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City of Edmonds tp
Traffic Impact Analysis Worksheet
Name of Proposed Project:
Owner/Applicant
Name
Street/Mailing Address
city State Zip
Telephone:, 110to - (it 9 - ?, I P) Z_
Applicant Contact Person:
%Mkt
Name
Street/1\4ai ling Address
City.
Telephone:
State Zip
Traffic Engineer who prepared the Traffic Impact Analysis (if applicable): olk
Firm Name
Telephone:
THRESHOLD LEVELS OF ANALYSIS
Contact Name
E-mail:
Project Traffic Levels
Sections to Complete
1. Less than 25 peak -hour trips generated
I and 7 only (Worksheet/Checklist)
11. More than 25 peak -hour trips generated
All sections
1. PROJECT DESCRIPTION
a. Location - Street address: 5,72-4 WA- 1, N ST
(Attach a vicinity map and site plan.)
b. Specify existing land use:
c. Specify proposed type and size of development: WY) 6 L / CCZ6
I If
(# of residential units andlor squarefootage of building)
Revised on 6124110
E82 - Traffic Impact Analysis Worksheet
Page I of 5
7. MITIGATION RECOMMENDATIONS
State recommended measures and fees required to mitigate project specific traffic impacts. Traffic
impact fee shall be calculated from the Edmonds Road Impact Fee Rate Study Table 4 (attached)
and as identified in ECDC 18.82.120, except as otherwise provided for independent fee calculations
in ECDC 18.82.130.
CHANGE IN USE
Fee for prior use shall be based on fee established at the time the prior use was permitted. If the
previous use was permitted prior to the adoption of Ordinance 3516 (effective date: 09/12/04),
the 2004 ECDC 18.82.120 impact fee shall be used.
Units in
ITE Land Use Category Per Unit square feet,
Fee Rate # of dwelling,
vfp, etc.
New Use is X
Prior Use 0 G(L $ 1�3 X
New Use Fee: $
0 NEW DEVELOPMENT
New Use
0 OTHER
IsPrior Use Fee: $
Units in
ITE Land Use Category Per Unit square feet,
Fee Rate # of dwelling,
vfp, etc.
$ X
MITIGATION FEE RECOMMENDATION:
S
INDEPENDENT FEE CALCULATION:. $200.00 (+ consultant fee)
$
TOTAL TRAFFIC IMPACT FEE
$
city
Division Approval
9
No impact fees will be due, nor will a credit be given, for an impact fee calculation resulting in a net negative.
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 5 of 5
PLANNING DATA
Multi -tenant Bu
Business License Information
BUILDING NAME: ADB FILE #:
SITE ADDRESS: �-kA%g —ZONING:. �
BUSINESS NAME: r
,)
SUITE NO.
USE(S) PROPOSED:
ALLOWED?:
Legal Nonconforming Land Use Determination Issued(Y/N) CUP File:
PARKING: Use: Or--;:r ta�R L-DI C'k
No. Spaces Required:
x -:ET
--(floor area, # employees, etc.)
BUSINESS NAME: ' Nat ON4
SUITE NO.
USE(S) PROPOSED: "N, r;:,% t4.; C's
ALLOWED?N
Legal Nonconforming Land Use Determination Issued(Y/N) CUP File:
PARKING: Use:Q�r-i,-4 c -)I
0()j: p L c_-No. Spaces Required:
-ora-
x oo
(flo rea, # employees, etc.)
BUSINESS NAME:
SUITE NO.
USE(S) PROPOSED: Z�r Lrz,, tAQ
156 ALLOWED?: qq-,
Legal Nonconforming Land Use Determination Issued(Y/N) CUP File:
PARKING: UseQEtHtcr,,..r
No. Spaces Required:-K7-
x I '!R�o Z , _.
. (floor area, # employees, etc.)
BUSINESS NAME:
Ssg=vir, F SUITE NO.
USE(S) PROPOSED:
ALLOWED?: jq5
Legal Nonconforming Land Use Determination lssued(Y/N) CUP File:
PARKING: Use: :�_ �e tc-P-
No. Spaces Required:
-
x - q�o 'ET
--(floor area, #employees, etc.) =
BUSINESS NAME: SUITE NO.
USE(S) PROPOSED: ALLOWED?:
Legal Nonconforming Land Use Determination lssued(Y/N) CUP File:
PARKING: Use: 5-0�csq_ No. Spaces Required:
x - a 10 - (floor area, # employees, etc.) =
BUSINESS NAME: SUITE NO.
USE(S) PROPOSED: ALLOWED?:
Legal Nonconforming Land Use Determination Issued(Y/N) CUP File:
PARKING: Use: No. Spaces Required:
x (floor area, # employees, etc.) =
PARKING:
Total Required: I
Actual Provided: �k (0
M; 0� a -, Y 4-Term E i TL,-Z-j I a'
Plan Review By:
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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).
An applicant, or his/her representative, must fill out
tht 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 -domplete 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:
Name U
MOJAA
Street Address
z-::�[ fflonA �8 'T1020
city State Zip
-7 71 - -�37/-/ 3
te"lephone
Signature
Date
Applicant Representative:
I
Street Address
cj-,4ad,�, wA (M,?, o
city �tate zip
(q Z6) r7 T/-,C� — N-14
Telephone
Signature
—izi-,201 (-Tcl
Date I . I
cxccepflon�anakad.doc
(over)
CA FILE NO.
Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soils/topography ydrology/vegetation)
1. Site Address/Location: Ma*
2. Property Tax Account Number: q -
"2
0 -C)oq- on
3. Approximate Site Size (acres or square feetl: (p,
4. Is this site currently developed? —LL yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Y 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
I 0-feet over a horizontal distance of 3 3 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 of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: AIM Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Ak) floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? - 0 Flows are seasonal? (What time of year?
10. Site is primarily: forested ow :shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: /�b
— ----------------- — ------- — -- — --- - — ----------- — For City Staff Use Only ----- — ------ --- ------------ — - — ----------- — -- — ------
-DA-.4 - -
Aim
81 is Zon
SCS mapp I e d soil type . (s)? Milk W'IqV — U411V - LIA �ff-40&' -1/'n alr
.j. Wetland inven*io.ry** or C.A. map indicates wetland. present on site?
:4. Critical Areas inventory or C.A. map 'indicates -Critical Area o n* site -A)n
5. Site within designated earth subsidence landslide hazard area?
�6. Site designated 'o''n*dle'Environmentally Sensitive Areas.Map? No
Ac�_chk.doc; Rev
APPLICATION
for
The City of Edmonds SIDE SEVMR PERNaT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
to- -o6,IM76
OWNER ......... 1!11; ........ ........... PERMIT No . ......................
..... ............ ................... CONTRACTOR ............................................................. . ..................................
ADDRESS Yt ...................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
�.J.p
A
h �� A,
ipp��1q7J
ed:
DATE................................................ By ......................................................................
t
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/N,AME OF BUSINESS
t h) I' j6s!,�S'p
MAiLING ADDRESS
-5-C)LI 4_" CA I' IS
CITY ZIP [TELEPHONE
f - - -, . r"NQ I , )A i 41'?f;'ka-x
NAME
ADDRESS
NAME
CITY I ZIP , I TELEPHONE
LICENSE NUMBER . EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
PLUMBING / MECH
Q,ADDITION
COMMERCIAL X2"tOMPLIANCE
',REMODEL
APARTMENT
SIGN
REPAIR
0 GRADING CYDS'
o FENCE
X FT
Q DEMOLISH
TANK .0
OTHER
GARAGE
RETAINING WALL
13
CARPORT
ROCKERY
RENEWAL
ITYWOF U& ' BUSINESS OR ACTIVITY) EXPLAIN:
NJ
NUMBER
N MBER OF' Am-
CRITICAL
OF
DUELLINP,
AREAS
STORIES
UNIT$
NUMBER
OESC'RIBE WORK TO BE DONE
nrA
I"
Jr)
1. 1,1
HE.AT SOURCE GLAZING % LOT SLOPE %
kN CHECK NO: VESTED DATE
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER CMV,4
J00 SUITE PT#
ADDRESS
17A
PLAT NA0t/SVBDIV1SIOh NO.
LOT No.
LIP NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'TESCP A*Oved
RW Parents Required
Street yea Penns Rewo
EXISTING PROPOSED
I-pection Required
Sidewalk Required
REQUIRED DEDICATION FT
Undergrotmd
Wmataquirea 13
METEh SIZE
LINE SIZE
NO. OF FIXTURES
PR� REQUIRED
YES13 NO C3
REMARKS
z
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAJNAGE
FIRE REVIEWED BY DATE
W
C 0 Z_
me
IEL
VARIANCE OR CV
SHORELINE OR A0B#
INSPECTION
B 0 N
REO'D
EP)D'
DST
POSTED
P
E3 YES Cj NO
SEPA REVIEW
SIGN AREA
1. . HINGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROP(?SED
.XP
LOT COVERAGE
REQUIRED SETBACKS (FT.).
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE R EAR
FRONT URSIDE RFAR
z
ING
LOT AREA
P�NNING REVIEWED BY DATI
.PARK '
REID I PROVIIED
>
1.
I , _ 0". L
4
CHECKF50 87PE 00 L S ICTI OCCUPANT
m_�, GROUP
Fit �t E
SPECIAL INSPECTOR JARE OCCUPAIT
REQUIRED 0 YES LOAD
REMARKS, 1. :' " "; I _21
PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION RE
VALUATION $
DeiscriptIon FEE
Plan Check
Building
Plumbing
Mechanical.
1=
a
3
t:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED THIS PERMrr COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
grading
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN lell DAYS
SEE BACK OF PINK PERMTT.FOR MORE INFORMATION
Engr. Inspi-i ion
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGN L S AND SUCCESORS
Traffic Mitigation
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Mew
FROM THE ISSUANCE 00 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT.BE
DEEMED TO MODIFV; WAIVE OR REDUCELANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE crrys ABILITY TO ENFO010EANY ORDINANCE PROVISION.-
Landscape Insp.,
I HERESY 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING QONSTRVC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, I NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE IA69%-GQPE OF THE STATE OF WASHINGTONL RELATING TO
CALL
C^0 JkjjQ0=d__rj U
A
This
Bull ing
I L '0 r,
WORKMEN'S COMPENS 0
AR0"SUFfNCE AN RCW 18.27.
S (0 R DATE SIG ED IAO
1 _7 I WK-5)
771-0220
'ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY ABUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND. APPROVAL OR A CERTIFI- 771-0221
CATE OF OCCUPANCY. HAS BEEN GRANTED. UBC SECTION 109
10/01 FAX
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
#
Total Arhibunt Due
Receipt #
pplication is not a permh until signed by the
Mcial P� hiql�er Deputy: and Fees are paid, and
;0jPt Is ackhbVedged In space provided.
DATf
BY, 'DAYE—"'--
ORIGINAL - FILE YELLOW - RISPE94
PINK - OWNER GOLD - ASSESSOR