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21811 95TH AVE W.PDF9288 1 21811 95TH AVE W m #P20 CA File No: 20 0 9— 0 Critical Areas Checklist Site Information (soils/ topography/ hydrology/vegetation) 1. Site Address/ Location: lh^e, (, -zi, - oo 6 lei q C) (9 0�0 2. Property Tax Account Number: L 000 7-1 , 3. Approximate Site Size (acres or square feet): 4. - Is this site currently developed? /� yes; no. If yes; how is site developed? < 5. Describe the general site topography. Check all that apply. XFlat: 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 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: tl Approx. Depth: 7. Site contains areas of seasonal standing water: /10 Approx. Depth: What season(s) of the year? 8. Site is in the floodway V1 Q floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? - ki () 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: n 0 1. Plan Check Number, if applicable? 2. Site is Zoned? 3. SCS mapped s 4 5. For City Staff Use Only Critical Areas inventory or C.A. map indicatesCri tical Area on site? /V�q- — Site within. designated earth subsidence landslide hazard area? Af 0 DETERMINATION STUDY WAIVER #P20 City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 -C. 167 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, or soil surveys). Date Received: -2- City Receipt#: Critical Areas File#: CCO-20OW0371V Critical Areas Checklist Fee: $135.00 Date Mailed to Applicant.-��-#-Qk 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 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 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 attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information ftimished by the applicant, his/her/its agents or employees. By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to fiElLthiis applica'7 listed below. SIGNATURE OF APPLICANVAGENT Property Owner's Authorization By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the ublic offi. cials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and pos att4ant to 7th )a I 3 _ M, ,e ? - a SIGNATURE OF OWNER DATE 0, ),-) r� / I PLEAbL PRINT ULEARLY I Owne p Hcant: H, e4i7)NI -+PIC Name Q Applicant Representative: Name � I �2 � k 0) 5 +- Are- U-) Street Address Street Address �j (MD \A (� S ( - 'L GD-0 City State Zip City State Telephone: -9 / 0Z d") -�(q 006 Telephone: Email address (optional): d�4d N1 (b (W Lte-�- Email Address (optional): J _J Zip is IN Ok N 0 do C)O- C-T WO 0 �A 0 b�o - 000 -b i-1 z e� U 0 U 0 (D WJ Cf) 0 1, CITY OF EDMONDS Wmit No. 72 4 PUBLIC WORKS DEPARTMENT STREET FILE Issue Date RIGHT - OF - WAY CONSTRUCTION PERMIT A. eAddress or vicinity of Construction e Permit Issued To: 21811 95 AV U Plat 164-67,004 9 Owner: Ong Co Name 805 -156 AV MS. Mailing Address )3al-1cwc, T-Jaoh!nRton 98007 (-,try, State, Zip Code 9 Contractor: Same Ao Aboyc Name Mailing Address * Type of Work to be Done: Inrot-ra 11 New Sond c- Work in Connection With: El Sub or Plat N Single Family El Comml. / Ind. 0 Apt. Condo. Pavement Cut: 0 Yes El No State License Number City, State, Zip Code Telephone Number * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * B. APPLICANT TO READ AND SIGN INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal. proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call 775-2525, extension 220. . 4 . I understand that this permli' I Signature: Owner or Age available at ob for inspection purposes at all times. W — 4A, T)nre 10/17/79 THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES CALL DIAL - DIG PRIOR TO BEGINNING WORK C. Issued By. :._;c: Time Authorized: Vold after days Special Conditions: Arnmencirrients: Permit Fee: Security Deposit: Receipt No.: Fund III Fee: Street Cut Dimensions X * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * Eng. Div. December 1978 FIELD INSPECTION A ES (Fund. 111 - .90te con'v to Street Dent. Comments: Diagram: 4`4 , Contractor called for inspection T ,41ork Disa.pproved By: Date: B�. Date - Work Approved By: Date: Z-Zf Inspector: Ena. Div. December 1979 NOTICE: No"Wa ranty--OT-amc-(-, The -information shown on the attached Hed for use by the City Of map(s) was com ' P' Edmonds, its Empl.oyees and Consultants. Th,.e City of 'Edrn.onds does. not. warrant the accuracy of anything set for.th on these rn a p ('S*') - A n . V person or entity -requesting a should conduct an.independent COPY ation shown-o inquiry regarding the rm _tFe -MaP(S)/ including, but not limited to, c ion of any sewer stub shown. Suc the lo' at' sewer stubs may or may not e.xist and may or may not exist at the location shown, Neitheir the r"ity of Erdmbn(ds nor its 11� em pl-o-yee-s o.r off icers -shal] be 1.1a. bal-e for iffiE information given on this map(s), nor for 'ded based any one representation provi upon said map(SN). APPLICATION L' for The' City of Edmond$, SIDE SEWER PERMIT EASEMENT NO . ............................................ NEW CONSTRUCTION REPAIRS F-1 LID NO - ------------------ ASMT. NO. - ............... OWNER CONTRACTOR --- 4�!�P- ................................ ------------------------------------------------------------ ---------------------------------------------------------------- PERMIT NO. JOB ADDRESS -------- ------------ LEGAL DESCRIPTION: LOT NO - ---------------- V�5 ................ BLOCK NO - ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ NAME OF ADDITION .-Fa7-'C ...... "L4 E—=� --------- t--x:)c�%-rkc>r-4 1�1 ----------------------------------------------------------- 0 0 W M""', '-V 1�:�, _z-1 WF 7 F Ek; E AT S IP6�' RT ENY, 'P, 5472 PERM coyeii�g.. any 'Portion, of the 'construction.).' ORE Call� 115-2525 for, side-.�sewer inspecti0n& ISEr bj-,�sat, sun�, or holiday, inspections. ((L pection will be, providedL within-2� houis:.afier requst. V Ins .............. I ?_r venU6 �95th�,A .............................. ....................... 21 ....................................................... C, UCTION .......... ........ ...................... qADDRESS'0L Addition #3 ............ ........ ..................... ........................ I.. ......................... ip,!noN. .......... ....... Lo �PROP ERT-Y -,LEdAA,;­DESCR ........ ............. ........... .......... .......... ........... ........... ................ ......... ...................................... ......... ............ .......................... I ......................... .............. ................. ........................ ................ A1%03/0PV BU, 11,LDER .................. :7 .... 77 .......................................................... OIWNER ............... ........... ............. ...... ..... ................ Ae ........... ........ ............................................. s ...... All ...... the.city,'iialliftary sewer neet to, is 19'7�_! for -repair and/or, con ion Of a side sewer, ran & ........................ -Pernus _dan V"t Or Of Edmonds ordinanees. S. be, employed. to construe FOLLOWING,;_._�, .6fite�jn a permit"to construct -sewer In -side �rbpeiL,ty -line., "klicensed' Side Sewer Contractormust of the, property aY cted. -Do -not cover arI portion oi! sewer before it has.been Inspe No. J�TheL o ners , � - . ,, . :, -able from the City.EngirI office side�seweiAfi%street�area. Right-of-W&Y Permit obtain ll,work,pe�formddjnxity right-6f-way requirm an, Invasion of. get;Pe It. NOTE: i4G. 2L­�, ­ j_ L ' .1.16:030' and Regulations govern�ing side, sewers when you .. rM �66taI - UM Lgrade, of 2%. N6 bends In grade E , NO: '3� informatiort regaxding Ordinamce 1 property line; minim NOT' ''at least 30 inches coverage at property -line and 12 inches. inside, d s have NOTE"No 4�—Top of sl e,sewer,mu t� 'sha�iper.Aha�n i/s ,Arill be, permitted. Contractors shall be responsible.for, failure due to,improper ion. 'in" street: must �be water settled and surface of stredt restored to originsa. co ndit pletion. .40 -&L-,Trenches ces except to in - NOTE I w�rk,'whicbt.mak &veldp.within one year,of Cora rovided for in 1he permit, or to do any work on the main sewer or its appurtenan or do, any other work than is p TENo. &—It lw,unlaw No ful'ito-'alte sert tjfe;�Jplpe-ir�WAhe ....... BY ................ . .. ... ;0. BY ................. Date .......... w ........ .......... ....... . Byi.: .............. Date ........ Date., .. .. .......... �DISA�PPROVVED: By........... .... ... ate'.. 75 ... 6-W ... APPROVED. .7­'IV.., AWI� ................... .................... ................................................................................. Rejyjar. I' ....... ................... ................ ............. ............................................................................ ......... ........... ................................. M ....................... ........................................ .......... ............. W­,...­ .... 7 .... : , . J�* ction, ...... -:K!��equest For Inspe �C6pie&'MUST Be Signed By owner of Firm Perf6rming, Constrilqtion PRIO —7— BOTH,.Yerrilit nstructed..under,,this permi ereby,certify��',that the side sewer installation co .................... �h �f Contra Oting Firra Performing Construction K -(Owner �o -overning ordinances of the City: of Edmonds. l�--,-Insta-Jled��:in'�licc..ordance,with.all',g M, .... ..... 19.�? Dated'Ahis ........ ;,, .......... (lay, of m ....... ....................... j 'Othe e wer Ell Sewer E], r Gas !E]-,' -Tel h 'PO 11, C ej�.,,BgFORE you -dig for: Water.'E], e APPUCAInON a The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO - ------------------------ ------------------- NEW CONSTRUCTION REPAIRS LID NO-,��-- --- - --- �- �N ----------- OWNER ......... ----------------- CONTRACTOR ............. PER -MIT NO. JOB ADDRESS .... 2.�� ------ LEGAL DESCRIPTION: LOT NO - ------- 19 ------------------------ BLOCK NO . ....... ---------------------------- ............................................ I --------------------------------------- ..................................... --------------------------------------- NAME OF ADDITION ...... R--0 ------ ------ ------ ...................................... ---------------- RECEIVED MAY 17 1976 ez Approved: DATE............................................ By --------------------------------------------------- Memo to: Director of Maintenance & Operation Public Works From: City Engineer Subject: Sewer Connection Charges Legai Description: Lot 19, R.C. Munger No. 3 Commonly known as: 21811 95th Ave. W. Z.F.F. Calculation: 68.83 Z.F.F. x !�5_50 Lateral x Unit x $ 25 9- cc: Da"ce januaa _Ij, 1976 PFCP-177� JAN A151976J Public W Oviner: Valtorn, Burr , f�� - $ 378.57 Connection Fee $ —0— Lateral Charge $ 25.00 Trunk Charge 10.00 Permit $ 413.57 TOTAL Form 6 STREET FILE te —JaTivary 14, 1976 Memo to: Director of Maintenance & Operation PFCF!V'7r` Public Works From: City Eng ineer JAN 15 1976 1. vue ? Subject: Sewer Connection Charges Pub Ic wt. Legal Description: Lot 19, R.C. Manger tb. 3 Commonly known as: 21811 95th Ave. w. Owner: TKalter Burr Z.F.F. Calculation: 68.83 Z.F.F. x 15.50 Lateral x Unit x $ 25 cc: $ 378.57 Connection Fee $ —0— Lateral Charge $ 25.00 Trunk Charge $ 10.00 permit $ 413.57 TOTAL Form 6 STREET FI.LE Memo to: Director of Maintenance & Operation Public Works From: City Engineer Subject: Sewer Connection Charges Legal Description: Lot 19, R.C.*Munc .jer No. 3 Date —Januarv, 14, 1976 Commonly known as: 21811 95th Ave. W. Owner: w4f#r Burr Z.F.F. Calculation: 68.83 Z.P.F. x 5.50 Lateral x Unit x $ 25 cc: $ 378.57 connection Fee $ —0— Lateral Charge $ 25.00 Trunk Charge 10.00 Permit $ 413.57 TOTAL rorm 6 [A Iro- JAVP-rt- IBUPM -Zt 95 AVG- ,/,o �r / f t4e, 4r. A141d6 6W- 1VO, '3 i A 1p =7o - rs, L 45, 1-14-74 REGARDING: 21811 - 95th Avenue West (address) R-E C 0 R D 0 F C 0 N T A C T S DATE NAME, PHONE NO., & COMMENTS ACTION TAKEN INITIALS ADDRESS of CALLER S/17/76 Walter Burr Allied Backhoe obtained permit #S472. JT S/25/76 -Connection cgMleted. JT REGARDING: 21811 - 95th Avenue West 4QS:-0�2o'Ro (address) R E C 0 R D 0 F C 0 N T A C T S DATE NAME., PHONE NO., & ADDRESS of CALLER COMMENTS ACTION TAKEN INITIALS 2/13/76 Walter Burr Certified Letter No. 406740 sent Letter received. JT 6636 Laurel Ave. requiring hook-up within 60 days. 2/17/76 Omaha,, Nebraska Mr. Burr called from Omaha for Jack to return call 2/18/76 JT (402) S71-6239 Jack. Jack not in. Has tried for 3 between 3:30 and 4:00 p.m. years to connect but was told he could not. 2/19/76 Mr. Burr called from Omaha. May take JT longer to install sewer. He will have to connect into main on 218th. He will send in legal and requests a list of side -sewer contractors. 2/23/76 Received letter with legal description JT and requesting contractors list. 2/25/76 Certified Letter No. 406753 sent with Letter received. JT copy of connection feq and list of t contract ors/*'1S.'_5 -4 2/27/76 Mr. Burr called from Omaha. Had just Explained difference between connection received letter. Questioned connection fee and assessment. JT fee. 4/26/76 Larry Ogle checked. House is vacant. Water was turned off and meter JT locked. Utility Billing has been notified. Also left door hanger. 5/7/76 Jim Mohr of McPherson Realty called JT and talked with Jack. They are handling sale of property. He will contact Burr and request hook-up or allow connection fee on sale of property. S/10/76 Received check from Mr. Burr for Sent receipt for check on S/11/76. JT connection fee. He also requested that we contact Allied Backhoe so they could begin the installation. 5/13/76 1 called Allied Backhoe and informed JT them the connection fee had been paid. CITY of EDMONDS 200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525 Department of Pubfic Works May 11, 1976 -511A Mr. or Mrs. Walter E. Burr 6636 Laurel Avenue Omaha, Nebraska 68104 Dear Mr. or Mrs. Burr: Attached please find receipt for your check, Number 4727 in ' the amount of $4i3.57, which Daid the sewer connection charge for 21811 - 95th Avenue West, Edmonds, in full. We will also, at your request, contact Allied Backhoe and inform them this fee has been paid. Thank you for your cooperation, Sincerely, Fcri JOHN B. MITCHELL Water/Sewer Supt. j t Attachment CITY OF EDMONDS N? 4610 OFFICE OF PUBLIC WORKS WATER DEPARTMENT RECEIPTS Date My .. //j .. /CTI/0 .............. Received of .. . ....... ..................... . ......................................................................... For No. x ........ .&. . . - t' ........... ;; 7-j k . ..... .............. 46'e --1-' For No. . ......... ... ... .. . . ............................................... AmountNo. / ---- I --- -- ------------------ .................................................. Amoun 0. 2 * k N C ... *.'*"* ------------------------------- ............. ......... By. .... . .... . ..... ................................... WALTER E. OR MRS. EDRIE J. BURR 6636 LAUREL AVENUE OMAHA, NEBRASKA 68104 PHONE 571-6239 PAVTOTHE ORDER OF. ............... 2 r/19' .............. $ ....... 4 ...... $ 443,; NOO 4727 27.2 1040 -M,�- 5 DOLLARS The Omaha National Bank OMAHA. NEBRAS!CA 613102,, -4: 1040111000 21: 2 S Sell 2!l1GL, 2111 Le ? 2 ? 1-7 7q -laCV-, Z-2�9 RECEIVED A 7 4' MAY 10 1976 Public Works Dept. CITY of EDMONDS 200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525 Department of Public Works February 24j 1976 CERTIFIED MAIL 406 ��_? Mr. or Mrs. Walter Burr 6636 Laurel Avenue Omaha) Nebraska 68104 Dear Mr. or Mrs. Burr: As requested in your letter dated February 19, 1976, please find attached a'copy of your connection fee, in the amount of $413.57, which must be paid in full prior to obtaining a Side -Sewer Permit. Also attached is a list of Licensed and Bonded Side -Sewer Contractors approved by the City of Edmonds. If we can be of further assistance, please contact us. Sincerely, 411JIOHN B. MITCHELL Water/Se'wer Supt. jt Attachments COMPIke it�uns I 4- ShNDER'--- '.�d 2-. Add your address in7 the -'-RETURN TO space,or� re�erse, '1- The-fdl,lowin service* ig,fequ _9 ested (check Pne). El Sh6w.to whorn'an.d date delivered --------- F7 $how to,wh6m,-date3 & address of deliv'ery.. '35� - 'PFLIVER..ONLY TO ADE�RESSEE And - show to whoin and' dale.delivered. 0' .,. ADDRESSE,. E�. and.. - ihoiAr to wh9rp� 4ate,',and� a4diess "'-deliv�ry. A TICLE ADD A -RES-- 0r -mrfs.' -Buitt W, > G) i 6636-lau-ta -.AvOffue �,3.:AhTICLE.DESCRIPTIbN� RtGl��T E- -RED-. N IFIED NO. I SURED-NO.- 4067 i r .(Alw; MiSseqvV& haVe x6��j -iVeo jife: SIGNATURE._-.- Z", ML DA-fE, i�7 6EL JVERY. 5-� ADORE t�-'(Co plete only, if re srea) �4 6 TV L A % I j In 1�- CID 411,,Sk]�TDER: Complete items I'and 2. Add your address in the "RETURN TO" space o. je�erse- ��rfie foliowking service is,requested (cheek Show to.4om and date delivered ----- 150 Show to whom., date, & address. &f delivery., -DIELNA ONLY TO'AbDkEg�EE, 41id' *show to�wh6rn and' -d' Ate. d.eli - 650 'TO M Dh11L1,Vk.k 6N.LY ADDRESSEE'afid % shomi . to, wh(5n�, �wdate, And tf A.ddress "deli�lery ........ --------- ----------- ---- 954 2.-ARTICLE A-DbRb§��� 606- tau 1, AVenue 7-7 -3. AkTItLE 15E�CRIPYION: REGI ��TERED- NO;, qERTIFIEDj NO;, INSURE& Na.-, _1� J., 4067.4-9-. !�kLta-16��gnattire of. add -e or i3gent) I- have rec6%;6d- the� ribed, 4sove., IGNATURE 4. LIVERY',* 'POS�TMAOK .0m f ie ADDAIE�s (d P164 qm�l: ques�ej �6. UNAbLE TO -,D-EL)VER-r-F3tt�A-G-!§C- CLERKi� CS'. RECEIPT FOR CERTIFIED MAIL-30� (plus Postage) 11",'J IIIAIL 17TO, No� 406740 > -0 -n Z�; Ta % C7, C, 0 x Z4 % z !E W cn > m M W (D (D c-.N s G m m C, m CD 0 C;; F CO o -- ­, 1171tIOVA110NAL MAIL 1�ee other side) GPo: 127o o.3g7.,,. 7 z� 2 - /2 RECEIVED FEB 2 3 1976 Publ�' orks 6P.I. ROUTING MRY Ln i t i a! Date 4. All Z1, lje� From: [Date: jr r El CITY of EDMONDS 200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525 Department of Public Works February 13, 1976 CERTIFIED MAIL,#q66 -7ilo Mr. or Mrs. Walter Burr 6636 Laurel Avenue Omaha, Nebraska 1� Dear Mr. or Mrs. Burr: City records indicate that you are the owner ' of the property located at 21811 - 95th Avenue West, Edmonds, Washington, and that sanitary sewer service is available to your residence. Homeowners abutting this sewer main installation have sixty (60) days in which to connect to this sewer service following construction completionj per Edmonds City Code. Enclosed, you will find copies of applicable excerpts from the Edmonds City Code (11.16.020, 11.16.001, 11.16.010, and 11.16.240), explaining connection procedures. In accordance with the aforementioned City Ordinances, you are hereby instructed to make the necessary sewer connection. Failure to accomplish this connection within sixty (60) days from the date of this letter will result in the termination of water service to the subject,property, in accordance with City Code 11.16.240. Requirements for obtaining a Side -Sewer Permit are a plot -plan drawing of the proposed connection, the legal description for the property, payment of connection fees and copies of all recorded easements (where applicable), and payment of the $35 Permit fee. Side -Sewer Permits may be obtained at the Public Works Department, 200 Dayton Street, Edmonds, between the hours of 8:00 a.m. and 5:00 p,.m., Monday through Friday. Please phone Mr. John B. Mitchell,, Water/Sewer Superintendent, at 775-252S, extension 226, for any information or assistance you may desire. Sincerely, SIGNED J. HERB GILBO Director JBM: j t Enclosures TO Sewer Depa-rUmnt Public TAbrks INTER -OFFICE COMMUNICATIONS DATE January 19, 19 _7� FROM Richard H Alleii Assistant City Engineer JAN 2 0 JW6 SUBJECT: Sewer for Plat of Bell -in Gra-rdens r1he subject sanitary sewer has been inspected and accepted for hook- up. It is now penussible to issue side sewer permits. For those properties within the City abutting this sewer line that have not made ocnnections- to date, a notice should be sent requiring them. to connect writhin the time Liniit as set by Ordinance.' Connection Menm have been made up and forwarded to your office for each of the prop- erties effected. RFM:mjr