21830 76TH AVE W.PDF111111111111
6342
21830 76TH AVE W
r Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I . Site Address/Location: z I t Iz 4 ?,19 -�o I ( � kyc W
2. Property Tax Account Number:
uare feet):
-1 Approximate Site Size (acres or sq 0 r219
4. Is this site currently developed? X yes; no.
If yes; how is site developed? idma
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
ZME
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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 3 )0% 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 o f year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: N/k Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a k or an area where water flows across the grounds surface? Flows are year-
round? typ 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:
DETEAMINATION
fta_;hk.doc; Re� 10/03/97
A-1. . MAVE�
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City 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).
f4 0 V 2 3 1998
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 infor m-ation (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).
Owner/Applicant:
Name r t �vdAt-i
2.1
Street Address
WPP45 f 0
city State Zip
4-L5 - 4547
Telephone
Signature
Date
Applicant Representative:
63
Name
2-24,4 Riwvsrc& �� ';;� 2,7P
Street Address
Ngv� � Vaim � Or
city State Zip
3(ao -
ATelepe
Sig ature
1117,4119
Date
(over)
vreception\Janakad.doc
411 C. 1 B913
November 25, 1998
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning/ Building * Parks and Recreation e Engineering * Wastewater Treatment Plant
Sound Urdogical Associates, P.S.
21600 Highway 99, Suite 200
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist # 98-288 & 98-289
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a co py of this Critical Areas Checklist "DETERMINATION" for your records.
.... .................. .......... ........... ............ ...... '....... ...... ......... .. .......
... . . . ...... .......
xi
NTINFORMAT N O�PEWOTEO. ......................... ........................
...........
.............
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECK —LIST OR CRITICAL AREAS STUff.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
wo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL AIIIIIIIIIIII
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
* Architectural Design Board
C:ReceptIon\Jana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
ill
STREET Ar
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. 0 EDMONDS, WA 98026 -1206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
1"S t . 18 () Q
February 18, 1997
Dr. Ben Thal
21616 - 76th Ave. W. Ste 103
Edmonds, WA 98026
Subject: Leak Credit at 21830 - 76th Ave. W. - Account - #452775
Dear Dr. Thal:
I have reviewed your account and will allow a credit for the billing period of
September 16, 1996 through November 18, 1996 in accordance with our City policy. The
policy states that the customer will be billed at the retail rate based upon the average water
consumption for the same period during the previous year. In addition, the excess water
lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three
year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Z�x -
Scott Hig #and
Acting Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit96\#452775
e Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
y
Day & Nite
Plumbing & Heating, Inc.
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Since 1954
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CITY.
D.O. Box 1021, * 5700 - B 188 St. SW
ftter
0
LYNNWOOD, WA 98046
PHONE
DAYNIPHO44CM
QLaIiV.
DATE
4 OS rA 1A /11 - f h A 1,4�
-7 4-7
ZIP
-77-5-- 6 577 77/— S;'dl
INVOICE
CONTRACT
rJOB LOCATION
v, 'Au
PHONE
7-7/-22SI
DIAGNOSIS RECOMMENDATIONS / DESCRIPTION OF WORK
CITY.
DESCRIPTION
AMOU
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F�SOURCE M:� �/yC
DIVISION:
WATER
PRESSURE
PSI
SUBCONTRACTORS
MATERIAL
0(
.1 �. 1. 1 . : .. -WARRANTY
I. lill PLUMBING: All workmanship and materials are warranted for one (1) year
HEATING: unless otherwise specified or as stated on back of this form.
0 None (Reason)
N DRAINCLEANING: Warranted for thirty (30) days for labor only unless
otherwise specified or as stated on back of this form.
0 None. (Reason)
(Warranty work perloffned durbV r"dar business hours),
EQUIPMENT
LABOR . . .
MY
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PAID BY:
0 C'K'#
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0 CASH
0 CLIENT
VOT��R
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TECHNICIAN
TIME
RATE
AMOUNT
SERVICE CALL
r_75
FLAT RATE
MIORK AUTHORIZATION:
J, the undersigned, am owner/authorized representativettenant 'of the above mentioned
,,�remises do hereby'authodze.the above described work and agree to the terms,
riditions, and have read the lien information, as stated- on both sides of this form.
[me a Material 0 Flat Rate I $
T
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f OUT OUT
LABOR TOTAL
ORDERED BY
COMPLETED D
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SIGNATURE (I hereby adcnowledge the swisfactorycorn0elion MIR """i
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PLEASEPAYFROM
THIS INVOICE
222
(`DATE
FD—JLY
Day & Nite
PLUMBING
ibing & Heating, Inc.
775-6464.- 353-6464
S
0
6NAME
FdAt, n L e-*1 -
0
[HEATI 364-0959 9 653-6464.
L
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ADDRESS
LIC
Since 1954
P,.O. Box 1021 * 5700 - B .188 St. SW
T
0
Cny
F)f'h D
VtTE IP
1� IVA
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LYNNWOOD, WA 98046 411%.W
ater PHONE
DAYNIPHO44CM CQyaj1iy. jq,
MU
DIAGNOSIS RECOMMENDATIONS DESCRIPTION OF WORK
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rA_C;,.0 eufL �A .16 ltt�PAJIA, CLAJ NA 7tk C 1��'
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�!�qURCEK e pezi DIVISION: (LMXQAyC WATER
.2 PRESSURE
EGUIPMENT
WARRANTY
PSI
10-PLUMBING: All workmanship and materials are -warranted for one (1) year
ITATING: back of this form. PAID BY: TECHNICIAN TIME
unless otherwise specified or as stated on
0 None (Reason) 0 CK . #
"'M DRAINCLEANING: Warranted for thirty (30) days for labor only unless
El cc
otherwise specified or as stated on back of this form.
0 None (Reason)
(Warranty work perlornied during regular business hours) 0 CASH
0 CLIENT
ORK AUTHORIZATION:
OTY.
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INVOIC E
.CONTRACT
"JOB LOCATION
q,
A ue
PHONE
DESCRIPTION
MATERIAL
LABOR
AMOUNT SERVICE CALL
FLAT RATE
<
AMOUNT
7TT�
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h6undersigned, am owner/authorized represdntativeltenant of the above rrienti6ned )kI0THER
prL-mises do hereby authorize the above descn**bed work and agree to the terms, "10,Aj &c& gr
conditions, and have read the lien information, as stated on both sides of this form.
r LABOR TOETAAL
rial 0 Flat Rate of $ ORDERED BY$/,,,, J��D Dff
ime and mate
OUT I=N
f"', A SIGNATURE (I he" aclumviedge the satisladorycompletion of the above describedwoft) PLEASEPAYFROM
V f - ; " .. y I THIS INVOICE
4-�' /
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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 forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the 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
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICAMN
The City of lEdmonck for MENT NO . ...................................
ClnC CC%MCO DCOAAIT EASE ........
NEW CONSTRUCTION REPAIRS LID NO . ......... ........ ASMT. NO - -------
'NO.OWNER ........................ �l ....... ---------------------- ............ CONTRACTOR ...................................................................... PERMIT
0
JOB ADDRESS ... ...
- - ----------- ..... ---------------------- UGAL DESCRIPTION: LOT N r ....................... ------------- BLOCK NO --------- *.---.2=.-------.-.:---
..................................................................................................................................................................
NAMEOF ADDITION ............................................................................. .........................................
4q,
Approved:
DATE.. B, -.1. C:r .........
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7-75-2525 for side sewer Inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspections.
ADDRESSLOCA93ON OF CONSTRUCTION ................................. I ................. .................................... . .......................................................
PROPERTY LEGAL DESCRIPTION .....
.............................. :_J ...................... I ..................... I ........................ I .......................................................
.............................................................................................................................................................................................................................................................
................. OIVNERAWDJOR BUILDER ........... ........... ................................... ......... I .......................................................
...............................................
CONTRACTOWSNAME & ADDRESS ........ �., .......... ... . ...................... I ........... ..... I .................................................................................................
Permission Is granted ....
...... ........ ................. for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance wii� ... C-I't-y", -�i ... Edmonds ordinances.
A\,_�JNTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The 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—All work performed In city right-of-way requires an Invasion of Rlght-of-Way Permit obtaInable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 Inches coverage at property line and 12 Inches inside property line; minimum grade of 20/0. No bends in grade
sharper than 1/8 will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to orIgInaJ condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--It Is unlawful to alter or do any other work than Is provided for in the permJt, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe Into the wye.
DISAPPROVEDn
APPROVEDDate
Date ... .................................... By ................
....... ......................
Date .... By ................ Date .................................... By ................
By ..... C ......... . ...... . ...................................................................
Remarks: ........................................................................................................................................................................................................................
.............................................................................................................................................................................................................................................................
BOTH P it Copies XUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
I L ..................................... ... I hereby certify that the side sewer installation constructed under this permit
(Ow,nerof' ��Ortract*ing .... Firm" Performing Construction)
WL_ c
n§tal ed 7ina cordance with all governing ordinances of the City of Edmonds.
........ 1
Dated this... ......................... day of.
4 V Check BEFORE you dig for: Water E], Gas E], Telephone E], Power
Sewer [:], Other [:] V V
Z1930 ��-th AIv-f W
52,1 �
,��jaj_jo WORKS DEP
� Ze
APPLICATION
for
The City of Edmonds SEDE SEWER PqMkIT EASEMENT No . .............................
NEW CONSTRUCTION gr'o' REPAIRS r-1
OWNER........ ...... -----------------------------------------------------------------------------------
ADDRESS ..... .............. ;7�--c,.7.) ... ..........................................
------- ---- --
la
Y "Ir
CONTRACTOR............... ............................................... ----------------- ---------------- PERMIT No., -
LEGAL DESCRIPTION: LOT No . ......... / ................................ BLOCK No . ....... 2
....................................
NAME OF ADDITION
.......................................................................................................................................
IDI
Approved:
DATE................................................ By .......................... ............................... ...........
Date -Nnyember 21, 1974
Memo to: Director of Maintenance & Operation
Public Works RECEIVED
From: City Engineer NOV 21 19740d
Subject: Sewer Connection Charges
Legal Description: The S 76.19 ft of Lot 1, Block 2, Plat of Hadley's
Acres as recorded in the records of Snohomish County,
Washington-
Commonly known as: 21830 76th Avenue W. Owner: Unknown
Z.F.F. Calculation:
77.12 Z.F.F. x $5.50 ) = $ 427.90 Connection Fee
I Lateral x $100 ) = $ 100.00 Lateral�Charge
I Unit x $ 25 ) = $� 25.00 Trunk Charge
cc: Terrace Realty (Dolly)
(?46- 4�-U �, IJII�� A,7116171.
$ 10.00 Permit
$ 562.90 TOTAL
Form 6
0
0
Standard Form No. 1034-A PUBLIC VOUCHER FOR PUFWSES AND
7 GAO 5000 SERVICES OTH
1034-211-01 ER THAN PMSONAL
VOUCHER NO.
17
— J
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT DATE VOUCHER PREPARED
FEDERAL HOUSING ADMINISTRATION
5W Log= Bldg* CON RACT NUMBEfR AND DATE
5th & Uhion RECEIVED
REQUISITION NUMBER AND DAT E
6 1974
PAYEE'S F =4CUDS POLIO WNS 10 AMMIT INCLUDE
NAME 2W DMW ST, ZIP CODE
AND IN YOUR
ADDRESS EmwDstva. "020 ADDRESS
NAME CONTR OLlopt.Code
SCHEDULE NO.
PAID BY
DATE INVOICE RECEIVED
DISCOUNT TERMS
PAYEE'S ACCOUN T NUMBER
SHIPPED FROM TO WEIGHT
GOVERNMENT B/L NUMBER
NUMBER
AND DATE
OF ORDER
DATE OF
DELIVERY
ORSERVICE
ARTICLES OR SERVICES
(Enter description, item number of contract orFederat
supply schedule, and other information deemed necessary)
QUAN-
TITY
UNIT PRICE
AMOUNT
COST
PER
Purchase Ordet
Nos., If any
11-21-74
Services on acquired property(ies) shown on
attachment(s). FHA Case Number(s)
# 561-101287-221
21830-76th We Edmcmd
SEWER OWNEMICS & ASS=UST
CMARGESs DUE PAXABLE NOW.o.eee
$
562.90
(Uso continuation sheet(s) if necessary) (Payee must NOT use the space below) TOTAL
$ 562.90
PA E T:
XC'OMPLETE
F]PARTIAL
—E] FINAL
F�PROGRESS
El ADVANCE
APPROVED FOR
o I
EXCHANGE RATE
, , ��' -:'� - ;�
$I-00
DIFFERENCES
BY2
TITLE
P"RAI ty -%fioialist
Amount verified; correct for
�g.a.r. or mitial.)
MEMORANDUM
ACCOUNTING CLASSIFICATION
MAIL" WITH CHECK
CHECK NU—MBER ON TREASURER OF THE UNITED STATES
CHECK NUMBER ON (Name of ban k)
CL
C ASH DATE
$
PAYEES
0
F.
L
1A
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
11
Date November 21. 1974
M
Legal Description: The S 76.19 ft of Lot 1, Block 2, Plat of Hadley's
Acres as recorded in the records of Snohomish County,
—Washington
Commonly known as*:.2.1830 76,th"Avenue-W. Owner:Unknown
Z.F.F. Calculation:
(77-12 ) Z.F.F. x $5.50
) Lateral x $100
) Unit x ( $ 25
cc:Terrace Realty (Dolly)
$ 427.90 Connection Fee
$ 100.00 Lateral�Charge
S 25.00 Trunk Charge
$ 10.00 Permit
$ 562.90 TOTAL
LEIF R. L"ARSON, PA.
EDMONDS CITY ENGINEER
Form 6
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/C�ed-t�ICATION
for
The City of Edmonds c urg SICDE SEWER
NEW CONSTRUCTION ��REPAIRS 0 F."FJ4ENT No . ..........................................
OVYINM....... rl?�eq ..........................................................................................
ADDRESS..... .............. ........... ---------------------- ......
9
CONTR Pee,
............... ....... ............ ................ ................................... PERNaT No . ......................
LEGAL DE ION: LOT No . ..... .......... . ......... : .......... ....... BLOCK No . ...........
NAME OF ADDITION ............ fic-,ec-,5
..................... .............................................. .................
Approved:
DATE............................................ ... By— ................................ .......
PIL-A T-
TL
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ACTION TAB o"fl
To: Date
From:
0 FOR YOUR COMMENTS FOR YOUR INFORMATION
0 FOR YOUR APPROVAL El NOTE & RETURN
0 TAKE APPROPRIATE ACTION C] NOTE& FILE
0 CALL ME 0 FOR YOUR SIGNATURE
0 SEE ME 0
COMMENTS:
A401 KO A*
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-1-MX
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LF 004-2
(Form OA-4)
@ Copyright 1969, 1970 Laurel Office Aids, Inc.. Bronxville, N.Y.