1250 BIRCH ST.PDF11111111111111
10312
1250 BIRCH ST
ADDRESS: k9 60 �tI Vi
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
0''
CRITICAL AREAS,,T-bti- DETERMINATION: ❑ Conditional Waiver ❑ Study Required kwaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
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 #:
WATER METER TAP CARD DA
OTHER:
LOT: BLOCK:
L:\TEMP\DSTs\Forms\Street File Checklist.doc
FILE NO. ZDDO--1}
.016cal Areas Check
---------------------------------------=--
Site Information (soil shop oggraphy/hydrology/ve etation)
1. Site Address/Location: (VT
2. Property Tax Account Number:
3.
Approximate Site Size (acres or,
4. Is this site currently developed,
es; 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: NI nviP Approx. Depth:
7. Site contains areas of seasonal standing water: N ov1 ,, ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creel or an area where water flows cr s the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year? ),
10. Site is primarily: forested : me .dow - : shrubs. : mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: ,
.77777.77F,
i. 'r7•lt is Zoned? . •.•. ... t r N < rr. r r ✓ r5 y
y,
3CSnaFPed sorl'type�s)"`'
Netlepd' ivento nor p:tlicat4 wetland present on stfe
:. t✓ritica Att as Itivento yr G A ua `irtr icates Cc>tiea Area>on srte�
; s' . Site Rhin deslghated':eandsit a hazard are g Q
:,;; :.Slte de5tgnateci ors the Environrnen€allensrtivs
p t T P, A M IN. TI..0N r" ,' �' �a`. • : : f� <; ; : :�:zr :,<
?y .•i'Ii _ ..,<.nL.o.•' . n£ c'• ?. , '� _•r--.*.�-:w'+: n,�.. :,�T,NF�7: ;;^+'ii
P:lann� M• # �� '•� ♦ '� x <rT • h S, $ f ��
"a ehkdoc; Rw 1QMM
�• OORECEwED
City of Edmonds MAR 212000
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
CRITICAL AREAS CHECKLISTAQS 15o7S
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/ pplicant:
Name
Street Address
City State Zip
.60go
Teleph
Signature
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
c:recepeionVanakaci.doc
(over)
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No............................................
NEW CONSTRUCTION ❑ REPAIRS
400-09900
OWNER........... Mjt... Pe---MQQdx................................................................... CONTRACTOR--••---------•------------------....------------...........------.............-•----.............. PERMIT No.......................
ADDRESS 1250 Birch St...... ................ LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No. ............................................
................ •
•
•
•
•
NAMEOF ADDITION----••-•..............................•-•--•---..........................................................................................
CDC
Dye Tested On Sewer 1972
Approved:
DATE................................................ By......................---.............................................