22721 76TH AVE W.PDFiiiiii iiiiii
6374
22721 76TH AVE W
ADDRESS: c2cq—/c�21 --76 0,
TAX ACCOUNT/PARCEL NUMBER: 6YJ6 0/ 0 0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: a gq— Iq DETERMINATION: [] Conditional Waiver F] Study Required .50vaiver
DISCRETIONARY PERMIT #'S:
Ab�� &ph'ralnlai)
IV
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA
OTHER:
LATEMP\DSTs\Fomis\Street File Checklist.doc
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).
APPLICATION CARD No . ......................................
for
The City of Edmond VRW FILE SIDDE SEWER PERBHT EASEMENT No . ......................................
OUTSIDE INSIDE REPAIRS
10
OWNER........ ---------- /� ............ .......................................... CONTRACTOR ............... 6��AZe.le -------------------------------------------------------------- PERMIT No.
STREET
HOUSENo - -------- .................. 7�� ............... ------------------ -- ... ...... AVENUE LOT No - ---------------------------------------------------------------------- BLOCK No . ...............................................
1212 ?.2
NAMEADD - -----------------------------------------------------------------------------------------------------------------------------------------------------
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BACKFILL WORK ORDER ISSUED
SEWER WORK ORDER ISSUED .....
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Date Approved:
DEPOSIT, $ .................................
........... DATE ................................................ By ...................................................................
RFcEIVED
mAy 17 1999
PERMIT COUNTER
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RECEIVED:
OCT 0 6 1999
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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APPROVED BY PLANNING,
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RECEIVED
OCT 0 6 1999 -
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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Critical Areas Checklist
--------------------------------------------------------------
Site Information (§oils/topography/hydrology/vegetation)
1. Site Address/Location: 6 A V 4 19
2. Property Tax Account Number:
00
3. Approximate Site Size (acres or sq feet):
_14AV
4. Is this site currently developed? 7yes; 4//"-n'o.
Z
Aw
If yes; how is site developed? #a /- 4L, 1 '2 r 1'(2j' t d
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
1 0-feet over a horizontal distance of 3 3 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: 16o Approx. Depth:
7. Site contains areas of seasonal standing water: o Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IV,9 floodplain. 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Xe2 Flows are seasonal? (What time of year?
10. Site is primarily: forested 47 -meadow shrubs A0 mixed A'�;'
urban landscaped (lawn,shrubs etc) &�4
11. Obvious wetland is present on site:
^ca_chk.dm Re� 10103/97
City of Edmonds
NW CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person prepariing 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 detennination 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:
Rc
Name
0
Street Address
city State Zip
-63
Telephone
Signature
Applicant Representative:
den,, AL�,L6,
Name
Street Address
City State
Telephone
Signature
Zip
Date
cxeceptionyanakaddoc.
Date
(over)
4,-2 C. 18 (),3
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 e Planning/ Building * Parks and Recreation e Engineering e Wastewater Treatment Plant
January 21, 1999
Henry Hochberg
18022 1 59th Avenue N.E.
Woodinville, WA 98072
Subject: Determination regarding Critical Areas Checklist # 99-14
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" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL ARE -AS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
moo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Eric: Determination
*Architectural Design Board
C:ReceptIoMJana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you,
Planning Secretary
* Incorporated August 11, 1890 e
Sister Cities International — Hekinan,,Japan
0 0
PLANNING DATA
Ne--W bOM 1,4,, �__
NAME:. Hb�� M,D.
41 —
Q �Ij
SITE ADDRESS: 2-272-t- -7&-Ave O—DATE: 6/3/9?
ZONING: . P-M- z-, + PLAN CHK#: L - 67
PROJECT DESCRIPTION: t-,- Y-
USE(S) PROPOSED: ]>-� 01AU, - ALLOWED?: �1,f '
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED tv
(Y/N)
CUP File: ��a- 2,4- 74 - Pfbfas,,;,�
ADB FILE #: 99 -4-Z OR DATE WAIVED:
PLANS MATCH APPROVED PLAN: &h
PARKING:
Use: 0*� "4 QIA- Cz No. Spaces Required: yAc,
X - (floor area, # employees, etc.)
Use:
No. Spaces Required: i
X (floor area, # employees, etc.)
Total Required: 9 '�g&-ftj - Actual Provided: 9 -si2d;64f
SETBACKS: mo s wt`i� $ fA P�,� -/. �,� - IVI'A
Required Setbacks:
Front: Left Side: —Right Side: Rear:
Actual Setbacks:
Front: Left Side: Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
MAXIMUM FLOOR AREA: VIA
Maximum Allowed: Actual:
BUILDING HEIGHT: NIA
Maximum Allowed: Actual Height:
Modulation Allowed?: Modulation Height:
Datum Point: Datum Elevation:
LANDSCAPING:
Matches ADB approved: ' N-t
Bond: Z �,m - 6� �� Ni*,
SUBDIVISION:
CRITICAL AREAS #: 'N - 14 - t-)K�v,--
4oAf11e3%perTnWPLANDAc.D0C
SEPA DETERMINATION:
SHORELINE REQUIREW: N.
LOT AGGREGATION REQUIRED?: A.
OTHER:-- -
Plan Review By:
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PLANNING DATA
NE-W �-Om L,
NAME: T�k- -
SITE ADDRESS: DATE:
ZONING: - -A\ —7, - PLAN
ECT POCRIPTION:
A
i
USE(S) PROPOSED: EW 0 ALLOW
LEGAL NONCONFORJII�G � ND USE DETERMINATION ISSUED�TTO�—*�(
CUP File:
ADS FILEM P�3R— �1-4�, ORDATEWAIVED:
PLANS MATCH APPROVED PLAN:
PARKING:
Use: No. Spaces Required: t 2&A
X (floor area, # employees, etc.)
Use: No. Spaces Required:
X (floor area, # employ
Total Required: Actual Provided:
SETBACKS:
Required -Setbacks:
Front: NIA Left Side: Right Side: Rear-o—�al
Actual Setbacki�- 4
Front: Left Side: Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
MAXIMUM FLOOR AREA: I
Maximum Allowed: —AA .-Actual:—
BUILDING HEIGHT:
Maximum Allowed:— N I 1A _Actual Height:
Modulation Allowed?: Modulation Height:
Datum Point: Datum Elevation:
LANDSCAPING: t
Matches ADS approved:(
Bond:
SUBDIVISION:
CRITICAL AREAS
cAfila%permWPLANDA&DOC C avtr )
0
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SEPA DETERMINATION:
SHORELINE REQUIRED?:
LOT AGGREGATION REQUIRED?:
c:\filaskpermRt^PLAN0Ac,D0C
T I C
TO PERMITTEE AND/OR OWNER
PARTIAL APPROVAL
8 q 0. 1 VIOLATION
CORRECTIONS REQUIRED
Perinit Number q :� 0,z�,-j Owner HOCt-Me(z
Job Address .7- 2,71 q-1 AVE
No PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY
WITH ALL APPLICABLE CITY CODES.
CONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
STOP WORK - UNTIL AUTHORIZED To CONTINUE By CITY INSPECTOR.
71 CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE
NEXT PHASE IS STARTED; To AVOID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
F-1 JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE ]FROM STREET.
71 APPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE.
F-1 WORK DESCRIBED BELOW HAS BEEN INSPECTED AND Is APPROVED.
5�1 CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
F-1 RECALL FOR INSPECTION.
PA,VZY�tNCI 'z* I — -5 Dc) N o-r Mf_�F_T AA 1A).
W kr)TIk F_ e— ArrKovQP PL-,,N-r,/ Arjo e_rT1 T-TA t- OA.11,0,
1�_�O(k&F_CZT -Alt-00 C4.L-L- f6A- I �j P A-- C_-r I '. r'j
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rJ c�
kANOA AJO yz
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTIONS CALL 771-0220.
Building Division ED Planning Department CA Engineering Department F I Fire Department
CITY OF EDMONDS
K\,\/ Inspector AUC,, 0�il-\ Date
MEMORANDUM
Date: April 2, 1999
To: Jamal Mahmoud, Traffic Engineer
From: Go rdy Hyde, Development Services Engineer
Subject: ADB Application for Hochberg at 22721 — 76" Ave. W. (ADB-99-42)
N
Attached is additional information the Planning Division received in response to your
request for this ADB application. Please re return your comments to me for inclusion
into a memo to the Planning Division �y 14
Thank you for a rapid response.
ok
r K'Lt-� 9) 1 M I
415/1
City of Edmonds
Development Services Department
�01
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HENRY HOCHBERG, M.D.
7935216 TH Street SW #E RECEIVED
Edmonds, WA 98026 APR - 11999
425-672-2427 PERMIT COUNTER
March 3 1,'1999
Meg Gruwell
City of Edmonds
Development Services Department
121 5th Ave. North
Edmonds, WA 98020
Dear Ms: Gruwell:
I am writing to respond to each of the 14 items in your letter of March 18 regarding additional information
to complete our ADB application., File No. ADB-99-42.
1. 1 intend to be the only doctor using my office. I estimate approximately 20 patient visits per day. 2
/2. The number of peak PM trips will vary by the day. On Monday I anticipate a mwdinum of3trips -T 41�
during the hours 4 to 6 PM. On Tuesday, as I close at 5 PK I 'an'ticipate onlydq-rips. I am closed on 0
Wednesday ' so there will be no trips at PM peak. On Thursday I anticipate 8 trips, and on Friday, as I F
close at 3 PK I anticipate no trips diuing PM peak. C9
3. Please see the attached parking configuration sketch. All stall widths and lengths are based upon my
reading of Edmonds City requirements for parking stalls. The width of the turning aisle is 32 feet, 4
inches. Av�fx'
-"-/4. The driveway width is 26 feet 8 inches. There is no slope at the entrance. The parking lot gradually
. slopes downward at 3 to 4 degrees,
5. No landscaping mill be changed.
6. 1 have decided not to have a freestanding sign. I will post a small sign on the side of the building. I
have attached a sketch of this sign and have indicated on one of the photographs where it will be
situated.
7. As noted above, I will no longer erect a freestanding sign.
8. 1 have provided a mock-up of the wall -mounted sign.
9. Currently, the parking lot has NO configuration. It does not appear that it was ever striped. Hence, all
parking slots and turning aisle will conform to current Edmonds codes as far as I can interpret them.
10. There are no delineated stalls currently.
11, There will be no changes to the parking area other than patching or re -paying and striping.
12. 1 have enclosed a sketch of what the proposed front office door will look like.
9
0
City of Edmonds
Meg Gruwell
March 31, 1999
Page 2
13. Please see the photographs I have enclosed of several sides of the office. I have used marker to indicate
where the proposed door and sign will be located.
14. 1 do not have anything involving color.
Thank you for helping me with this daunting, slightly overwbeln-dng process. I understand that the city has
many regulations, but my proposed changes are really very simplewArith minimal visual impact. HopeUly,
you will be able to grant a waiver for most, if not all, of this re -model.
Henry Hochberg, MD.
RECEIVED
APR - 11999
PERMIT COUNTER
-----------
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Conditional Use Description
The following is a description of the proposed use of the split level house located at
22721 76th Ave. West:
I intend to use the house as an office for my practice of family medicine. My practice is
ope'!b�tudays per week. Office hours are as follows:
Monday: 9am - 6pm
Tuesday: 9am - 5pm
Wednesday: Closed
Thursday: 9am - 6pm
Friday-8am - 3pm
Saturday and Sunday: Closed
It is anticipated that I will see an average of 15 to 20 patients per day. An equivalent
number of vehicles would be expected to use the parking lot throughout the day,
With the exception of adding a door providing handicap access, installing a small sign at
the existing parking lot entrance with my name on it and the use of professional
landscaping, there will be no'changes to the exterior of the house or to the grounds.
There is no expected impact on noise or pollution levels as a result of this practice. No
hazardous materials will be on site.
I am willing to make myself available to any concerned citizen should any questions arise
about my proposal.
Henry Hochberg, M.D.
4 4-A� t�p
5a "'.� . , t'Ti �
A
Date:
To:
From:
MEMORANDUM
1(
MarcWK 1999
Gordy Hyde,'Development Services Engineer
Jamal Mahmoud, Traffic Engineer 3 /V)
Subject: ADB Application for family medicine at (Dr Hochberg) 22721 — 76h Ave
— W. (-APB 99-IQ�Ian �Check — )
I have not received any submittal regarding the above referenced subject. Please
disregard my hand written comments on your memo dated March 5, 1999. Please
follow the direction and the requirements on memo dated -Feb. 2, 1999, below is the
text of the memo.
Traffic report is required.
1 . Calculate number of PM Peak trips.
2. Submit parking configuration
3. Show Driveway width, cross section, and slope.
Thanks.
F:\ENGRUAMALkGordy-DR\A99-42b.DOC
City of Edmonds
C8mmunity Services Department
Engineering Division
MEMORANDUM
Date: March 11, 1999
To: Planning Division
From: Gordy Hyde, Development Services Engineerqc,64--
Subject: ADB for Hochberg at 22721 — 76hAve. W. (ADB-99-042)
The Engineering Division reviewed the subject plan. The applicant needs to provide the
information requested by the Traffic Engineer in the attached memo. The applicant must comply
with the conditions of any future applications. The applicant should be informed that future
permits may require a design perforined by a Professional Engineer. Water quality amendments
as well as detention for storm water may be required to be constructed. A site plan showing on -
site improvements and street improvements will be required. On -street parking must be revised
to conform to city standards. The Engineering Division has.no other comments on the subject
application. The application is not complete until the Traffic Engineer approves the traffic study.
City of Edmonds
aw-
Development Services Department
0 0
Date:
To:
From:
MEMORANDUM
0
MarcWK 1999
Gordy Hyde, Development Services Engineer
Jarnal Mahmoud, Traffic Engineer 3 /1
Subject: ADB Application for family medicine at (Dr Hochberg) 22721 - 7611, Ave
W. (ADB 99-42) (Plan Check - )
I have not received any submittal regarding the above referenced subject. Please
disregard my hand written comments on your memo dated March 5, 1999. Please
follow the direction and the requirements on memo dated Feb. 2, 1999, below is the
text of the memo.
Traffic report is required.
I . Calculate number of PM Peak trips.
2. Submit parking configuration
3. Show Driveway width, cross section, and slope.
Thanks.
City of Edmonds
---------------
Community Services Department
Engineering Division
F:\ENGR\JAMAL\Gordy-DR\A99-42b.DOC
MEMORANDUM
Date: March 9, 1999
To: Jamal Malunoud, Traffic Engineer
From: Gordy Hyde, Development Services Engineer 9
Subject: ADB Application for Hochberg at 22721 — 76hAve. W. (ADB-99-42)
Dr. Hochberg applied for a Conditional Use on this site (CU-99-18). When you reviewed
that application, you responded with the attached memo requiring a trip generati6h study,
parking configuration and driveway details. As far as I can tell from our files you never received
and/or approved the required trip generation study. Engineering never received, reviewed, or
approved any of the required details.
Dr. Hochberg has now applied for an ADB review and you returned my memo indicating
that no mitigation is required, the parking is okay and all is approved.
Please clarify for the files what needs to be provided. If you have approved other submittals,
please include a copy for the file. Thank you.
City of Edmonds
Development Services Department
0
MEMORANDUM
Date: March 9, 1999
To: Jamal Mahmoud, Traffic Engineer
From: Gordy Hyde, Development Services Engineer
Subject: ADB Application for Hochberg at 22721 — 76" Ave. W. (ADB-99-42)
Dr. Hochberg applied for a Conditional Use on this site (CU-99-18). When you reviewed
that application, you responded with the attached memo requiring a trip generation study,
parking configuration and driveway details. As far as I can tell from our files you never received
and/or approved the required trip generation study. Engineering never received, reviewed, or
approved any of the required details.
Dr. Hochberg has now applied for an ADB review and you returned my memo indicating
that no mitigation is required, the parking is okay and all is approved.
Please clarify for the files what needs to be provided. If you have approved other submittals,
please include a copy for the file. Thank you.
City of Edmonds
Development Services Department
MEMORANDUM
Date: March 5, 1999
To: Jamal Mahmoud, Traffic Engineer
From: Gordy Hyde, Development Services Engineer
Subject: ADB Application for Hochberg at 22721 — 76" Ave. W. (ADB-99-42)
Engineering received the attached ADB application today. Please review the attached plans
and return your comments to me for inclusion into a memo to the Planning Division by March
18, 1999. Thank you for providing a rapid review and response.
P a
N 0 "C111i't
Pv k iV'I --:*, 6 k
77, /-\
City of Edmonds
Development Services Department
V�p
E
MEMORANDUM
Date: March 5, 1999
To: Jamal Mahmoud, Traffic Engineer
From: Gordy Hyde, Development Services Engineer
Subject: ADB Application for Hochberg at 22721 — 76"' Ave. W. (ADB-99-42)
Engineering received the attached ADB application today. Please review the attached plans
and return your comments to me for inclusion into a memo to the Planning Division by March
18, 1999. Thank you for providing a rapid review and response.
City of Edmonds
Development Services Department
El
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El
13
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9
cityTf edmonds RECEIVE
land use application MAR 0 3 1999
ARCHITECTURAL DESIGN BOARD
COMP PLAN AMENDMENT
CONDITIONAL USE PERMIT
HOME OCCUPATION
FORMAL SUBDIVISION
SHORT SUBDIVISION
LOT LINE ADJUSTMENT
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT/
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE
EXCEPTION
OTHER
Applicant
Address
FILE# ADS,-qq-4Z- ZONE �?—M -
DATE�1:575] �';-(REC-D BY
FE&R-�(��RECEIPT#
HEARING DATE
13 HE Q STAFF El PB Ll A DB Q CC
ACTION TAKEN:
13 APPROVED El DENIED 0 APPEALED
APPEAL#
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Property Address or Location 2� 4yr W Kid WA 54-0.2,0
Property Owner
Address
Agent
Address
Phone
Phone
Tax Acc # �5-31�z nop Oc>/ 00 Sec. Twp.
I — _ Rng.
Legal Description A c Di) OD /- 67
Details of Project or Proposed Use
The undersigned applicant, and his/ her/ its heirs, and assigns, in consideration of the processing of the
application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all
damages, including reasonable attorneys fees, arising from any action or infraction based in whole or in part upon
false, misleading, inaccurate or incomplete information furnished by the applicant, his/ her/ its agents or
employees.
The undersigned applicant grants his/ her/ its permission for public officials and the staff of the City of Edmonds to
enter the subject property for the purpose of inspection and posting attendant to this application..
SIGNATURE OF APPLICANT/ OWNER/ AGENT
RIECEIVED.
MAR 0 3 1999
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MEMORANDUM
Date: February 3, 1999
To: Planning Division
From: Gordy Hyde, Development Services Engineer
Subject: CU for Hochberg at 22721 — 76 Ih Ave. W. (CU-99-018)
The Engineering Division reviewed the subject plan. The applicant needs to provide the
information requested by the Traffic Engineer in the attached memo. The applicant must comply
with the conditions of any future applications. The applicant should be informed that ftiture
permits may require a design performed by a Professional Engineer. Water quality amendments
as well as detention for storm water may be required to be constructed. A site plan showing on -
site improvements and street improvements will be required. On -street parking must be revised
to conform to city standards. The Engineering Division has no other comments on the subject
application. The application is not complete until the Traffic Engineer approves the traffic study.
City of Edmonds
Development Services Department
LI
MEMORANDUM
Date: February 2, 1999
To: Gordy Hyde, Development Services Engineer
From: Jamal Mahmoud, Traffic Engineer N.IA
Subject: Conditional Use permit for family medicine at 22721 — 76h Ave W. (ADB
- � (Plan Check — )
Traffic report is required.
1 . Calculate number of PM Peak trips.
2. Submit parking configuration
3. Show Driveway width, cross section, and slope.
Thanks.
City of Edmonds
Community Services Department
. / Engineering Division
city& edmonds
2 7
land use application
0 ARCHITECTURAL DESIGN BOARD
El COMP PLAN AMENDMENT
J( CONDITIONAL USE PERMIT
E3 HOME OCCUPATION
C3 FORMAL SUBDIVISION
C3 SHORT SUBDIVISION
E3 LOT LINE ADJUSTMENT
C3 PLANNED RESIDENTIAL DEVELOPMENT
E3 OFFICIAL STREET MAP AMENDMENT
STREET VACATION
C3 REZONE
E) SHORELINE PERMIT
0 VARIANCE / REASONABLE USE
EXCEPTION
E3 OTHER
FILE# (/Lk-t1q �19 ZONE RMA#
[DATE 01 11 REC'D BY-JqeV
FEE RECEIPT#
�-/ Z, 78
7ING DATE
HE E) STAFF El PB El ADB 0 CC
ACTION TAKEN:
El APPROVED (3 DENIED El APPEALED
APPEAL#
Applicant 'L� em d + tA ; Ho" b Phone (�L',�T
Address 190,22., 112"" zh�-L AZE WA 2�012-
Property Address or Location '�2,fj V
Property Owner 4- He-.IcV Phone 4*->S-- :217zL —
Address
A g e n t � 1--,L Lnq A V,-) �'(A �, 01 1*1 5 0 A) Phone
Address
TaxAcc# 661&o0Q00JQoo-2- Sec. Twp. _ Rng.
I
Legal Description
Details of Project or Proposed Use
A . - -
r
The undersigned applicant, and his/ her/ its heirs, and assigns, in consideration of 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 in part upon
false, misleading, inaccurate or incomplete information furnished by the applicant, his/ her/ its agents or
employees.
The undersigned applicant grants his/ her/ its permission for public officials and the staff of the City of Edmonds to
enter the subject property for the purpose of inspection and posting aft9ndant to thJis application.
SIGNATURE OF APPLICANT/ OWNER/ AGENT
'ITY 0
0.
Civic Center Edmowls, Washington 98020
City Clerk Phone'775-2525 ANNUAL FEES PENALTY AFTER FEB. 15
DATE LICENSE N
CITY of EDMONDS BU9
EEFFsFi -'of
NSTRUCTIONS:
All items must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
JULY 31. 1/2 FEE.
El HOME OCCUPATION
$10.00 (A)
ADDITIONAL $5.00 11
�yl SMALL BUSINESS
$15.00 (B)
ADDITIONAL $7.50 C1
11 Business with 10 or
more employees
ADDITIONAL $25.00 E
$50.00 (C)
KNEW APPLICATION (LA)
0 RENEWAL
(LB)
0 CHANGE
(LC)
NGESj_ 0 DELETE
(LD)
P ':
,�>7-
BUSINESS ADDRESS
INDIVIDUAL
PARTNERSHIP CORPORATION
(S)
(P) (C)
OWNERS NAME
HOME ADDRESS
1�; 5t) NO R T H -�,T R G_
HOML PHONE
D��TE OF BIRTH
PLACE OF BIRTH
SOCIAL SECURITY NUMBER
r-4
EMERGENCY
NOTIFICATION: (1)
NAME& TELEPHONE 'W R1 NS�
57,1� 74
(PLEASE
LIST TWO) (2)
NAME & TELEPHONE W1 R
".1V R OH 1 0
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATURE
STAFF REVIEW -
DO NOT WRITE BELOW THIS LINE
FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE
K APPROVE 0 DISAPPROVE
SIGNATURE
LAND USE CODE ZONING CODE
IRIC 1 1-1 1 1 1 1 —1
CONDITIONAL USE PERMIT
COMMENTS = E= =
BUILDING DEPARTMENT DATE
&--9PPROVE 0 DISAPPROVE
SIGNATURE e5
COMMENTS:
I I I i CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
Buildigg
0
Hotel/Motel
(L)
Permit
El
Apt. Bldg.
(A)
I I I 1 1:1 ED
Office Bldg.
(0)
Occupancy
0
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
0
School
(S)
FIRE DEPARTMENT DATE 7- R-90 U. F. 1. R.
APPROVE 0 DISAPPROVE
COMMENTS:
POLICE DEPARTMENT
'0 DISAPPROVE
0 APPROVE DATE 7X2,11PI SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE' 7117 SIGNATURE
Comm
L)
ASO
USE PERMIT
CITY OF EDMONDS I ZONE NUMIMiR 7 1_6
CONSTRUCTION PEIAMIT APPLICATION jog S1
OWNER NAME/NAME Ol� BUSINESS I ADDRESS D CQJ aj L) � W -
AAILIN11 �ULY z
I & 0 -2- C,
'ITY
ZIP TELEPHONE NUMi!
Woo4%ov Me Ot 53 OJA_�! 2 --5'1 &
IAME
ADDRESS
CITY ZIP TELEPHONE NUMBER
NAM&k4e� )jWCO.
----------
ADDRIP6,
ZIP. EPHONE NUMBER
TION DATE
STATE LIr-FFJ` .-IRA
'rebebments
Legal Liescription of Property - include a
-22-72-1 _76 A,4
TaiAcc-ount —
Parcel No. �> C) o C) 0 - 0 o 0 00 L_
PUBLIC RIGHT OF WAY PER'OFFICIAL STREET MAP.
TESCP Approved
0
RW Permit Required
13
EXISTING REQUIRED DEDICATION --7—
Street Use Permit Req'd
0
Inspection Required
0
PROPOSED
Sidewalk Required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
Z
cc
W
WZ
Z
w
EINEW
RESIDENTIAL
Li
PLUMBINGMECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGEOFUSE
REMODEL
APT.BLDG.
T2�IGN
REPAIR
GRADING
CYDS.
FENCE
( x _FT)
DEMOLISH
WOODSTOVE
INSERT
SWIMPOOL
HOT TUB/SPA
GARAGE
RETAINING WALL/
0
CARPORT
El ROCKERY
RENEWAL
ENGRJEERING MEMO DATED
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
S16N FV?,
NUMBER NUMBER OF CRITICAL W
3 OF DWELLING AREAS
, STORIES UNITS NUMBER L
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
444a]
q 11 -
VARIANCE OR CU
ADB #
? 1 —1 If)
SHORELINE #
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED ROPOSED
A3L
LOWED D
I
to & 1p 8,30
IPROPOSE
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (F7
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAF
�JA
I
N 11
LOT AREA
PLANNING REVIEW BY
DATE
REMARKS
(AA ,� �
Zz. W 15 (/-A^ 4% tJ 14�r -4, K4
CHECKED BY
TYP� OF CONSTRUCTION
C DE
OCCUPANT
GROUP
.7
SPECIAL INSPECTOR
OCCUPANT
REQUIRED
0 YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
Z
co
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
U
GLAZING
HEAT SOURCE:
%
PLUMBING
Plan Check No., , Y�l 0
MECHANICAL
This Permit covers work to be done on private property 0NL7.
GRADINGIFILL
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
20 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 deemed to
PLAN CHECK DEPOSIT
9U
modify, waive or reduce any requirement of any city ordinance
0 nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
v;za
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY
Code of the State of Washington relating to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insuraq_g"ria RCW 18-27.
INSPECTION
acknowledged in space provided.
SIGNAT E IQ IN VER R A ENT) TE SIGNED
U
DEPARTMeNT
OFFICIAL'S SIGNATURE 0 ATE
CITY OF
EDMO�DS
6ACLI�OR
EL VE
EASE
ATTENTIO'
INSPIECTiO N
IT IS UNLAWFUL TO USE QA d9C,6PY`;.A,,jUILQ!,W�' MSYR CTLJAE,,,
'bii,mNAI
UNTIL A FINAL INSPECTION HAS BEEN',.'MADE`AN6 APPRD�Al_ OR
77 11'��10 2 0
F I, YELLOW — I'nspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC _
SECTION 109
z, 2
F% J.— C 1/ 1/2
PINK — Owner GOLD — Assessor
..'a,