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10315 242ND PL SW.PDF10315 242N D PL SW • • ADDRESS: �DJ — '/� � nwl TAX ACCOUNT/PARCEL NUMBER: SS� �% � 4y BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: y �( DETERMINATION: ❑ Conditional Waiver ❑ Study Requiredaiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DA SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMITS) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER: LATEMP\DSTs\Forms\Street File Checklist.doc 01/24/2002 17:07 425-827-1444 AAA TANK SVC INC PAGE 02 • C41OLG NO. Critical Areas Checklist Site Information (soils/topography/hydro�logy/vegetat'on) 1. Site Address/Location: ��31 r7 Zy Z� I" L S� __� �tiME'►1C�S td ci �g 2. Property Tax Account Number: 3. Approximate Site Size (acres or square feet): ZD d 4. Is this site currently developed? Ryes; _.._ no. If yes; how is site developed? 5 E S 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. _ Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of snore than 15% and less than 30% ( a vertical rue of 10-feet over a horizontal distance of 33 to 66-6et). Steep: grades of greater than 30% present on site (a vertical rise of Iafeet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: no ; Approx. Depth: 7. Site contains areas of seasonal standing water: 0 0 ; Approx. Depth: What season(s) of the year? 8. Site is in the fkx dway(G tloodplain n C7 of a water course. 9. Site contains a crack or an area where water flows across the grounds surface? Flows are year- round? A Q Flows are seasonal? A 0 (What time of year? ). 10. Site is primarily: forested ; meadow ; shrubs ; mixed ; urban landscaped Oawn,shrubs etc) -X_ . I t _ Obvious wetland is present on site: For City staff use Onty 1. Site is Zoned? 2. stS :pup and imil type($)? ALDFP-W46P u RIE'M- 3r-:.: `Wetlagd inva�tory or C.A. nuip indicates wetland premat on site? .4. Xritical'Am.a inventory or C.A. map .indicates Critical Area on site? . L4 S.. Sites designated earth subsidened landslide haard area'! t;1, PIS�I✓l�1Z �-. 6:. 4ite4w!g.n1ted on the EnviroaitkatAl Sansitive'Arm Mapl i 01/24/2002 17:07 425-827-1444 • "Y % •tiI d dg�,�y9 City of Edmonds AAA i ANI' SVC. INC • Critical Areas Checklist 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 a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas stye 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, PAGE el and submit it to the City. The City will rttiew 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 a lilican-t should also submit a vicinity m�a,�p or plot plank c indi�vt uaiylots of the parcel with enough detail that City staff can find .and identify the subject parcei(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 mist stab in completing their preliminary assessment of the site. I have completed the atuched 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: Name z 2 ►1d �� Siw Street Adduce City, State, ZIP Phone -©2- iparurw Date Applicant Representative: Name Suv* Addis City, State, ZIP Phone Signature y Dates