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CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 1022 SPRUCE ST. EDMONOS
2. Property Tax Account Number: Z SZ :�p 3 - I - 6 Z L - ooc) S
3. Approximate Site Size (acres or square feet): qyso ,
4. Is this site currently developed? ✓ yes; no.
If yes; how is site developed? RSS%Dt-Nnt Ai
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. A0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: 0 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain ty A of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Np 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. U
For City Staff Use Only -
1. Site is Zoned? / )
2. SCS mapped soil type(s)? N,00 V r bw�/ d l s�•�•p t ex ? ^- 6 % S, 6,0 e-
3. Wetland inventory or C.A. map indicates wetland present on site?
4. :.Critical Areas inventory or C.A. map indicates Critical Area on site? A-10
5. Site within designated earth subsidence landslide hazard area? / IV
6. Site designated on the Environmentally Sensitive Areas Map? lj/b
DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER QQ
Reviewed by:
Pla er Date
Rev 01roA/9a
City of Edmonds
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,
COUNTER
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(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 assist
staff in completing their preliminary
assessment of the site.
I have completed the attached 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:
Ftiltx pie MEI10
Name
IOZZ SP9,0C&
Street Address
tD ow>s- WIC gRbZo 206-474-711y
City, State, ZIP Phone
-t*Signatu Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
m
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
L Site Address/Location: 1022 SPRUCE ST, F-PKOND5
2. Property Tax Account Number: . Z SZ 40 3 - I - 0 26 - 000 s
3. Approximate Site Size (acres or square feet): q?SO S
4. Is this site currently developed? ✓ yes; no.
If yes; how is site developed? 9,S$%0t.Wnt A1
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; A0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: 40 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodwaytYA_ floodplain RJA of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? iko Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ;meadow ; shrubs ; mixed ;
urban landscaped (lawn,shruhs etc)
11. Obvious wetland is present on site: tA_0
—For City Staff Use Only --
1. Site is Zoned? /
2.. SCS mapped soil type(s)? W.w Ur b0 ,/ � - Pic Z-e `%'o s16,4 L
3. Wetland inventory or C.A. map indicates wetland present on site?
4:-:-..Critical Areas inventory or C.A. map indicates Critical Area on site? /(/b
5. 'Site within designated earth subsidence landslide hazard area? /yO
6. Site designated on the Environmentally Sensitive Areas Map? /j/b
DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER QQ
Reviewed by:
Pla er Date
Rev 01/ON90
890 199
0
City of Edmonds
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots 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 assist
staff in completing their preliminary
assessment of the site.
l have completed the attached 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
IOZZ ISP9,0CP -t'T.
Street Address
tDMot,kbS- WA gROZO 206-474-?l17,-
City, State, ZIP Phone
Signatu Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature
Date
IM
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OE II�x/NA OFBUSINESS
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MAILING ADDRESS F••
IQZZ - �;?F vcE ST
CITY ZIP TELEPHONE NUMBER
UhAOQbS cW20 734-37tL
NAME
TELEPHONE NUMBER
USE
ZONE
ADDRESS
PERMIT
NUMBER
KI SUBDIVISION NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
RW Permit Required ❑ p
EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑ '
,.,, �• . Inspection Required ❑
PROPOSED Sidewalk Required ❑
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO ❑
ADDRESS
x
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2
ENGINEERING MEMO DATED
REVIEWED
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED
REVIEWED
Z
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STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADB NO.
'•'
ALLOWED PROPOSED COMPLETE JEXEMPT
• ,�
EXP l�
VARIANCE OR CU PLANNING REVIEW BY,:'
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Z
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Legal Description of Property - include all
{a GE 0 3
Z T WP Z I
easements
SHORELINE
"....
DATE
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SETBACKS — FEET
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HEIGHT
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LOT COVERAGE
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Property
TaxAccount.5�G *'-0?-t,w coo
Parcel Na �La rt
REMARKS
El
EjNEW ® RESIDENTIAL PLUMBING
t.
V.ADDITION COMMERCIAL
El MECHANICAL
i
® REMODEL APT. BLDG.
El SIGN
CHECKED BY
TYPE OF CONSTRUCTION
E
CODE
1.911
GRCaP I
i
GRADING FENCE
CYDS. . L— X _Fri
REPAIR a a
ElWOODSTOVE
DEMOLISH D INSERT
6 gsl � RETAINING WALL/
�GARP'r"' 1:1ROCKERY
SWIM POOL
HOT TUB/SPA
El RENEWAL
SPECIAL INSPECTOR
REQUIRED
� YES
AREA
D
LOAD
LOAD
REMARKS
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21
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
'A NUMBER
^"
I NUMBER F
CRITICA
AREAS
NUMBER L�
STORIES
UNITSLING
DESCRIBE WORK
TO BE DONE (ATTACH PLOT
PLAN)
o' ' la 9 �AT_ W
I� t �' `' ``'
'�`
FINAL INSPECTION REQUIRED
L) . )�
VALUATION
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
C� C
, 1t5 r vf. N ��'L L
GLAZING
0 B
PLUMBING
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Plan Check No. ...w.�tr7 'e+�
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require. Separate permission.
STATE SURCHARGE
Permit Application:180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
ENO. INSPECTION FEE
"Applicant, On behalf of his or her spouse, heirs, assigns and
y
J
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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swhatever
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employees, and agents from any and all claims for damages of
nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be. 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."
PLAN CHECK DEPOSIT
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
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz•
ed thereby, no person will be employed in violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code of the State of Washington relating to Workmen's.Compensa•
WORK NOTED
tion Insurance and RCW 18.27.
SIGNATUR (OWNER OR'GIE DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATTENTIO
CALL. FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
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11
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC /
CHAPTER 3.
S (�
IZ2
BY
17<;�s
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFMdSS1Rl;DATE
O•
RELEASED BY: DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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