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537 5TH AVE S.PDFIIIIIIIIIIII 5191 537 5TH AVE S 1'.La ry- Ot -14 4 .�Y APPLICATION for The City of Edmoncfs-, SIDE SEWER PERMIT NEW CONSTRUCTION 0 REPAIRS EASEMENT No . .......................................... 104-05750 OWNER ............ Donald Brown -------------------------------------------------------------------------------------------------- CONTRACTOR .................. ............................................................................... PERMIT No . ...................... ADDRESS ........ 537 ... m --- 5.th..Avenue ... 5 . . ................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................ NAME OF ADDITION 0 DYE TESTED ON SE14ER JULY, 1972 Approved: DATE..... .......................................... By ............ ......................................................... City of Edmonds Development Services Department Planning Division Phone-' 425.771.0220 Fax: 425-.771.0221 Tle Critical Areas Checklist contained on this form is to be filled out by any person preparing a Dev*61opment 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 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 inveriffw . - ctEry ff joi surveys). APR 2 9 2002 QF-Q�AIT rr)l INITM Date Received: 2-1 - �2� — �2c� 9 City Receipt #: Critical keas File #: 'c;,-'�� —0-0-0 C ri c" I Areas Checklist,F6e: ti- a $45.00 Date Mailed to ADDlicant: �.�e A --J property bii&, or his/her authorized representative, must fillt,ou't'&e 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 information (e.g. site plan, topography map, etc.) or studies in con unction 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 information ar4 qxhibits herewith submitted are trite and correct to the best of my knowledge and that I am authorize0fo" TihjOa pWtion on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT%SC,2.( 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.po�� �ndant _to this application. SIGNATURE OF OWNER Owner/Applicant: Jea.VL't�xdae-la Name �il r-cl d I-S C Street Address C--c � M * or) d 31 0 City State Zip Telephone: 42-5 -4,q) Email address (optional): DATE -K-1 — -Z q — 0 —7— . Applicant Representative: 'ba V C- i-,-' le V(?k(- Name 1030 / Street Address I-wnnt,oc>cd LLN4 '180 S-4 City State zip Telephone: 412-5 1 -,�)E?2 �5- Email Address (optional): Critical Areas Checklist.doc/3.19.2001 Critical Areas Checklist CA File No: 1DA -Oo3 Site Information (soils/ topQgraphy/hydrology/vegetation) 1. Site Address/ Location: .5 rn C" d, 2. Property Tax Account Number: (e-5/4 5-40 0dQ0 ZY -00 3. Approximate Site Size (acres or square- feet): 170 4. Is this site currently developed?x— yes; no. If yes; how is site developed? _ <::,% 1111"Icte ( 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'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 horiz o*ntal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standin water: - Approx. Depth: . 9 446- 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain of a water 'course. 9. Site o t creek or an area where w,*er flows uNss the grounds surface? Flowp are year-round? Flows are season'al?,,-'K5� 4/(What time of year 10. Site is primarily: forested meadow ;shrubs mixed urban landscaped (lawnshrubs etc) A-- 11. Obvious wetland is present on site: 1110 XWAIVER 3te: Critical Areas Checklist.doc/3.19.2001 S MEET FILE V February 14, 1980 MEMO FOR RECORD SUBJECT: CLAIM FOR DAMAGES - 537 FIFTH AVENUE SOUTH On October 18, 1970, at 537 Fifth Avenue South, the resident called regarding his car being stuck in the driveway approach to Fifth Avenue. The Street Division had previously removed existing concrete to be replaced with city standard sidewalk under Fifth Avenue project. Dirt had been placed in the approach to bring to grade. Heavy rains had fallen previous to this date. John Walvatne of the Street Division had talked to the resident regarding the access and was told that everything was ok. Resident drove out stopping before entering Fifth Avenue. His wheels hit the edge of the asphalt, then he spun his wheels causing his car to high center and causing damage. ///�z BOBBY MILLS, STREET FOREMAN BM: j ak d4 to—r dt min dJt. fq * "f RECEIVED OCT 17 1979 kv J , eA4-11" CLAIM MR MAGES 0 0 _f 1 8 1979 Edmonds MY Clark NOTICE 01 e Mr. I Pubfir. Worf�s Claim MUST be presented to the City Council and filed with the City Clerk within 220 days from the date of Accident or Accrual of Damages. TO THE CITY COUNCIL OF THE CITY OF ZDKqNYS: PLrAsE TAKE NOTICE, THAT ;&Z7 (i —ried, give husband's e WEID NOW RESIDES AT C-5 z41R Istate present actual address by street, number and city) AND WHO FOR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT Z (Give residence by street, number and city) CLAIMS DAMAGES OF AND FROM THE CITr OF EDMONDS IN THE SUM OF S arising out of the following circumstances: Describe Claim, giving DATE and TIME injury or damage occurred, PLACE and full particulars. Accurately locate and describe defects caus- ing injury or daw e and all acts of negli- gence claimed. 9 Accurately desceLbe injuries or damage 61fO L) '00�2 State items of damage claimed. Itemize all expenses and losses., ;7 v ez oz-Ze (Maim must be sworn to by claimant) '00, 0001, gna u 0 SUMMED AND SWORN TO before me this day of fi��tary Public in and for the tate of Washington, residing at ', :!, 4,1� ddg� IQ.,W MIDAS MUFFLER SHOPS LV ITEM QUAN.1 PART NO. DESCRIPTION UNIT PRICE AMOUNT BELLEVUE 12005 N.E. 12th St. 454-2782 t_ a LYNNWOOD 21407 HIway 99 774-2184 EVERETT 4319 Rucker Avo. 252-2185 LAKE CITY 11019 Lake CRY WSYN 364-1390 MUFFLER R 7-5 L RESONATOR R KIRKLAND 1�1 BELLEVUE CONNECTOR PIPE FIF RRI LF1 I TAILPIPE R 13 Z:5 M L Z6Z RF (A DO EXHAUST FIR PIPE ILF, ILRI I -:nPHONE NO.: I YEA Clamps or Welds CHROME/EXT. BRACKETS HANGERS GASKETS HEAT VALVE SHOCK F ABSORBERS R MACPHERSON F STRUTS _R COMFORT COIL TOTAL I I LABOR ORIGINAL ESTIMATE MUFFLER PARTS EXHAUST PIPE TAIL PIPE LABOR HEAT VALVE SUB TOTAL SHOCK ABSORBERS CUSTOM TAX TOTAL LABOR TOTAL WORK AUTHORIZATION I hereby authorize the above repair work to be done along with necessary materials. You and your employees may operate ab ve veb4�..Je for purposes of testing, inspection �s_li C i,-. - ckn I d d nabovevehicleto or delivery at my risk. An express mechani sa OW e a o secure the amount of repairs thereto. Yqu'wKnot be h ible fo sordam- age to vehicle or articles left in vehicl inq$eoffire ant othercause beyond your control. Slanatur 7 % 1-1 DATE 'r, .1 SPEEDOMI READING 1:1 - 6ALLARD 7055 1 51h N.W. 784-7220 1:1 NSE PLATE NO. Z.-I LOCAL WARRANTY ON GLASS PACKED MUFFLERS Glass packed mufflers are guaranteed for as long as you own your carATTHIS SHOP ONLY, against manufacturing defects and normal wear. These glass packed mufflers arenotto beconfused with -the famous "MIDAS" muffler guaran- teed nationwide for as long as you own your car. Glass packed mufflers will be- come louder with use and are not guaranteed to meet legal sound requirements. ADDITIONAL PARTS AMOU T T9 PAZY, PARTS Ix X/ :1 �dl ADDITIONAL AUTHORIZED AMOUNT PARTS LABOR TAX TOTAL X Signature LABOR SUB TOTAL TAX 7 TOTAL Guarantees are Non-transferrable INDICATE HOW PAID CASH CHECK M/C 8 OF A DIAL FF.CH.j OVER 10 NO, [E,, c,,] REFUND DRIVER'S LIC. NO. M 0. DAY YEAR Received By PERAHT APPLICATION REQUMEMENTS TO: - - Permit Coordinator, Building Division "EET FILE FROM: Lyle Chrisman, Engineering Inspector STR OWNER: 4�1^ PLAN CK # ADDRESS: DATE: After review of the subject permit application, the following requirements mustbe met. 1. Construction hours are: WEEKDAYS .......... 7:00 A.M.-10:00 P.M. WEEKENDS/HOLIDAYS ..... 10:00 A.M.-6:00 P.M. 2. A separate RIGHT-OF-WAY- Construction Permit is required for all work on Publicproperty. (ECDC 18.60) 3. Truck haul route plan must be submitted and approved prior to permit issuance. 4. Builder/Owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d) 5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STRE"S OR 10 FEET FROMANY CLOSED DRAINAGE FACIL- 17T BUILDERIOWNER IS REPSONSIBLE FOR IDEN77FHNG COND127ONS ON 771E DRAWING (ECDC18.30.50G) 6 FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUC77ON (ECDC 18.30) 7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES, FOUNDATION DRAINS, AND CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30) ' - S. Repair or replace all defective existing curb, gutter, and sidewalk adjacent to the property. If an intersection is involved a handicap ramp may be required. Contractor shall meet with the City Engineering Staff to determine the extent of repair prior to issuance of the permit. (ECDC 18.90) 9. Driveway slope shall not exceed 14 % without a waiver. Every attempt should be made -to keep the slope below 14 Fc'. Waiver granted to _%. (ECDC 18.80.060D) 10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate perimit is required. (ECDC 18.80.060C) 11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO ANDAFTER POURING. (ECDC 18.30) 12. No burning of.construction refuse without a permit from the Fire Department. 13. Connection to City water system is required. There is a separate.charge for the water meter. (ECDC 7.30) - 14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20) 15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18. 10) 16. Connection to the City sanitary system is required. A separate permit is required. LIEN9 A6Wf_ Fees paid: Yes No Charge (ECDC 18.10) 17. Underground wiring is required on all new construction; and for additions, alterations, and repairs that exceed 50% of the total assessed value of the structure. (ECDC 18.05.010) 18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCU_ PANCYOF THE BUILDING OR STRUCTURE. (ECDC18.90) 19. 2 . 0. V STREET FILE CITY OF EDMONDS USE PERMIT ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT ADDRESS 4 OWNER NAME /NAME OF BUSINESS 4-\ f3v LEGAL DESCRIPTION CHECKI SUBDIVISION NO. LID NO. 0 0 MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. EXISTING — REOUIRED DEDICATION PROPOSE TESCP App,wed 0 R W Permit Required 0 Str at Use Permit Req'd 0 Insepection Required 0 Side.alk Required 0 CITY ZIP 9 V-- BEA -7 1 NAME 5 REMARKS ADDRESS L) X < Z F,—TY Z77LEPHONE NUMBER NAME (0 ENGINEERING MEMO DATED REVIEW BY ADDRESS METER SIZE BUILDING SUPPLY SIZE NO. IOF FIXTURES 0 cc cr CITY ZIP FLEPHONE NUMBER Z STATE LICENSE NUMBER 7 REMARKS SIGN AREA ALLOWED PROPOSED SEPA REVIEW COMPLETE ADS NO. Legal Description of Property - include all easements Z 1EXEMPT SHORELINE I 0 EXP VARIANCE OR CLI PLANNING REVIEW BY DATE SETBACKS — FEET HEIGHT COVERAGE FRONT SIDE REAR I ILOT Tax Account Parcel No -1'77,3 ElNEW 1:1 RESIDENTIAL PLUMBING 1:1 AODIALTER El COMMERCIAL D MECHANICAL El REPAIR F-1 APT.BI_ . Do. SIGN CHECKED BY TYPE OF CONSTRUCTION CODE I D—g toy 0 HEIGHT GRADING FENCE DEMOLISH El CAR ORT - CYOS. I swim x _FT) REMODEL GARAGE POOL. . 0 E]wDOD STOVE I F-1 RETAINING WALL/ SPECIAL INSPECTOR JAREA REOUI RED YES C 0 CUP G ROUP A NCY OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER UBC 305 INSERT I I ROCKERY RENEWAL 0 (TYPE OF USE. BUSINESS 914 ACTIVITY) EXPLAIN: NUMBER OF STORIES NUMBER OF 10 )WE LLING UN S DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) FINAL INSPECTION REQUIRED VALUATION U PLAN CHECK FEE 7F4EE BUILDING PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Any construction on the public domain (curbs , sidewpiks, STATE SURCHARGE driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days - Provided Work Is Started Within 180 Permit Limit: 1 Year Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, aSSiQnS and ENG. INSPECTION FEE successors in interest, agrees to indemnify, defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of PLAN CHECK DEPOSIT whatever nature, arising directly or Indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirement of any city ordinance no r limit in any way the City's ability to enforce any ordinance provision." TOTAL AMOUNT DUE I hereby acknowledge that I have read this application; that the information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL authorized agent of the owner. I agree to comply with city and THIS PERMIT state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her Code of the State of Washington relating to Workmen's Comperea- WORK NOTED Deputy; and fees are paid, and receipt is INSPECTION acknowledged in space provided. SIGNATURE (OWNER OR AGENT) SIG ED DEPARTMENT CITY OF OFF1 SiG T RE DATE EDMONDS 2 Z ?Ie2_12 Zl_f — CALL FOR RELEASED BY: DATE ATTENTION INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A F�NAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 3202 ORIGINAL — File YELLOW — Inspector !_F!,F�IFCATE OF OCCUPANCY HAS BEEN GRANTED. UBC S ri T 7 ", EE' FILE OF EDMONDS Ubt PERMIT ZONE NUMBER '3`105,37 CONSTROCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS ca SUITE/X ADDRESS e'l 1.7. LEGAL DESCRIPTION CHECKI S 5DIVISION NO. LID NO, MAILING ADDRESS Z 3: -5' 0 -?7 TE -5 CITY ZIP :4rf�IE31­1)�E N U%tv PUBLIC MIGHT OF WAY PER OFFICIAL STREET MA P EXISTING REQUIRED DEDICATION APSCOPVED BY 2-0 77+ NAME /1P / RIGHT OF WAY CONSTRUCTION PERM IT'REQUI REDA ADDRESS ST REET USE PERMIT REQUIRED 0 535 A1'4 I P1 5 T. 1 REVIEW BY L) CITY ZIP rffl[EPHONE NUMBER SEE ENGINEERING MEMO DATED 9 So -z,.)T77.4 - 0 -Y 3,c) REMARKS NAME A."a - Pla"�,161,F,1Z 16,1 r- �,e C.- 4�k- y J_ C IA6P 12rjV 0 Q METER SIZE 7 UPPLY SIZE UNITS CITY ZIP TELEPHONE NUMBER 77rG IFIXTURE Z C, 0 �'7 4 - REMARKS STAT9 LICENSE NUMBER o M SIGN AREA ENV. REVIEW ADS NO. Le of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT (ga.lDescription Z below or attach two copies) SHORELINE 0 0 n I � F 5 F lqe im — _qjj6e 0qW,-VJ 1� L/01/ 1/31 VARIANC . E .. 0 R ._CU_ PLL�Nl P RE!7BY �AT� 1P A t 1 y— /8, SETBACKS - FEET HEIG�T LOT CO FRONT_Z67� SIDES IEAPI�; 7E Tax Account Parcel No.2_1 7 C) REMARKS NEW RESIDENTIAL PLUMBING 9ADDIALTER EJ COMMERCIAL MECHANICAL APT.BLDG. REPAIR SIGN EXCAVATE FILL FENCE CHECKED By TYPE IF CINS;7TION cc E HEIGHT D� .Z DEMOLISH OR GRA 1 x _FT) 460A CARPORT S IM REMODEL GARAG E Z El POWDL PEC;1,A L INSPECTOR ]AREA OC UPANCY OCCUPANT REO FIED GRQUPk_ LOAD . 11WODD STO El J�T RETAIN NG WALL/ INSERTV ROCKERIY RENEWAL I YES C NO REMARKS Z 0 (TYPE OF USE BUSINESS OR ACTNITY) EXPLAIN: PROGRESS INSPECTIONS PER LIBC 305 P 3r i , L t 7- AUS IeW /5,7 ln.41`k�4-w, ,OE. NUMBER OF STORIES, OF + 9 [NUMBER DWELLING UNITS NATURE OF WORK TO BE DONE ATTACH PLOT PLAN) 7 FINAL INSPECTION REOUIRED LJ P001E C)LIA VALUATION FEE PLAN CHECK FEE le"4091yMpIr-4 7V 64-6 -1671 BUILDING 49 Z3 (a ybs PLUMBING Plan &ck No. MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Any construction on the public domain (curbs, sidewalks, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Permit Application: 180 Days Permit Limit: 1 Year - Provided Worl� is Started Within 180 Days A "Applicant, on behalf of his or her spouse, heirs, assigns and p p 5 u c c a S S successors in interest, agrees to indemnify, defend and hold h a r m a s harmless the City of Edmonds, Washington, its officials, a m 0 a 2 employees, and agents from any and all claims for damages of p y W h a a v a whatever nature, arising directly Or Indirectly from the issuance I In - of this permit. Issuance of this permit shall not be deemed to p PLAN CHECK DEPOSIT m d modify, waive or reduce any requirement of any city ordinance y no I I m nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE provision." p r. v is '0 r I her I hereby acknowledge that I have read this application; that the by in format 1 0, information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL a h ad . t - 7 authorized agent of the owner. I agree to comply with city and THIS PERMIT -tat ws state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application is not a permit until ed I he eb y ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his I Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is tion Insurance. INSPECTION acknowledged in space provided. SIGNAT URE (OWNER OR AGENT) ED SIGN DEPARTMENT 2r��,6 JDATE G4TY OF OFF19I&I.-S SIGNATURE E ,<V EDMONDS 7AF/W ATTENTION PALL FOR 00 E L_�A BY/' INSPECTI( )N _7 ZIR91 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 77.1-3202 UNTIL A F:NAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. PINK — Owner GOLD — Assessor 102-87 7 1 77 — b"THEET FILE Z"j"' TR- a E E T F I I" F CITY OF EDMONDS 250 5th AVE. N. - EDMONDS, WASHINGTON 98020 - (206) 771-3202 COMMUNITY SERVICES June 26, 1987 Don Brown 537 5th Ave. S. Edmonds, WA 98020 Dear Resident: LARRY S. NAUGHTEN MAYOR PETER E. HAHN DIRECTOR The City of Edmonds is currently engaging in a program to improve its wastewater treatment system. One of the major parts of the program is reducing the volume of flow into our treatment plant. A major item contributing to this problem is the infiltration of stormwater runoff from roofs, drains, etc. into our sanitary sewers. A series of tests were completed by an independent engineering,.firm. They pumped smoke into sewer lines and recorded where it was escaping, thereby locating the stormwater infiltration sources. Your property has been identified as having a roof drain connected to the sewer and the City requires, per the Community Development Code, Chapter 18.10, Section 18.10.030, that this problem be corrected. Please contact myself or Everett Akau of our Water/SeW6r Section by July 24, 1987 to provide you with further information and to answer your questions. Member of the staff will be glad to advise you as to your best solution. Your assistance in disconnecting this source is requested no later than August 7, 1987. Sincerely, Archie Brena Water/Sewer Supervisor AB/1 k cc: Bobby Mills RUNOFFL/TXTWATER PUBLIC WORKS PLANNING PARKS AND RECREATION ENGINEERING CITY Copy DETERMINATION OF NONSIGNIFICANCE Description of proposal Addition to a single family residence 87F�� FILE# N/A Proponent Ethel & Ed Brown 537 5th Ave. S., Edmonds WA, 98026 Location of proposal, including street address, if any 537 5th Ave. S. Edmonds, WA 98026 Lead Agency Edmonds Planning Division The lead agency-fo-r this proposal has determined that it does not have a probable significant adverse impact on the environment. An environmental impact statement (EIS) is not required under RCW 43.21C.030(2)(c). This decision was made after review of a completed environmental checklist and other information on file with the lead agency. This information is available to the public on request. X There is no comment period for this DNS. This DNS is issued under 197-11-340(2); the lead agency will not act on this proposal for 15 days from the date below. Comments must be submitted by Responsible Official John Bissell Position/Title Code Enforcement Tech. Phone 771-3202 Address 250 5th Ave. N., Edmonds WA 98020 Date June 6, 1991 Signature X You may appeal this determination of nonsignificance to— Hearing Examiner at 250 5th Ave. North, Edmonds, WA 98020 no later than-5:00 p.m. June 16, 1991 by filing a written appeal citing reasons. You should be prepared to make specific factual objections. Contact John Bissell to read or ask about the procedures for SEPA appeals. There is no agency appeal. Complete this checklist for nonproject proposals; even though questions may be answered "does not apply". IN ADDITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D). For nonproject actions, the references in the checklist to the words "project," "applicant," and "property or site" should be read as "proposal," "proposer," and "affected geographic area." respectively. A. BACKGROUND 1. Name of proposed project, if applicable: a-'P11-,0WN JSDDITION 2. Name of applicant: r-1VIN 1�— J-0 1E'> P—ow �4 3. Address and phone number of applicant and contact person: 5*�' AqfF-. <, <>,4 J�-S - ? -2 -41 - go g (3 4. Date checklist prepared: - qlz S/9 / 7 - APR 10, 1 - 5. Agency requesting checklist: 6. Proposed timing or schedule (including phasing, if applicable): -FC) SC) 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. DO yl�Q-T lzy,)(Dw 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. �X NcT 10. List any government approvals or permits that will be needed for your proposal, if known. ZQ tLJO I YA 6.-?V-r-YA I-T 11. Give brief, complete description of your proposal, including the proposed uses and the size of the project and site. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You*do not need to repeat those answers on this page. (Lead agencies may modify this form to include additional specific information on project description.) r,3 f�Y uiLr-> 11-46 &-0T:)rnotA I Mr5w F-Oor- o o�= VxkS-T1r-A&, 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related to this checklist. rxlk-ko Q:D%j wina". TO BE COMPLETED BY APPLICANT B. ENVIRONMENTAL ELEMENTS EVALUATION FOR AGENCY USE ONLY 1. Earth a --General description of the site (circle one) rolling, hilly, (�D mountainous, other (9 e b. What is the steepest slope on the site (approximate percent slope)? c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland. -P0 kJ oT teK) C) V-f d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. " 0 e. Describe the purpose. type, and approximate quantities of any filling or grading proposed. Indicate source of fill. t-A 0 f t L- L � 6 F-1:,� r— J�-- f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. +4 0 g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? S C) �6 h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: Ahdl--�- 2. Air a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities if known. -T-) CJ 57- b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. IAJ 0 c. Proposed measures to reduce or control emissions orother impacts to air, if any: 3. Water a. Surface: 1) Is there any surface water body on or in the immediate vicinity of the site (including year-round and seasonal streams, saltwater, lakes, ponds. wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into. rJ.V—=. CIOP-11,3a-12- 2) Will the project require any work over, in or adjacent to (within 200 feet) the described waters? If yes, please describe and attach available plans. "If-F—S 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. N 0 �A t=_ 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. 1_� 0 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. NO 6) Does the proposal involve any discharges of waste materials to s6fface waters? If so, describe the type of waste and anticipated volume of discharge. VJ C) b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities if known. N 0 2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: Domestic sewage; industrial, containing the following chemicals... ; agricultural; etc.). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable), or the number of animals or humans the system(s) are expected to serve. H C)O F— c. Water Runoff (including storm water): 1) Describe the source of runoff (including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow? Will this water flow into other waters? If so, describe. P Ow V.1 C"'p 0 T—xi4 1-4 12-ja i w 2) Could waste materials enter ground or surface waters? If so, generally describe. d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: VU 0 K3 T—� 4. Plants a. Check or circle types of vegetation found on the site: deciduous tree: alder, maple, aspen, other evorgreen tree: fir, cedar, pine, other _t—snj:ubs &,�rass pasture crop or grain wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other water plants: water lily, eelgrass, milfoil, other other types of vegetation b. What kind and amount of vegetation will be removed or altered? t 6fj�,-SS c. List threatened or endangered species known to be on or near the site. .Po �JO-rte--VOOL)') d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: �j 0 yo —�-- 5. Animals a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: birds: hawk, heron, eagle, songbirds, other: ............................. mammals: deer, bear, elk, beaver, other: ................................. fish: bass, salmon, trout, herring, shellfish, other: .................... b. List any threatened or endangered species known to be on or near the site. T)Ms WO_r b_ppuy c. Is the site part of a migration route? If so, explain. -r;;. 0 T_=S vo o-T- O-P f LY d. Proposed measures to preserve or enhance wildlife, if any: AX) K) V_� 6. Energy and Natural Resources J a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet the completed project's energy needs? Describe whether it will be used for heating, manufacturing, etc. r-Lec4 Gcs, PTG-4 'Aousr- itst_- b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. K) 0 c. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: ri 0 K� ff- 7. Environmental Health a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe. fl) 0 1) Describe special emergency services that might be required. ,_4/1N1 2) Proposed measures to reduce or control environmental health hazards, if any: b. Noise 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, other)? No �-A E_E 2) What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (for example: traffic, construction, operation, other)? Indicate what hours noise would come from the site. C'O Y.) S71P 3) Proposed measures to reduce or control noise impacts, if any: 8. Land and Shoreline Use a. What is the current use of the site and adjacent properties? P_V_-51D v5yicc b. Has the site been used for agriculture? If so, describe. hi 0 c. Describe any structures on the site. t-A O�L S e f cv^� in, (i M d. Will any structures be demolished? If so, what? e. What is the current comprehensive plan designation of the site? 'r-IC N C_)_T_ r—A (3 %A1 h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. -Do roorc- ��Ow i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? oj OVQ VL k. Proposed measures to avoid or reduce displacement impacts, if any: -Ocvs ma—rApru� 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: ""(3-r -z::,-FPu-e 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. 067 -fN_1PFU( b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. Vtllff-s QOT c. Proposed measures to reduce or control housing impacts, if any: poc-:� tAO--L c)u� F1 I 10'.. Aesthetics a. What is the tallest height of any proposed structure(s), n , ot including antennas; what is the principal exterior building material(s) proposed? E�Lj__V- t2lolcl A.SA-1 -) W001D b. What views in the immediate vicinity would be altered or obstructed? 00rilff- c. Proposed measures to reduce or control aesthetic impacts, if any: �J 0 pi le—:1 11. Light and Glare a. What type of light or glare will the proposal produce? What time of day would it -mainly occur? -rJ OVyr—L b. Could light or glare from the finished project be a safety hazard or interfere with views? VU 0 c. What existing off -site sources -of light or glare may affect your proposal? ro C) K3 E:- d. Proposed measures to reduce or control light and glare impacts, if any: ir-i 0 IQ r_� 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? rU 0 N 1:_� b. Would the proposed project displace any existing recreational uses? If so, describe. V._J 0 c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: V%J 0 K3 e_ 13. Historic and Cultural Preservation a. Are there any places or objects listed on, or proposed for, national, state, or local preservation registers known to be on or next to the site? If so, generally describe. N 0 b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. N C) ro t:-- - c. Proposed measures to reduce or control impacts, if any: 14. Transportation a. Identify public streets and highways serving the site, and describe proposed access to the existing street system. Show on site plans, if any. S + V) Ao r-- b. Is site currently served by public transit? If not, what is the approximate distance to the nearest transit stop? c. How many parking.spaces would the completed project have? How many would the project eliminate? tie '—� "O-r d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). V'J G e. Will the project use (or occur in the immediate vicinity of) water, rail. or air transportation? If so, generally describe. VO 0 f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. QOE:C, fl-Y g. Proposed measures to reduce or control transportation impacts, if any: K-) 0 YO r-2' 15. Public Services a. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally describe. YQ 0 b. Proposed measures to reduce or control direct impacts on public services, if any. V%'� OT- 16. Utilities a. Circle utilities currently available at the site:((�lect:ricity, natural gas, i sy 'Cyc s em, ot .) t er. b. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity which might be needed. C. SIGNATURE The above answers areru; and , s that the 1/r" agency s �ej/ing Date Submitted: E-V 2 fo--,!� hevb!tst dofcTy.knowledge. I understand 0 m - i s e ision. .............. ��./ ............................. D. Supplemental Sheet for Nonproject Actions (Rezones, Code Changes, Annexations, etc.) -- Do not use this sheet for project actions. Because these questions are very general, it may be helpful to read them in conjunction with the list of the elements of the environment. When answering these questions, be aware of the extent the proposal, or the types of activities likely to result from the proposal, would affect the item at a greater intensity or at a faster rate than if the proposal were not implemented. Respond briefly and in geni!ral terms. 1. How would the proposal be likely to increase discharge to water; emissions to air; production, storage, or release of toxic or hazardous substances; or production of noise? Proposed measures to avoid or reduce such increases are: 2. How would the proposal be likely to affect plants, animals, fish, or marine life? Proposed measures to protect or conserve plants, animals, fish, or marine life are: 3. How would the proposal be likely to deplete energy or natural resources? Proposed measures to protect or conserve energy and natural resources are: 4. How would the proposal be likely to use or affect environmentally sensitive areas or areas designated (or eligible or under study) for governmental protection; such as parks, wilderness, wild and scenic rivers, threatened or endangered species habitat, historic or cultural sites, wetlands, floodplains, or prime farmlands? Proposed measures to protect such resources or to avoid or reduce impacts are: 5. How would the proposal be likely to affect land and shoreline use, including whether it would allow or encourage land or shoreline uses incompatible with exi'sting plans? Proposed measures to avoid or reduce shoreline and land use impacts are: 6. How would the proposal be likely to increase demands on transportation or public services and utilities? Proposed measures to reduce or respond to such demand(s) are: 7. Identify, if possible, whether the proposal may conflict with local*, state, or federal laws or requirements for the protection of the environment. ENVCHK3/PFORMS 1 )DATE RECEIVED P RMIT EXPIRES C.ITY OF #.DMOND,S, USE PERMIT ZONE NUMBER CONSTRUCTION PERMIT APPLICATION 'Do 8 APT# ADDRESS. ,PC( �CLJ C1 J* CC t) OWNER NAME/NAME OF BUSINESS ea I - L, a.- a P�AT `WAME1SVBDMSION N9. LOT NO. L4 LID NO. bLXW,�It, LID FEE S MAILING ADDRESS 4 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED. REQUIRED DEDICATION FT TESC PePmAP Rw * =1d street Use Pwmft Rwtd Inspection RdquWW S&dewatk Req&ed Undergmund Wftg mQtdred 13 CITY ZIP TE I LEPHONE 7:j Use, ."E 'METER SIZE LINE SIZE No. OF FIXTURES PRV REQUIRED YES 13 NO 13 z ADDRESS REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE PITY ZIP TELEPHONE NAME 4r 1-')ec.K Craf4t(6 ENGINEERING. REVIEW.ED/DATE ADDRESS* 0 FIRE REVIEWEDBY DATE uj x m CITY ZIP TELEPHONE VARIANCE OR CU SHORELINE OR AD3* INSPECTION RE(XD Q YES , ]ONO BOND POSTED STATE LICENSE NUMBER EXPIRATION DATE 1< 01 C,4ECKED BY -/0'2_ SEPA REVIEW COMPLETE EXEMPT EXP SIGN AREA ALLOWED PROPOSED "H91GHT: ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL NO.' 0 L-Pli.L�tb_qob 00,14 00 �NEIN RESIDENTIAL 0 PLUMBING MECH 0 COMM .. E RCI . AL OMPLIANCE OR ADDITION C 0 CHANGE OF USE Lot COVERAGE ALLOWED 06POSED 4 REQUIRED SETBACKS (Fr.) FRONT.. SIDE REAR 16, PROPOSED Si*CKS (Fr.) FRONT URf E I REAR A z PARKING REOD PRO )ED 1. E LOT AREA PLA I REVI ED ATE 1( q —c — '401 764 .)7 3 REMODEL 0 APARTMENT 0 SIGN z I GRADING FENCE REPAIR CYDS X FT) O'DEMOUSH 0 TANK [a �OTHEW [3 GARAGE o RETAINING WALL CARPORT ROCKERY RENEWAL .-(TYPE -OF USE. eusjNr;Sq�VR ACTIV.fm EXPLAIN: Z:IA REMARKS RSFLAXIEMF�Jr _T" CAECVED BY TYPE OF c!M1i6N ]CODE OCCUPANT GROUP -NUMBER" 0 "' -,' I F STORIES NUMBER OF. J.DWELUNG UNITS CRITICAL Lo* AREAS eT P7 S P E C SPECIAL INSPECTOR R E 0 REQUIRED YES JAREA OC cuPANT LOAD. DESCRIBE WORK TO BEPONE R E m A REMARKS. P R PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION RECVD 0 -o VA NAWATION $ Do Description FEE Description FEE Plan PIbiIfChbCk HEAT SOURCE GLAZIP40 % LOT APPE Building PLAN CHECK NO' VESTEDPATE �PlUrribing. o Mechanical THIS F DTED. THIS PERMIT COVERS WORK TO BE DOME ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWIALKSj DRIVEWIIYSj MARQUEES, ETC.) WILL REQUIRE Recording Fee t: .'SEPARATE PERMISSION. En r. Review 9 City.surcharge 'PERMIT APPLICATION: 11100AYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN. 180 DAYS Engr. Inspection State Surcharge SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT. ON BEHA LF OF HIS OR HER.SPOUSE, HEI R I S. ASSIGN . S A No SUCC . E . SORS Traffic Mitigation Pla nPhk Deposit IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF 1!�9 EDMONDS. WASHINGTON, ITS OFFICIALS..EMPLOYEES, AND AGENTS FROM ANY AND Fire 'Review Receipt# ALL CLAIMS FOR DAMAGES OFW"ATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY. FROAt THE ISSUANCE, OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE .9 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount Due 21 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVIS ION. - Landscape Insp. Receipt i� I HEREBY ACKNOWLEDGE THAT 1. HAVE READ INS APPLICATION; THAT THE INFORMATION GIVEN -IS CORRECr AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WffHCrTY AND'STATE LAWS REGULATING CONSTRUC- CALL This application Is not a pennituntill signed by the TION; AND IN DOING THE VORK AUTHORIZED THEREBY, NO PERSON,WILL BE EMPLOYED Building Officiall br hisffier Deputy: and Fees are paid, and IN VIOLATION 00 THE LA60R� CODE OF THE STATE OF WASHINGTON RELATING10 FOR INSPECTION receipt Is acknovAedged In spape pmwidad. WORKMENS COMPENSATION INSURANCE AND RCW.18.27. F iALs sfi3NATu JR DATE MONATUkE.(O DAT9 SIGIN71). 1A0 %425) A;) .. .. .1. VIM v mia 7711-0220 RECEASED BY I E ATTENT1014 EXT 11333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDINdOR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND.4PPROVAL OR.A C0 771-0221 RTIFI- ORIGI& - FIWI- YELLOW - Wdpwr& CATE OFOCCUPANIbY. HAS BEEN GRANTED. UBC SECTION 109 10/01 FAX PINK - OWNER - GOLD - ASSESSOR 0 -20 0001(0-5 006 6011 00 ty(-e VA atcf Z) -60 -"T- 7-0 &sc- 'POD ZONE SETBACKS: FRONT SIDE REAR OTHER HEIGHT a "TREET FILE �R RECEIVED JUN -7 '200? BUILDING DEPT. SO V1, z & ;a 04co -X-/f ST t E T I L E F?ECEIVED JUN - 7 2002 BUILDING DEPT.