21910 95TH AVE W.PDFiiiiiiiiiiii
9298
21910 95TH AVE W
JZ.
CA FILE NO. —
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topo goraphy/ hydrology/ vegetalion
1. Site Address/ Location: Z C1 I o It)A q p Z_
2. Property Tax Account Number- 7 1 000 o15 oo
3. Approximate Site Size (acres or square feet): / 2-6)
4. Is this site currently developed? >� yes; no.
If yes; how is site developed? 5 i,�j t-0 &_I� 5 P VCf
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site genera-Uy 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: A/0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: AJO Approx. Depth:
What season(s) of the year?
8. Site is in the floodway__Z�() floodplain NQ) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? 1,11.2 Flows are seasonal? A10 (What time of year? It- o
10. Site is primarily: forested A/ meadow A10 shrubs �Vo mixed /V 0
urban landscaped (lawnshrubs etc) ye<,
11. Obvious wetland is present on site: Al 0
For di�, S*taff' Use, Only
!,,::' SiteisZon*ed?
— k, A_ V_., n) /11 107
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
infon-nation 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).
Owner/Applicant:
61VIVk
Name
6 2 1110
- -
Street Address
city State Zip
q 2- �5- , 77)
Telephone
Signature
Applicant Representative:
'-� A �14
Name
Street Address
city State
Telephone
Signature
Zip
Date
vreception\janakaddoc
Date
(over)
10c, ()"I
March 6, 1998
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works o Planning/ Building o Parks and Recreation * Engineering * Wastewater Treatment Plant
Glen A. Johnson
2191095 1h Avenue West
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist #98-63
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 copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS"DETERMINATION11 FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENV
1RONMENTAL CHECKLIST OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination. ,
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 4E
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
Thank you.
Sharla Graham
Acting Planning Secretary
C:ReceptIon\Jana\CRLTR.doc
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT STREET FILE Issue Date a 3
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. eAddress or vicinity of Construction 0 Permit Issued To: Al Cn
21910 95th Av. W.
Z
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0
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Owner: ' Washington Hatural Gas Co.
Name
805 156th Ave. N.E.
Mailing Address
Bellevue, Wash. 98007
city, I State, Zip Code
e Contractor: Same as above
Name
Mailing Address
City, State, Zip Code
e Type of Work to be Done: InStAll nOT47
service
Work in Connection With:
El Sub or Plat M1 Single Family
El Comml. / Ind. E Apt. Condo.
9 Pavement Cut: El Yes El No
State License Number
Telephone Number
* * NO WORK TO'BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMNITY: 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 whamoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of its 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 Controtto 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 7 7 5 - 2 5 2 5, extension -2�. .1.5
I understand that this permi,_m�e avaiI&W&1#-+e job6t'e for inspection purposes at all times.
Signature: Date 8-01-8 .3
Owner or Agent/
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after —days
Special Conditions:
Ammendments:
Permit Fee: Aaaon
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 NOTES
(Fund 111 - Route cony to Street Dent.
Comments:
Diagram:
Contractor called for inspection
Work Disa.pproved By:
Work Approved By:
Inspector:
Yes No
Date: Bv: Date:
Date:
Ena. Div. December 1978
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MOTAGE 8Y TYPE
STREET FILE
CITY of EDMONDS
200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525
Department of Public Works
August 16, 1977
Mrs. DeHart
21910 - 95th Street S.W.
Edmonds, Washington 98020
Dear Mrs. DeHart:
In April, 1977, you paid sewer connection charges
to the City of Edmonds in accordance with our City
Code. The City Council in their meeting of June 7,
1977, authorized the preparation of an amendment to the
City Code which was'passed July 5, 1977 (Ordinance No. 1925).
Based upon the amended Code, you are hereby refunded $141.83,
Treasurer's Check No. 409. A copy of the connection charge
memorandum is enclosed for your.information.
Yo s v u
C
L LEIF LARSON, P.E.
D jr
irejor of Public Works
LRL: rf
Enclosures
nds 98-239
Zity of Edmo 409 —
EdrnOnds, Washington
August 16, 1977 19
Xr-'�Arpp;jis, Washington,.
k
..............
-141-83-
i alu DOLLARS $
PAY
TO THE
ORDER Mrs. DeHart
OF
21910 - 95th ST SVI City of Edmonds
Edi-aonds, Washington 98020
L Do
EDIVIONDSBRANCH 0 �
PEOPLES NATIONAL BANK OF WASHINGTON
EDMOND-S. WASHINGTON TRE;,*60ER
DUSCRIPTION Refund Sew6r Connection Fee 411-000-000-471.03.00
Ppr nrclinancp #lc)7r, June 7. 1977
WARRANTS REDEEMED
BONDS & COUPONS REDEEMED
PRINCIPAL
INTEREST
DESCRIPTION
IDENT. Nos.
BONDS
COUPONS
CLAIMS
SALARY
L. 1. D. N 0.
L.I.D. NO.
L.I.D. NO.
Date August 10, 1977
MEMO TO: John B. Mitchell
Water/Sewer Superintendent
FROM: Richard H. Allen
. Assistant City Engineer
SUBJECT: SEWER CONNECTION CHARGES
Legal Description: Lot 15, R.C. Munger No. 3
Commonly known as: 21910 95th Ave. W. Owner: Mrs. DeHart
CORRECTED CHARGE:
Z.F.F. Calculation:
44.7 Z.F.F. x $9.33
-0- Lateral x
1 Unit(s) x $25
$ 417.05 Connection Fee
$ Lateral Charge
$ 25.00 Trunk Charge
10.00 Permit
PAID: $593.88 $ 452.05 TOTAL
TOTAL DUE: 452.05
REFUND: Tf)V�-�3
REFUND DUE MR - $141.83
APPROVED BY : (yrT
rson, P.E.
Director of Public Works
CC: Owner
5/10/77
0,
Memo to; Directot- of Maintenance & O.perat.1.01)
Public Works
From: City Engineer
.Subject: Sewer Connection Charges
Legal Description: Lot 15, R.C. Pkvigpr No. 3
4-7- -2 -�
c4poz.-Ce- PE 9�
C 0 U
L C T-
Commonly known as.: 21910 - 9501 Aire. P.I. Owiier
PIrs. Pe Hart
Z.F.F. Calculation: V/7 9) Soo
44.7 Z . F. F. x
$ connection Fee
Lateral X $ 0 Lateral Cha'rge
-Uni t x . $25 $ 2S.00 Trunk Charge.
$---10.00 Permit
/-7
�1171 TOTAL
aim
cc: /Mrs. Deflart LFTF R. LARSON, P..,]-.,.
City, Enginecr
v S*L. 0
q1i 181
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2108
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NOTICE.
'0w-a r-r a n" -a
K . 'shown an the attached
The -informatiOn tY 01
map(s) was com ' piled for use by the C1
Edmonds/ its Empl-oyees and Consultants.
nt the
Th,..e City ofEcIm.onds does. not. warra
n these
accuracy of anything set for.th 0
M a p (s). A n . y person or entity -requesting a
conduct an independent
copyshould
-c
Informat"on shown
Inquiry regarding the lmlt(2d to,
_ff�e -rn a p (S) / I n c I u d i n g, but not J
n of any sewer stub shown, Su(
the locatio
'not exist and ma�,
sewer stubs may or may
or may not exist at the location shown
Neit-heir the �ity of Edmond-s' nor its
emp`oyee's O*r off icers -shal] be 1--ja-b-1--e for th
inforMation given on this map(5), nor for
entation provided based
anyone repres
upon said. map(S'
n
APPLICATION
for
The City of Edmonds EASEMENT NO - ----------- --------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO . ..... _ .......... ASMT. NO.
- ------------
7-L
OWNER ---------- - ------ Y --------- E)'� —7 ----------- V3 ---------------------- CONTRACTOR ------------------------------------------------------------------ --------------- PERMIT NO. -------------
JOB ADDRESS ............. LEGAL DESCRIPTION- LOT NO - --------------- ------ --------------- BLOCK NO - ------------------------------------
0
_F -71 Pr-1
NAME OF ADDITION ...... ...... L:A�_ ------------------------ -----------------------------------
-rue.
La5_
7
7 4
Approved:
DATE.......... ---------- By --------_---
AM
CITY: OVEDM 4DS, -WER.'PERM,
SIDE'SEN
0', N
-E T
WATEWSEWERDEPARTM N
RMIT
PE
Y
rtI6 of the construction
(call '.7752525. for side -sewer. nspktlon's;:BFFORK. covering any, po n
ections.
hin- 24' �ours after. requst. NO Sat., Sum, 'or.,holiday. Insp
�I.speqt!?n will be provided*.wit.
951h AvC%nu.e jWest ............... ....................................... ........
ADDRESs -L, ocAT-10N,,6F'.00N5TRU&10N ........ . ................................ .................................................. .
Lot- 15 A&:L .'MqA,9 ... .................. ....................
-��,PR6-PERTY"I;EGYAL','DESCRIlpTiol�q,..: ...................... I ......... .......
........... ..........
................. ......... ..................... ......
.......... ..........
............................. .................. M� .............................. ....... ...........
-T
D6ffart;.-
................. .......... ....................... . ......................... ....................... !, ....... .............. I .........
... .. :�OWNER ANU/OR BU'I1MER--
. . . . . . . . . . . 7'
.......... .... ...... ................ .......... ...
th --- C
'CGNTKACT()R?S',',N-AME',& ADDRES,
of er to the city., Sarijta�y,"er
1 7' re and/or connection a side sew
TeOw is .2..: ........ ......... 1977.,jo
riangsi granted'...
-ATTENTION- IS:-dki-1,11 5.TO!'THF;,F-OLLOW1NG,: 'jlne.:A. licensed,,S Ide - sewer, Confract6r i�ust'be:;empi6l.�����'�����ruc�t
NOTE�No�, I�Theowners,of thc'prope�ty.,may obtaln,A permit -jo construct sewer inside properf�.
-,street -area, Do� not cover any. portion of sewer before it has been inspected.
,sIde,sewer'in 'Way -PermIt`obtaJrribIe;:f romAhe- City, Engincer's, of flee.
-140TE No 2—ANII, �work . �-performed An*�6.jt'j. right -of -way� rcilllir'es an.4nvasjon6f Rjght�.of-
-':governing side sewersi.when-ypu get Permit.
NOTE No. 3—Obtalw f 611, tnf ormationt regardIng,-,Ordin�nce 11., 16.030 *and Regulations rlum*-grAde�of 2%. 'Nc�,Obim si ingra4e,
f si -.3o ge at moperty line and i2jncbea inside., property line; minir
,NOTE', No. 4—Top"'o d�,isewe'r,':MugChave,at 1�azt ..Inc es covera
sharper tha�n".i�,,,\vill.-be'-permitted� r�qn,,I�ls:jorj-failure� dde to lrnpro�ei:.
settled: and',surface 'of�,street-' re4tored. to� original condition Contractors shalI,be.
NOTE I !No. 5--Tr�nches; In stFeet',must'be water
awidIA
ws'� or I n e �xcept to,in-
work w�ich�rgay,*d'evelo�',Wit.hin,6n6,yea.r*of completiont,' rit on-�the. mairr:8 ts, appuitens, e a,
: opaltey�' oth I er work,tban j!'provld6d".f(jri1n �Ahe permit 0 a, y..-Wo
—It Is
NOTE: No.,'.6 unI or, do,'any
sert the�tplpjeAnt&the wye._
7,
-Date
'By� ..............
........... . ............. --
B . ............... . Date. ... lky
DISAPPROVEV E]; ........... Y__ ... .... ......
.............................
.................
............
APPROV,
. ....................................... ...... .............
Pvelmrks:�.' ....................................... ................................
................. ............ ............ .......
...................... ................ ... .................
. ...... .......... ............ M ..................
........... 7 ....................... ..... ...
Requpst For Inspecton,
jgn 1�0"
ign ner of irm,*Perf6ililin
BOTM'P, --- ST 9,:,
:4
--irtstiallati" m constructed.,uncler
YA-hatAheI side;lsewe� 0
eby� certif
. ..........
6 ing::Fi Performing Constructiow),.
Bi
�"_l jj .�Llr�,governing,'t�oidind�iice§� of',the,)City, of Edinon&,.
,wa insialle A_ cc e�
j ................... ......
atedi -this....
9
of.. .. . ........
&Y.
.6
6T El' -V'A
Power. E],,- Sbwer, El;,
Gas
ibfIeck BEFORE'.you dfg�, f orr Water _
APPUCATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
e SIDE SEWER PERM
NEW CONSTRUCTION Ej REPAIRS E] LID A &.-NO.
OWNER
----------- ------------ -------------------- CONTRACTOR ------ kj-��r ----- R.0 -LOO/V- PERMIT NO.
�Sj.
JOB ADDRESS ------ Pa
;.W-1 ------------------------------------------------- LEGAL DESCRIPTION: LOT NO. -Air --------- -1. ---------------- BLOCK NO.
4-v4s&)d's- I
---------------------------------------------------------------------------------------------------------------- .............. REa ............
NAME OF ADDITION ------------------------------------------------ -, R 7 1977
---------------- ...... ---------- A? -------------------------------
Pubic WOrM D@I*-
Approved:
DATE-------------------------------------------- By --------------------------------------------------- Yi7yg
Da te December 6, 1976
Memo to; Director of Maintenan'ce & O.�.)eration
r Public works
From: City-Engiiiee*r
,Subject: Sewer Connection Charges
Legal Descriptioii: Lot 15j JZ. C. Mm9pr No. .3
Commonly known as.: 21910 95t1i Ave. W. Owner: Mrs.. De I Tar t
Z.F.F..Calculation:
44'.7 (.12.50 $ 558.88 Connection Fee
Lateral X $ 0 Lateral Charge
Unit x $25 $ 25.00. Trunk Charge.
$ 10.00 Permit
$593.88� TOTAL
LFI F R. LARSON, P T-' .
cc rs. Del lart
City Engineer
2108
I
I
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description: Lot 15, R.C. Munger No. 3
Commonly known as: . 21910 95th Ave. W.
Z.F.F. Calculation:
44.7 ).Z.F.F.. X 12.50
Lateral X
1 Unit x $25
cc:, Mrs. DeHart
Date— December 6. 1976
RECEIVED
Public r S Ueol.
Owner: Mrs. De Hart
$ 558.88 connection Fee
$ 0 Lateral Charge
$ 25.00 Trunk Charge
$ 10.00 Permit
$593.88 TOTAL
LEI
Cit��
E�,�ARSON, P.E.
gineer
2108
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December 6, 1976
Mrs. L. A. M lart
21910 95t1i Avento W.
Edmonds, Washington 98020
near �trs. Delfart:
SUBJEM Sanit2a Sewer romection
In reference to your rea ' uest by telephone for information regarding
the recuired sewer hook-up, please he advised of the foll(x%dng:
1) We bave reviewed the location of sanitary sewers versus the
position of your residence. As shown on the attachhed s�-etch, it
is recommended that your scnrr ca*ection be routed to the north.
2) Also attached is a copy of the computed connection charge
which will become due and payable to the City of Edmord-s at the
tine a sewer permit is obtained.
3) It is recousnended that you contact three sewer contractors
and obtain estimates for completion of this sewer connection.
4) If you find (as you indicated the case might be) that a
financial hardship is being placed upon you at the time, you
may appeal through the City of rdmonds Public Worls Sewer Tle-
partment for an extension of time or other arrangements.
If you have any further questions,, please do not hesitate to call
US*
Yours very truly,
LEIP R. LARSM, P.E.
UWlsc City Engineer
att.
Date T) - ecember 6 2 1976,
Memo to; Director of Maintenance & Operation
Public Works
From: City Engineer
Subject:,, Sewer Connection Charges
Legal Descriptio.11: Lot. 15, R.C. Wulger No. 3
Commonly.known as: 21910 95th Av Jart
Owner: P irs Pe I
Z.F.F. Calculation:
.44.7 Z.F,.F. x 12.SO
$
5,58.88
Connection Fee
Lateral x
$
0
Lateral Charge
Unit X $25
$
2.5.00
Trunk Charge
$
10.00
Permit
$593.819
TOTAL
CC: Mrs.. Polkart
IT I F R.. LARSON, P.E.
City.Fmgineer
2108
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f%VM -9" FILE
CA FILE NO.
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetati?n�
1. Site Address/ Location: /, ( 'I 10 - 'I � /�_ V /Ij .- 0,V65
2. Property Tax Account Number.
000 0/ 5 O'D
3. Approximate Site Size (acres or square feet): / ?,0
4. Is this site currently developed? )� yes; no.
If yes; how is site developed? 5i4t-P �- i 16 5 (, d,-,1cf
5. Describe the general site topography, Check all that apply.
Flat: less than 5-feet elevation change over entire site.
204 q � 6 __10
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: /t/D ; Approx. Depth:
7. Site contains areas of seasonal standing water: AJO Approx. Depth: —
What season(s) of the year?
8. Site is in the floodway__Z�� floodplain—_LL of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? ill.) Flows are seasonal? /t/O (What time of year? It- 0
10. Site is primarily: forested A/ meadow AID shrubs A,�o mixed
urban landscaped (lawnshrubs etc) Ye
I
11. Obvious wetland is present on site:
/V 0
ArA Ak-doe RffYO2111/97
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).
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 infon-nation (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
2,111 o - 6? 5- /1 L)
Street Address
e z o
city State Zip
q 2 -5 ' 7 -7
Telephone
Signature
A'1P
Date
Applicant Representative:
e5A
Name
Street Address
city State
Telephone
Signature
Date
Zip
creception\janakad.doc
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