1015 MAPLE ST.PDFIIIIII IIIII IIIII IIIII IIIII IIII IIII12119
1015 MAPLE ST
City of Edmonds rk c Q110 S
CFJT1CAL 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 are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it. to the
City. The City will review the checklist, make: a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge. (fill out the appropriate column below).
Owner/Applicant:
Name.
//0 /--i--i`-
Street Address
City State Zip
Applicant Representative:
Name
Street Address
City State Zip
Telephone Tel /
S6&ure Signature
9-a J =C/�4
Date
Date
(over)
c:recepdon�anakacl.doc
Critical Areas Checklist
--------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: Ck-
2. Property Tax Account Number: 4.120 1-02, fgU l,
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 'l5% and less than 30% ( a vertical rise of
'10-feet over a`horizontal distance of 33 to 664eet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: /L C) ; Approx. Depth:
7. Site contains areas of seasonal standing water: 1\C) ; Approx. Depth:
What season(s). of the year?
S. Site is in the floodway, y floodplain V—t) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? " (What time of year? )
10. Site is primarily: forested : meadow : shrubs : mixed
urban landscaped.(lawn,shrubs etc)
11. Obvious wetland is present on site: (X-Z
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CA FILE NO. C-A -U - i6
Critical Areas Checklist
------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
Site Address/Location:
Cl(-
2. Property Tax Account Number: &l'±I
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? -_ yes; no.
If yes; how is site developed?
Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: rk.y ; Approx. Depth:
7. Site contains areas of seasonal standing water: Y-NO ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway _ y-\. floodplain V-0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year? )
10. Site is primarily: forested : meadow _ : shrubs : mixed —
urban landscaped (lawn,s.hrubs etc)
11. Obvious wetland is present on site: ('\.Z
STt1D1�RI✓ iRpD
.CO3YDITIO�f�,3L i?Y.�IVE1� ..
4
:Reviewed by �•: ,�� .:�
Planner T
..... .. .. .. ..... _. ,....... Date
AcVhkdoC RW 10/07ro7
City of Edmonds �1 I S
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 are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
\/ham �e-jz'
Name.
t
Street Address
%�ryldf���s ey/j �IeD _1d -3-V/
City State Zip
Telephone
SjJQ&re
Y� Z
Date
Applicant Representative:
Name
Street Address
lie
City State Zip
Tel /
Signature
Date
cncepdon�ana\cacl.doc
(over)
The City of Edmonds Side Sewer Drawing EASEMENT NO. ...................... ........ ....
103-03400 NEW CONSTRUCTION [-] REPAIRS 7 LID NO . .............. ... ASMT. NO . .. ...............
OWNER------ JO .. ANN ... GORDZ -------------------------------------------------------- CONTRACTOR --------------------------- -------------------------------------------------------- PERMIT NO. ....................
JOB ADDRESS -------- LO-1-5 --- MARLE --- STREET ------------- ----------------- LEGAL DESCRIPTION: LOT NO. ----- ................................ BLOCK NO- ----.....-------------------------..
A
NAMEOF ADDITION .......................................................................................................................
DYE TESTED ON SEWER
Approved:
PWW-0001-11175 (REV.11178) DATE ............................................ By ............................................................
;:5Canne 0,6.r�O
10147 mpv� lb�
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DATE RECEIVED
.
P ERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE
PERMIT
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sell
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
SUITE/APT#
ADDRESS
1 e OLONO.PLAT
OWNER NiU✓ZAA k [E OF BUSINESS
NAME/SUBDIVISION NO.
LID NO.
LID FEE $
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MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP roved
RW Permit Required ❑
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EXISTING
PROPOSED
Street Use Permit Req'd (3
Inspection Required ❑
CITY ZIP
TELEPHONE
Sidewalk Required ❑
M
s
—
REQUIRED DEDICATION FT
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES ❑ NO O
O
ADDRESS
REMARKS
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OWNER/CONTRACTOR
RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP
TELEPHONE
NAME
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ENGINEERING
REVIEWED/DATE
ADDRESS tj
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FIRE REVIEWED BY
DATE
CITY
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'XZ/I'P�(A�
LTELEPHONE Q
EXPIRATIONDATE
STATELICENSE NUMBER RATION
C CKED BY
VARIANCE OR CU
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SHORELINE OR-ADB#
INSPECTION
BOND
REO'D
POSTED
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L ICI /�(I (kuzl
❑YES NO
SEPA REVIEW
COMPLETE EXEMPT•,
SIGN AREA '
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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EXP - •
❑ NEW RESIDENTIAL ❑ PLUMBING
UMBING / MECH
LOT COVERAGE
'REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT.,,UR SIDE REAR
O
❑ AUDITION ❑ COMMERCIAL ❑ COMPLIANCE OR
'
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CHANGE OF USE.
PARKING
REQ'D PROVIDED'
LOT AREA :
PLANNING REVIEWED BY DATE
❑ REMODEL ❑ APARTMENT ❑ SIGN
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❑ REPAIR ❑ GRADING
❑ FENCE
REMARKS
CYDS X FT)
❑ DEMOLISH TANK ❑ OTHER
GARAGE
❑ CARPORT ❑ RETAINING WALL ❑
RENEWALROCKERY
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(TYPE OF USE. BUSINES OR ACTIVITY) EXPLAIN:LL .
CHECKED BY
TYPE.CIF ONSTRUCTION
CODE OCCUPANT
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GROUP
NUMBER
NUMBER OF 11
CRITICAL3
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AREA - OOADPANT
OF
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AREASNUMBER
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STORIES
UNITS
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REQUIREDa YES
DESCRIBE WORK TO BE DONE
C7
REMARKS
PROGRESS: INSPECTIONS
PER.UBC.,108%FINAL INSPECTIONREO'D
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5
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VALUATION
FEE
•
PLAN CHECK FEE
HEAT SO CE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
'PLUMBING'
y
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRADING/FILL
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SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
C HARGE
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PERMIT LIMIT: 1•YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. R VIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
H
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
i
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
FEE
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY ALL
=
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
=
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
REC I
TOTAL AMOUNT DUE
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY 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 ine
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 THRfSeTE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE A W 18.27.
-
OF IALS SIGNATURE DATE
SIGNATURE (OWNER AG NT) DATE SIGNED
I
_
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1 -0220
UJAdj
•
RELEASED BY ATE
ATTENTION
EXT1333
IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
%71'0221
A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL • FILE • YELLOW - INSPECTOR
FAX
PINK -OWNER GOLD •ASSESSOR
5/98