1153 C AVE.PDFIIIIIIIIIIIIII
10490
1153 C AVE
ADDRESS: 1153 1 ��Le _
TAX ACCOUNT/PARCEL NUMBER: l) O 6(,a c- )ba()C) �D0
jb BUILDING PERMIT (NEW STRUCTURE): I [ 3 D 1 q2,&� )e
COVENANTS(RECORDED)FOR:
CRITICAL AREASDETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
PERMITS (OTHER):
r[•�iZi��3r��i.Iv7�r�r�rys��®i�JC��L��l►Lrlut[;���7
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR: o�
WATER METER TAP CARD DATED: 1 Z���O�
LOT: BLOCK:
LATEMP\DSTs\Forms\Street File Checklist.doc
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Date of. -Work
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CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation) .
1. Site Address/l ocation: /
_( t9 3 C.,
2. Property Tax Account Number:
3. Approximate Site Size (acres or square f
4, is this site currently developed? des, no.
If yes; how is site developed? 7i��.�� s_
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
RECEIVED
J U N 1 6 1994
PERMIT COUNTER
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-few).
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: lo ; 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 coarse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? 111J (What time of year? ).
10. Site is primarily: forested ;meadow ;shrubs ;mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: IflIQ .
U
0
°'90•19"
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 Fdmonds 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,
1R CF
J01 6 1994
PERMIT 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:
ame
Street Address
Applicant Representative:
Name
sued Address
Phone City, State, ZIP Phone
Date
Signature
Date
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS f-I
OWNER ........ ........................ CONTRACTOR
------- ---- -------------------------
STREET
HOUSE No. & .............. c ........ ......................... AVENUE LOT No.
NAME ADD . .............
15
a 60'
0
Date Y
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .................................
SEWER WORK ORDER ISSUED ..........................................
CARD No . ......................
EASEMENT No . ......................
x4e� ----------
---------- 7& PERMIT No. ..... ....
---- — ---------
.................................................... BLOCK No. ...............................................
................................................................................................................................
Approved:
DA. . .... .. ....... 13 . ..... . .... ......... .. ................
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e 6APP, .. * p D APPv�. .
Building Department Permit t,t,nis:on Yaar s
CITY OF'EDA,IONDS }
•
1 t to construct the following :vork m accordance with tho accompanying Plana M'
APPLICATION' is hereby,mad.e for n parml
Y +r and specifications: No Sta Sec
Ground Area..:_....._
/ r ......_.....-.. -
��t�.�,r-tee � ..
WORK
cnst ...... .....................
_....:
_.:.... ................ Use Zone
Cope•
' Plans Submitted � <....- ...... Height_:
q r/J �' Fire Zone
// rr ..... ........._....
-< • • Address ...11.-1..`3..__........ `..............
- LOCATION — o
°ow ra$e
` - Recorded Lot.........:.••... Bloc:r_..._............. Add'n........................
•�_J._...• Sid ._
Min. Bldg. Setbacks, Front and Rear .•
` Width.. .......... ..-.... - ... r 3
ELot Area-.--.-.-.-..._....._...............�
phone
Ar
't // !` "'•••- .....,. J�
d1-...........
A(.
... _................... .
owner.Si" t
......... Phone..
r r ........ Address.........._..._..................................._.....
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plansby..._.._._._.--...__._..-...._.................._..........................._....-...-...........-.._......................_. ... ..
Addrea�...
Phone
-Bldg ._..._-...._...........
............
1
Phone 1.
Address• ................ -..
Fltg. by... —...-
f
Phone �•
1 . - • . .. � -'......................... Address .........................
4 Heating by.--_.._......_..-..._..:..._.............................r
Phone
....._----_......._.........................
Address ........................................... vc 1 +
- - Elect by...____.-_...... .'.
- .....-...... „ •..;.,,rye
t Remarks .
. .. -...
t,
k-1
_......................................................_..............................-._..................._-.........
_... .._.._.
- ltin the work '•'
...____.-..._...._....-..._._..... with all applicable Codes and State Laws regal, g • .:, '.�a" ,- _
The above is a correct' statement and I agree to comply _ (O/�J' `�r'•�/
r t1L-•� _.. Date. { �•-;` E ?.`A
AddresG
C✓csl� a ..�.� J' e...`..=•-•'• ... .... ......................
Signed: Owner/Agaat.. �—`•�- t 7 zi
�-
4,
pp6tMIT for the above work is hereby pertinent notationsbject to thereon. a above conditions, ar,4 to compliance with the apPro' P s r Y
and specifications and Bull g PERMIT',PF,ES'17
VALUATION (Jg. Bld.... S:(Oa..
O
1
Host > .. n, r�
.APPROVED: a q� � �� �v`•4"i�+c�� l
Elect ...,. f.........._. 1 2 C•.
Date...7.. ....•.........................................
aw
/ others
BUILDING DEPA:RTJvTE1TT / �/� ' � ' }t • • '�
BYR�. �•............";..TOTAL FEE�:T g
xiFe�,
Engineer'b inspection ahail be covered before inspection and approval
NOTES: No work regg ng Building Department City neer prior to consirvctlon of all site utillttea; such
Twenty -Pour ('.'.h) hour notice requested. Contact the City Eng
curbs, paving, driveways, sewer, water and street connections.W.