21409 80TH AVE W.PDF111111111111
7181
21409 80TH AVE W
NOTICE:
No warranty of accuracy.
The -information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edmonds does not warrant the
accuracy of anything set for ' th on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
regarding the information shown on
___F
t e -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-l-oyee-s o-r officers shall be hable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
CIVIC CENTER— WATER -SEWER DEPARTMENT Caji ]PROSPect 6-1107 when' work
is ready for inspection. (No i-P—
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 2659
ADDRESS .................. 82a.,n._2jSt --- Avenue ... Snu:th ....................
OV*rNER ----- Pete_.Saj=0_We.j)
------------------------------------------- CONTRACTOR ---------------- MCW
...............................................................
Permission is granted -------- January. ---- 4 ............. 19 ... U, for ------------------------ days to REPAIR or CONNECT a side sewer
,with City Sewers in accordance with application On file and governing ordinances.
ATTENTION IS CAI -LED TO THE FOLLOWING:
NOTE No. 1—Tbe owners of the Property may obtain a Permit to Construct sewer Inside Property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been Inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11-16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches Inside property line; minimum grade of 2%.
No bends in grade sharper than % will be Permitted.
No. 4—Trenches In street must be water settled said surface of street restored to original condition. Contractors shall be responsible for
failure due to Improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the main sewer or its appur-
tene.nces except to insert the pipe into the wye.
APPLICATION
ItNA I.,
a for
The City of Edmon SEDE SEWER PERYUT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
OWNER
.............................................. CONTRACTOR ------------------------------------------------------------------- PERMIT No.
ADDRESS ...............
...........................
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
4/ 41 NAME OF ADDITION ............................ ..............................................................
L
7-
e.7
Approved:
DATE ..Z ...... ....... .............. B,
.... ... .....
61ijEET FILE
Date: December 27, 1967_
Memo to: John E. Moran
Supt. of Public Works
From: LBif R. Larso-.
C.-ty Engineer
Subject: Sewer Connection Charges
Property Description: The Last 150,00 feet of the South 200,00 feet of the North
310*00 feet of the West 180,00 feet of the South half of the West half of the North-
east quarter of the Ifortheast quarter, Section 309 T27H9 R4E.1, VIA., except the South
100*00 feet,of the West 74,00 feet thereof,
Commonly Known as: $23 - 21st Avenue South Owner: Peter Salamonsen
Z.F.F. Calculation:
x
(42,65) x
42.65 Z.F.F.
$ 300.00 connection ree (Minimum)
Public Works Department Use Only:
Units x ($25.00) s 275,00
$ 10,00
$ 505.00
Trunk Charge
Permit
TOTAL
Date: December-27, 1967
Memo to: John E. Moran
Supt. of Public Works
rrom: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Property Description: The East.150.00 feet of the South 200.00 feet of the North
310.00-feet of the West 180.00 feet of the South half of the West half of the North-
east quarter of the Northeast quarter, Section 30, T27N, R4E, W.M., except the South
100.00-feet of the West,74.00 feet thereof.
Commonly Known as: .823 - 21st Avenue South Owner: Peter Salamonsen
z.r.F. Calculation:
x 42.65 z.r.r.
142.65) x ($5.50 $ 300.00 Connection ree (Minimum)
Public Works Department Use Only:
(11 ) Units x ($25.00)
$�275.00 Trunk Charge
$ 10.00 Permit
$585.00 TOTAL
I
#P20 5 LD?z 14
I I., C. 1 -6 1) -
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0 221
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 the application 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, o,r so
surveys)'.
Date Received: I ti
City Receipt M
Critical Areas File#:
Critical Areas Checklist Fee: $155.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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 n . ecessary 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 propeit� described on this form. - In
addition, the applicant shall include other pertinent
information. �e.g. site' plan, topography map, etc.) or
studies in copjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The -undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney7s fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete infonnation furnished by the applicant, his/her/it . s agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true- and correct to the best of my
knowledge andthat I am authorized to file this application on the behalf of the owner as listed below.
ce-1 t 4
SIGNATURE OF APPLicANT/AGENT DATE
Property Owner's Authorization if
By my signature, I certify that I have autliorized the above Applicant/Agent to apply for the subject land use. application,
and grant, my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
Owner/Applicant:
. .I&Akr k, <��10_k4
Name
/0 41W / 7 7
Street Address
city State Zip
Telephone: &(5�6 Y15-91:_010-
Email address:
Applicant Representative:
'Nam
Street Address
, City
State
Telephone:
Email Address:
JUN 0 2'2014
Zip
Pevised on I ill 8112 P20 - Critical Areas Checklist. doc 0 EVEW t- tv i M-I'S E RV 10 ES ftg I of 2 .
011Y OF EDMONDS
#P20 CA File No: CR,�CV(�) I
Critical.Areas Checklist
Site Information.(soils/ topography/ hydrology/ veg'etation)
1. Site Address/ Location: JEC/410';Ic.�s
2. Property Tax Account Number: j7(9Y�2oC1(9/04,3&eVS. t CZ4FO !Y(616 )k-1
3. Approximate Site'Size (acres or square feet):
4. Is this site currently developed? Yyes; no.
If yes; how is site developed? 'k, K'� t-
5. Describe the general sitetopography, * Check all that apply.
6"Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less thari 15% (a vertical rise of 10-feet over a. horizontal
distance:of 66-feet).
Hilly: slopes present on site of moie.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: JQ0 Approx. Depth-
7. Site contains areas of seasonal standing water: -00 Approx. Depth:
What season(s) of the year? (3 V�.
8. Site is in the floodway floodplain C) of a water course..
9. Site conta creek or an area where water flows across the grounds surface? Flows are year-round?
C� Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: LIL-D
-------For City Staff Use Only
1. Plan Check Number, if applicable? RLD2014os7so
2. Site is Zoned?
3. SCS mapped'soff type(s)? ge =21 1"I'A A�bae� 6e?!4�
t9 7o A�
4. Critical Areas inventory or C.A. map indicates Critical Area on site?.
I r7
5. . Site within designated earth subsidence landslide hazard area?
SITE DETERMINATION
Reviewed bv:
W
Revised on 12118112 P20 - Critical Areas Checklist. doc Page 2 of2
BUSIN# LICENSE APPLICATION
CITY OF EDMONDS
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020
TELEPHONE (206) 775-2525
0_4
FILE
INSTRUCTIONS
PRINT APPLICABLE LICENSE CLASS. FEE. AND PENALTY PAID
F,IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15
2. NEW BUSINES& COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
3. SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY)
4. LICENSE WILL BE MAILED TO YOU -UNLESS YOU ARE NOTIFI
TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION, PRINT CHANGES AT RIGHT.
r2. APPLICANT
NAME SOCIAL SECURITY NO.
DATE OF BIRT=BIRTH
HOME ADDRESS
ANNUAL FEES
TYPE BUS. CLASS FEE PENALTY
HOME A $10.00 S 5.00
SMALL B 15.00 7.50
*GENERAL C 50.00 25.00
OVER M'�MPL'07EES'lDR- E Ma %;Z-R K -
OVER 120 MAN-MONTFIS PER_'?f-AR
CLASS I FEE PAID PENALTY PAID
I <v (,,I
3. BUSINESS IDENTIFICATION
BUSINESS NAME
NATURE OF BUSINESS BUSINESS PHONE
WASH. STATE TAX NR. EMPLOYEES ORGAN. JOCCUPANCY
TYPE ORGANIZATION
IF BUSINESS.IS:,
TYPE
CAPACITY
C
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
0
C CORPORATION
APT.BLDG.
A
NR OR APTS
D
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
E
P PARTNERSHIP
. RESTAURANT
R
NR OF SEATS
S
S SOLE OWNER
HOSP./NURS. HOME
H
NR OF BEDS
SCHOOL .
S
NR OF STUDENTS.
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
5. EMERGENCY NOTIFICATION
NAM
AREA
TELEPHONE
(1)
(2)
OFFICIAL USE ONLY
U.F.I.R. CODE
BLDG.
PERMIT
OCCUP1
C.U. PERMIT
AND USE
ZONING
C�Ty CLERK'S
S GNATURE
OFfI lAt US ONLv
LICENSE NUMBE
LA -NEW BUS
LB RENEWAL
LC CHANGE
LD DELETE
CLASSIYEARI LIC. EFFEC. DATE REASG. LIC. NO. SPEC
RECEIPT NO
INT 'X'
IN SPEC. BOX
FOR ISSUE Of
PENALTY
LICENSE WITH
A— AC' ACTION,
F D PAID c 0 R R E C T E D
I ) 1 5 i 0 1 1 i
0 Q 7&lc/
STAFF ACTION
FVERSE APPL. NO.:
DE DATE:
APPLICATION FOR:
NEW LIC. LICENSE
REN
BUS, El EW YEAR
-LICENSE'. APPO'CATION AND CHANGF&<
PLEASE PRINT CLEARLY
/2. APPLICANT
I =LAST NAME. FIRST INITIAL LICIALSECURITY NUMBER
�i L L Il 1111 1 111 1 1 P.1
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY �EARJ =CITY ST,ATE]
Jill I
11 -In 4 �'i I 111 TO D I IN 1") 121 , 'I id y I
HOME ADDRESS
N!ATURE)OF B SIESS (DRUG STORE. CPA. ETC) BUSINESS PHONE
c',
7
WASH. STATE TAX NR. ANTICIPATED YPE OF OCCUPANCY
N Pi C
(REGISTRATION) NR.EMPLOYEES TY E APACITY
D 161 in
ENTER APPLICABLE TYPES AND CAPACIT
Y
4. BUSINESS ADDRESS
12�L-09 I 18iC)th,Av I
STREET APT. NO.
P I, 10.i P �177 I I I I I I
CITY STATE ZIP CODE
-L YN IN IC I ci D I I I I I I I I I I L 101
/5, EMERGENCY NOTIFICATION (IN EVENT OF FIRE. BURGLARY. ETC.)
�AST NAME, FIRST INITIAL AREA CODF TELEPHONE
(1) 1, 0 v T 21 0 6 7 7 Ic 13 131
LAST NAME. FIRST INITIAL AREA CODF TELEPHONE
(2)
5S OFFICIAL USE ONLY
PRIM. UNITS FU —S BLDG. PERMIT CUP
U.F.I.R. GR�p
CODE A
COND. USE PERMI ZONING
L,-,j
APPLICANT'S
._;j �,- TI:
SIGNATURE
APPROVED Lj DISAPPROVED DATE BUS. TITLE
3. BUSINESS IDENTIFICATION
US(NESS NAME (FUL0-R, k-l- mal
OFfI lAt US ONLv
LICENSE NUMBE
LA -NEW BUS
LB RENEWAL
LC CHANGE
LD DELETE
CLASSIYEARI LIC. EFFEC. DATE REASG. LIC. NO. SPEC
RECEIPT NO
INT 'X'
IN SPEC. BOX
FOR ISSUE Of
PENALTY
LICENSE WITH
A— AC' ACTION,
F D PAID c 0 R R E C T E D
I ) 1 5 i 0 1 1 i
0 Q 7&lc/
STAFF ACTION
FVERSE APPL. NO.:
DE DATE:
APPLICATION FOR:
NEW LIC. LICENSE
REN
BUS, El EW YEAR
-LICENSE'. APPO'CATION AND CHANGF&<
PLEASE PRINT CLEARLY
/2. APPLICANT
I =LAST NAME. FIRST INITIAL LICIALSECURITY NUMBER
�i L L Il 1111 1 111 1 1 P.1
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY �EARJ =CITY ST,ATE]
Jill I
11 -In 4 �'i I 111 TO D I IN 1") 121 , 'I id y I
HOME ADDRESS
N!ATURE)OF B SIESS (DRUG STORE. CPA. ETC) BUSINESS PHONE
c',
7
WASH. STATE TAX NR. ANTICIPATED YPE OF OCCUPANCY
N Pi C
(REGISTRATION) NR.EMPLOYEES TY E APACITY
D 161 in
ENTER APPLICABLE TYPES AND CAPACIT
Y
4. BUSINESS ADDRESS
12�L-09 I 18iC)th,Av I
STREET APT. NO.
P I, 10.i P �177 I I I I I I
CITY STATE ZIP CODE
-L YN IN IC I ci D I I I I I I I I I I L 101
/5, EMERGENCY NOTIFICATION (IN EVENT OF FIRE. BURGLARY. ETC.)
�AST NAME, FIRST INITIAL AREA CODF TELEPHONE
(1) 1, 0 v T 21 0 6 7 7 Ic 13 131
LAST NAME. FIRST INITIAL AREA CODF TELEPHONE
(2)
5S OFFICIAL USE ONLY
PRIM. UNITS FU —S BLDG. PERMIT CUP
U.F.I.R. GR�p
CODE A
COND. USE PERMI ZONING
L,-,j
APPLICANT'S
._;j �,- TI:
SIGNATURE
APPROVED Lj DISAPPROVED DATE BUS. TITLE
3. BUSINESS IDENTIFICATION
US(NESS NAME (FUL0-R, k-l- mal
/2. APPLICANT
I =LAST NAME. FIRST INITIAL LICIALSECURITY NUMBER
�i L L Il 1111 1 111 1 1 P.1
DATE OF BIRTH PLACE OF BIRTH
0. 1 DAY �EARJ =CITY ST,ATE]
Jill I
11 -In 4 �'i I 111 TO D I IN 1") 121 , 'I id y I
HOME ADDRESS
N!ATURE)OF B SIESS (DRUG STORE. CPA. ETC) BUSINESS PHONE
c',
7
WASH. STATE TAX NR. ANTICIPATED YPE OF OCCUPANCY
N Pi C
(REGISTRATION) NR.EMPLOYEES TY E APACITY
D 161 in
ENTER APPLICABLE TYPES AND CAPACIT
Y
4. BUSINESS ADDRESS
12�L-09 I 18iC)th,Av I
STREET APT. NO.
P I, 10.i P �177 I I I I I I
CITY STATE ZIP CODE
-L YN IN IC I ci D I I I I I I I I I I L 101
/5, EMERGENCY NOTIFICATION (IN EVENT OF FIRE. BURGLARY. ETC.)
�AST NAME, FIRST INITIAL AREA CODF TELEPHONE
(1) 1, 0 v T 21 0 6 7 7 Ic 13 131
LAST NAME. FIRST INITIAL AREA CODF TELEPHONE
(2)
5S OFFICIAL USE ONLY
PRIM. UNITS FU —S BLDG. PERMIT CUP
U.F.I.R. GR�p
CODE A
COND. USE PERMI ZONING
L,-,j
APPLICANT'S
._;j �,- TI:
SIGNATURE
APPROVED Lj DISAPPROVED DATE BUS. TITLE
3. BUSINESS IDENTIFICATION
US(NESS NAME (FUL0-R, k-l- mal
APPROVED Lj DISAPPROVED DATE BUS. TITLE
3. BUSINESS IDENTIFICATION
US(NESS NAME (FUL0-R, k-l- mal
3. BUSINESS IDENTIFICATION
US(NESS NAME (FUL0-R, k-l- mal
PLANNING DA
New Commercial I s
STREET
Name:
Dal:4 17- -3 y
Site Address: 1( oct Vv\
Plan Check #: BLD -zo
Project Description: -2- ce,� --o(Zo t'
Use(s) Proposedz----�
Allowed Use: CW� NO)
CUP File Number.---'
To Allow What Uses.
Legal Nonconforming Land Use Determination Issued: (YES I N 00
Reduced Site Plan Provided: (Y61 NO)
Zoning: q
Map Page:
Comp Plan Designation-./Wdtc N LI-/
Comer Lot: (YES / N06
Flag Lot (YES 1
ADB File Number (date waived):
Lot Area:
Plans Match AD6 Approved: (YES NO)
Shoreline Required: (YES to:P
Critical Areas Determination
El Study Required
Zwaiver
SEOA Determination:
K-Exempt
Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form?-
Str t.-
Side-
Sidr
Rear -:-
A. &q1.%q .04;� tq
Street:-
14-
Side
lb t—
1
Side:
Rear:
P
Lot CoverageAWAR-Required: (kA_K
Lot Coverage~ Provided: 7 3�,6 YO
'U2-OS-7'
Lot CoveragoW-*R Calculations: Ale� *j
Building�Hejot
Datum Point:
Datum Eleva.tio n:
Maximum Height:
Actu al Height:
J
Subdivision:
Lot Aggregation Required: JV
0
Landscaping Matches'ADB Approved:
Landscaping Bid Provided: (YES / NO) [-�o/AJ mount (100% Bid):
ac�s,.,f
Plan Review By: c2r,�
PLANNING DATA STREET FILE]
New Commercial I Multi -Family Projects
Parking Tenant Required
P
Business Name Type/Use Ratio Area Parking
Total Parking Required.
Total Parking Provlde d
malti-A
# Bedrooms per Dwelling Unit
Parking Ratio
# Units
Required
Parking
1 Bedroom
1.51D.U.
2 Bedrooms
1-8/0.U.
L7�
7
7-otal Parking Required.
17 7 or
Total Parking Provided.'
C
-3 aw� 0-,
Plan Review By:
rM- 7- Corneil Flag -v*�Ant 6-ftEMUTI�r
A
Sqbacks 2auired Actual, t-0 5c-'�Je Srrz19)tJ-, IS N)�'T
Front WPI&A
SideO 1� r1) to 0 10 L 16N S1 I euT
_�i-L . ,f STML OIMCI'�S'OMS 77) M
- 15- 10 -Y
Rear 0 S�rod M (2'0 1 37r6Z CAAavzw cli
L
Wo —pArnu�j(-) -ru i3e s-TrmMo
Met, VN
1�lc SRONi,) oN Ten�;sc InArZS.
HeisLt Jz_ t
v C V?-
110 L 14\
(T-YFIC*0
t
90T
V
< -
x
OVED PLArIN
A
UK
TO
+101
Z 01,,q6
4- plow
1w 11
Ilk
T-7—
'11 Iq
00
7
couk-,T
E)�(. 1. .51"
106 1
7- 100. OP
46
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< '77
APPRO ED
F1 D P
\a�
z
1__ k-
0 1
k � A 4
0
A. 0 t
PARKING SPACES REQ'D d'
PTR
OWNER/CONTrzACTOR IS RESPONSiBLE PARKING SPACES PROPOSED
APPROVED BY ENGINEERIN
FOR EROSION WINTROL. ANI) DRAINAC-E ARRIER FREE PARKING SPACES
........ .
Ai)Plicant sha I rePair/replace all damage to
MUlkies. or..4,1zr,=,_,,,,.
. 12�P' te:
right-of-way op �,' 'Ovement97 in City Oat
, '], Tv standards that is caused
Or Occul,,; during the permitted project.
I WNS AL., CO 0 ML'i C,.r 4, 04r;- ST,0 g�/ -rtw CAqk�
.. ........
C05 To M RA 6& 9�, I l!"" Pf
--LAIN
6cw PA-v� (.,'-Y Jv, pe�
u STREET FILE
Lt6�kt, FT161,3 - RESUB
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BUILDING DEPARTMENT
MONDS
GiTy OF ED
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