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7107 156TH ST SW.PDF7107 156TH ST SVV -0 ADDRESS: �/ 7 - / TAX ACCOUNT/PARCEL NUMBER: ?�D 5� e �( (i�.j[D 4!�73 BUILDING PERMIT (NEW STRUCTURE): COVENANTS(RECORDED)FOR: CRITICAL AREAS: ,QZ- - 07-3 —15 DETERMINATION: ❑ Conditional Waiver ❑ Study Required kaiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): 'Will_ PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID SHORT PLAT FILE: LOT: BLOCK:: !-� SIDE SEWER AS BUILT DATED: SIDE SEWER PERIVHT(S) #: �; 1P V SOILS REPORT DA STREET USE / ENCROACHMENT PERMIT FOR: WATER METER TAP CARD DATED: LATEMP\DSTs\Forms\Street File Checklist.doc W -110-7&fY 60py -W-ET Fl�-' FILE## N/A DETERMINATION OF NONSIGNIFICANCE Description of proposal Addition and Remodel of an existing single family residence Proponent Jack O'Neil/Ellen Jones 7107 156th St. S.W., Edmonds, WA 98020 Location of proposal, including street address, if any 7107 156th St. S.W., Edmonds, WA 98020 Lead Agency Edmonds Planning Division The lead agency for 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 Q Responsible Official Jeffrey S. Wilson Position/Title Current Planning Supervisor Phone 771-3202 Address 250 5th Ave. N., Edmonds WA 98020 Date Lots 1 `�f Signature -T X You may appeal this determination of nonsignificance to Hearing Examiner at 250 5th Ave. North, Edmonds, WA 98020 no later than October 26, 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: �Lf/dGKtta-f �a�i�/T7'oyi Ga �7Oe(S / l!//�� �d026 2. Name of applicant: L Kal�ti /11.19e �� CD••l.�.cc{v�', �c/faM+ Cor,s7iiac�ioN 3. Address and phone number of applicant and contact person: c /ZW . 4. Date checklist prepared: -7 G —G C, �; Z 5. Agency requesting checklist: / C� 11-`/ 0 T= L ,0 /71- /7S 6. Proposed timing or schedule (including phasing, if applicable): evnol 'r c-&o of addifie� , cv�, plcfc, f-o s �i/9i , be fi•,is 1w./ I y //9z 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. )�AOI► C 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. /v o 10. List any government approvals or permits that will be needed for your proposal, if known. ('on5%'vG�1oA Pe-p+,7% ca� er,O—Uoro.uals 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.) Eh/ais'a h*�ts1ti' dc.:roora,� � f+. 44,re17o1r of • 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. 71o7 s w 1561-ti , See Pl"r desc' % A'nri TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site (circle one): Flat, rollin hilly, steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? o%7o 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. - -*W , "L& / d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. he, e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. rJor�C n,ectssaiy . g f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. jl(o g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? 291 !o h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: 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? I//f any, generally describe and give approximate quantities if �known. SQCedq(!S� Alpieal oleSmQ// 4��/7IOTj (i(JOf4li hdt 's�7CC/ GUY b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. IAIO c. Proposed measures to reduce or control emissions or other impacts to air, if any: poet /�to.lc� 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. 0 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. A1a 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. �cl o He 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. 'A/v 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. A10 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. J/o 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. /Vo • • 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. M- 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. hoof ?F� ke ,(i✓e/t' �s^oi., isovu tilt 5ia�l/,3 vtdowi.s�oi.c.�.s 2) Could waste materials enter ground or surface waters? If so, generally describe. )VO d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: /love 4. Plants a. Check or circle types of vegetation found on the site: ✓ deciduous tree: alder, maple, aspen, other tr evergreen tree: fir, cedar, pine, other ✓ shrubs A. grass _ 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? gOhc oid di -itoy iv co vr�- a.c�. ,�a�` is Gur�t.olt�y fa,-k�+f sPof c. List threatened or endangered species known to be on or near the site. nOhG d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: .4or jW. L '�.s� •% . /Uo 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, gbirds other: ........................... mammals: deer, bear, elk, er: ..... haw.% :...................... fish: bass, salmon, trout, herring, shellfish, other: .................... b. List any threatened or endangered species known to be on or near the site. /%Ght c. Is the site part of a migration route? If so, explain. /1 o d. Proposed measures to preserve or enhance wildlife, if any: pOhc 6. Energy and'Natural Resources 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. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. 140 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: hone: 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. ho 1) Describe special emergency services that might be required. h 0 --e- 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)? 4_0>1_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. / qp~ e.1-c q�,�,� GflsasJS^vcl�lol �7oNGs Saws, fl�t�ss�eq✓1r�q. 4) ,Cor 4 week s or %PSS 8'Ar» SI�/yi C� 3) Proposed measures to reduce or control noise impacts, if any: 09 ptv- 8. Land and Shoreline Use a. What is the current use of the site and adjacent properties? )&sIde.'Val , 5-"4 7'X -° b. Has the site been used for agriculture? If so, describe. . 170 c. Describe any structures on the site. 'i s'1179/c r�Gh�o� 1o4-1sc d. Will any structures be demolished? If so, what? e. What is the current comprehensive plan designation of the site? h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? k. Proposed measures to avoid or reduce displacement impacts, if any: �t 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: IJ oh c Aie!/; d 11"`J 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. S�L.,� pi. at ecisTsn�' b. Approximately how many units, if.any, would be eliminated? Indicate whether high, middle, or low-income housing. D c. Proposed measures to reduce or control housing impacts, if any: 10'._. Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? ��rstiay ht: � 2S' /�,�0/,�,� Lit • .SGt.Ya�. b. What views in the immediate vicinity would be altered or obstructed? q pole- c. Proposed measures to reduce or control aesthetic impacts, if any: 11. light and Glare a. What type of light or glare will the proposal produce? What time of day would it -mainly occur? h OAC b. Could light or glare from the finished project be a safety hazard or interfere with views? h° c. What existing off -site sources -of light or glare may affect your proposal? d. Proposed measures to reduce or control light and glare impacts, if any: 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? /p,pru b. Would the proposed project displace any existing recreational uses? If so, describe. 0 c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: 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. �o b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. A107t,Z- 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. -5bo IS6�4 St , Edi.,en,Cd . DrivcrMar . Su sr7- pla•I 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? z Govgi�./ Par, 9 5�sscae ^01-J . /Vo c an pcs 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 e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. 149 a f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. 2 g. Proposed measures to reduce or control transportation impacts, if any: 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. b. Proposed measures to reduce or control direct impacts on public services, if any. y eh� 16. Utilities a ' le ut' ' ies currently available at the site: ctr•icit , tural a4 s, water use service a one nitary se septic system, other. 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. SI.GNATURE The above answers are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Signature: 2f!................................................ DateSubmitted: ........................................................ 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 general 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 existing plans? Proposed measures to avoid or reduce shoreline and land use impacts are: U 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 0 STREET FILI 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 0). 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: /Sd ?,44 Eii/�on e�S 411q 9 SO 26 2. Name of applicant: Ket�4 CD"Ge.eeiv�', �CCtfa,►+ Corrs7iae�io.. 4641 3. Address and phone number of applicant and contact person: 4. Date checklist prepared: 7/7/9/ 5. Agency requesting checklist: 6. Proposed timing or schedule (including phasing, if applicable): Coas'i 4.h' b ofad�/ifiali . �o.�, /�fc, t sfa� �i/9i , b� finis �e.r !� y ��9i. 7. Do you.have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. N° 8. List any environmental information you know about that has been prepared, or will be ••prepared, directly related to this proposal. /vOHC 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. /Y ./ o 10. List any government approvals or permits that will be needed for your proposal, if known. ('onsh"vcfta� �trn„ �' � ca7� er 6.�iwa.•��s 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.) Eh /aa'c•tsTv 6c.(roo.•�� % 200. %'t' sp • %T , w,�jo-r °'� bY�toorl , bpi• C1 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. 7/07 .5W /S6E4, kM. Sac Ple'r q�GS!iip fio.o TO BE COMPLETED BY APPLICANT EVALUATION FOR AGENCY USE ONLY B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site (circle one): Flat, rolli�� hilly, steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? '? 7,, 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. .--a./ , "r t / d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. he e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. i7ol� /iectssivy • g f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. �(o g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? Z5' T., h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: /Jon,c /�Gta�G� 9 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. Sa•�aivs� tl,,pkal of small 4dq/.lio* — Guo&dd riot 4-Akct b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. jK/o c. Proposed measures to reduce or control emissions or other 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. 0 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. A1a 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. doNc 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose, and approximate quantities if known. �o 5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan. 1Jo 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. jto 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. wo • • 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. M 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. roof t� b� •l� vr.-t,/ fron, �ovu vta g ..�1`I/3 v� �..�„ sp•s a„� w�11 Soa !c zulo` frocu.� sane /low• 2) Could waste materials enter ground or surface waters? If so, generally describe. VO d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: /Jolla 4. Plants a. Check or circle types of vegetation found on the site: deciduous tree: alder, maple, aspen, other evergreen tree: fir, cedar, pine, other ✓ shrubs grass _ 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? f A""r /S Curznfly done— add,az fv coac.- a.e.t ✓✓ c. List threatened or endangered species known to be on or near the site. nOhG d. Proposed landscaping, use of native plants, or other measures to preserve or enhance vegetation on the site, if any: .4oT' a.Gzcady exr.,, s it&e� . It/o aAWrhv i^. o/ ��ro�pose • 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. ,/?on-e c. Is the site part of a migration route? If so, explain. /7 0 d. Proposed measures to preserve or enhance wildlife, if any: /tOgc 6. Energy and -Natural Resources 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. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. IKIo 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: �jvna 7. Environmental Health a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazard66s waste, that could occur as a result of this proposal? If so, describe. ho 1) Describe special emergency services that might be required. h o "'G 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)? 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. / I21vJGs �SsrwS, htt�s,�grlrq. e fG��- Owee%S or 3) Proposed measures to reduce or control noise impacts, if any: 12 ptv_ 8. Land and Shoreline Use a. What is the current use of the site and adjacent properties? <-1 � /e 71' J b. Has the site been used for agriculture? If so, describe. /:7v c. Describe any structures on the site. .SiAf /e r'Rh,o6 lovse d. Will any structures be demolished? If so, what? e. What is the current comprehensive plan designation of the site? r' h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. 7 i. Approximately how many people would reside or work in the completed project? j. Approximately how many people would the completed project displace? k. Proposed measures to avoid or reduce displacement impacts, if any: /110XLt 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: ,n a a AGe o-O 1" ? 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low-income housing. c. Proposed measures to reduce or control housing impacts, if any: 19.. Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? ey-15PI hf: -' 2y �,.BP�e.� Lit • b. What views in the immediate vicinity would be altered or obstructed? c. Proposed measures to reduce or control aesthetic impacts, if any: 4 ore. le.e.1e.0 11. Light and Glare a. What type of light or glare will the proposal produce? What time of day would it mainly occur? `j orte, b. Could light or glare from the finished project be a safety hazard or interfere with views? h° c. What existing off -site sources of light or glare may affect your proposal? 4 a_)-u d. Proposed measures to reduce or control light and glare impacts, if any: 12. Recreation a. What designated and informal recreational opportunities are in the immediate vicinity? b. Would the proposed project displace any existing recreational uses? If so, describe. �a c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: 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. �o b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. {7IO-A,Z- 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. SW /561-4 St , Ed6ft� . po-lmer,4xr . Se�e sib p12� 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? .Z G per,/ f1r#4 '09 5Paccao />o kJ/(lo c`i an pcs 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). 4v e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. ha f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. 2 g. Proposed measures to reduce or control transportation impacts, if any: 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. h� b. Proposed measures to reduce or control direct impacts on public services, if any. 16. Utilities a. Circle utilities currently available at the site: electricity, natural gas, water, refuse service, telephone, sanitary sewer septic system, other. 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 are true and complete to the best of my knowledge. I understand that the lead agency is relying on them to make its decision. Signature: ....................... ... ........... DateSubmitted: ........................................................ 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 general 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 existing 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 DA Zone A 507 RECEIVEC) :Nove�rnbes 4, 1cicil NOV 0 7 1991 ENGINEERING - .:a�o dnm04AS-11-9a. 9so a6 VecLr (YID. Ckresmun , Z have, re ce � Oect_ �0 Q%r 1,e firs . C(CJe4d NCuc nK beP I . (I e_� txcs-�tn� M ded,`cc,�-e.. s ��oo+ s�� i a -� Pia perf �o(Aers l eo 6111- csf. (Yl h �cs,b �n� amd T do nc ' lj Cuvt j +c rn& ke- s Lkc A d eel i cc,*tciA VQ. -Ae, we loo f< _Ccrwc%rc1 : 4c) re ce w t &� 6(.,P b LA l t r Pe1'm d- cs soon CL s Foss < <b le, .� � 4n k.. cols,,, so M C.lc k -�o (- y� �a a .rl c c c f e r &_ `VO l V ,r> Incerle/� IE-HeA C\A)cl1/-64OC45 RECEIVED N0V 0 7 1991 EJYGINEE R1NG dN►�cMds lam.- 990 ac. --------------------- --------- ----- ucsi n ` ' Z- dec,(i cc _r�--�'►�Ls�---��—look_.�a�wc�---- _ - t _ce_<CJAA-- -nw, b ui l4 f.. errn '--C�S�Svo n _r�s oss_i �b le- a cud- - Ca�1`0►a. �`n- - ... lY1Ce1� . ------------ {E PLANNING DATA SITE ADDRESS: 1-7 PROJECT DESCRIPTION: REDUCED SITE PLAN PROVIDED es No Ajo I pi b1 e-aa®W1Aje - MAP PAGE: CORNER LOT: es / o FLAG LOT: Yes / o ZONING: S -1 Z CRITICAL AREAS DETERMINATION ❑ Study Required: ❑ Waiver ❑ Conditional Waiver 14a a4 SEPA DETERMINATION: AJ ❑ Fee ❑ Checklist ❑ APO list w/ notarized form Zfternpt ❑eeded for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake 8I Ilinger) �._ S—,v SETBACKS: Required Setbacks: / Street:125 Left Sider Right Side: Lid Rear:J ; Actual Setbacks: ' Street: ;Zj Left Side: Right Side: Street map checked for addition setback required? Yes / DNA ❑ DETACHED ST CTURES: ❑ ROCKE S: ❑ FE S/TRELLISES: Y WINDOWS / PROJECTING MODULATION: STAIRS / DECKS: 0*-_, PARKING:. Required: c BUILDING HEIGHT: Dati Ma) A.D.U. CREA SUBDIVISION: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / No OTHER: Plan Review By: NewBPPlanningDataForrr DOC °13.0 APPROVED BY PLAN ING D� 1S,o 1 � 4 . OWNE C '1 F i iy.io i FOR E spA01#.7 15, t /1�' /SVA �.44?'Ak#A %317. ? fo► ,fir. - --- /.a,z~;. � - Yid �►..- �.�-.sod -t = SO c-a-., fit. AD& N w J*rvws �,gef ► u CPIYI,f%V�-�- ndd gX �j caYe ITRACTOR iS RESPONSIBL 57 )N CONTROL AND DAMAGE �µ?>�.vVotilS F" W cr, full U J uj 6� i a-., O. J 0 L APPROVED AS NOTED 61 BY ENGINEERING -f � �arY►YMf,�. - Date: ? OWNER/CONTRACTOR IS RESPONSIBLE FOR EROSION CONTROL AND DAMAGE APPROVED AS NOTED BY ENGINEERING L5 M�fA-m Date: - L 'NoRivi ZONE [2— SETBACKS.- FR SIDE OTHER HEIGHT 0,/'�" c2a-1 CITY OF EDMONDS BUILDING DEPARTMENT WORK-2, ADDRESS -7 10-1 -5�7 OWNER APPROVED DATE: 7/?�AW BLDG. OFFICIAL Pii�r6llT NUMBER �T -710 - � l^DATE RECEIVED .-"' " PERMIT EXPIRES E PERMIT CITY OF EDMONDS ZONE e� l� NUMBER CONSTRUCTION PERMIT APPLICATION ADDJ08 ITE/) RESS OWNER NAME/NAME OF BUSINESS �VV e I PLAT NAME/SUBDIVISION NO. LQT NO. LID NO. W AILING ADDRESS 1 LID FEE $ TESCP F ' ( A PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Per/mitit proved Required 4.�' _ Street Use Permit Rq'd ZIP TELEPHONE EXISTING PROPOSED Inspection Rg0ed Side c T�v /I walk Required p I� t,�S � REQUIRED DEDICATION FT W;,I„�e,�ed p NAME 'CJ C� / METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES ❑ NO ❑ S Lu III C ADDRESS REMARKS zz V OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE CITY ZIP TELEPHONE 47 A,) CGW l 5 CA- LU QJ NAM- CBL N f ` ' pi r" ,J S I ENGINEERING REVIEWED BY DATE C AD/DFS//'(� �Jf�_4 ( �11 / �"' "(M C / j -'"7 Q1 /J A1/1� /f0( / `� (�'�lJ� �/l/�J i FIRE `REVIEWED BY l�irr ( DATE L.f'/CJ W C C7 ZIP TELEPHONE cc (' �1J) O (�Y r �JV Z / VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND STA LLIICj'E�NSE NUMBER E(X/PIRATION AT HECktY,.. RE 'D POSTED I �J \ �� C? OYES O $rr) SEPA REVIEW SIGN AREA HEIGHT Rj PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED /ALLLOWED, ,PROPOSED )U U (7 �n 0 r Q ii U EXP �r I745 �.7_5 ❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROCOMPLIANCE ORPOSED FRONT SLIDE REAR FRONT UR SI E REAR .�• ❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE �� O ✓'`� O f .15 r ,*'.2'5 e;?-7 -1' ' �7• ❑ REMODEL ❑ MULTIFAMILY ❑ 'PARKING LOT AREA PLANNING REVIEWED BY DATE REOD SIGN PROVID REPAIR GRADIN FENCE ED 750�Y" ,2/ �r ❑ ❑ CYDS ❑ ( X FT) R M RK J ER a ®is/G17'L°. % . ❑ nDEMOLISH ❑ TANK PC GARAGE ❑ RETAINING WALL ❑F RE ER ROCKERY YFIRE ALARM z ❑ CARPORT (TYPE OF USE, BUSINqp OR ACTIvEXP IN: r CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT ic O /9 / C/7- GROUP Q,t GNUMBER NUMBER OF CRITICAL � e� O i `J OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT STORIES z UNITS NUMBER a REQUIRED []ES / LOAD DESCRIBE WORK TO BE DONE REMARKS f )1�(J PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 1 o cJi� C'G ��- � m �. $AL10N i TGl s/ Dom/ /l/4 /� Description FEE Description FEE Plan Check State Surcharge t1fAT S URCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: �" VESTED DATE Plumbing 40 T�A <--k M5 Mechanical �O THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t_ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Q. 7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. s Engr. Review m PERMIT APPLICATION: 180 DAYS d PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection � SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit 70. IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Q EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE r] DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # ICAION; THAT THE INORMAON GIVEN ES COR ECTEAND THAT I AM THE OACKNOWLDGE THAT I HAVE WNER, OR THIS APPLTHETDULY AUTHOR Z DFAGENTTIOF APPLICATION APPROV L THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODJE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSAT CE AND RCW 18.27. SIGNAT f( R DATE SIGNED OFFICIALS SIGNATURE ,ATE 771 -0220 LE SE Y DATE ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELL -INSP CTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER • GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN -ACCOUNTING rl , PERMIT EXPIRES v CITY OF EDMONDS PERMIT USE L12 ZONE 2 Z NUMBER CONSTRUCTION PERMIT APPUCATION JOB 8URE/APTi '�% ADDRESS 1 %1 � NAYEMAME OF BUSINESS PLAT NAME/SUBDMSION NO. LOT NO. LID NO. S — , C LID FEE III 5 MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ESCP Approsad RW Pennl Required o y / S /S� EXISTING -- PROPOSED Street Use Parml Ra N mepe�0e Rewired CITY ZIP TELEPHONE Z yZ %Z ©'T REQUIRED DEDICATION FT Sidewalk Required Undergroundr T O Q NAME MR SIZE NO. OF RE8 PRV REOUIRE YES 17 NO T� v �u C ADDRESS REMARKS = V 11L _ OWNER/CONTRACTOR RESPON818LE FOR EROSION CONTROWDRAINAGE n REA atJ CITY ZIP TELEPHONE i NAME /' CB # t Cuslin Cd, [ U E INEERING REVIEWED BY DATII ADDRESS a _ / al 2 O J e- AI /Y7di ` FIRE REVIEWED BY DATE W CITY' % ZIP TELEPHONE V _f t_) VARIANCE OR CU SHORELINE OR ADB# INSPECTION R D BOND POSTED. STATE LICENSE NUMBER EXPIRATION DATE ECKED BY p 07 0 ?A6L .�.��.. YES 13 O 8EPA REVIEW SIGN AREA HEIGHT a PROPERTY TAX XCCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSE ;r j — � 1 EXP ❑ NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWF� PROPOS FRONT SIDEI REAR FRONT L/R SIDE REAR oo OR COMPLIANF USE �ADDm�N' ❑rCOMMERCILL ❑ I� ""� r CHANGE - PARKING I R qD PROy�DED of750 LOT AREAJPNIN REVIEWED•BY ATEE'� 0/ � RFMODEL � '' ❑ MULTIFAMILY ❑ SIGN g u FENCE ❑ REPAIR CYDS ❑ ( X FT) E ARKS OTHER ❑ DEMOLISH ❑ TANK ❑ -- "nO r _ ❑ CCAARPPOORT ❑ ROCKERY E RETAINING WALL ❑ FIRE FIRE SPRINKLER ALARM �R O (TYPE OF USE, BUSINESS OR A N: _ CHECKED BY TYPE OF CON TRUCTION C CCUPANT ' U OROUR 4. GNUMBER ///,,,••-.. NUMBER OF CRITICAL SPECIAL IN P CTION AREA O OCCUPANT OF . • DWELLING UNITS AREAS NUMBERO O STORIES REQUIRED -S I LOAD DESCRIBE WORK TO BE bokE REMARKS PROGRESS INSPECTION$ PER BC 1081FINAL INSPlICTION RECtD 9 11-30 � v _ VALUATION 1_� $ Description FEE Desdfiptlon FEE PlanjChtCk `~ �. State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Bt111ding PeamR� w City Surcharge ' PLAN CHECK NO: ^ VESTED DA. 6F..,.,r`'``. rt Plumbing; 'Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS P"MR COVE4 WQ,QRKTO ONLX RUBgC. t BE DONE ON PRIVATE PROPERTY ANY CONSTRUCTIOft'ON�HE „_,. .. DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIR SEPARATE PERMISSION. - ` FtWew ccEngr. W PERMITAPPLICATION: ISO DAYS n PERMIT LIMM 1 YEAR - PROVIDED WORK IS STARTED Wr HIN ISO DAYS Engr. InspectionO SEE BACK OF PINK PERMIT FOR MORE INFORMATION •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOR8 Fire Review Plan Chk. Deposit ` IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF. EDMONDS, WASHINGTON, ITS OFFICIALS; EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection O Receipt # OR ALL CLAIMS FOR DAMAGES OF NEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 9' FROM THE ISSUANCE OF THIS PE)t`MR ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFY, WANE OR RVDUCE ANY REQUIREMENT OF ANY CRY ORDINANCE Landscape Insp. Total Amt. Due If = NOR LIMIT IN ANY WAY THE cays ABILITY TO ENFORCE ANY ORDINANCE PROVISION' Saw Recording Fee Receipt # I HEREBY 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND'STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION ; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED _ Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged Ina ce ded WORKMEN'S COMPENSATI RANCE AND RCW 18.27. (GNAT 19 OWNER AGENT) DATE SIGNED (425) "r L / '/ 1 0220 RELE BY ATE ATTENTION - EXT 1333 L2, IT IS UNLAWFUL TO USE OR OCCUPY &BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 RINK -OWNER GOLD -ASSESSOR 04�02 PRESS HARD -YOU ARE MAKINGS COPIES GREEN -ACCOUNTING LEv�T7�rd SL-c vR- nM P Pgo,.je ®. =po o ti STREET FILE 5 .!� P ^q-- w4 �v er LezA 1371M ,5& g 1�r CAme - w/ram +ArOm If39q 3 /or G �_k&, WdAfvr ws..�373y"'A. !COUNTER _ !t ,.nc�� t3..:/oiJt- L—D rilc 33So saki ' Sir �� r� aew� Say ssr ,=T c--,coot?I vNa1L ST�1i' :EMS ii?i,. 1 C^�LEvd7I-6 7/07 S W /ss * Awo vDs = o' p"wnw Qy mkl-- SAon/cjV_t,tJA Ga k I Ile , 40 d, AIW*k VW4- e • joll j 10 4e oz J 0- '60 TOO en ,OIPAe 41ro Lq 2 0 7- Ao ox 9-.Z?4 -4.o CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS, 250 Fifth Avenue North, Edmonds, Washington APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT (Submit 3 Copies) Permit to be issued to---- .................... ee.. For installation at: (street address) ....... 'J/..Di.-.� '4.-'=f s"�'-.. . -........... Addition or SubdivisionrGU..!� ..- �Q dQ` ... C ........................ Lot...,.lr.1�..... Block ....J........... Type of Building: New..X..... Existing ............ Single family residence.�E3'-_ Number of bedrooms --- %F Other: (specify type or use) BuildersB ""! .- 'e�,S-------------------•....................ddress.�j 0. 3..-."k' 11... i. /z'•�' , Designer.....-. �!!!�`�y.. �c31%/� /7-P � 50, ,Grj� asps 1------------------------ Address_ ... ...... ' . --- ---. .....� 1>..... Soil Log Hole No. 1. -----®~.QeAe!>stl� .MOLT �G.o/1'�....u/...crr.�.......... ------------------e ...rzocc�.�l.....r-f12-'---'G.. Soil Log Hole No. 2....... ..4....--1.3�r� �tft2.�..-.8.��l�9d/.... ./.�G .T..:.p--- --•------•------- Elevation of Water Table, if encountered. (Distance from ground surface) ........................................ Correct'ons to control surface water if needed.;'... �BCt� 000 !' C .fl...4`....to ...... P.. !`.. d.s. . Specify if any removing or grading of topsoil in field area../«s?/...... ................ ......... ................................. I.............. -----•------------•--...-----•------------------••------•---....------•----------...-----...---------•---•---------...........----.................................----••---........---...--------------- Percolation : Test Hole No. 1 —Average Rate--.�..Jr....�...3d.. .. (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 2—Average Rate.-li 2.... o................(Fall in minutes/inch-bottom 6" test hole) Test Hole No. 3 —Average Rate.-4. �..4F.' ..............3........ ...---- (Fall in minutes/inch-bottom 6" test hole) Average percolation rate on which to base drain field design ae..17��l Date Taken ---- 9�/-Z 4* Septic tank requirements based on present rules and regulations: Septic Tank Size...-.©.. .... gallons. Amount of Square Feet of Disposal Field....... '�� 0 ......... . Signature —Designer s ---- •--------- ----- -. ----- ..... Date .------ DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) Permit issued (date)...... ,// .9 .Permit Number....e a�L Remarks :...... . --..0 SIREET FILE • �f CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington SEPTIC TANK INSTALLATION PLAN (Submit in 'Triplicate) ADDRESS OF PROPERTY..l..�v.l.....' . ��.."`. �.�.J..l..w...!............. Lot No.,PW.1.7......... Permit No..1.5 Owner-- - ..... Address . _.._.................................... Phone..--- .................. Builder. ..h'Q .... .... ...... Address4f,?0 .-..04W.' 5 .�`,./ .... Phone.,,.,oVX4_-/Of/ lllesigncr---- /�< �ll� e� _- ----------...... Address-,--sp '/ -�%� ��.$'.�., ���� Phone.����d�L� Installer/.T/ J/:J>.4!j,<1....,46�G'/�ET ... Address %�� ../YIG,���� Phone,;!..��:.�•e-,� I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of grades, fills, surface drains, etc.) listed by me on my sewage disposal system permit application dated.9�Zr-�G� _ ..... .....................................have been complied with. Signature of Designer Date TO BE FILLED IN BY CITY ENGINEER ONLY Accepted.eted ..------Date....17... -c�.. Not Acce..................................... Date .. ...... .. .... Signatureof Sanitarian........................................................................................ Remarks: ...... Appxoved..pex..de;z.ignex.'s.. certifieatQr1.......................................................................................... INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest detail and still contain the entire site on one page. ATTENTION HOME OWNER: Your septic tank has limitations! It was designed and installed to care for an average -sire family. Over- loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to remember: 1. Have your tank checked periodically to see if pumping is necessary (2%2-3 years). 2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield. 3. Do not excavate, fill, place a structure, driveway or, patio in, on, or over the drainfield. 4. Limit toilet fixture disposal to sanitary wastes and toilet tissue. 5. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and disposal field. E-- KICVt '♦ ♦/ op Q � 04 o J.c/.�*' • iio. o J 24 �' r✓c°rs6%i/eS'st% a // G� / "' I i r '�e� �A 10 or" ,r. N SEWAGE DISPOSAL PERMIT Septic Tank ........ ------- gals. CITY OF E D M O N D S No. . ...... Disp. Fie ' Id ......... ----- sq. ft. Department of Public Works Other.-------- Name ........ ------- ------ ------------------- ....... _ ....... ----_-------------- ------------is hereby authorized to install/ repair sewage disposal system at ............ �­f - ------------ ------- ................................................................................................ Date issued ' Permit expires one year from d4 of issue DO NOT COVER BEFORE APPROVED By DESIGNER OR SANITARIAN I hereby certify this system was installed under my supervision and control and complies with all provisions of the City of Edmonds Resolutions. Signatureof Installer ............................................................................ Date ....................... Approved E] Disapproved Date ---------------------------------------- ----------------------- By .................................................................................. Remarks:__ ----------------------------------------------------------------------------------------------- SANITARIANOR DESIGNER ---------------------------------------------- : ---------- ---------------------------------------- Date -This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed. I CITY OF EDMONDS 4PUE';IC WORKS DEPARTMa FOR INSPECTION CALL •permit t�i®�.6o SIDE SEWER PERMIT �= 3�Z Ext. Issue Date * PERMIT MUST BE POSTED ON JOB SITE Address of Construction Property Legal Description (include all easements) �yNNwnnn� Single Family Residence .)<' Multi -Family No. of Units Commercial Owner and/or Builder ..�'/Ci;��G ,L Contractor & License No. Invasion into City Right -of -Way: NoYes (If Yes Right-of- way Construction Permit Required - Call Dial Dig ( AA121-17AAA ) before excavation). 1-800-454-5555 7. Cross other private property: Yes No X Easement required - attach legal description and county easement number. READ THE FOLLOWING AND SIGN: a. Property owners must obtain a permit to install side sewers on their property. A licensed side sewer contractor must be employed to construct side.sewers.in the public right-of-way. b. The side sewer contractor assumes full,reponsibility for each installation for one year. C. Commercial establishment requires a minimum of a six inch (6") side sewer line. d. Side sewers may not be installed closer than thirty inches (30") to any structure. e. Side sewer lines must be laid at a minimum grade. of 2% (1.15°) and maximum grade of 100% (450). f. No turn in side sewer greater than 45° (1/8,bend) is0allowed between cleanout. All 90 turns must be constructed of a 45 (1/8 bend) and Wye with removable cap. g. No down spouts, footing drains or floor drains can be connected to side sewer system. h. Pea gravel is required for bedding when installing sewer lines through other than granular soil. i. Cleanouts are required at 30"-60" from each plumbing exit line and at minimum intervals of 100' along sewer line run. j. Trenches within City right-of-way must be restored to original conditions. Contractors shall be responsible for right-of-way failure due to poor compaction of fill.. k.. Side sewer must be left uncovered until inspected and approved by the City. 1. Inspection during normal working hours only. Two (2) working days notice required.X�-, DATE: /16 8 R4 I certify t at I have read and shall comply with the above PERMIT FEE: DISAPPROVED DISAPPROVED By: Date: U W B Date: CONNECTION FEE: 04 APPROVED By: 7MWDate: w * PERMIT MUST BE POSTED ON JOB 5 TE • The City of Edmonds Side Sewer Drawing EASEMENT NO- ----------------------------- ------- MEAD. Cota4eartom NEW CONSTRUCTION [:] REPAIRS D LID NO. 2,1.0 ..... . ASMT. NO. -- ------- ..... . OWNER ..... G ------ 01ACRkEL .... -------------- --------- CONTRACTOR pw!4m -- ...... . --------------------------------- --------------------- PERMIT NO. -65G,0- JOB ADDRESS .-M.0.7 ------ f,56-r . . .....ST, -S-W ........... LEGAL DESCRIPTION: LOT NO. ------------ .................. ...... BLOCK NO. t�NNWOOD-11NE y_ US rj I-SbP 47t.a.wvc G"CiP c.*.c-AP 32' NAMEOF ADDITION ........................................................... --------- VOP 4:*C.a.WVE 6-op C-O.C-Skp 0 CARPORT 10' 9,up rac.*.WVE c,op ra-c.o c-AP j I-- i G T14 ST' sw. Approved: TE 4-.B 0 `3 A O LE) SN 0A N O N 2062676 RECORD RECORDED SEER NATIONAL U INSURANCE CO. PNINTY OFFIC! ►I AM 9:C: is DUBUQUE, AUDITOR SH COUNTY �--------------• I. v� I OF RFC• 0 / Statutory Warranty Warranty Deed THE GRANTOR 1 LD:k'ICI{ R. ;iCUD and T LEbi II. iU D, hi,-; wri-fe for and in consideration of Fulfillment of real eoLate contract Y.a FORM L58F in hand paid, conveys and warrants to, CH., S ETCI=11zm E-iOSi'I1•iS and J�w�Iil';I DO'GTi i I.CiSi:Ti a, his �.i fe the following described real estate, situated in the County of S1 Ci iISII ,State of Washington: The South 125 feet of the �ieslk, 110 feet of the fol.lo-riq, described tract: All that I-)ortion of Tract 56, Land's eadot•:dale Tracts, accor6in;; to plat thereof recorded in Volume 6 of Plats, page 26, records of said county, described as :follows: Pef;innin� at. the Southirest corner of said Tract 56; thence Last 128 feet to the -true point of thence continue Last to the Southeast corner of said Tract 56; the ace, north ,aloni~ the East line 300 feet; thence hest parallel to the South line to a point 128 feet from the iles-t boundary of Tract 56; thence South 300 feet to the true TJO Lht of ihG'{'i n:n �,.nr?. _ ?,i 'i,il a'f-e - +,he Gmin+:kr of .13, VITOITfru SUBJECT to restrictions and covenants now of record. This deed is given in fulfillment of that certain real estate contract between the parties hereto, lurch loth . 19 67 . and conditioned for the conveyance of the above dated described property. and the ^covenannsnh n ofrrranty h under the purchaser in saidlcont contract, shall not • NOTICE: No warranty of accuracy. The information shown on the attached map(s) was compiled for use by the City of Edmonds, its Employees and Consultants. The City of Edmonds does not warrant the accuracy of anything set forth on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the map(s), including, but not limited to, the location of any sewer stub shown. Such sewer stubs may or may not exist and may or may not exist at the location shown. Neither the City of Edmonds nor its employees or officers shall be liable for the information given on map(s), nor for any one representation provided based upon said map(s). • � 23 Checklist CAFile No: �— M - 5 Areas C Critical Site Information (soils/topography/ hydrology/ vegett at orl��Jo 1. Site Address/Location: 7 / LO S_G CbA 1) u 05 91 SO 6 2. Property Tax Account Number: 5DEC( 00 D 05(a 03 a t d -P7- 3. Approximate Site Size (acres or squa a feet):'J, 7*�0 4. Is this site currently developed? es; 1no. 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. YRolling: 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 verti 1 *se FILE 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:RECEIVED 7. Site contains areas of seasonal standing water: Ald Approx. Depth: JAN 10 2G03 What season(s) of the year? PERMIT COUNTER 8. Site is in the floodway A401 floodplain , /0 of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? 4 o Flows are seasonal? (what time of year? ). 10. Site is primarily: forested ; meadow ;shrubs ; mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present oil site: 4 Critical+Areas�ii 15. Stte wtthut' deli y 'RpviPwi+ii1, r t,e S ac .�,i a�i7Y� RE y e a ea: on stte?.• � N`6" � .° �` c : y .area? No. �. 4,^i�r .. `.. �_.t„ F4 -i �,irS. �+•� �eik'i�flY;'� .�Y� CERIVIIlVATION s , Critical Areas Check] ist.doc/3.19.2001 -1 pF ED�j City offld;mond:s Development Services Department Planning Division Phone: 425 :.771.0220 g90 Fax: 425.771.0221 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 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 inventories, maps, or soil surveys). Date,ReceivMV_Jl 1-1 -7 —O a- City3Receipt M allac' Critical Areas File M Critical AA ei as` heckiist Fee: 1 U5.00 _71 Date Mailed to Applicant: A propertyowner, Gpr; his/her, authorized representative, must fill out the checklist, sign and date it, and submit it to the City: 'The' City' will � eview 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 conjunction 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 and exhibits herewith submitted are true and correct to the .best of my knowledge and that I am authorized to filets application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT ' I Vlid- --- � DATE /G / / 'i—/ O Zz 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 posting attendant to this application. SIGNATURE OF OWNER lJ u-CX DATE I� l7- 02. Owner/Applicant: Name (' Street Address ! �} ourA r��t • 7 �ya �o City State Zip hn Telephone: T 5 2qg %i Email address (optional): Cnt1-S tO.Q4j-Cnm Critical Areas Check] ist.doc/3.19.2001 _Applicant Representative: i ( K 2 dv R Name Street Address 3 h \'( tit ,-- uJ *- 01 l33 City State Zip Telephone:% d 6 — I ? / l 5'0 Email Address (optional): I. P90METY' AMR 7107 5W 15" aPHOMPS, WA loo.& .OWNER: JA". AND eUAN 04v- 0!,* - 'o IRA SoWTd 126 MOT lie FW OF Te MW*e-P TRACT: AL 'ri4A1 PoeTiOH OF IMT. -"6, Mr-4�blU 6e- TC--%, AC40900-4 191 TgP- rLAr liLUMOF a=WPW R4 VOLUME 6, eF FLK[t." Fvr: zf., F45"Mm cp oH014vHleH COLO-411(, WA5Rt4d'rVH, M*MSW As FOLAMYS: 564NNSC AT 'IM WWVJWW C004M OF S&D tA--r -4,; --P40f, OMT 121 Forn -ro T#I?- -rave. ?4014T OF 86Glt4NW-; -015HC2-' Clot-MINUP. OAST - r;l I-- SCV-JWT CaND& OF 410 JPAGT ei-; -r+4e- tiOa4l. ALCA44 VA5T UHe. %o MO'T� . 5L I -fH5 30mv wr-,T;, 1191VIF, WW FArZAU a 7�1 A PolWT lzg-FffWr FE014 IW- WEST Do-OW.'r of -rvcGr -;(.; -Mgpcc 5o1414 !,m Irgipr rp folw OF sr4"-tHe-- FL,�m ACFA 6aFf. sl%-'s 9- er r--rAag-F L-V IS15* � 'T 9 &LP4 &ALOA La-r vvfieAGE e-wr.*- 22f. s*'7- STRE.ET FILE 7/0 7 - ---- —110, -PILOT PLAN C^Ls: Yo ". l'o, +jr ATE AE'EIVED PERMIT EXPIRESUSE v bJ CITY OF EDMONDS ONE !7 2 NUMBIER CONSTRUCTION PERMIT APPLICATION ooRE33 -7 --� _ SUMAPT# ' 5 t ER NO ER NAMEMAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. r 1 I I /4 N �' S 7 LID FEE III W MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required = O / S /S� EXISTING PROPOSED Street flee Penult Rwtd Inspection Required o Sidewalk Required CITY ZIP TELEPHONE C OZ.+,,1Z ) _ �w�, �f' � �/. REQUIRED DEDICATION FT Underground s Wiring required 1�1 NAME r ETER SIZE �tOCSIA NO. OFjqXTURES PRV REQUIRE O 1 \2 vea YES ❑ NO Z W � ADDRESS REMARKS = _ • _ OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAIIhAG`E� a w. 1) ! ` W Q At 1Y-7 "- CITY ZIP TELEPHONE 11ore (AlA- S1,966— biz ' /t s­6 NAME / v' CB # t n �• C us (,. d nl r ►J E REVIEWED BY DA ic ADDRESS �INEERING / A _ O Z /y 7 ` FIRE REVIEWED( BY DATE CITY ZIP TELEPHONE LL O _� e- tAA . cif 1.) 0 6 — (o/ VARIANCE OR CU SHORELINE OR ADB#' INSPECTION RSD'DI BOND POSTED STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY &6L SEPA REVIEW - SIGN AREA HEIGHT a PROPERTY TAX `ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSE? EXP ❑ NEW RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) FRONT L/R SIDE REAR ' COMPLIANCE OR ALLOWFC5 PROPOSEjj FRONTI SIDE REAR t I = �ADDmON'' ❑ COMMERCIAL ❑ CHANGE OF USE �Q 1 z - R�MOOELr ❑ MULTIFAMILY ❑ SIGN PARKING R D PROV DED LOT AREAJP&NINGREVIEWED'BY —1 � ATF1 0I f�l a �y FENCE ❑ REPAIR :: C I CYDS ❑ ( X FT) I5O n E ARKS ❑ DEMOUSH ❑ TANK ❑ OTHER ALL GARAGE RETAINING WALL FIRE SPRINKLER ❑ ❑ ❑ FIRE ALARM _ CARPORT ROCKERY .�•+ti �..+J . O u (TYPE OF USE, BUSINESS OR ASI : .% / CHECKED BY TYPE OF CON TRUCTION C {OCCUPANT ' GROUP t GNUMBER to OF `' - NUMBER OF DWELLING CRITICAL AREAS SPECIAL INSPCTION AREA _3 0 OCCUPANT O STORIES UNITS NUM ZERO REQUIRED YES /� � LOAD DESCRIBE WORK TO BE ONE " REMARKS PROGRESS INSPECTION$ PER BC 108/FINAL INSPECTION REO'D _ Q_' )177 („ < �1% _ AL VALUATION `. l Al $ U/�-� � e Description FEE Des iption FEE Pla 11 Chddk �. State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % YBuildng' Pe>rmitCity Surcharge PLAN CHECK NO: VESTED DA, !...,.,,%'- .'' Plumbing. IQ 3 'Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERT WQRK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTIONbN THE P(18LIC, .- 9 Grading .,, DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUI• SEPARATE PERMISSION. QEngr. R'bview, W PERMITAPPLCATION: 180 DAYS a PERMIT LIMM 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection ' 00 SEE BACK OF PINK PERMIT FOR MORE INFORMATION y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit _ m IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF. �/ ^ EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # G ALL CLAIMS FOR DAMAGES OF WWEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ` FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 0DEEMED TO MODIFY, WAIVE OR REbUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due = NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording Fee Receipt # I HEREBY 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND'STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in sp4cep vided WORKMEN'S COMPENSATI 1� RANCE AND RCW 18.27. I (GNAT � NER SN(OWAGENDATE SIGNED % ,D E (A� Z J(42 J1-022 RELATE ATTENTION Off 1333 Z 10 IT IS UNLAWFUL TO USE OR OCCUPY A,BUILDING OR STRUCTURE UNTIL 'A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-, oRICi1NAL •FILE • YELLOW. INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER • GOLD -ASSESSOR :•.04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN• ACCOUNTING