 49.91
feet to the Northwest markin of Pacific Highway then S 25*12 06 West along said Northwest margin
114.98 feet to said West line of said lot then N 00*3144 West along West line of 104.13 feet to the
point of beginnini!
Assessors Tax Parcel ID # (s): 5807-000-007-02
VVHEREAS, the above named owner is desirous of utilizing an existing three compartment
sink at the place of business known as My-T-Mart located at 7202 212th Street Southwest in
Edmonds. And whereas a three compartment sink is required by Snohomish County Health
Department for Happy Jacks espresso building. And whereas a grease trap is required by Uniform
Plumbing Code Chapter 711, on a three compartment sink and whereas Mr. Trogdon has received
approval from My-T-Mart owner Mr. Ali to utilize the three compartment sink at 7202 212th Street
Southwest. And whereas both property owners of the referenced premises are agreeable to imposing
a restrictive covenant in order for the Building Official to approve such a condition and whereas, the
City is concerned that future owners understand the plumbing code conditions in approving such an
arrangement for use of an off -site three compartment sink the following covenant is established.
0
0
RETURN ADDRESS:
City of Edmonds, City Clerk's Office
505 Be"ll Street
Edmonds, WA 98020
WITNESSETH, that for and in consideration of the premises, the above named owners do
hereby declare and grant to the City of Edmonds as Grantee the following restrictive covenant, to -
wit:
That at the time of the execution of this Covenant the Grantors have chosen to meet the
Snohomish County Health Department requirement. for. a three compartment sink by utilizing the
existing My-T-Mart ' three compartment sink located at 720.2 212th Street Southwest and that the
owner of My-T-Mart Mr. Ali agrees that the referenced sink shall remain accessible to operators or
owners of Happy Jacks Espresso during normal bn.siness 1.1tours and -shall not be denied use or access
during normal business -hours, UNTIL OR UNLESS, 1) the State Building Code or Snohomish
County Health Department Ordinances are amended in such a way to allow relief from the three
compartment sink/grease trap requirement or 2) an alternate location and three compartment
sink/grease trap are proposed to the City for review and approval. Current and future owners shall
adhere to this covenant for the subject building(s) and no changes to this situation shall be made
without approval by the City of Edmonds Building Official. This covenant may not be amended,
modified or revoked without prior written notification to the City 30 days in advance of attempted
amendment, modification or revocation.
Said Covenant shall be binding upon all present. and future owners of said real estate and their heirs,
successors and assigns.
DATED this
_*y of V 19—D
GRANTOR
State of Washington
)SS
County of_kk8��
I certify that I know or have satisfactory evidence that Ta&elraAn 4- A d~j Ali signed
this instrument, on oath stated that h9lit was authorized to execut� the instrument and
acknowledged it as the (title) of (name of party
on behalf on whom instrument was executed) to be the free and voluntary act of such party for the
uses and purposes mentions in this instrument. Subscribed and sworn to before me this
day of 19 Cr
.............
Notary Public in anti for the State of Washington.
V
My commission expires
RETURN ADDRESS:,
City of Edmonds, Ci ty C1 erk's Of f i ce
B611 Street
Edmonds, WA 98020
WITNESSETH, that for and in consideration of the premises, the above named owners do
hereby declare and grant to the City of Edmonds as Grantee the following restrictive covenant, to -
wit:
That at the time of the execution of thig Covenant the Grantors have chosen to meet the
Snohomish County Health Department requirement. for. a three compartment sink by utilizing the
existing My-T-Mart three compartment sink located at 7202 212th Street Southwest and that We
owner of My-T-Mart Mr. Ali agrees that the referenced sink shall remain accessible to operators or
owners of Happy Jocks Espresso during normal bt-siness Ahours and -shal'A not be denied use or access
during normal business,hours, UNTIL OR UNLESS, 1) the State Building Code or Snohomish
County Health Department Ordinances are amended in such a way to allow relief from the three
compartment sink/grease trap r equirement or 2) an alternate location and three compartment
sink/grease trap are proposed to the City for review and approval. Current and future owners shall
adhere to this covenant for the subject building(s) and no changes to this situation shall be made
without approval by the City of Edmonds Building Official. This covenant may not be amended,
modified or revoked without prior written notification to the City 30 days in advance of attempted
amendment, modification or revocation.
Said Covenant shall be binding upon all present. and future owners of said real estate and their heirs,
successors and assigns.
1017
GRANTOR
State of Washington
)SS
County o&ILIQ�k
I certify that I know or have satisfactory evidcnce that signed
this instrument, on oath stated that 6*%t was authorized to executd the instrument and
acknowledged it as the (title) of (name of party
on behalf on whom instrument was executed) to be the free and voluntary act of such party for the
uses and purposes mentions in this instrument. Subscribed and sworn to before me this
day of
19 cr?
Notary Public in and for the State of Washington.
.J: 0' My commission expires
SrATIE
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07/01/97 15:02
p.0002 Recorded
Snohomish County
RETURN ADDRESS:
City of Edmonds, City -Clerk's Office
505,Bell Street
Edmonds, WA 98020
BUILDING
AUO - 8 1997
DECLARATION OF RESTRICTI VE COVENANT
THREE COMPARTMENT SINK/GREASE TRAP UTILIZATION
Reference#: - Building Permit #970224
Grantor(s): (1) Jack Trogdon ' (2)_ Mo ammad T.. Ali
Grantee(s): __ City of Edmonds
Legal Description (abbreviated): Sec 29 Twn 27N _RnLY 4E Qtr 2
OR Lot Block Plat
Assessor's Tax Parcel ID#(s): (1) 5807�000-007-02
-Assessor's Tax Parcel ID# not yet assigned
WHEREAS, Jack Trogdon is the owner of the building on the
subject described real estate in the City of Edmonds, to wit:
Property Address: H ppv Jacks Espresso 21208 Hiph 99, Edmonds
Legal Description: Solners 5 Acre Tracts Block 000 D-02 all --of Tract 7 lying West of street road I
less commencing at the Northwest corner of said lot -then S_00*31 44E along West line of said lot
162-33 feet to the point of beginning t . hen S 89*52 54E _parallel with the North line of said lot 49.91
feet to the Northwest margin -of Pacific Hi2hwav then S 25*12 06 West alone said Northwest margin
114.98 feet to m 11
W-West line of said lot then N,00*31 44 West alona-West line of 104.13 feet to the
point of beginnine
Assessor's lax irarcel 11) # (s): 5807-000-007-02
WHEREAS, the above named owner is desirous of utilizing an existing three compartment
sink at the place of business known as My-T-Mart located at 7202 212th Street Southwest in
Edmonds. And whereas a three compartment sink is required by Snohomish County Health
Department for Happy Jacks espresso building. And whereas a grease trap is required by Uniform
Plumbing Code Chapter 711, on a three compartment sink and whereas Mr. Trogdon has received
approval from My-T-Mart owner Mr. Ali to utilize the three compartment sink at 7202 212th Street
Southwest. And whereas both property owners of the referenced premises are agreeable to imposing
a restrictive covenant in order for the Building Official to approve such a condition and whereas, the
City is concerned that future owners understand the plumbing code conditions in approving such an
arrangement for use of an off -site three compartment sink the following covenant is established.
USE PERMIT
CITY OF EDMONDS N NUMBER
ZO E 66 5
CONSTRUCTION PERMIT APPLICA-1 111,011111 JOB -IT I SUITE/APT #
C� . NER NAME,,1NA OF 78�SN,. E S S ADDRESS !:� / 2-08 Hwy
"4 I r - CRIPTION CHE71SION NO. LID 110,
'L 4 LEGAL DES
Uj MAIPNG ADDRESS
Z
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 0
Rw Permit Required 0
-�,,�RIRIEOUIRE
EXISTING D DEDICATION Street Use Permit Req'd 13
inspection Required
PROPOSED k Required
NAME Sidewal 0 Cc
W
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
L
YESO NO 0
L)
w a
REMARKS
0
ZIP TELEPHONE NUIl ul
a: CITY %W14 All ei, r q �P. .4 14 1 Ill W Q�l ffiz
;Z&7_qqS 6
-NAME vLle sijv% iw a Ire 4
ADDRESS
ENG DATED REVI
7IN7RI G MEM EWED By'
1 0
R CITY ?zip TELEPHONE NUMBER 9l;;IO 30W I-Il
FIRE MEMO DATED REVIEWEDBY
Z W
IC
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- STATE LICENSE NUMBER EXPIRATION DATE ILL
SIGN AREA SEPA REVIEW %�B,N!7
'1 13 e_ r S k 44_2 32 3_Z__. Pill ALLOWED PROPOSED COMPLETE EXEMPT 6)6
Legal Dedcription of Pro erty - include all easements Aft
SHORELINE 0
�'7 EXP
VARIANCE OR CU PLAI'l h tE By ?,DA
ll 30 -7
Uj
SETBACKS -FEET HEIGHT ILOT COVERAGE
Z
FRONT 14-), SIDE REAR/)
REMARKS
_j Property 5r
Tax Account Poo- ovio-
Parcel No.
NEW El RESIDENTIAL PLUMBINGIMECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. SIGN
CHE TYPE OF CONSTRUCTION CODE OCCUPANT
GRADING FENCE
EIREPAIR El CYOS. ( x _FT) "7 �Y
WOODSTOVE SWIM POOL ECIAL INSPECTOR AREA OCCUPANT
EIDEMOUSH INSERT HOT TUB/SPA AEOUIRED LOAD
0 YES
F�GARAGE RETAINING WALL/
CARPORT ROCKERY RENEWAL REMARKS 13
PROGRESS INSPECTIONS PER UBC108 Z
OZ (TYPE OF.USE. BUSINESS OR ACTIVITY) EXPL a
_j
cc
0
10 NUMBER NUMBER OF CRITIC
w S
0 OF DWELLING AREA
ca STORIES UNITS NUMBER
DESCRIBE WORK TO B DONE (ATTACH LOT P . LANlII All 1
FINAL INSPECTION REOUIRED
VALUATION FEE
PLAN CHECK FEE
1171V IV AL.0/7 BUILDING
GLAZING
HEAT SOURCE:
% PLUMBING
Plan. Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public I domain (curbs, sidewolks,
driveways, marquees, etc .).Will rbquire separate permission. STATE SURCHARGE
Permit Application: 180 Days STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant,.on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
cr whatever nature, arising directly or Indirectly from the Issuance
of this permit. issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision .11 1
( hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
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
ed thereby, no person will be employed In violation . of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insuranceand RreW 18.27. INSPECTION acknowled.ged in space provided.
Gl (OW ER OR APEY) OAT IGNED DEPARTMENT
47
/7f CITY OF 0 E ZIZ4 DATE
EDMONDS 4??
;Air
CALL FOR VLEAS": too' TE
AV ENTION INSPECTION a_
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE t
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 �w4 Ill File /YF1 I LOW Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 el PINK - Owner GOLD - Assessor
":7
od 6 - q Wo
M
CITY OF EDMONDS . ZONE
CONSTRUCTION PERMIT APPLICATION I
JOB.
c ER NAMEINAME OF BUSINESS [ADDRESS
iw�,k-rR6 0 LEGAL DESCRIPTI
40
MAILING ADDRESS
PERMIT
NUMBER
NO.
A Tit
,,,,j.,U,1TE/ P
LID NO.
I /Y5 / / 45 F 4 ti 1k:::Z1 .. P BLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 0
CITY .4 ZIP
i,-&
NAME
:>
uj ADDRESS
a: CITY ZIP TELEPHONE NUMBER
NAME
�,_. ,!5,1 dw,
ADDRESS I
/&-303
CT ZIP TELtPHONE NUMBER
& Vv
1-11411k,> ?9-d-x, 13&.S--1133
STATE LICENSE NUMBER EXPIRATION DATE
,�; L) - - /- '71?
I —ni nacrrintinn rif Pronartv - include all easemeuts 1)hft
Property
S7rsv 7 — (:)�0'2—
Tax Account
Parcel No.
7- am - W&- C%?
KEW
RESIDENTIAL
/Kogj�!MECH
ADDITION
lfzzz
L/_T-COMMERCIAL
COMPLIANCE OR
D CHANGE OF USE
REMODEL
APT. BLDG.
SIGN
E] REPAIR
GRADING
CYDS.
FENCE
I x _FT)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
CARPORT
F7 RETAINING WALL
ROCKERY
r RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN,
NUMBER
'OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL '710- 1
AREAS
NUMBER CAVjYk
DESCRIBE WORK TO BE DONUATTACH PLOT PLAN)
EXISTING — REOUIRED DEDICATION
RW Permit Required 0
Street Use Permit Req*d 0
PROPOSED
Inspection Required X
Sidewalk Required 0 cc
LU
ME,y5SIZVI
5111
LINJSIZE
NO. OF FIXTURES
I PRV REQUIRED
IESANO
;EMARKS Dy,.Ve Wok,11 0 VI
2 12 k.L4
W
C
X 6
ENGINEERING MEMO DATED
REVIEWED BY
9-7
FIRE MEMO DATED
J-30-177
REVIEWED BY
.7 (OA4,q c,
. In 'S
SIGN AREA
SEPA REVIEW
ADS NO.
ALLOWED PROPOSED
1
COMPLETE I EXE�PT
4?6-10(0
1
1 SHORELINE I
I I EXP I
VARIANCE OR CU I �PLANNMMREVIEW By
SETBACKS — FEET HEIGHY I LQT COVERAGE Z
Z
FRONT SIDE REAR
REMARKS
f
Alp 05414 Ar- Avhm4wly _Azm�
'HECKED BY
TYPE OF CONSTRUCTION CODE 11CUPA1
UW-J
/4v/ GRO 0
SPECIAL INSPECTOR I AR�0,5� OCCUPANT
REQUIRED 13 YES LOAD 3
REMARKS
PROGRESS INSPECTIONS PER UBC 108
0 A4
1) Z5jjr1,f>5&
FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
'Zo
_1'11,yk14
HEAT SOURCE: s .: v -
oil e,
GLAZING
-? %
PLUMBING
qPlan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers worWto be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require, separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
wW
I
a:
<
=
0
0
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of. Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising direct ly or indirectly from the Issuance
of this permit. issuance of this permit shall not be deemed to�
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no.person will be employed in violati,on of the Labor
Code of the State of Washington relating to Workmen's Compensa-
tion insurance and RCW 18.a
DATE SIGNED
77_�
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OF�.tClf3AIGN JDATE I
C,
EDMONDS
AfTENTION-
CALL FOR
INSPECTION
RELE�S Er-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STR6&URE
UNTIL -A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-022o
O`RGINAL File YELLOW- Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 lvt- L? --J -0--f
PINK - Owner GOLD - Assessor
�e
A
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4' 7't56VfT_ H,
J 1-tQ'J 99
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JAN 2
CITY OF ECiViOi"",:)3
nAmr
BUILDING DEPARTW,,lZ7_NT COUNTER
_160 4p
WORK j2* 46all0k;q- --- <,
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OWNER j d
I — - 2
;[;rFPROVED DATE:
C r.,G
0
FFICIAL
P E R T NUMBER
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r CITY*OF EDMOND9
BUILDING DEPARTMENT
-MMIT COUNTER
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ADDRES S ",? k 2- 0 V�kU 4qj
OWNER COTY copy
AF!PROVED D E:__
C, ou. OFFICA
'"PER.11,31T NU�VIPER
1-7
CITY-CORY,
JAN 2 7 1997
PERMIT COUNTER
A
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