1017 CAROL WAY.PDF11111111111111
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1017 CAROL WAY
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TAX ACCOUNT/PARCEL NUMBER:�O �gnnZ`1 bD \.'ZX�
BUILDING PERMIT (NEW STRUCTURE): �� Dl I l z
COVENANTS(RECORDED)FOR:
CRITICAL AREAS :qZ�'!% DETERMINATION: []Conditional Waiver Study Required ❑Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: (-3 BLOCK:
SIDE SEWER AS BUILT DATED: �P�I f
SIDE SEWER PERMIT(S) #: I I
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LATEMP\DST's\Forms\Street File Checklist.doc
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AppL No /9
A PL6CATlOM:: PERO
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Building Department.
t hmt on y
CITY OF EDMONDS•
to cor7atruct the following avork m
acco?dance che�acoom i
APP%@�:QTI®N i3 hereby made,for a'peraut
herewith for. app wal.:
tS
panying'plans and specificatioaa. Two sets am submitted
•
Off st.:
^� new i' alter .....
Work',' -tddn repair ............ ....
r
ezone 8
Use zone �..
t
. Pu
Occupancy...... Const. type............
Lot .. .� Blk
Address...........
C/
,tank
� � • L.+t frontage ................ .........:. Area.......0 /
. ' 1. 'side
Bldg. eat-Ixtclw •— franc ............Q2 �' .Y- r. side.... %�� •7 '
Norma
Tel
pwner(-....
).
..... Addrass............
.. Tel N o t
.:Builder..
"
Tel
Addr ess....
..Plans by :.................................... .,.
..• ° i
... -,
,'. .. ...... ...
'.- ..............
- ................................:. `.....
.., ... ....................... ..... ...... ...................
I agree to comply with all applicable Codes'an lace regulatrrigxthras-�
The above s a cot statement, and
work. -
;.
Y
Datew�
'' .. Address. .....
. Signed :Owner/Agent ... ... ��'
L, e
is hereby approved, subject to the above conditions, and to oompliuice antl%the XP Y
PERMff for the above work
. proved plans and specifications. and Building Department notarions thereon.
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,a
�+ Recd.by
Valuation ........... /
C? ..'Vv..... Permit fee.....:...:
I}ate.. � -. {6/�„r �. , �"Y t a� �-s�•p J� �' t,• `'v
Building Department, By...
5 it f Y J
Ihis'Permit does not cover Plumbing, Sewer or Electrical rnsta r } is 1 s s+,
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CA FILE NO.
Critical Areas Checklist
----------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/I.;ocation:G�-
2. Property Tax Account Number: /t2 �7" Q00 -G 0�31 —dam D
3. Approximate Site Size (acres or square feet): CI
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 15% and less than 30% ( a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30%present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: ; Approx. Depth:
7. Site contains areas of seasonal standing water: ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a cr " 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 ; mead o ; shrubs :mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
-------------------------------=----------------- For City Staff Use Only------- -------= -------------- -- -- -----
1, Site is Zoned? �F P
2. SCS mappedsoil type(s)? A (�W� L�r�.;; �6,n c� Coi�t 5 :`r� s�rat•.0 .
31 wetland inventory or C.A. map indicates wetland. -present on site?
4. 'Critical Areas inventory or C.-A. map indicates Critical Area on site? !v
5.. Site within designatedearth. subsideace landslide.hazard area?:.. �
6. Site designafed on the Environmenially.Sensitive Areas Map? r � w �N�✓
City of Edmonds
1107CRITICAL 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: Applicant Representative:
9F�
Name Name
Street Address
City State
Telephone
Signature
Date
Street Address
Zip City State
Telephone
Signature
Date
Zip
(over)
c:reception\jana\cacl.doc
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El
APPLICATION
for
The City of &Won& SIDE SEWER PERMIT
OUTSIDE: INSIDE REPAIRS 0
OWNER ........... *�.. ... :Y. .... .
HOUSE No. .. .14�17
... A.0.4.t........................
)2-
CARD No. ....... Z11.. j. - . .-
EASEMENT No.. ..........--... ........... ..........-
..... CONTRACTOR ... /74k. ...... .. ........... ..... PERMIT No.
STREET
.... AVENUE LOT No ......... ......................... I ...... ....... .............. BLOCK No . ............................................................
NAMEADD ....... ............. ......... 9 ........... ..........................................................
3 6
L C K
P
44
Al
Date Approved:
RACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $............... ......................................
SEWER WORK ORDER ISSUED ......... ...................................... DATE.. ............ . . . ..........
............................District
City of Edmonds ---Water Department
N 0 r � TAP CARD ,
JJ
- �,, Date....
Meter
No..l........................ No........................................:
Tap
Size.............................. Size ...............
Mfgrs. No ............ ...W.............. Style......................For .- ..............
...........................................................................................................................................
..
LotNo ........................................... Blk•No...................................._..............
Add........................................................................
Service Location .........1 D/...
........................................................................................ L~G'
.. .. .........
MeterLocation...........................................................:........
.................................................................:..............................................
Make Tap
............................................................................._..............
Pressure..............................lbs. Test.................................... %v
Send Bills to ...............................:
..............
.........................................
Date of Work..
................................................................................................................ Foreman
Guar. Voucher No ........................................... $..........................................
'Remarks:
.........................................................................................................................................
...........................................................................................................
.... ..
........................................................................................ ., .........................
..........................................................................................................................._..............
...........................................................................................................................................
...........................................................................................................................................
............................................•---------....................................................................................
OUTGOING Index .......... Reg ....... Route Bk......... Stencil ...... Card ......
..
INCOMING Index .......... Reg ....... Route Bk......... Stencil ...... Card ........
Crg/,
i
r �
daterial Chargeable to Installatio: Aeters
i
NO.
SIZE
DESCRIPTION
RATE
AMOUNT
..r
------------
..........
Meter .....................................
...........
........................
Meter Box ..............................
..............
.............
._.......
.....................
Meter Plate ............................
..............
.............
.........
--------------
..........
Check Valve ............................---.........
_...... .....
..........
..............
.........
Pipe, Galv. Screw ................. ...............
............
..........
.............
..........
Nipples ....................................
..............
........
..----..
..............
..........
Bushings .. ................................
..............
---------•--
..........
...............
..........
Plain Ells ................................
..............
.............
..........
..........
St. Ells ....................................
.............
----- .........
---------- •---
..........
------
•---------
Tees .........................................
......................................................
......................................................
--.......
...........
..............
.........
.......
I ...........
.......
..........
..........
Material Chargeable to Taps Connected
NO. SIZE DESCRIPTION
&ATE
AMOUNT
..............
..........
Pipe, Black Screw ......................�
..---•---•--.
.......
..............
..........
Pipe, Galv. Screw .-----....-•-.....
...............
......................
........................
Lead Connections......................................................
-•-----•-•..............
Curb Cocks ..............................-----.------
•-----......
.........
-------•---
------
Corp. Cocks ...........................
..........
........
....
..............
..........
Unions..................................................
-------------
........
..............
------
Saddles ................................
..............
.........
.........
..............
.......
Nipples .-• ..................................
............
.--...... •
........
....-•---•..............
Bushings ...-----•--••--.....---.........
..............
..........
..........
...........
•.........
Plain Ells .................................
............
.............
..........
----------------------
Street Ells .............................
.............
.............
..........
.............
..........
Tees..........................................
...............
......... _...........
.....I ........
..........
Curb Boxes .................... ..------
-------.._...............
..........
.......................
S. O. Extensions ..... -..............
..............
......................
......... •----
..........
Gates ........................................
...............
............
...........
-----•---•--•
..........
Plugs........................................
.............
............
..........