430 12TH PL N.PDF1111111111
668
430 12TH PL N
RECEIVED
OCT 2 9 1999
City of Edmonds
DEVELOPMENT SERVICES
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 I-Lis/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 infor mation'(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:
L, I C - OMR 1�5—
Name
Street Address
' �1-v
7;'4005 UA- IY02D
city State Zip'
1-�m - -7-74 - �-,�2,1
Telephone
Applicant Representative:
Name
Street Address
City State
Telephone
Signature
Date
Zip
::rccepflonVana\cac1.doc (over)
CA FILE JV0.q q —2�,9 0
Critical Areas Checklist
---------------------------------------------------------------
Site Information (soil s/topography/hydrology/vegetation)
I Site Address/Location: 4 1 Z4�� F L tJ
2. Property Tax Account Number: r7 Q I Z - 0 cc) - 0 1 (v - ce-.7o 4-
3. Approximate Site Size (acres or square feet): -
4. Is this site currently developed? 4"-yes; no.
If yes; how is site developed? t�,V-
.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 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
I 0-feet over a horizontal distance of 33 to 66-feet).*
Stee-p: 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 of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: &0 _; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway AJ 0 floodplain— 1V of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? — IJO — 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:
ft4_ch1Ld*c; Ray 10/03/97
-t � �3
,?C. 1 S9
November 19, 1999
L. & C. Harris
43012 1h Place No.
Edmonds, WA 98020
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES'DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist # 99-290
Dear Applicant:
BARBARA FAHEY
MAYOR
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.
................
........ -INFORMATIO TO BE-N TE ........
........................ ...........
................ ................ N .......
.............
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIO NAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
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 _4M
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:ReceptionUana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
City �QfEdmonds
RIGHT-OF-WAY CONSTRUCTION
Permit Number.
Issue Date:— /,?- -:12
A. Address or Vicuillity of Construction: 43.0 12th Pl N
--mmox— 1) '�) B.
9 0
C. Contractor: Gte Northwest
. PERMIT
Type of Work (be specific): Replacing telephone service drop from
pedestal to stub o�t.
Incorporated - Contact: L'Bill Jira 823-6683 or mobile 669-5716
Mailing Address: 22118 20th Av SE, Sufte 130 Phone:
State License #: Bothell, WA 98021 Liability Insurance:
Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F-1 Commercial F] Subdivision El City Project g] Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family [] Single Family n Other 2100-9P001DB 242310
INSPECTOR: INSPECTOR: WL-\.�VWA
F. Pavement or Concrete Cut : 0 Yes [@No G. Size of Cut: — x H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands apd by his signature to this application, agrees to hold th6.City ofEdmonds harmles' m h*juri`esp'Vmages, or
claims of any kind or description whatsoever, foreseen orunforeseen, that may be made -Ai3t the City ofEdmonds, �ran�y ?It's deparst'ments or
employees, including or not limited to the defense of any legalproccedings including defense costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FO*A__]�E�14)p OF ONE YEAR FVLFOTINGe FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FfN WETPATCH
IS COMPLETED B 17 CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUA NCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit willbe
available on site at 11 tim,
Signature: 71� - T ection purposes. Date: December 14, 1994
(CyAf6a-&f,grt Agent) John Stewart
0 rns Supv-OSP E
CALL DIAL-A-DIV PRIOR TO B'ERIINNING WORK
FOR CITY USE ONLY
APPROVEWBY:� RIGHT OF,WAY DEPOSIT
Jk
DAYS DISRUPTIWFEE/FUND 111:
TIME AUTHORIZED: VOID AFTER
SPECIAL CONDITIONS: RESTORATION FEE:,,;
PERMIT FEE:
TOTAL,`,7E: 470
COMMENTS: RECEIPT, FEE -
DATE: ISSUED, BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1991
xk .. - 7,
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
LEGEND
PERIAT SUBMITTED BY
GTE
m
M
I If
r
�13
i IF
PEDS a
POLES 0
ROAD BORES
OVERHEAD LINES—
LM UTILITY POTHOLE ED
LIG TRENCHING ----UGT—
R.o.w.
EOP
THE FOLLOWING INFO TO BE PROVIDED
RIGHT OF WAY LINESEOP OR FACE OF CURB, EXISTING SIDEWALK. POLES. ROAD CUTS AND THE UTILITY UNDER ROAD CUTS.
ABOVE GROUND FACILITIES.(Te:) PEDS.BOXES.CABINETS. ETC.,UNDERCROUND TRENCHING AND OVERHEAD LINES.
FOOTAGE OF WORK IN R.O.W.
0
LL
LEGEND
a:
PERMIT SUBMITTED BY
GTE
!mpg
,cc
I
F13
PEDS a
POLES 0
ROAD BORES
OVERHEAD LINES
I.D. UTILITY POTHOLE [Z)
LIG TRENCHNG ---WT—
------- -------------
-
�30
R.O.w.
EOP
THE FOLLOWING INFO TO BE PROVIDED
RIGI-IT OF WAY LINESEOP ORFACE OF CURB.EXISTING SIDEWALK. POLES. ROAD CUTS AND THEUTILITY UNDER ROAD CUTS.
ABOVE GROUND FACIL.ITIES.(Te:) PEDS.BOXES.CABINETS. ETC..UNDERGROLM TRENCHING AND OVERHEAD LINES.
-FOOTAGE OF WORK IN R.O.W.
Of
LL
xr-/
CITY of EDMONDS PLICATION DATE
SUREETT WE
-.,,7 Civic Center - Edmonds, Washington 98020
XIM
V4 ;F;' city cie,k Phone 775-2525
LICENSE NO. A+e44"5
L FEES PENALTY AFTER
0 HOME OCC16LPATION
IUM E U(' A] ION
1P
INSTRUCTIONS:
CLAS
YEAR
LIC. EFFEC. DATE
REASG. LIC. NO.JSPEC.
$10.00
ADDITI $5.00 0
All items must be completed
v,
I
SS
I S LL, BUSINESS
r
or application will not be ac-
RECEIPT NO.
DATE PAID
A
PRINTW
—/�o - $
1:7s-t�
ADD AL $T50 CO3
cepted.
IN SPEC. BOX
s w, 1 0 or
11 ess with 10 or
Sign and return application
FEE PAID
PENALTY,PAID
FOR ISSUE OF
CORRECTED
rno�ree employees
$50.00 (C)
1
L S 00
ADDITIONAL $25.00
with fee. Renewals recf -t;ved
LICEN WIT H
SE ""
'LC'ACTION.
El NEWAPPLICATION (LA)
after February 15 must pay
penalty in addition to fee.
n RENEWAL
(LB)
NE\,%' BUSINESSES AFTER
0 CHANGE
(I-C)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) EI DELETE
(LD)
NAME OF FIRM
BUSINESS PHONE
NO.
OF EMPLOYEES
AIRIA CARPETS
1
776-2454
1
1
MAILING ADDRESS NATURE OF BUSINESS
430-12TIA PIL N SALES/RFTAIL
EID M rj NJ 0 S WA 9 80 2 0
BUSINESS ADDRESS I INDIVIDUAL PARTNERSHIP CORPORATION
60 1 -4-" M A I N S T I F-x-� (S) = (P) (C)
OWNERS NAME HOME ADDRESS 430 12TH PIL N
HARR I S C E 1.) M!71 A I-) S W A 98020
HOMEPHONE DATE OF BIRTH PLACE OF BIRTH
�q f
I SOCIAL SECURITY NUMBER
8 / I) I //14 F A T f I- F --44-5575
538
EMERGENCY NOTIFICATION (1) NAME & TELEPHONE I R I S C 206-778-8265
(PLEASE LIST TWO) (2) NAME& TELEPHONE -LUNDIN E' = -.,, 206-778-5277
WASHINGTON STATE TAX NO.600-224-874
APPLICANT'S SIGNATURE
UU INU I WHI I h 13F-LUW I HIS LINL
STAFF REVIEW: 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 LAND USE CODE ZONING CODE
X APPROVE 0 DISAPPROVE SIGNATURE FP]
CONDITIONAL USE PERMIT
COMMENTS
BUILDING DEPARTMENT
DATE
E—:-'APPROVE 0 DISAPPROVE
SIGNATURE
Building 0 Hotel/motel
Permit 0 Apt. Bldg.
(L)
(A)
0 Office Bldg.
(0)
Occupancy 0 Restaurant
(R)
COMMENTS:
Group ED Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
0 School
(S)
FIRE DEPARTMENT
DAT
U. F. 1. R.
K-1. APPROVE 0 DISAPPROVE
SIGNATUR
COMMENTS:
Z
POLIC-E DEPARTMENT
q/,APPROVE 0 DISAPPROVE
DATE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE
DATE SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY CLERK
SEDF-SE, WIVER: f RMS I
z C PTI V1. 0 F I E DiM, 0� N S'
D 7
M/A-TkX.-.' SkWERDEPARTUV�ENT.
38 4,
jP
STR
1,- .1 -1-107#,for., Ide ;sewer,' Inspe&lbr�s!- -BEI.-ORE: -coveringi- -�Lny, portion- w. �the, const
call( 7,7f
is ru
pre
Inspei�tionlwilitibe-�provia'�dI wl thi)n,.:2T hours:. after request. N;);S&t.,';Su�_,or, holiday, ins
-41.
Esgfi�&e 424:,7;,-'12th-P1aCe_.-'
.................... .
...... .........
................. . ............................. .. ........ ....... ....
77 .................
�:4, Ali 7
RR.Qj�h k70L'tG�iili,DESO RiPrMb Lot- 16, S map-1 b'W* dod. Vi I I aqe,-No, A�.
N....................................................................
..................... ..................................
.............................. ............. �7....
............................
............................. ................................................
.......................................................................... ......... ........ :7
'&'-LAUNDSE
HENDRICkSEN'.
.. ......... .... ... ... .... ............ EX ANDY-OR-B I ILDER ... N_
... WN
V
.............. ............. �: ........ w ......... ...........
` .. ........ .......... ...... .......
ADDRES S ...... ''LYmMiyod
ynnWood,Sewer A- Cons t �-: -4 A KOAA0 -Mapl e
_�COXT-RAGT-,OR1SON6MV(&, L ...... * ....... ........ 72 ....... 2
. ............... ...................... ..............
J Un e-..,- 14
..... ........................... ...........
l�y"stem��ihtlaword'ance�,WIifi,tClty?,;�f,,-,,Edmondst�ordin'ance.s., -sewer,
�,4 WTIONOIS CA IL 01',THEI FOL1OWJ'N'G::*
f "T'he,,,owners)i6f'�the�,property,mELy-,�io�t�in,;a-,-pe�rpit.,;*to.-constru I ct',sewer I b&r C' r
slae� ewer .,,,,6tr, it n,,Ide:,property.�lin�;..'A,;Iicensed�,Si�e.�Se o�t'a'dior.!r��st�.,�e�,e�i�'ioydd ito,,'construct
eGarew.,1D6in6t cover any'portiori��of�,.',sewee,,b6f(jr�
hast-been, inspected,.
ilght-of-w.ay:;yequires,.ah,.Invasioni,of RJght`of-W&*y Perrrdt-,obta . ihable, from Ahe 'City�',E . n-jlneer',ii,6ff
lbe.
—Obtaint,ful ' lt?lnformation�;regaidini,',drdi�nande- -1-11. 1'6.030,'�and*',Regula'tions.�,,g��drnling',��sld��tse�ie��-,�4he.n,.'�o.,u,.Ret, pe it.!,'.'
�V�pof'..ide,,s�wer,-lm6it,haN;e,�at-',Ie'E�st 30'Ifiches';coverage �a_A� property . -line- , and,121� , inch - e3r,ifiside, property - , - Hn . e; mininju
6r.Aham..'A. willobei,permitted'..' rd,!9radevdf,�2.-%;,. Nm)bendsj1lnj:grade,
street -,;restored! to),origina3��condition-.;�,ContriLetors'shallilb�,,responsibl6 16r, fafilure),dae, �fdl din proper,.
NOTtlNoi.!5 --- T�enchesi,in,!sereet,must.ilie:,Aiater,iet.tied,andl!sur.fac��'of,
work mhlchVmay ?develop- within', ne.yearlof�,cornPleti
0 on,
0 lawfulk o,'
t �alter'iondo)lany,;other workt than s(,proy . dedl :f . or In� 1. the,perrr&,,,
thvjiJipe)intb11the�, yei_� fO -work�pv.lthe: rn&W�se%�r;�or! ifs4ppurtepancesrtexce.pV Aopirr-.
ser�.
Date ... ...............
'blrs.,�&PROMED) 'IE]) P t .............. * ...... By.: ... -Date;... .... .........
Y, ........ y
. .............
................................ ................ .......... M� ....... ............... . .
..................
........... ...... I----.-,-- ........... ......... ..... ..... ............
................ ....... ................. ......................
. ............... .....................
......... ........................ , .......... ...................................................... .............. ............... .
............. 7 ........ ......... I ......... .........
MOT.11��,Rbrmit,,Co fe A A S B
P s, U V e U. .
........ h'ereby, ,certlf.y,-ti-hat,�,'the-is'id'e'l�s'ewer, instal latio'n�,cohitructedlliuiid er4h! sipermit
BR
n raC m
er'tof'lConf tV lngConstructfc�n i.`�:
tall, dMn%c,cordanc,e)kw.1tb:al gpmerning',ordinancesi
....... ....
-07 ...... .......
L i'aied; t1tis'...V.. - (of:
Y
heek.BEF�OREII� '0
widik�'Ibii; Water- jEj (E)', 'T el ' Son6�' h JI"'-
eP "P, 10t er,IE]l ., V Vj
2
-1
4
4
APPLICATION
for
The City of Edmonds SEDE SEWER PERMT
EASEMENT No . ...................
NEW CONSTRUCTION REPAIRS 0 .......................
KST. 4�a4--
OWNER .... 4 .. ........................................................................................... CONTRACTOR LN'N.NW000 SEWSR C6 -PERMIT No.... ...................
........................................ -------- -- * ......
��—Vzr" LEGAL DESCRIPTIO 1466
ADDRESSINNINNIP.Ow -------------------------------------------------------------------------------------------- N: LOT No . .............................................. BLOCK No
L�A k rnA En % L P-�
4v
.............................................
Ail I AL - � -
:1 Numt5=K 44
....................................
I *
0
6
.71
mEr. i
FILE
CITY of ED!,!G!47j,1s
i7
11-101�� 'S�,ItPAPTMENT
Routing of
Building Permit Applicati ons
Proposed
Property
Address of Ari�)lication:
430 - 12th Place North
W A
c0),.,,.! F k.,,r s
s T -W K.
N T C C
USE P RKPr
BUILDING DIPARTIAINT ZONE NZ
Applicant FW UKBMR
PERMIT . APPLICATION belde Heavy Lines
X4KV (OR NA"_OF
(�241S / re -
Al C LOT"'^C*aAGIC
AC,
KAXLING �'SSL LE 'HEIII—H—T — — — — — — WOW —ISE—D 1-1 UfiW-
7-
LEFRONN HURNEF-- _i?�?�UALA �A��Al. A
5— /' J "'� (� / ev
7rl;j, � � Tz_ —REQUIRED YARDS
NAMZ DR
ED
PROPOL ER_
FRONT SIDE REAR Nf—
FRO S; RIZA It
A
A ANCE R
yEq (I NO PERMIT NU B
CITY ON MBER PLANNING I)EFT7AFFR()VAL
STREET II/W I — DIIFICIENCY THIS PROPERTY
NAME! KXIHTING STREET R/W ............ FT.
COMP. PLAN ST. R/W PT.
FT.
REMARKS
CITY KZ=D BY
LE ONE NTTWdffi5t
M&rZReIzz NERVICZ 9
_m'aTT'-bRn rum".1111" NUVBZR CLSAJUNCIC CHM0 By
a-Floperty (Show Below Or Att4a Your case")
A TYPE CONNECTI
VERIFIED BY
PERMIT NUM
-K—EMARKS
IIUC ZONE I TYPI
E OF CONSTRUCTION
T IMPRovED
BT=
10 0 ?,to
PfC_ _PWCTOR REWUIRJ�D i 'oemipAwIly GROUP
IAL INS _-f0_RRK_ CU
ADD IL- HZIRDENTIAL LINE .3 YES 0 NO
1 11 GAS
N ON -RESIDENTIAL 0 THIS SITE IS LOCATED IN T f ITY
- I I SIGN OF EDMONDS. LOCAL SALES TAX
ItHn"Ll, BE
DZWOL RNTAINING RE A 00112 U.N.
lam WALL
ALTZZ EXCAVATM 0 FENCE
El a 17LL Ft.)
REPAIR PRE- OVE
P.0
ur UTORI
UNITS
Valuation 1pt
Ft— Cbftk N . ..... ... 21�
BUILDING
PLUMBING
TL�A ,,d...
_,e) HEAT A GAB LINO
RECEIVED
PENCE
111rN
JAN 9 1973 t
RETAINING WALL
N
SWIMMING POOL
T)KMOLI
TIom
PRE-MOVII INSPECTION
=CAVATION OR FILL
meriall here" "knowledge ust z 110" read uds appilcatiom: mat We JR. TOTAL AAKOUNT OUR
Imd U011 411TIA Is am : am th" I am me oww, m re': "t, Aq'h'
ago, or we ow1ur. I Agree to 0=91Y was, city " State law mint.
le""of "hes"o"UM; &M In daft"" work guthDrift(I UN"Ity, no put= ArrENTION APPLICA TiION APPROVAL
Witt he 'MP'QM IS VICISUM of the Labor Code or the state of Weehl.st_ THIS rERMT
rel to W coulliene'tion I!m m At;Tuoluzxo This application is not a pern-dt until
E: P It ON Tftr (Xxc*Pt 109MOLMome which ONIT THE Signed by the Building ofticial or We I)ep.
V1 In MilletY days; MOVED,114 DUELDINCIS sh.11 he WORK NOTZD utY; and fees are paid, and receipt Is ac-
Vt the.) I . katowledged in space providedL
AQVW) A SIGNE INSPECTION
DEP&RTMICNT
crr� or
(INOM Ap,plicaxt Subject to Pidn Cbeck Fee EDMONDS A
Title Feltutit covers Work So be Soo, an prIVpte p"pseq, 0.1107
Any ammcires es as pubft 6mals Jwh" drl�wmee,
—one", so.) writ re4mem, "P.." tied=. ma
RECEIVED
4AN 9 1973
F"T
lb
APPLICATION
for
The City of Edmonds SIDE SEWER PERNaT EASEMENT No.. .........................................
'-�NEW CONSTRUCTION E)
REPAIRS 0
7-
O*NER ............... CONTRACTOR ........ �:w!g -
PERMIT No...9.31/...
RESS ------- / BLOCK No . .............................................
. ................... ........ LEGAL DESCRIPTION: LOT No . ..... /4 . ................................
NAME OF ADDITIO11T ......... Alo
.... .. . ..........................
0
:10
51
'41
T�t
13
Approved:
0
DATE................................................ By ............................................