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City of Edmond
Traffic Impact Analysis Worksheet
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PP—ropos roject: f Vl,—;LA _r I Q11j 4-,-7
0040orlApplicant Applicant Contact Person:
N(2)��7 PQ VA LL
Name
S treet/Mailing Address
2 YV)
city State Zip
Telephone:WA::�S); -310 - 2:71
Se�di?^LL 0. MW"s-0\1
Name
Iq -�y &411
Street/Mailing Address
:�7� uE: WA q61
city State Zip
Telephone: &;_?� - '45;Gl
Traffic Engineer who prepared the Traffic Impact Analysis (if applicable):
Finn 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: 1
ff
(Attach a vicinity map and site plan.)
b. Specify existing land use: KA 14"J_�r
Specify proposed type and size of development:
(# of residential units andlor squarefootage of building)
Revised on 6124110 E82 - Trajfic Impact Analysis Worksheet Page I of 5
10
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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.
ITE Land Use Category Per Unit
I Fee Rate
New Use X
--710 1 Prior Use X
$
I
New Use Fee: $ Prior Use Fee: $ $
0 NEW DEVELOPMENT
Units in
square feet,
# of dwelling,
vfp, etc.
'�2 �)- 2 2-
-��'7- 71
Units in
ITE Land Use Category Per Unit square feet,
Fee Rate of dwelling,
vfp, etc.
New Use $ X
[I OTHER
Fee
MITIGATION FEE RECOMMENDATION:
-1c
S
INDEPENDENT FEE CALCULATION: $200.00 (+ consult
$
TOTAL TRAFFIC IMPACT FEE
City of Edmonds',
g'Vivis�n Approval
' 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 - Trajfic Impact Analysis Worksheet Page 5 of 5
95
4/8/2011
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CITY of EDMONDS BUj&SS LICENSE APiR�HIEIR
Civic Center - Edmonds, Washington 9 DAO LICENSE NO.
8
IMF 9
Woe� r L - TYPE OF BUSINESS ANNUAL FEE AFTER FEB. 15
City Clerk Phone 775-2525 T"' E E
0.
CIL
YEAR I
LIC. EFFEC. DATE
REAENT�Igj qq.
5p,��-
El, (A) HOME OCCUPATION
$15.00
$ 22.50
NSTRUCTIONS:
IVA
71 (B) BUSINESSWITH
$20.00
$ 30.00
All items must be completed
RECEIPT NO.,
DATE PAID
1 TO 3 EMPLOYEES
A—
or application will not be ac-
21'
PRINT 'X'
IN SPEC. BOX
E] (c) BUSINESSWITH
4 TO 9 EMPLOYEES
$22.00
$ 33.00
cepted.
1AA
1
FOR ISSUE OF
Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
LICENSE WITH
BUSINESS WITH 10 .
0 (D) OR MORE EMPLOYEES
$75.00
$112.50
with fee. Renewals received
11144:�4)1
1
C'ACTION.
after February 15 must pay
2--NEW APPLICATION
(LA)
penalty in addition to fee.
0 RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 112 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(L D)
NAME OF FIRM
BUSINESS PHONE
NO.
OF EMPLOYEES,
lu
I n-,/n
Lq1*C:1ff
-50 IV/Y—
MAILING ADDRESS
NATURE OF BUSINESS
W7
BUSINESSADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
(P) (C)
OWNERS NAME HOME ADDRESS
a
HOMEPHONE DATE OF BIRTH BIRTH SOCIAL SECURITY NUMBER
/ (-I) - " - �y S_,�7/- _ & -7
71, �/, I /,-,y cl"�,eML- �2 � _!�
EMERGENCY NOTIFICATION (1) NAME&TELEPHONE
(PLEASE LIST TWO) (2) NAME& TELEPHONE 71,1
WASHINGTON STATE TAX NO.
APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR 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
-5 APPROVE 0 DISAPPROVE
SIGNATURE
CONDITIONAL USE PERMIT
-COMMENTS
BUI DING DEPARTMENT DATE 10-1-bi
�%PPROVE 0 DISAPPROVE SIGNATUREJ(
COMMENTS:
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
Building
0
Hotel/Motel
(L)
Permit
0
Apt. Bldg.
(A)
0
Office Bldg.
(0)
Occupancy
E1
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
0
School
(S)
FIRE DEPARTMENT DATE A2 - U. F. 1. R.
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
P!��ICE DEPARTMENT
DATE URE
P APPROVE 0 DISAPPROVE SIGNAT
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY CI FRK
STAFF ACTION^
B!,ISINO LICENSE APPLICATION 'REVERSE APPL. NO.:
CITY OF EDMONDS SIDE DATE:
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020
rAPPLICATION FOR:
F_
TELEPHONE (206) 775-2525 NEW [:] L LICENSE
BUS. R IECN E YEAR
OF IAL Q5E QNLY
�17 INSTRUCTIONS _N
U, PRINT APPLICABLE LICENSE CLASS, FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15,
2: NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
3. SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY).
4. LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION PRINT CHANGES AT RIGHT.
N
HOME ADDRESS
3. BUSINESS IDENTIFICATION
11 ANNUAL FEES
TYPE BUS. CLASS FEE PENALTY
HOME A $10.00 $ 5.00
SMALL B 15.00 7.50
*GENERAL C 50.00 25.00
NESS I BUSINESS PHONE
WASH. STATE TAX NR. I EMPLOYEES I ORGAN. JOCCUPANCY
*OVER, 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
CLASS FEE PAID I PENALTY PA71D
TYPE ORGANIZATION
IF BUSINESS IS:
TYPE
CAPACITY
C
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
0
C CORPORATION
APT.BLDG.
A
NR OR APTS
D
L LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
E
P PARTNERSHIP
RESTAURANT
R
NR OF SEATS
s
S SOLE OWNER
HOSPJNURS. HOME
H
NR OF BEDS
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
5. EMERGENCY NOTIFICATION
_TNAMI
AREA
TELEPHONE
OFFICIAL USE ONLY
U.F.I.R. CO DE
I BLDG.
PERMIT .
OCCUP1
C.U. PERMIT
LAND U!��
LICENSE
NUMBEiR
LA NEW BUS
j
[:CTIJ�
LB RENEWAL
LC CHANGE
�
LD DELETE
CLASS
YEAR
LIC. EFFEC. DATE
REASG. LIC. N 0.
SPEC
RECEIPT NO.
DATE PAID
A�
PRINT X
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
FEE PAID
PENALTY PAID
LICENSE WITH
t:)
'LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
IK,0, RP, .-r,
DATE OF BIRTH
MO. I DAY I YEAR
/ ic / 1�1
HOME ADDRESS
TY NUMBER
PLACE OF BIRTH
CITY
fl6l)(l IV14�141rixi 1,51.1i'5K
3. BUSINESS IDENTIFICATION
IBUSINESS NAME (FULL)
IV. 0
15
NATURE OF BUSINESS (DRUG STORE, CPA, ETC) BUSINESS PHONE
651,914 1 1 1 1 7* - k Y-AIA
WASH. STATE TAX NR. ANTICIPATED TYPE OF I OCCUPANCY
IREGISTVATION) fNR. EM�PL�OYEES �RGAN� FTYPE� CAPACITY
0 5
it ENTER APPLICABLE T YPES AND CAPACII t
'4. BUSINESS A&DORESS
BLD MEE APT. NO.
BLDG. NUMBER
ISTREET I r�PT—,N01
I STATE I I ZIP Cl
W 'A I 1 0 cl.
I flol
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL TELEPHONE
(1). F,
1 717 1
LAST. NAME. FIRST IIIJITIAL TELEPHONE
U. F. 1. R.
CODE
— 5S OFFICIAL USE ONLY —
PRIM. . UNITS . BUS.-] FBLDG. PERMIT
COND. USE PERMIT LAND USE
-1 1 1 1 1 1 1 1 " Ll - I
CITY CLERK'S
P
Al PLICANT'S
SIG19ATURE
SI
SIGNATURE
rBUS.
APPROVED F� DISAPPROVED DATE
I TITLE
OCCUP.
FORM CC-1 (10/76)
RETURN TO CITY CLEK&Am
DEPAR� C
PUBLIC VORKS IST
BUI1,DING PERMIT,REVIEW.
(address) (date)
Street Right -of -Way Existing
RE
Z
Access Easements Existing
FEW-
tJA
F4
P4
Utility Easement Existing
REQD
Lot Per Subdivision Plat
Assessor Map
Site Plan Checked for Accuracy_
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
'-7
.Z
Review by_
Date
�sting Water Main Size
. ate� I i�n Re;u�ired
Service -.Required
ce e. 5 jre�
Si
Hydrant Size
P4
Hydrant Reqd Per Fire e-
qd
Size
Detector Check Meter Reqd-
Cross Connection Ins�pec
Fire D17epar:tn�ient ts
t ts_
:3:
Water Itter Charge Reqd.
Review by.
Date
tic Tank Design Approved
Date
Sept Tank Pernit Reqd.
No.
Sanitary r Availability.
5Permit
Pro.j.
Drawing No.
File No.
Side Sewer Availa * 'ty
Sanitary Sewer Connecti Fee Reqd.
:3:
Review by
te
Open Ditch Existing _
Reqd.
",�ize
Culvert Reqd.
P4
Req
Catch Basin,;d.
S
Indic on Site Plan
Lc�
Shoulder dra* e 'mainuain collection on
swale open runo
0
N-11
Mdnhol�ereqd.
Indicate on Site P
Co Z
So* Conditions and Ground Water Field Checked
2
ew by
v
Date
ra, A
rfln
4
Revised: lvlO-1977
Page: 2
Revised: Iv 10-1977
Line
Type
OW egoeli Area (square feet)
Non -Regulated
Exempt
Regulated
2.
Replaced
3.
4.
New (Post 1977 4 4 4 4 4 4 4 4 4
Total Regulated Impervious Area
Miligation required �fhi excess of2000qf
+ t
5.
6.
Total Area Mitigated by Existing Stormwater Management System(s)
Regulated Area Not Yet Mitigated
7.
Area Proposed to be Mitigated by Low Impact Development Techniques
8.
Area Proposed to be Mitlgated'through Conventional SV,/M Techniques
b1cJ20120380-Rev . elations-El.doc RE'S"7t !B, Page 1 of 2
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BY ENUNEERING
Date:—�— 0
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