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RECEIVED
APR - 7 1999
DEMOPMENT SERVICES CTR.
CITY OF EDMONDS
CAFILENO. q61_0
Critical, Are"'as Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: LAD.
2. Property Tax Account Number: 37 34y — 4f:k::;0 -2 — 0 13 — 07 C�(,
3. Approximate Site Size (acres or square feet): 70oo
4. Is this site currently developed? yes; —no.
N--
If yes; how is site developed? r__�V_
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6.. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: L Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplai of a water course.
9. Site contain� acreek or an area where water flows aqross the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested shrubs
Meadow mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
- ---------------- — ------------------- ------------ F Ci Staff Use Only-
---------------------------------------------------
Site is Zoned?
.. .. . .......
0:0 M :::i.AA
:2.:�:.:: :S S::rnap ed:s'6' i'lly e(s)? Aw.
p p . ....
.3— ',:.Wetland::ifiv . en . tor . y -or C A.: ma . p4ndicates wet land pr . e s e . nt on site?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
iie w i t hin d esignat ed ea rth su . b . s . i . d . e . n . ce .. I . andslide hazard area? 140
Sit d_.... 41 i
d i :' ': ;: M .. . . . I �.
i e, esignate brithe.i.EnvirOn ent Y'S&ft iti ':A'
s... ve r.eas:: �: ap
Dt-MMINAVON
�ra�chk.doc; Rev 10103/97
RECEIVED RECEIVED
MAR 17 1999
APR - 7 1999
City of Edmonds SERVICES CTR. PERMIT COUNTER
C17Y OF EDMONDS
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).
ix 16wner/Applicant: Applicant Representative:
Name Name
Street Address
city State Zip
'71-Z,5
Telephone
-70Yr, U".
Signature
7 56:
Street Address
Bn I-K ca--Z� CJA-
City State Zip
qZ,5- — -5 5-2 — 0 `7 72,
Telephone
Signature
-3L) 177 -7 /IF
Date Date
c:recepflon\jana\cac1.doc (over)
HffE%EET1 FILE
C -OF EDMONDS SIBE -SEWER ;PERMIT
ITY
11 9 0 1 9.q PERMIT N;d 8436
Address - of Constructio I n:
opo ov.- S ;70, 0-� /V,0100 4r/ it h/
Property Legal Description -(Include all easements):
Fio of 1VAV Z_rd
EDM*�-_.J RFECE.IVED�
-m 1.1vt 1 993
AN
PUBLIC WORKS DEPT.
Owner and/or Contractor: W Ke- K
State License No. Building Permit No. /VA
esingle F'amily
0 Multi -Family (No. of Units
El Commercial
El Publ'ic
Inva . sion into City Right -of -Way: O/No 11 Yes
RW Construction Permit No.
Cross other Private Property: Ce�o F-1 Yes
Attach legal description and copy of recorded easement
I certify that I have read and shall comply with all city requirements
as indicated on the back of tf��Permit -Card.
Date
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE, USE ONLY
FOR INSPECTION C PUBLIC WORKS DEPT.
Permit Fee: W, cc) 771 (J200squed By
Trunk Charge: zs� 00 Date Issued: k-21- L73
Assessment Fee: Receipt No.
Lid No.:
Partial Inspection: Date -Initial -
Comments
Reason Rejected:
Date -initial
i
Fin6l Inspection Approved: DatA_J__�__31nitialt�:�
PERMIT MUST. BE POSTED ON JOB SITE
WhiteCopy:File Gio�en Copy: Inspector 'Buff Copy: Applicant
Revised MID
Side Sewer Drawin
;,he City of Edmonds EASEMENT NO - --------------------------------------------
if f t -
NEW CONSTRUCTION E] REPAIRS EA LID NO. -ASMT. NO - ---------------
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR -------------------------------------------------- --------------------------------- PERMI-r NO. .64�SG
JOB ADDRESS .2-1-9-11 ------ 5-3-RD --- Avt--Wt ..................... LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
4'0f!
CAP j "DP
7
9,
2., op. 17.51
BDP
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Gllpw.c.-
?'D P
G"r-.O.W-�jF-
cskp 110P
PWW-0001-11/75 (REV.11/78)
NAMEOF ADDITION ------------------------------------------------------------------------------------------------------------------
15aprie- 0'�Ags
r ( I �� oj,�j
35 DP
4'*' c-0- im,
C-41%P op
2.20 1 comet -
218 11 93R.D Av.W.
Approved: SEPTic TANK NOT
FIU-F-D �Ser
All"
DATE----------- By 0/0.0 -------------------------------------
0,
PLANNING DATA
STREET FILE
NAME: �hmduf c,
SITE ADDRESSA Ill q_-�)d Ak. DATE:
ZONING: PLAN CHK#: -7
CORNERLO (Yes/No) FLAG LOT .(Yes/No)
SETBACKS:
Required Setbacks:
Front: 2,q' Left Side:7,15 Right Side: 7 Rear:
Actual Setbacks: /
Front: ZIS-' Left Side: Right Side: R e a r:
Street map checked for additional setback required?_Aj I m (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED _(Y/N)
LOT COVERAGE:
Maximum Allowed:. Actual.
'7) / 4C2 / 6
BUILDING HEIGHT: -11, 1
Maximum Allowed:— �Ft) —Actual Height: Mo
SUBDIVISION:
CRITICAL AREAS #: qq�6q
SEPA DETERMINATION:
LOT AREA: 61UA-111-1 �T
OTHER:
NOTICE:
-N'O...W"a r.r a T..r.—ac c-u
The information on the attached
lied for use by the City Of
map(s) was com * p
Edmonds/ its Empl-oyees and Consultants.
Th,.e City of *Edm.onds does ' n ot. warrant the
these
accuracy of anything set for.th on
M a P ('s'). A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding the 1nfC*)rrn'ati(:)n shown- o
-t-Fe -map(s)/ including, but not J'rn'ted to
the location of any sewer stub shown. Suc
sewer stubs may or may- not e.xist and may
or may not exist at the location shown
%,-,Ity of Edmonlr_AIS nor its
Neitheir the `* or thE
e m pt o-y e e-s o -r o ff i -c e r s s. h. a I- I b e 1--i a. Hi-e f
n on this map(s), nor for
information g Ve d
entation provided base
any one repres
Upon'sald map(s),
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE
'4f t6
NUMBER
US
ZO
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
el
ADDRESS..,�?/8
OWNER NAME/NAME OF BUSINESS
L
f BA R A. k 4A o 7v:1- P LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
W MAILING ADDRESS
z
0
U C W1 J PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
CITY ZIP I�PHONE I 1.� RW Perrr�it Requ,,sqk/o 0
EXISTING REQUIRED DEDICATION_ Street Use P04 Reciez
C-641 qeO2,-, PROPOSED inspection Required Y�e5
NAME f�fdew8k Re-qui,ed/Vo 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
Y E S NO
ADDRES.S I I 1�7—
REMARKS
TQ - a�,Y I Adek)ujf "D GL::��IaLj Col,-IXae 9
CITY ZIP TELEPHONE U
22 :�5 4 12- `5 -7 -12-
U <1'
3 to 4- Ct -�J EW �-1 P My, o J-5
ENGINE�RING MEMO DATED REVIEWED BY
ix ADDRESS
0 FIRE MEMO DATED
' 175'2 5,1 L-) A REVIEWED BY LL
cc 9
t- I LL
z CIT-4-4 TELEPHONE
0 � ?z 2 VARIAPCE OR CU DB# HORELINE #
0 /00 /-/,;, ^1 f r /-/ 9
STATE LICENSE NUMBER EXPIF,IATION DATE CHECKED BY
-J�—)4c ILf OC? SE11oA RIEVIEW SIGN AREA— HEIGHT
Z COMPLETE ErT A . LLOWED R POSED ALLOWED, , PROPOSED
LEGAL DESCRIPTION OF PROPERTY INCLUDE ALL EASOMENTS
EXP
&
LOT COVERAGE REQUIRED ATBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWEI�,j PROPOSED FRONT SIDE REAR FRONT R IDE REAR
Uj
PROPERTY TAX A Af ,
CCOUNT PARCEL No. z
LU AREA PLANZRE E Y 4ATE
-3 CK,
NEW RESIDENTIAl
ADDITION COMMERCIAL
f2e REMODEL APARTMENT
REPAIR GRADING
CYDS
DEMOLISH TANK
GARAGE RETA INING WALL
0 CARPORT ROCKERY
MX %��IIMECH
COMPLIANCE OR
CHANGE OF USE
SIGN
F N
FENCE
E C E
x FT)
( _ X FT)
0 T H ER
o 'OTHER
R N EW
RENEWAL
E A L
REMARKS
CH E C K E D I Y
CHECKEDBY
ITY—OFCONSTRUCTION
IrM
CODE
I 41
OCCUPANT
GROUP A
S P I JAL I IN I
SPECIAL INSPECTOR JAREA
Ec s
R E R
REQUIRED [-
Ou ED YES j
E
-
,
OCCUPANT
LOAD
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
15/= .
oe-
R M
REMARKS
E R KS
PROGRESS INSPECTIONS PER UBC 108 A -,-
P R G R
NUMBER
0 F -Z
STORIES
NUMBER OF
DWELLING
UNITS
T
CRITICAL
ICAL
AS
AREAS
NUMBER -t 7 —47
B ER 7
�,L4 zift- - 131 cufflj�21 -S L-ff
DESCRIBE WORK TO BE DONE
34?2
av to
40e%14 Ar 50U Im &two-�
e— 6VIo7opr
FINAL INSPECTION'.
REQUIRED
t4 < 'W.4—i
.o,
711�,.ol -
VALUATION
FEE
OfMVJ[Ai (-rFK=:f—V142F— rt(A—t`
.... ..
S>4�, 4 Vk)
HEAT SOURCE GLAZING% LOT SLOPE %
014—
QUILDING C
PLAN CHECK NO: VESTED DATE
PLt
PLUMBINK
MECHA�ICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
7j DOMAIN (CUREIS,SIDEWALKS, DRIVEWAYS, MAROUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
w PERMIT APPLICATION: 180 DAYS
0.
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
V) W "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES T 0 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE, OF THIS PERMIT SHALL NOT BE
-j
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I " -
.
TOTAL AMOUNT DUE 53 13.)-
I HEREBY ACKNOWLEDGE THAT I HAVE R EAD THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
This application is not a permit until signed by Inez
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION Building Official or his/her Deputy: and Fees are paid. and
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
receipt is acknowledged in space provided.
SIG NATtfRE.(OWNER 0 DATE SIGNED
(425) 0 Sl JURE DATE
GAGIT
4,11
)U
771 -0220
ATTENTION
REL E Y_ ..,bATE
L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS. BEEN GRANTED.. UBC SECTION'109
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD . ASSESSOR
5/98