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CITY OF EDMONDS FILE
HEARING EXAMINER DATE /Oa�4�
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APPLICATION FOR CONDITIONAL USE PERMIT F E E 0
RECT # 773'1
A P 0 S C,,//
HEARING DATE
A P P L I C A N T & ADDRESS �/S e. '42e U e.-I,, -v VL, 0Ak IIAIb,114�4
CITY & ZIP CA PHONE
INDICATE TYPE OR DEGREE OF INTEREST IN PROPERTY
OWNER- ADDRESS N E
LOCATION OR ADDRESS OF PROPERTY
(
LEGAL DESCRIPTION OF PROPERTY in<
To be completed by the Planning Division: Use Zone
Legal description checked and approved by: Date:
CONDITIONAL USE REQUESTED: 4 e,
DETAILS OF PROPOSED USAGE: -51"'1
re of Applicant, Owner or Representative
Release/Hold Harmless Agreement
The undersigned applicant, his heirs and assigns, in consideration for the City
processing the application agrees to release, indemnify, defend and hold the City of
Edmonds harmless from any and all damages and/or claims for damages, including reasonable
attorneys' fees, arising from any action or inaction based in whole or in part upon
false, misleading or incomplete information furnished by the applicant, his agents or
employees. Permission to Enter Subject Property
The undersigned applicant grants his, her or its permission for public officials and the
staff of the City of Edmonds to enter the subject property for the purpose of inspection
and posting attendant to this application.
Sig;Xture of Applicant, uwner or KeprebellLdLlvt
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ENVIRONMENTAL CHECKLIST
Purpose or Checklist:
The State Environmental Polic), Act (SEPA), chapter 43.21C RCIA'. require-, all governmental ap-encieS.1.0 consider
the environmental impacts of a proposal beforc making decisions. An environmental impact statement (EIS) must be
prcpa cd for all proposals with probable significant adverse impacts on the quality of Lhe environment. The purpose of
this chccklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce
C, - decide whether an EIS is required.
or avoid impacts from thc'proposal, if it can be done) and to help the aacnc)
Instructions for Applicants:
This environmental checklist asks you to describe some basic information about your proposal. Governmental anen-
�M.
the environmental impacts of your proposal are significant., requiring
cies use this checklist to determine whether I nive the best de -
preparation of an EIS. Answer the questions briefly. with the most precise information known, or ,
scription you can. wledge. In most cases, you should
You must answer each question accurately and carefully, to the best of your kno 0
be able to answer the questions from your own observations or project plans without the need to hire experts. If you
reaffi, do not know the answer, or if a question does not apply to your proposal, write "do not know" or "does not ap
ply"' Complete answers to the questions now may avoid unnecessary delays later. I ig
some questions ask about governmental regulations, such as zoning, shoreline, and andmark des mations. Answer
these questions if you can. If you have problems, the aovernmental a2encies can assist od of time or on
The checklist questions ap�ly to all parts of your proposal, even if you plan to do them over a peri
different parcels of land. Attach any additionaf information that will help describe your proposal or its environmental
effects. The aaency to which you sibmit this checklist may ask you to explain your answers or provide additional in-
formation reasonably -related to determining if there may be significant adverse impact.
Usc or checklist f�r nonproject proposals:
Complete this checklist for nonproject proposals. even though questions may be answered "does not apply." IN AD-
DITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part 6).
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:
Birth and Family Clinic Mecical Building
2. Name of applicant: Wi I liam R. Weaver
3. A
, ddress and phone number or applicant and contact person:
'+343 E. Douglas Dr. , Oak Harbor, WA 98277, 2o6—* 675-1013
4. Date checklist prepared: October 26, 1987
5. Agency requesting checklist: City of Edmonds Planning Department
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6. Proposed timing or schedule (includin& phasing, if applicable):
Construction will commence in the Spring of 1988 and complete
the Summer of 1988.
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal?
If yes, explain.
No
8. List anv environmental information you knoA about that has been prepared. or will be prepared, directly related to
this proposal..,..
Not known
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.
Not known
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10. List any government lapprovals or permits that will be needed for your proposal, if known.
Conditional Use Permit,City of Edmonds
Architdctural Review Board,City of Edmonds
Landscaping Permit, City of Edmonds
Dail,ldtqy permit, City of Edmonds
1. Give brief, complete description of your proposal, including the proposed uses and the size of the project and site.
M
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 infor-
mation on project description.)
Development of a 5,200 sq. ft. two story medical building with additional
underground parking on a 14,870 sq. ft. site with -accessory parking and
landscaping.
12. Location of the proposal'. Give sufficient information for a person to understand the precise location of your pro-
posed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur
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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.
Project is located at -the northeast quadrant of the inteirsection of 76th avenue
and 219th Street SW. The address for the medical building will be� .11qcluded
i-n—devel-oppie,ri-t—report-.
TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat,(� hilly, steep slopes, mountainous,
other
b. What is the steepest slope on the site (approximate percent slope)?
110%
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EVALUATION FOR
AGENCY USE ONLY
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�TO BE C0hII11.r.,I*rI) BY APPLICAN'r EVALUATION FOR
A G L.NCY USE ONLY
c. What peneral iypes of soils are found oil (tic Site (for M1111ple, Ckl)', sand, gravel, pent,
m -)'? If you know tile classification of agricultural soils, specil) IIICITI and note any prime
uck
farmland.
silty sand with gravel over glacial till on the northern 60% of 'the site
he southern
and 4 feet of fill over the silty sand,gravel and till on t
portion of the site.
d. Are there surface indications or history of unsiable soils in the i111111C(liniC Vicinity? If S0,
describe.
No
e. Describe tile purpose, type, and apprOXiIII.Ite ClUantities of any filling or gradino pro-
POSCLI. Indicate source of fill.
Approximately 405 cubic yards of fill will h;eed-jO be removed.
Site will be brought to a finish grade to allow for accessibity
and parking lot 1�
F. Could erosion occur as a result of clearing, construction. or use'? If So, gencralk, dei� qribe.
A minimum controlled amount of erosion could occur- durifig the construction phase.
Not a permanent condition#
g. About what percent of the site will be covered %vith iniperviOLIS surfaces after project
construction (for example, asphalt or buildinos)'?.
670/d.impervious surfaces
h. Proposed measures to reduce or control erosion, or other impacts it) the earth if -any:
During'donstruction erosion controlled by detention of'surface
runoff. After construction nonerosion surfaces and landscaping.
2. Air
a. What types of emissions to the air Would result from tile proposal (i.e., dust, autonlobile,
odors, industrial wood smoke) durina construction and when tile project is completed'! if
any. eenerally describe and give approximate quanlities if known.
Emissi - ons typical to the type of construction. Upon completion typical
emissions of a medical parcticed
b. Are there any off—iiie sources ol' emissions or odor that may affect your proposal'? 11' so,
generally describe.
None
C. Proposed Illeasures to reduce ur control amissions or other impacts to air, if any:
None
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TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
3. Water
a. Surface:
1) Is there an), surface water body on or in the immediate vicinity of the site (including
vear—round and seasonal streams, saltwater. lakes, ponds, wetlands)? If yes, describe type
and provide names. If appropriate, state what stream or river it no%A,s into.
No
2) Will the project require any work over. in, or adjacent to (within 200 feet) the described
waters? If yes, please des.cribe and attach available plans.
No
3) Btimate 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. In-
dicate the source of fill material.
None
4) Will the proposal require surface water withdrawals or diversions? Give general de-
scription, purpose, and approximate quantities if known.
No
5) Does the proposal lie within a 100—year floodplain? If so, note location on the site
plan.
No
6) Does the proposal involve an), discharges of waste materials to surface waters? If so,
describe the type of waste and anticipated volume of discharge.
None
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.
No ground water wi I I be drawn and no discharge to ground water due to
depth of ground water.
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 or houses to be served (if applicable), or the number of animals or
humans the system(s) are expected to serve.
None
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'Zy
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
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.
source of runoff — roof and parking lot — method of collection on
site
retention sy stem— method of disposal — storm sewer.
2) Could waste materials enter ground or surface waters? If so, generally describe.
No
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if
any:
Curb and gutters, landscaping, grading and onsite retention of
surface runoff.
4. Plants
a. Check or circle types of vegetation found on the site:
deciduous tree: alder, maple, aspen, other
evergreen tree: Fir, �edar, pine, other
shrubs
grass
pasture
crop or -rain
wet soil plants: cattail. buttercup, bulli skunk cabbaae, other
water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of veaetation will be removed or altered?
100% of all vegetation will be removed.
c. List threatened or endangered species known to be on or near the site.
None
d. Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the. site, if any:
Landscaping in parking lot area, perimeter of building and site
boundaries.
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,4�1 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.
None
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c. Is the site part of a migration route? If so, explain.
No
d. Proposed measures to preserve or enhance wildlife, if any:
None
6. Enerav and Natural Resources
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a. What kinds of cncrg� (electric, natural gas, oil, wood stove, solar) will be used to meet
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the completed project's energy needs? Describe whether it will be used for heating, manu-
facturing, etc.
Electricity typical of a medical building.
b. 'Would your project affect the potential use of solar energy by adjacent properties? If so,
Coenerally jescribe.
No
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:
Will meet State of Washington energy codes.
7. Environmental Health
a. Are there an), 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.
None
1) Describe special emergency services that might be required.
Typical of a medical clinic.
2) Proposed measures to reduce or control environmental health hazards, if any:
None
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
None
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)? Indi-
cate what hours noise would come from the site.
Short term construction Ta,.m. — 7 p.m.
Long term traffic noise . .
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EVALUATION FOR
AGENCY USE ONLY
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
3) Proposed measures to reduce or control noise impacts, if any:
None
8. Land and Shoreline Use
a. What is the current use of vhc site and adjacent properties?
Current,use of site is two single family residencef. The property to the north
& west 6t:e prof6ssionaloffice6. To the east & south — single family residence!�-',
b. Has the site been used'for agriculture? Ifso, describe.
No
c. Describe any structures on the site.
Two single family residences.
d. Will anY structures be demolished? If so, what?
Yes — Two old houses
e.' What is the current zoning classification of the site?
RM — 244
f. What is the current comprehensive plan designation of the site?
RM — 2.4
If applicable, what is the current shoreline master program designation of the site?
No
h. Has any part of the site been classified as an "environmentally sensitive" area? If so,
specify.
No
i. Approximately' how many people would reside or work in the completed project?
12 (not all at one time)
j. Approximately how many people would the completed project displace'?
4
k. Proposed measures to avoid or reduce displacement impacts. if any:
None
1. Proposed measures to ensure the proposal is compatible with existing and projected land
uses and plans, if any:
Project conforms w I ith exi,sting development Ln the area.
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TO BL COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
9. Housing
a. Approximately how man), units would be provided, if any? Indicate whether high, mid
die, or low—income housing.
None
b. Approximately how many units, if any, would be eliminated? Indicate whether high,
middle, or low—income housing.
Two low income houses
c. Proposed measures to reduce or control housing impacts, if any:
V
None
10. Aesthetics
a. What is the tallest heicht of an), proposed structure(s), not including antennas; what is
the principal exterior building material(s) proposed?
25'
b. What views in the immediate vicinity would be altered or obstructed?
None
c. Proposed measures to reduce or control aesthetic impacts, if am
Architecturally designed building with landscapi-ng-;-
1. Light and Glare
IM
a. What type of light or alare will the proposal produce? NN'hat time of day would it mainly
occur?
None
b. Could light or glare from the finished project be a safety hazard or interfere with views?
No
c. What existing off -site sources of light or glare may affect your proposal?
No
d. Proposed measures to reduce or control light and glare impacts, if any:
None
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
0
Edmonds High School, ice Arena.
b. Would the proposed project displace any existing recreational uses? if so, describe.
No
'A
TO BE COMPLETED BY APPLICANT
c. Proposed measures to reduce or control impacts on recreation, including recreation op-
licant, if any:
portunities to be provided by thc,projcct or app
None
13. Historic and Cultural Preservation
a. Are there any places or objects listed on, or proposed for, national, state, or local preser
vation re-isters known to be on or next to the site? If so, generally describe.
No
b. Generally des'cribe any landmarks or evidence of historic, archaeolos!ical. scientific, or
cultural importance known to be on or next -to the site.
None
c. Proposed 'Measures to reduce or control impacts. if any:
None
14. Transportation
a. Identify public streets and highways serving the site. and describe proposed access to the
. = - �Ians. if any.
existin street system. Show on site
Site abuts 76th Ave. West and 219th Street SW with access from
site to both streets, see site plan.
b. Is site curren tly served by public transit? If not. what is the approximate distance to the
nearest transit stop'?
Yes
c. How many parking spaces would the completed project have? How many would the
project eliminate'?
26 completed parking spaces - none eliminated.
d. Will the proposal require any new roads or streets. or improvements to existing roads or
streets. not includina driveways'? If so. generally describe (indicate whether public or
private).
improvement will be made to 219th SW.
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transporta-
tion? If so, generally describe.
No
If
n
f. How manv vehicular trips per day would be generated by the completed project'
known, indicate when peak volumes would occur.
I 1 :00 a m.
peak volume 9:00 a.m.
10 O.M. 5kOO g-m-
vehicular 'trip ay n;t now
EVALUATION FOR
AGEN,CY USE ONLY
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TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
g. Proposed measures to reduce or control transportation impacts, if any:
None
15. Public Services
a. Would the project result in an increased need for public services (for example: firc pro-
tection, police protection, health care, schools, other)? If so. generally describe.
-Yes typical for,a medical clinic.
b. Proposed measures to reduce or control direct impacts on public services, if any.
None
16. Utilities
a. Circle utilities currently available at the site: (fec�trici :,��6ra_t_c_r e_fu_sr__s_er`v�3>
ice, ��6�(�s�anitai— �se%v �septic system, other.
b. Describe the utilities that are proposed for the project, the utility providing the service,
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and the -eneral construction activities on the site or in the immediate vicinity which might
be needed.
Natural gat, Washington Natural Gas CQ.; Electricity,.,Snowhomish PUD.
Sewer district — City of Edmonds; Water; City of Edmonds.
C. SIGNATURE
The above answers are true and complete to the best of my knowledge. I understand that
the lead agency is relying on thegLi�ke its decision.
.........................................
Signature: .. ....... ;�. ..
Date Submitted: ...... ................................
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T() BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
D. -St"I'LENIENTAI. SlIFFT F01t NONPItOJECT ACTION'S (Rezones, Code Changes, Annexations, et'c.)
(60 not Ilse this sheet for project actions)
11CCilt'se these queslions are very gencral, it may be helpful to read therri in conjunction
�s'itll [Ile 11-il of. the elements of the crWil-Cifill'ient.
Whell 1,111swering illesc questions, be aw:ire of the extent the proposal, or the.types of
;Ictivilics likely IL) result from tile proposal, would'affecl tile iieln al a greater intensity or
11 a faster rale 111;in if tile proposal were not implerrienled. Respond brieny and in general
lernis.
I. I 'I MY would (Ile proposal be likely 1c) increase discharge to %voter; einissions to air; pro-
duciion, siora2e, or release of toxic or hazardotis substances; or production of noise?
None
PrOPOsed incastires to avoid or reduce such increases are:
None
2. How would ilic proposal be likely to affect plants, anirrials, fish, or marine life?
No affect
Proposed nicasures to protect or conserve plants, animals, risii, or marine life'are:
Landscaping & irrigation
3. How would the proposal be likely to depleic energy or natural resources'?
Typical of medical clinic
Proposed measures to protect or conserve energy and natural resources are:
Construction will meet State of Washington
4. How Nvould the proposal be likely to use or affect environnientally sensitive areas or ar-
eas designated (or eligible or under study) for governmental protection; stich as parks, Nvil-
derness, wild and scenic rivers, threatened or endangered species habitat, historic or cultural
sites, weilands, floodplains, or prime farnilands?
It wi-11 not Ose pr affect
Proposed nicasures to protect such resourcei or to ayoid or re(ILICU inipacts are:
None
5. 1 1()%y wotild the proposal be likely to affect land and shoreline use, including whather it
would allow or encourage land or shoreline uses incompatible %villi existing plans?
None
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EVALUATION FOR
TO BE COMPLETED BY APPLICANT
AGENCY USE ONLY
Proposed measures to avoid or reduce shoreline and land use impacts are:
None
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' 6. ' mx would the pnupoou\ be likely to increase demands on transportation or public ser-
vices and utilities? ,
' No increase demand on transportation
' but increase demand on fire and police prmt and'ub,ipY4tyos
Proposed measures »nreduce or respond iosuch dumund(s) arc:
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Non
7. Identify, if possible, whether the proposal may conflict with )oouL state, or [uduru\ \uoo
or requirements for the protection of the environment.
None
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—l2=
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Drs. M' er/Keaton/Gant
T i
To Thai
t v
21 2 K76th ve. W.
mo s W
monds, WA 020
B. Petty/Resident
21830 76th Ave. W.
Edmonds, WA 98020
James Fuller
P.O. Box 257
Olympia, WA 98507
Martin Fuller
22901 75th Ave. W.
Edmonds, WA 98020
M. French/Resident
7512 218th St SW #5
Edmonds, WA 98020
M. & G. Daniels/Resident
7512 218th St SW #7
Edmonds, WA 98020
Drs. Miller/Keaton/Gant/
Peoples Motg. Co.
Todd & Thai
#9149970
21616 76th Ave. W.
P.O. Box 1788
Edmonds, WA 98020
Seattle, WA 98111
Commonwealth Mtg.
Mark Morris/Resident
Petty, B #0944510
7516 218th St SW #1
P.O. Box 1420
Edmonds, WA 98020
Portland, OR 97297
G. Bernstein/Resident
Martin Fuller/Resident
7516 218th St SW #2
7516 218th St SW #3
Edmonds, WA 98020
Edmonds, WA 98020
Robert Wolfe/Resident
Family Savings Assoc.
7516 218th St SW #4
Wolfe, Robert
Edmonds, WA 98020
1109 N. 205th
Seattle, WA 98133
Federal Nat'l Mtg.
Sue Dixon/Resident,
Dixon, Sue
7512 218th St SW #6
10920 Wilshire Blvd.
Edmonds, WA 98020
Los Angeles, WA 90024
Capital Say. Bank F. A.
Capital Center Bldg -
Daniels, M. & G.
410 W. 5th Street
Olympia, WA 98507
KAR�