21926 83RD AVE W.PDF111111111111
7759
21926 83RD AVE W
CA File No:
Critical Areas Checklist
Site Infomiation (soils/ topography/ hydrology/ vegetation) ,
1. Site Address/ Location: 2�412_(n hue-
E33:�" Ave Wes4',
2. Property Tax Account Number: 5 4 11 . 00o oc) 1 0 0
93
4.
5
Approximate Site Size (acres or square feet):
Is this site currently developed?,',K yes;
If yes; how is site developed?
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 3Meet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: — Appro x. Depth:
What season(s) of the year?
8. Site is in the floodway — floodplain — of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? — (What time of year? — — ).
10. 3stit fl fo est d
meadow shrubs mixed
CuLan landscaped (lawn,shrubs etc)>
11. Obvious wetland is present on site: N i^3
1.
2.
3.
4.
5.
- For City Staff Use Only j2 L5(a
Plan Check Number, if applicable?
Site is Zoned? ?-.5 -
SCS, mapped soil type(s)? Nu2� r-- mw L-A r-� Qn*�� I C. -d
Critical Areas inventory or C.A. map indicates Critical Area on site?
Site within designated earth subsidence landslide hazard area? III b
DEI MvffNATION
STUDY REQUIRED
WAIVER
Critical Areas Checklist.doc/3.19.2001
E
0
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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 stak 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:— --,Yl.�21,1";91
City Receipt #:- �2 �Zl,-zlll
Critical Areas File #: C—A -0 1 -
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:_ —4-61
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 deten-nination 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 furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the inforination and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
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 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.
SIGNATURE OF OWNER 4Z44* DATE
I PLEASE PRINT CLEARLY
Owner/Applicant:
-�bb ark Veff., -Bf-own
Name
Wes+
/a I q 2- � 2 el -S
Street Address
F,� m a 3 �., -� - I, WA 13.02,0
City State Zip
Telephone: 42S-A-5)fl
Email address (optional): Vcrr-�feC,(Z�o�01.Co
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Check I i st. doc/3.1 9.2001
APPLICATION
The City of Edmonds-.,,,-,.,, for
SIDE SEWER PERMIT
OWNER
JOBADDRESS ................ ..................................... ........................ ..
0
EASEMENT NO. __ --------- ..........
CONTRACTOR RMIT NO. 25�!M>
TE
LEGAL DESCRIPTION: LOT NO - ----------------- I - ---------------- BLOCK NO . .....................
-------------------------------------------------------------------------------------- ...........................................................................
NAME OF ADDITION ...
.................................................................................
Approved:
DATE B
y 1-14441 -----------
f, *1
APPLICATION
The City of Edmonds for
SME SEWER PERMT
NEW CONSTRUCTION REPAIRS Cl EASMAENT No . ..........................................
OWNER ....... ......................... ................... CONTRACTOR
.... ......... ..... ......................... ................. ................. ...................... ..................................... pl:RMT No.
9 -7/ C72 -,
Approved:
DATE........................ ------------ ------- — By ....................... --------- — ..................................
NOTICE:
-a-.c�c u r-a-c-y
-N'o wa rra n Y
The information *shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e city of �Edm.qnds does not ' warrant the
accuracy of anything set for.th on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
..._.___Fe'map(s), including, but not limited to,
t
th-e 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
e m pl- o-y e e-s o -r o ff ic_ e,r s -s h- a I- I b e 11 a- b'Fe f o r t. h e
information given on this map(s), nor for
ation provided based
any one represent
upon . said map(s).
CIT'' OF EDMONDS - SIDE 'EWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT N? - .5303
Call 775-2525 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.
ADDRESS LOCATION OF CONSTRUCTION ........
PROPERTY LEGAL DESCRIPTION .................. —7!7—� --- 1� .........
.................................................. . ........... .......... . ........................................................................ . ............... .................................. . ..................................................
................................................................ O-,VNER,��NDIOR BUILDER .......... . "-.7 ............................................
CONTRACTOR'S NAME & ADDRESS ............ -Inrz . . ....................... .............................. . ... .......................................................
Permission Is granted ........ ................ 197—`Sr for repair and/or connection of a side sewer to the city sanitary sewer
ltnf i2.11
system in accordance with City f Edmonds ordinances.
ATTENTION 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 Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full Information regaxding Ordinazice 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—To-p 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.
NOTE No. 5--Trenches In street must be water settled and 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. 6--1t 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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDDate ... . ...... �. ..................... By ----------------
APPROVED -EeDate..— Z.-Ve... �� ...... z5 ......
D .......... 5-��.By ............... Date .............. . ................... By ................
By.. —
:
Remarks: ....... ........ ..........................
...
.................................
.
.....................................................................................................................................
— BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
.......... * ........ * -------- * .................. * ..... * ....... * ................... — .... .... hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm PerfGrming construction)
Gas installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............... . ........... day of ........................................................... —.1 19 .........
4 Check BEFORE you dig for: Water [3, Gas E], Telephone 0, Power 0, Sewer 0, Other 0
0
Date September 26, 1974
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer.Connection Charges
Legal Description:
Lot 1"* Patricia Ann:,PAtk, No'. 3:as recorded in Vol. 22 of Plats,
page 16, records of Snohomish County, Washington
IVED
ICk7A-
UUT
Commonly known as: 21926' 83d Avenue.W. . Niner: Elste Lahmann
Z.F.F. Calculation: Figured on L.I.D.. 192 final cost/ZFF $17.27688
76.91 Z. F. F. X ( $17.28 $ 1,328.76 Connection Fee
1 Lateral x ($150.00 $ 150.00 Lateral Charge
Unit x $ 25 25.00 Trunk Charge.
10.00 Permit
$ 1,513.76 TOTAL
cc: Mrs. E. Lahman
Form 6
4� North
utility
Pole
U)
4b" 4,
e—Eb.r- F=C-wax�
Existing Fence
Property Line
Dl%'.;: r/. el, 6, /
e. - -------
Bu,"L� LMII�11113 IL-,'CEP)--"'%R i MI ENT
WORK 'AO'A"o,
ADDRESO .491gVa
APPR�'..-IVED DATE:
BLDG.
F E k."Vi N T
E
ECEIVED
kPR 2 6 2001
�UILDING DEPT.
S liff
TR
FILE
REGARDING:
21926 83rd Avenue I -Vest 4--?
(address)
E C 0 R
D 0 F C 0 N T A
C T S
DATE
MAME, PHONE NO., &
ADDRESS of CALLER
COMMENT I S ACTION TAKEN
INITIALS
7/17/75
Chris Lahmann
Certified Letter'No. 406691 sent Letter received.
JT
requiring hook-up within 60 days.
9/S/75
Water Specialists came into the office
JT
to obtain permit. Connection fee of
$1,513.76 has not been paid. He -.will
call homeowner.
9/8/75
Mrs. Lahmann came into office and,
JT
obtained permit #5303. Connection fee
paid in full. Husband is in rest home.
10/10/75
Connection coM?loted.
JT
RECEIPT FOR CERTIFIED MAIL-30� (plus
I Ot[41 Ju
STR -�T A
21926 83rd Avenue West
W
(JO P 0 , STATE AND Zl� CODE
I CD -Edmonds Wa ton;98020
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UP IONAL ;FOR AODITIONAL FEES
v
111UHN -- bll-%Al� to Whom and date delivered I
R CEIPT i, 2 S With delivery to Id ressee only .......... �*
ho.......... . 6
ws to whorn, date an here delivered 3
With delivery to addressee only _ ..........
PE
PS CIAL DELIVER ::-�- �r.qWi�md) .... ......
Form
Apr. 1971 3800 NO INSURANCE COVERAGE PROVIDED —
NOT FOR INTERNATIONAL MAIL
stage)
AARK
,ATE
- 19 - N
(See other side)
GPO! 10700-397-4150
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ERE0,q iNS-URE:D�"At4D":CER�TkIFIED;':MAIL'
'-'i1!1ETURN1AJEC!�(PT-, JIREd
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DATE RECEIVED
lie PIRES
USE PERMIT
ZONE Joe _go
CITY OF EDMONDS . __5 13F NUMBER2_001-036-3
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS 0�1/ i��
Z a b
?2@o avyl kvr; '8-fown PLAT NAMEtUBDIVISION NO. 7f !LOT NO. &UD NO.
MAILING ADDRESS LID FEE $
uj
TESCP Approved 0
f2 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required a
0 Ave. Kkst Street Use Pennit Rocfd E3
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 0
F I Sdawalk Required 0
,4�rhm45 qbo?(o Hj,5_(040__sj0f REOUI RED DEDICATION — FT Underground
rg : Wiring required
NAME METER SIZE LINE SIZE TNO. OF FIXTURES PRV REQUIRED
YES 0 No 0 3
IL M
LU
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
CITY ZIP TELEPHONE faimo M.Oe- Aol.44ffZ #W- $,'p.
01'#1o0;P- 2;%rAW4dA_r
4`7
ENGINEERING
21�/tpx 7+ REVIEWEDIDAT
ADDRESS
FIRE �REVIEWEDBY DATE
CITY ZI P. TELEPHONE
0 XL
VARIANCE 00 dU "'SHORELINE ORIADE1111 INSPECTION IPBOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D OSTED
0 YES 0 NO
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL'NO. COMPLETE, EXEMPT ALLOWED PROPOSED AL'LOWED , PROPOSED
ul
_j
EXP
0 NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKSI(Fr.) PROPOSED SETBACKS (FT.)
101604d MECH....- "AUOW , E ., D ',`:��PROPOSED ��'.FRONTL��': SID L E:: 'A L EAR- FRONT�*,URSIDE REAR
0 ;COMMERCIAL
0 ADDITION 0 COM.LIAN E OR,: z
A
,CHANGE OF USE_ z
0 PARKING 'LOT AREA
0 REMODEL .'APARTMENT. 0 'SIGN REO'D I PROVIDED 91.
GRADING FENCE .1
0 REPAIR =t--
0. CYDS 0 RE_ MAHSG
MftT- 2fl'bm PRICIPF444Y
0 .?THER:
[D DEMOLISH 0 TANK
L4 �jg,
Ei GARAGE 0 RETA NING WALL
FIT OC I y C] RENEWAL
z CARPO R KER
(TYPE OF USE. BUSINE S OR ACTIVITY) EXPLAIN:
CHECKED 13Y - TYPE OF CONSTRUCTION OCCUPANT
GROUP
4e
w NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTOR JAREA OCCUPANT
STORIES z UNITS NUMB REQUIRED 0 YES LOAD
DESCRIBE WORK TO E
DO
REMARKS
FROGRESS'INSPECTIONS PER UBC1081FINAL INSPECTION REG'D 3
-Cce-4- 0� 4"re,. 5
VALUATION
FEE
PLAN CHECK FEE',
HE
AT §OUJ;FE GLAZING % LOT SLOPE %
ISUILDING"
DATE
PLAN CHtCKAI0: VESTED PLUMBING
ev �MECHANICAL
THIS PERMITAUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. "J%W&SURCHARGE
PERMIT APPILICATION: 180 DAYS
PERMIT ILIMIT: I YEAR - PROVIDED WORK,S STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
,r INSPECTION FEE
, ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF.THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR Ll MIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' RE72�
xi TOTAL AMOUNT DUE T5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPtICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWSREGULATING CONSTRUC- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
RKMEN S =0A1 IVN INSURANCE AND RCW 18.27. 1h ALS SIGNATURE
OF I DATV
TU I
LNA R IER R AGENT) DATE IGNED (425)
!�Pr 2_ I I'A j,&,Z
P,��� 1.41 771-0220 RtLEASED B�Y DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR