7019 LAKE BALLINGER WAY.PDF11111111111111
11813
7019 LAKE
BALLINGER WAY
CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 11DcA L_a)�e_ _?,pa%f) P.r \J�c.�\� F_dmi)nd_�' 9WJ&
2. Property Tax Account Number; DO LMe 009 9 001 0
3. Approximate Site Size (acres or square feet): 'D-0i5ig &T
4. Is this site currently developed? yes; _ no.
If yes; how is site developed?,
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site. 14o-a
&_3 �a Ke
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet). S+re-e+- -b �b tA 6e-
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 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: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway - floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow -shrubs mixed
urban landscaped (lawnshrubs etc) X
11. Obvious wetland is present on site: K) C)
For City Staff Use Only
1. Plan Check Number; if applicable?
2. Site is Zoned? T2_15 1- 12-
3. SCS mapped soil. type(s)? b�ngz" Prx=n n j Pe,� - - �� o v I L:T a n �-4�-
C 0 '�BLOP< a—
P� rA LA r'l r-) c_ot 'h c;
000
4. Critical Areas inventory or CA. map indicates Critical Area on site?
I -A P,� 01i LbCnC'q C-Y-- I -Ay —cc )a)A u i
5:
Site. wid-dn -designated earth subsidence landslide.hazard area RO
DETERMINATION
STUDY REQUMM WAIVER
Reviewe& br.: 0 ' o Date.- 0
Critical Areas Checklist.doc/3.19.2001
4215-481-5914 REITERS MPRINE
106 P02 JU-1 19 1151 11:51
I
-�"Aak. City of Edmonds Date Remlved:3�10[0 I
I>cvcloprzx=t Services Departnient City Remipt 0: 1 -1 Ci (P 0
Planning Division CrItical Areas File *-
Phone. 425.771.0220 Critical Areas Checklist Pee: $45.00
-'aZ 11-90 Fax: 42S.77I.=1 Date Mailed to Acolicant:
CRITWAL ARFAS CHECKLIST
The Critical Areas Checidist contained on this fox-m is to
be fillcd out by any Person preparing a Development
Fermit Application for the City of Edmonds prior to
hjsftm submittal of the application to the City.
The purpose of the Checklist is go enable City staff to
determine whether any potential Critical Axcas are, or
may be, present on the 6tft0c, property. The informsition
needed to complete the Checklist sbAmld be easily
available fi oz. obscrvatiom of tbc site or data available at
City Hall (Critical areas tuventorics, maps. ow soil
survey&).
A property owner, or hi&%er authorized x=p=sentM-c,
must fill out the checklist, sign and date it. and submit it
to the City. The City wiU review the checklist, make a
pr=ursory site visit. and ma a determination of the
subsequent steps necessary to coariplete a dewlopu cot
permit application.
Please subnut a vicinity map, along with the signed copy
of this form to assist City staff in Ending smd loaati:ng the
spccific piece of property describcd on this form In
addition, the applicaxit sball includc other pertinent
infarrnation (c-g- site plan. tovxWMphy map. aw.) or
studies in conjunction with t1ft Cbecidist to assistant utaff
in cornpleang their prelimmary axacesmictit of the site.
T-Ac urldersigned applicant, and his/herlits beiM and &&signs, in consideration an the processing of the application agrees
to release, jnd=rinjf�r, defend and hold the City of Edmonds harmless 1�om any and all damages. including re4wonable
snorecy,s fees, anising from any action or mfraction based in whole or part upon fid-sr, misIcading. inaccurate or
incomplete information furnished by the applicam hWhcrAts agerits or craployccs.
By my signature, I certify that the information and exiMbits here -with submitted are true and correct to the best of xny
knowledge and that I ain buthori7ed to fxlc this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANTIAGENT 164.01'-126 - - DATE
Property (>wucrlx Aurborizadon
By my signature, I certif�F that I have authori=d the *bo-ve Applicant/Agent to iikpply for the sutuect land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property ity, th,
purposes of in:spection and posti!�41attpa4znt to -pus application.
SIGNATURE OF 0 DA-M 0-1 ( &!3 12-c9t:, I
Owner/AfRucaut:
Hoa/rh i I ri 4 L-i rn'%+ed -FAr*-1r%ex-S P
Name
Street Address
city state Zip
Telephone: 4 WL'S 1 -1 -1 2-0 1h,
Email address (optional):
A pUcant Representative:
MArs:�5 Macirle—ND Qliisnn ze0rer
Name
2. D, C:)Y- all-2,
Street Address
n+ NNI p, gizog I
City State zip
Telephone:
Email Address (optional): R 64-e-rs gar i ne
0itical Am" Ch0CWistSQGn-19-=I I
-7J.q)0(
City of Edmonds
Critical Areas Determination
Applicant: Allison Reiter of Reiter's
Marine for Hoa / Thi Trieu
Family Limited Partnership
(Owner)
Determination #: CA-01-100
Project Name: I Permit Number: I
Site Location: 1 7109 Lake Ballinger Way Property Tax Acct #: 1 4888 008 0077 007]
Project Description:
Non -Project Specific
Determination: Study Required:
During review and inspection of the subject site, it was found that the site appears to contain a
critical area, including a Wetland pursuant to Chapter 20.15B of the Edmonds Community
Development Code (ECDC).
Based on these findings, prior to submission of any development permit, you will be required
satisfy the requirements of ECDC 20.15B by completing the following:
Wetland
It is not readily apparent from viewing the site that the site may contain a wetland. However,
based on the information that is currently available, portions of the shoreline along Lake
Ballinger contain wetlands. This is a concern for the shoreline portion of the subject site.
Wetland soils may underly the grass that extends almost to the water's edge. Past experience
with similar sites in the area support this.
Based on the above findings, a Critical Areas Study is required to determine the hydrology of the
area and to delineate the approximate boundaries of any wetland and identify its buffers. The
required qualified critical areas consultant needed to perform the study shall be a specialist in
botany, fisheries, wetland biology, and/or hydrology with a minimum of two years' field
experience with wetlands and/or streams in the Pacific Northwest. This part of the required
Critical Areas Study shall be performed as a three party agreement with the city selecting the
consultant and the property owner or applicant paying the fees.
The qualified critical areas consultant shall perform the following:
Classification of the wetland pursuant to the criteria established in ECDC Section
20.15B.060(A)(4) and (5).
2. Delineate the edge of the wetland on the site.
3. State any mitigating measures appropriate to preserving and protecting the wetland.
After the qualified critical areas consultant has delineated the stream and/or wetland boundary, a
surveyor licensed by the State of Washington must perform the following:
1. Physically mark the edge of the wetland.
2. Delineate the required buffer (see ECDC 20.1513.120. (A) and 20.15B.130.(C)).
3. Delineate the required building setback from the buffer (required setback is 15 feet).
4. Create a map showing the wetland, the buffer and the building setback.
The Land Surveyor is not required to enter into a three party contract
If the results of the Critical Areas Study determine that the lot may not be developed, the
applicant may apply for a Reasonable Use Exception and Variance pursuant to ECDC
20.15B.170(A) and 20.15B.040(C)).
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on the site, they may submit their proposal to
the Planning Department for review. If the Planning Department finds that the proposed
development permit will not adversely impact a Critical Area or its buffers, a conditional
waiver may be issued on a project by project basis.
Name
Date
13 Cited sections of the Edmonds Community Development Code (ECDC) can be found on the City of Edmonds
website at www.ci.edmonds.wa.us.
2
CA FILE.N0
Critical Areas Checklist
C1 q --b
---------- 7 ---------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: 64�j-:
V
2. Property Tax Account Number: 6W?)
co e,,, C'?
Approximate Site Size (acres or square feet):
4. Is this site currently developed? X yes; no.
If yes; how is site developed?
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
horizontal distance of less than 33-feet).
Other (please describe): �L �-
6. Site contains areas of year-round standing water: Q Approx. Depth:
7. Site contains areas of seasonal standing water
What season(s) of the year?/
N /A
0 _;Approx. Depth: _
8. Site is in the floodway '�E -5 floodplain— of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? N�11 A Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) (IA,,) -Y\ _ u-,Y4 t1v,&1
11. Obvious wetland is present on site: �k�
--------- --------------------------------------- -- — For-City:Staff Use Only --------- — ------------------------------------ -------
1,*..� .8jte.is.zoned�.
-Npe(s)'? 227:171,f
p d.
espily /V/J,(
W jI d i ...... .... ..
e an riventory or C.A. map indicates wedand present on site?
4. Critical Areas inventory or C.A.�map..indicates Critical Area on site?
.5. e: withinAesignated: earth. subsidence landslide, hazardarea
6 S' d sisnate
.:. 4 on the: En-Aroarnentally.Sensitive Areas;May.
qe: ...e..
DETERMINA.TION
STUDYB
*1 keview'ed
CO I ND . ITIONAL WAIVER
15,
/Date
^cs_chk*.doc; Rgv 10/03/97
City of Edmonds
RECEIVED
JAN 0 5 1998
PERMIT COUNTER
Critical Areas Checklist
"0C. is9v
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
I
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 determination of the subsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
orplotplan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
[z- � c ��, E� , [,,o e,
Name
-� 0 1 -1 �-AVe- �>4k"w
Street Address
E kvv-,L I vl-k
City, State, ZIP Phone
x-5
Sigfi�4r'e Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
City of Edmonds
Critical Areas Determination
Applicant: I Kirk Loe Determination #: I CA-98-02
Project Name: I Pernut Number: I
Site Location: 7019 Lake Ballinger Way Property Tax Acct #: 4888-008-010-0000
Project Description
Non Project Specific
Determination: Study Required:
The Critical Area review and site inspection has found that this property is located in an
Environmentally Sensitive Area and Wetland/Wildlife Habitat area.
Based on the above findings, a Critical Areas Study is required for further development of
the site to delineate the boundaries of the critical area, the buffers and setbacks. A licensed
surveyor and/or wetland biologist must delineate the critical area and determine the
wetland classification per ECDC Section 20.15B. 130.
If the property owner wishes to apply for a specific development permit which they
feel would not impact the Critical Area location on the site, they may submit- their
proposal to the Planning Department for review. If staff finds that the proposed
development permit will not adversely impact a Critical Area or its buffers, a
conditional waiver may be issued on a project by project basis.
Karissa Kawamoto
Name
1/15/98
Date
go _I qc�
October 12, 1995
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning a Parks and Recreation 9 Engineering
Mailed 10/12/95
J.R. Youngstrom
7019 Lake Ballinger Way
Edmonds, Wa. 98026
Re: Fence in City right-of-way
Dear Mr Youngstrom,
LAURA M. HALL
MAYOR
During a site visit to your westerly neighbor over concerns about his fence creating a sight distance
hazard and being in violation of the plat requirements, we noticed that your fence is constructed in the
City right-of-way and also was placed outside the parameters of the plat. Such structures are not
allowed in the right-of-way and with your neighbor relocating his fence, your fence will create a site
distance hazard. Therefore, your fence must be relocated to the property line.
Please take the appropriate action and relocate your fence to your property line by October 23, 1995. If
the fence is not relocated by that date, we will have the City crews remove it and the City will bill you
for the work.
In addition, the post office is anticipating relocating some mailboxes between 7001 and 7701 Lake
Ballinger Way, farther behind the sidewalk than currently located, for safety purposes and because
access to the right-of-way must be maintained.
If you have any questions, please contact me at 771-0220, extension 324.
Sincerely,
Addison L. Chrisman IV
Engineering Inspector Walker
ALC/sf
4e &
V, -volO�� 1), 7/0/
YUNGSTRM.DOC
e Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Ist �18 9� 0 Public Works Planning e Parks and Recreation e Engineering
January 22, 1996 Mailed 1/23/96
Mr. James Youngstrom
7019 Lake Ballinger Way
Edmonds, WA 98026
Subject: Fence in public right-of-way
Mr. Youngstrom:
BARBARA FAHEY
MAYOR
As you know, a portion of your fence is located within the public right-of-way.
You came into the Community Services Department some time ago and received
the necessary application forms for a street use permit. We have not yet
received the completed application.
A copy of -this letter is being sent to the Public Works Superintendent, Noel
Miller. The Public Works Division is legally authorized to remove obstructions
and require the land owner to pay the appropriate costs.
Your cooperation in bringing this fence into compliance as soon as possible
isappreciated. If there are any questions do not hesitate to contact meat 771-
0220.
Sincerely,
r4vo /
Gordon C. Hyde
Engineering Coordinator
GCH/sf
c: Noel Miller, Public Works Superintendent
4elv
W.Aaer
YOUNG196.130C
Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
890 . 199 -
STREET FILE
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning a Parks and Recreation e Engineering
January 1992
Mr. James Youngstrom
7019 Lake Ballinger Way
Edmonds, WA 98026
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
I have reviewed your account and will allow a credit to your account
according to our City policy: the average consumption for the same
period during the previous year charged at normal customer rates, plus
the excess usage charged at the City's cost, plus a surcharge of 15%
applied to the excess only. Only one leak credit will be granted in
any three year period.
Should you have any additional questions after you receive your new
billing, please contact Ilene Larson, Utility Billing Clerk.
Sincerely,
6z
"t�s
Ron
Holland
Water/Sewer Supervisor
RH/l k
cc: Ilene Larson
Utility Billing Clerk
#512425/TXTWATER
Incorporated August 11, 1890
PUSL J2
'C WUHKS DEPT.
MATERIAL
PRICE
AMOUNT
-y 2,y
j
e
�-j
Ji
6
7-
175
L(
2
I �V BE C�'�NTINUF:) ON OTHER SlrlE.)
DEAN MEYERS
PLUMBING & HEATING
Comm �ervlce & Repair
7105 196th Southwest
LYNNWO.OD, WASHINGTON 98036
(?0f3) 778-4131
TO :57
Zz2 �2
nowgum ma 2042
JOB PHONr I DATE OF CRIDER
" NAr i LOCATION
71,�7.2
UN LW VVf-)RK
C
-AMIW q,
/2 4
r
x
1"14
OIC f C 7X,'c- -1V
10001Z
d
LABOR
HOURS RATE AMC)UN7
TOTAL MATERIAL
3 5;--
TOTALLABOR
�,.TP nOmP;.ETFO
TAX
v 3'
RE (I
ci�ank CYOU-!
PAY THIS 41..MOUNT
Kt I UKN I H15
PORTION *SPRING CLEANING? THE NEXT HOUSEHOLD HAZARDOUS
WITH YOUR ROUNDUP DAYS WILL SC MAY 7t8,9 AT THE OLD EDMONDS
A HIUH sctibCL. ON 212TH. FOR INFO CALL 771-0220 X319.
PAYMENT Message *LANDSCAPING? DON-OT FORGET THAT MANY PLANTS HAVE
rEAR ALONG THIS PERFORATION -0-; MINIMAL WATER NEEDS ANT) THAT WATER CONSERVATION IS,
w For f.mpok,-T,AN-r, FOR INFO CALL. 771-0220 X318.
PRE�,1E,N*r.mN EXPOSITION OFSN 1-IOUSE APRIL 11, AT
You SEATTLE 91-�:ATINO BINGO CLUB Al' 22.111 1-499 PROM 10-4.
ALE,,
K'�O SHOW Al 22# DEMOS INCLUDE BASIC SECURITYt WINDOW
SECURITY'o OCKS� A(-4RMS AND OTHER, DEvIccs, PLEASE
FOR IWO CALL E,P 7'
u 7
17'. — 7 T,7=—�
11
c ne
ACCOUN I
City of Edmonds
449 729 280
1 249418
Edmonds Combined Utility 2/27/911 2/26/92
6 121-423� 2 14, 233
WATER- WASTEWATER':
SGRVICE 36.20
TOPM WA rER DAA INA G E 17 LAKE bALLINGER, WY
ViCE PAST DUt
RESS
AMR
LAKE BALI-INGER FI-A,A]RIDATED A 4' Mum
"'od
Al",
')UNT NUMeER:
512425
DUE AFTER: YOUNGSTROM JIM
3/27/92 '7019 LAKE BALLINGER WY
jNT OUE:
'299 � 71
EDMONDS WA 98026,-9544
COMBINED UTILITY: WATER WASTEWATER -- STORMWATER I/ DRAINAGE
-7019
YO
STREET FILE
78U58 4
FILE #
FOI;4%1 FOR [PKWWM//FI1,M,] DI:CUJZATION OF [9MMIMMNONSIGNIFICANICE]
DescTiption. of proposal Addition to existing single-fami.ly dwelling
Proponc-;nt Kevin T. Duncan
Location of Proposal 7019 Lake Ballinger Way
Lead Agcncy.
City of Edmonds
1his proposal has bccn determined to [)hmWnot ha�,e] a significant ad-
verse :�i!)=-t upon -'Ljie envirorj,,-,cnt. An EIS kwis not] required mder
W.T1 43.21C.030(2)(�). Ibis dcci-sion i�:as mado after revieiq by tho lead
a,0?C1K-), of a coil.ipleted en,,,imu-ticn.tal checklist and other inforniation. on
file ivith the 1�rid agency.
Responsible Official Nancy Edgmon Luster
Position/Title Associate City Plann'er
Zb /
Date October 9, 1978 C-cz�g�
t
ENVI . RONM'ENTAL . R . EVIEW #0584 DATE: 10 -1
FILE #
APPLICANT: fee \11,Aj Ou "co:-ro ADDRESS-?Q 9 1-ake /%�a ev CU a
A. GEOLOGY:* I
1. Underlying problems, faults? 0 C4,LL
2. Unique features, rock out croppin gs, promatories?-. M C-i/L C
B. HYDROLOGY:
1. Underground springs?. A) C/O (2
2. Aquifier recharge area?
3. Problems/Seasonal High water table? Joc-.)rtP_d a-"
4. Significant drainage problems? o Ahl,
C. ORIENTATION:
1. Does the site take best advantage of sun & shade?-
D. SOILS:
1. Any drainfield problems? -1(JC,7qe-
2. Any ponding problems? A)Cn P-
3. Erosion problems? /00 /ue
4. Slippage problems?— A)C,"e
5. Large cuts & fills?- IUClyle,
E. TOPOGRAPHY:
1. Scope? a-k buill
1�7 -1-0 0 t�
2. $roblems with access? /V �/n (?-
. 0
ENVIRONMENTAL REVIEW
PAGE 2
FILE #
F. VEGETATION:
1. Quality of vegetation.
2. Expected life of vegetation? IOCI-7e -�n furbed
0. [11IJ a 1�111 I
4. Increase in runoft coettici
G. WILDLIFE:
1. Is the site enumerated with wildlife? 00
2. Will removal of' vegetation disturb nesting or feedi.ng grounds? /UC)
3. Any unique species for this area? /1)(0
ADDITIONAL COMMENTS:
2
3
.4
5
6
9
10
11
1.2
13
14
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
.41
42
43
44
45
46
47
48
49
50
51
52
53
5/4
55
56
.57
58
59
60
780584
DATE: OcA a kcL-?Y
A $25 fee will be collected by the,City of Edmonds for analysis
of the Environmental Checklist.and the preparation of a Threshold
Determination. No fee will be charged for proposals which would
be categorically exempt if they were not located in an environ-
mentally sensitive area.
ENVIROMMEN'TAL CHECKLIST FOIRU11
1. BACKGROU14D
1. Name of Propollelt Y" C !--N
2. Address and Pho:)e Nunnt)er oi Proponent:
'70 ( Ct L \C- rk e VVIeIA in, 3 Ll�
3. Date CIC�TI_iSC SulunniLLed C)c_-,7- -3 (vt'7�r
4. Agency Ke -quiring CheckliSL
5. Haine of Proposal, if applicable:
6. F4a5G_Teali*(T Briet
ii-Ig but 110t liflliLCd to it.- SiZC, ),,ene,-,)l desi�,,n ele-
menus. and other factors �:hat: will give an accurate
understanding of its scope and nature):
L i D VZ
\VP - 6 , C2 F_ A-S'T 51
7. Fo—c�t-t*I—OIT—C)-I—Prol)or..i1 (6asFi—il3c the ph-ysj_._c__,TT —SeLL111j, Of
tile proposal, as well as the exceilL of tile land area
af[ccted by any envirohit-.ellLal im.pacts, including ally
OthC17 information 6.eeded to give an accuri,--' UlIderstand,
ing of che environmental setting of tile proposal):
8. F-s-Eivi.,iLed-Dace Tor Coll-,j)ICHOI-I 0 Proposed Act n
(�_, C�7 !, C�- lei �? V
9. I,i.st: 01. ail 1101-l'.1ics, Licullses or Goverli'llonL Approvals
Required for the Proposal (federal, State' alid local --
including rozones) :
-31-
1
2
3
.4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
10. Do you have any plans for future additions, expansion,
or further activity related to or connected with this
proposal? If yes, explain:,
r) C)
11. Do You kno,.,i ot which may affect
the pvoperty covered by your proposal? If yes, explain:
12. Attach any ocher ionlication �orm thal: has been coin-
pleted replarding the proposal; if none has. been com-
pleted, but is expected to be filed at sot-.,.e future
date, describe the nature of such application form:
II. ENVIRON'v'T.NTAL IMPACTS
(Explanat: ions of all "yes" and "maybe" answers are
required)
Yes Maybe
No
(1) Larth. Will the proposal result in:
(a) Unstable earth conditions or in
changes in. geologic substructures?
(b) Disruptions, displacements, Com-
.paction or overcovering of the soil?
(c) Change in topography or -ground
surface relief features?
(d) The destruction, covering, or
modification of'.any unique geologic
or physical features?
(e ) Any increase in wind or water
erosion of soils, either oil or off
the site?
(f) Changes in deposition or ero-7
sion of bea,ch sands , or changes
in siltation,' deposition or erosion
which may modify rhe channel of a
river or strezim or the bed'of the
.()Ce;ili or ally bay, inlet or lake?
ExpLination:
(2) Air. Will the proposal result in:
(a) Air emissions or decerioracion
of a6ibient air quality?
(h) The creation of objectionable
odors?
(c) Alteration of air movement,
moisture or temperature ' or ally
chanp,v in c' tmate, either locallly
or regionally?
Explanation:
-32-
2
-3;
4
5
61
7
8
q
101
11 1
12 i
131
14
15
16
17
18
11
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
111
42
43
44
45
146
47
48
49
50
51
52
53
54
55
56
57
58
Yes
Ol
eybe No
(3) Water. the 1')rol)osal result: in:
(a) Chn'nges in currents or the.
course or direction of %qater move-
ments, in either marine or fresh
waters?
(b) Changes in absorption rates,
drainage patterns, or.the rate and
amOu"t of surface water runoff?
(c) Alterations to the course or
flow of flood waters?
(d) Change in Hic amount of sur-
face %,later i
In ally ;.later body?
(e) Discharge into surface waters,
or in any'alLeration -of surface
water quality, including but not
limited to temperature, dissolved
oxygen or turbidity?
(f) Alteratioll of the direction
or rate- of flow of ground waters?
(9) Change in the quantity of
ground %.later!;, either through
direct additions or withdrawals,
or throU)',h interception of an
aquifer by cuts or excavations?
(h) Det-*erioration in ground water
quality, either through direet. in-
jection, or throu�,,h the scepq,e of
leachate, Phosphates, detergents,
waterboi-ne virus or bacteria, or
Other SUbSLallees ill.Lo the ground
waters?
(i) Reduction in the amount of
water oLherwi . -se available for
public viater Supplies?.
Explanation: C4 c—, C) -tL'j 0
kn CD
./4
(4) Flora. Will the proposal result in:
(a) Chang
e in the diversity of
species , or nwnbers of nny specie,.;
of flora (including trees, shrubs,
grass, crops, Illicroflora and
aquatic plants)?
(b) Reduction of the numbers of
any Ullj.(JLI(!, rare or endangered
SPecies of flora?
-33- 1
— L,--'
I
Yes Maybe No
(c) Introduction of new,species
of Elora into an area, or in a
31
barrier to the normal replenish�
4
ment Of existing species?
5
6
7
Reduction in acreage of any
Agricultural crop?
9
Explanation:
10
11
12
(5>
Fauna. Will the proposal result in:
13
(a) Changes in the diversity of
15
species, or numbers of any species'
1.6
of Fauna (birds, land animals
17
including reptiles, fish and shell-
18
19
fish, ben'thic organisms, insects -or
microfauna)?
20
21
(b) Reduction of Cho nupbers of
22
any unique, rare or endangered
23
S-Pecies of fauna?
24
25
(c) Introduction of new species
26
27
of fauna into.an area, or result
in a barxier to Cho migration.or
28
movement of fauna?
29
30
(d) DAerioration to existing
31
fish or wildlife habitat?
32
33
Explanation:
34
35
36
(6)
r0ise. Will the proposal increase
37
KNOTing noise levels?
38
39
Explanation:
110
41.
42
(7)-
Licht and Glare. Will the pro-
43
po PI-0 uce new light or
44
glare?
45
46
Explanation:
47
48
49
(8)
LanU Use, WL11 the proposal
50
reAult—Un the alteration of the
51
present or planned land use of an
52
area?
53
54
Exp lana C. [on:
55
34-
YCOMaybe No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35'
36
37
.38
39
40
41
42
43
44
45
146
47
48
49
50
51
52
53
54
55
56
57
58
.(9) Natural Resources. Will the pro
�`osa-1 —re�iaL n. . I
(a) Increase in the,rate of use
of any natural resources?
(b) Depletion of any nonrenewable
natural resource?
Explanation:
(10) Risk of Upset. Does tho proposal
involve risk of an explosion or
the release of hazardous subSLances
(includinp-, but not limited to,
oil.; pesticides, chemicals or
rildiation) in the event of an acci-.
dent or upset conditions?
Explanation:.
Pypill. a L i oil Wlill the proposal
alLOi tFIE location, distribution,
density, or growth rate of the
hunian populaL.4.on of an area?
Explanation:
(12) flousin - will. thc proposal affect
exi.stilij,
housing availability, or
create a demand for additional
housing?
Explanation:
(13) Ti7;ia.�,L)ort,'LiO-,)/Circulition. Will
UW p r o p o s a
L esu
Generation of additional
vehicular movement?
(b) Effects on existing parking
faciijuies, or demand for new
parking?
(c) impdct upon existing trans-
portation systems?
(d) Altel-aLiOIIS VO PI.-e-SCIIE
patterj)s of circulation or inove-
ItIC11L of 1)00plC and/or goods?
(e) AlLeraLions to waterborne,
rail or air traffic?
-35--
- - . _1z
. �
|
l
2
3|
4/
5
6
7
8
9
10
ll
12
13
14
is
16
17
18
19
20
21
22
23
211
25
26
27
28
29
]O
31
]2
22
.34
25
36
37�
!
38
/
29
40
41
42|
It3'
44
4}
A
47
48
49
50
51
}2
5]
)4
55
56�
57�
58�
59
60
61
..
Yes M�v)u- '�o
([> Increase in tr^[fic 'azur6o
r.o motor vehicles, bicyclists or '
pedestrians?
` uxylanntinn'
`
(14) Pvh\ic 5ccvicco� Will the pco-
- `�/v C-all -0 ffccc uyoo. or
re;Lilc in x ucmd for new Qovcrn-
mrotxi services in any of the
follovin& urouo:
(a) Fire protection?
(b) PoLicL, protection?
(c) Schools?
(J) Parks or other rcuceucion1:11
facilities?
(e) Maintenance of'public fucili-
tics, including roads? �
'Z
M Other governmental services?
Explanation:
(15) �n!�L. Will the proposal result in:
(,) Use of xubscaucial amounts of
[
tic l or energy?
(\`) Demand upon pxiscing sources
of cnocKy, or ccquicc d`e du,clop-
menc of new sources of energy?
�~~~
Explana-tion:
` ----'--------
(16) ULiliciCs. ;ill t-he proposal
r J's--i 't-r[-T-1-1 . ;I nocJ, for �.rxtemx,
or nlc,cxciono co the foLluniu8
oci1iciox:
(a) rower or natural 8uoY
(h) Comovnicxtionu systems?
L~^~-
(c) Vace,?
(J) Sewer or septic tanks?
(c) Sc000 vacuc drainage?
([) Solid waste and diupouaL?/ �
[xplan^tion-
I
21'
3
.4
51
7
811
11 10
111
12:
131
14
15
16
17
18
191
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
361
37
38
39
40
41
42
43
4 1;
45
46
47
48
149
50
51 s
52 a
53
51,
55
56
57
58
59 t
171 116111';Ill
L Fie Will Lite, J)L'oposal
cl:eation of Illy
Ur potellti,11 llealt1l
haza.rd (excluding Illental health)?
Explanz, t joll:
(18) Aes v ll 0 t, i C s will -the propo,al
iF —Cs L I tile obstrucLi
scellic ViSta 0 - 1: V, - .011 of any
J)Ublic, ()I- %�ijl t 'Cw open to tile
SUIt ill HIC C":ea Ile Pr011Osai re-
.tion of ,Ill
aQSL:heCiC;iIIy OffellsivL- Site Opel.,
to Public viel"?
Explanation:
Yes Ma vb C. J�o
0
— — -----------
(19) Recreati I Lhe . proposa I
jillp'let LlJ)OlJ Llle
qualicy ol: quantity Of
existing
I-ecrCiltioll"ll opflOrtUllj,tioS'�
(20) Ai.chvoIopic:,.11/
ri S C o r j. tile
aF1 0 F' of
Sig"ificant archeologic,,l or )is_
torical. sjv(�, structure, object
or building?
Explanation:
III - SIGNIATURE
I I. tile under!;igned, StzlVe tlllt I
tile ;11)0','(' informati( to the best of lily knovledge
-),, i, LrLW and Con'll.)"CLe. It is ullderstood
that th'e lead aAcllc�l maY WiLlidra,,, "11Y'd0clarati(
ficalice Chat it 111ii'i _)n of nol-l-signi-
..' it rCliailce upon tlli,,; cll,cj�]i
s"Ould there bC1 any misrepresentation or lack of ft e t
On nly parc disclosure
Proponent:. "7
1'!AC 197-1-0-370 WITHDRAWAL OP AFFIRIMATIVE TIMESHOLD
ilL �my tjln(� nfLc!r tile 011Lry ()f
tion of sirnific;Jnc,-? tile proponent i-,1oc!ifi.e.q -1 declara-
o ")"t, ill.IAIC jLld�-,JIJC�Jlt of t:11 -i d it;, "le Prol)osal
cl\'Orse erivirollil) e I e, cncy, f i c a n t
ntal i resuLill,,
-lj;pact:, - '.
ted, the decl.zll.-;lt:i.ol1 of -,ign i fi, C', lice -�Ilall. he wit
'Id a declara.cioll (-)f hdrav:ii
ea C1 -1Ca:1CL1 ClIlLered instead. The
" gency Slial I also revise Ul'? rer�isters aL fts SEPA
ublic inforriat-i-on ct"ItOr ziccordingly.
0 11 (..rl t Of it propos al j. ; a p r 1 %,,i mp the pro -
the pl-()pC)Szll
hall not h(t collsiderod modiiiod Ll;l,cil all Iicell.,�C i1pplica-
iolls for L11C PrOPosal arO YCX1iscd to refl.ect tile n,
odi f ication
-37-
V # , r'
ALI
U.1 DING DEPARTMTNT
Applicant Fill
PERMIT
ZONE NUMDFR
STHEET
FILE—
Pj MIT APPLICATION
inside Heavy Lin es
dq
JOB
ADDRESS
7 0
1E (OR NAME OF BUSINESS)
1
NUIT x(rie,
LEGAL LOT
PLAY NAME
DIVISION NV
W
MAILING ADDRESS
I
z
-8u-
x .
AO V,6")h 1
") I C1 L k
CITY
1.
ONE NUM13ER
PUBLIC RIGHT OF WAV PCR ORDINANCE NO.
ITELEP
'_7_7R _R
EXISTING RIGHT OF WAV
NAME
PROPOSED RIGHT OF WAV �O �40
U
DEFICIENCY OF RIGHT OF WAV
ADDRESS
STREET/UTILITV WORK REQUIRED VES ONO
9
U
PERMIT FOR WORK IN PU13LIC R/W YES [ONO
0
0:
4
CITY
NE NUMBER
UNDERGROUND WIRING REQUIRED YES ONO
U
CONNECTION TO SANITARY SEWER INVES El NO
M
NAM
SEPTIC TANK PERMIT REQUIRED OVES NNO
IL
D -
Z
SEPTIC TANK PERMIT NO.
0
ADDRESS
,u
2- Ck 0
SEE MEMO DATED
z
Q 1!-
CITY
Edmorldn
TELEPHONE NUMBER
-7
REMARKS
0
T5 -1 QLJ
U
5TATE LICENSL NUMBER
CITY LICENSE NUMBE
CHECKED BY
(-NO -)�SRc`t 9461,j-k I
Legal Description Of Pro0erty (Show Below Or Attach Four Copies)
METER SIZE
LY SIZE
Lot (NOCK 1-66
7
W
z
REMARKS
0
Dili
I-
IL
SIGN AREA
ENV. REVIEW
ADO NO.
a:
U
ALLOWED
PROPOSED
COMPLET
EXEMPT
(A
W
�f_
SHORELINE
0(1
REMARKS
W
�DI 7 S-7 rp on�ds
-de-
rnu
VARIANCE OR CU
411-
V 71
IPLANNING REVIEW By
DATE
1
n
T1 FRONT. /0 SIDE
ILOT COVERAGE
1:1 NEW
RESIDENTIAL
GAS
11 NE
REAR
El NON-RESIDENTIAL
TYPE OF CONSTRUCTION
CODE HEIGHT
121 ADD
SIGN
V
n7ro
_3
P'M AX
ElDEMOLISH RETAINING
WALL
1-1 ALTER EXCAVATE
,
SPECIAL INSPECTOR
REQUIRED
REA
A
OCCUPANCY OCCUPANT
GROUP LOAQ
I
FENCE
F� OR FILL I— X—FT)
0 YES
-AIS ?_
q
k
1z — :S
1:1 REPAIR PRE -MOVE swim
1:1
PLAN CHECKEfD 13Y THIS r Fus—LocATED IN THE CITY
OF EDMONDS. LOCAL SALES
INSP. DPOOL
TAX
SHOULD BE CODED 31.04.
Z
NUMBER OF STORIES
INUM BER OF
REMARKS
0
I-
I
DWELLING
I UNITS
I-
t
NATURE
OF WORK TO BE
ONE
U
V) --Gad
i h 60 4D CK I n k n nie_
W
D—
M
0
IL
W
P
OPCSED USE
PLAN CHECK FEE
VALUATION
FEE
-FL—OT
1 _440
IWI 2-
I'LAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
0
PLUMBING
J
W
>
0
MLECHANICAL
FENCE
>
0)
Applicant, on behalf of his or her spouse, heirs, assigns and
SIGN
z
3
I
W
-1
Successors in interest, agrees to indemnify, defend and hold harmless
E
the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
7E
Ir
,
agents from any and all claims for damages of whatever natt re,
0
T
. lit' 41ilL'k:tl%' III ill(firet-11\1 ff(�Irjj III(, is 1 -1 [nit "Sti-
:Irl�i . qla lit,(. of thiS I , I
S*"��MMING POOL
U
Date /02, �gs -A a
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
S UBJECT: -70 /q Z-A&P.
After review of the subject building permit application, we have the
following comments:
IV�� Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
[",�oK The contractor is required to keep the abutting streets cleaned
of dirt and debris caused by the construction.
The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within.the
Public Right -of -Way or public easement.
/-7 Driveway slope not to exceed 14%.
Connection to sanitary sewer required.
Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
/-7 Site drainage per code # See approved plans
-/-7 Curb /-7 Sidewalk 1-7 Pavingrequired.
/-7 Bond required for public improvements. Submit cost estimate.
/-7 Underground wiring required..
L—j Approved Engineering Plans required when applicable.
A
Rev. 7/78
Fof--Fred F-. Herzberg, P.E.
City Engineer
Department of Public Works
PUBLIC 'NORKS EUVIROINMENTAL REVIE'VI
PROJECT NAME: F-I LE ;y
krn� Dotk—�VA
ASSESSMENT DATED: 10
AN ENVIRONMENTAL REVIEW OF THE PROPOSAL HAS BEEN
COMPLETED AND THE FOLLOWING DETERMINATIONS HAVE
BEEN MADE:
M 'OvI k i IAIJ
k e— L r=—
r7/-A5iZ
A. / 0 A IZ---
PREPARED BY: DATE:
in/771
0
Z
:4 .
Z
1-4
0
Z
ln
7.
00MIC'14ORKS DEPART�� CHE Date
BUnDING PERaT REVIEW
�QA LA6-&Lr4,r.g -Mij4ddress
Street Right -of -Way F.-�istinj r-tu/40 REQD
Access Easements Existing REQD
Utility Easement Existing -HONF,- REQD
Lot per Subdivision Plat X Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Clieck Accuracy,of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd-.
Flood Hazard Zone
Shoreline Management Area -Ak I)
Slope, Soil, Vegetation V\h
Stream, Creek, Drainage Basin
Ey1sting Zoning Per Code OW -A 7--
Amenities Design Board Approval Reqd. Approval
ADB #
Board of Adjustment Approval Reqd.
RE -view Bv: Date:
- �w .
Existing Water Main Size J>Z!
Water M�in Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code —Size
Detector Check Meter Reqd.
Cross Connection Inspection AJO
Fire Department Comments
Water Meter Char
,F, Reqd.
Review by: Date:
60ptic Tanic Design i�pproved Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj. �C-S'e /5-0
Drawing No. I I - File No. :57. ve-01-7 — /
Side Sewer Availability m
Ll
Sanitary Sewer Connection Fee Reqd.
Revio.; B)r: VIS Date:
1K.K.
Open Ditch
Culvert Rcqd. Size
C4 Catch Basin Reqd. Indicate on Site Plan
0 Shoulder drainage n-nintai ion on sx4ale open runoff
rcqd. Indicate on Site Plan'
Soil Conditions and Ground ilater Field Checked
1110"riew h3� Date
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut' for Drivewa y R�qd.
0�
Rioit-of-Way Construction P
Bond Reqd. for Public lnprzi
Street Name Sign Reqd.
Ocher Sipiing Reqd.
ts
Pre P.errdt Site Inspection r-kide on
0
BY: SD,! -ER.
U
1-1 WATER
STREET
EI\IGLNT- ERINNG
I I
Special P\cquire-,-.),--1iLs listed in mcm to Cc=amir-y Dovelopmnt Department,
Building I)i,,,-isio,,i
BY Da te
o All iters filled in on Building Permit Application
BY ate
D,
PL4 Di-awrings Stap.-ped and Notations �kide
A4 BY
Wte
Approved'hy Ptiblic Doparri,,,cnt:
P,bvj.!;Od: 1-v 10-1977
(ep!s jeqso 003)
lown IMIJ1111111110:11NI tluj IUN 10T jdV
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Iierc .01aiaddressee....
RECERT,--",,�,"
e.ce xe the'�!ndmbered�ii�,t.ielel.dO�6ribe.d-belo�/'
REGISTEREO,� NO.',
IGNA-T�URE,OR"NAME.UF-ADDRESS�E,(Mvi!- ilvvziys.-b0filledjn)
CERTIFIED,(.NO
ISIGRATU t
RVOF ''ADD RESSEE3113 ENT, AF ANY,
7
ATE.'-,PEWVERED'_,',
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31
RECEIPT FOR CER TIFIED MAIL—W (PIUS postagi
FOS MARK
SENT TO c%4)AT.E
Cy)
Q0
STREET AND NO.
P.D.; STATE AND Zip CODE
i A� P—ECS ®R 24ZIV FEES
CD
TIONAL
di_04a iL__S_
F
delivered .............. I
s t whom and date 6
"Icr
'RETURN i delive y to addressee only ............
RECEIPT whom date and where delivered .. 3 0
2, She s only 850
SERVICES I deli y to addressee' .............
DELIVER TO ADDRESSEE ONL Y
—§P-E—CIAL DELIVERY (extra fee required)
Z
PS Form, NO INSURANCE COVERAGE !PROVIDED— (See other s
1 3800 * opol J970 0-397
Apr. 97 NOT FOR INTERNATIONAL MAIL
n,
iNDEk�4ii,1�6ii4iiif 6116.vi ihstr; c4ib`s;o other."side
S n
iASE' FtljkNISH,-'S-'E'RVI*CE"(S)"IN6'ICW.T;tCi.,,�6��:',16"H ECKEDBLOCK( -gy
�1 � ch rrg �a r a �'Ilir elf� ejlrii a a ra)
leian toes
V.
S how -address,-,:
L �_
'i ivhere�dblive&�d':,`,:t�. Dg�,fb,, add res�'eep
RECEIPT
RFGISTERED,,,,NO'. IGNATUM� ADDRESSEE wtist,�Iv�,a]jSr,�&,tlllode In)
�.NAME OF,
CER.T.IFIEDI-NOA
SIGNATURE.OF,ADDRESSEE�'S.AGENT,,:IF,ANY,�
JAWP AO —W
.K
DATE� DELIVERED =HE (021
e
'4 ez
FILE,r-
STREEI
PUBLIC WORKS EUVIROINMENTAL REVIEd
PROJECT NAME: 'I LE
F
ASSESSMENT DATED:
AN ENVIRONMENTAL REVIEW OF THE PROPOSAL HAS BEEN
COMPLETED AND THE FOLLOWING.DETERMINATIONS HAVE
BEEN MADE:
I 2=1 L) F=;=)
77)
m ki vv�
.. ....... ...
PREPARED BY: DATE:
REVISED: 10/77LV
-36
REGARDING:
7019 Lake Ballin_ger
Way
56.2 —60�10o
Ta_JTr_e__ssT
R E C 0 R
D 0 F C 0 N T A
C T S
DATE
NAME, PHONE NO. &
COMMENTS
ADDRESS of CALLER
5/l/74
William Smith
Certified
Letter No. 40639S sent
776-9291
requiring
hook-up within 60 days.
5/l/74
I've been
connected for 14 years
Please schedule
dye test.
5/2/74
D.I.O.S.
6/5/74
Certified
Letter No. 406469 sent
rescinding
letter.
0
ACTION TAKEN INITIALS
Letter received. TE
TE
TE
Letter received. TE
11
APPLICATION
for
The City of Edmonds SIODE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
OV,rNER ...... ................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ..... klq .......... 4aoi� ........ 6aj�ijl?- e.r .... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
j
en, Se
Approved:
DATE................................................ By ......................................................................