1416 7TH PL S.PDF111111111111
7003
14167TH PLS
STREET FILE RECEIVED '.
Critical Areas Checklist' MAR 3 1 WJ
Site Information PERMIT COUNTER
Project Name: ' Fe N C-, Permit Number.
Site Location: 1 LJ 1 % --1 P 1 • S, property Tax Account Number., 31 CO — d ono -7-0l q -d o `
Approximate Site Size (acres or square feet): R
Have you filled out a Critical Areas Checldist for a project on this site before? Iy
General Site Conditions
1. Has the site been cleared or logged?
Date of most recent action:
Soils / Topography
2 In the Snohomish County Soil Survey, what is the mapped soil type(s)? _ I M 6 YYr
3. Describe the general site topography. Check all that apply.
iC 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 of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation ^/
4. Site contains areas of year-round standing water: / O
5. Site contains areas of seasonal standing water: A6 Approx. Depth: _
6. Site is in the floodway(L, floodplain__&a__of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? /Yy flows
are year-round? 0Flows are seasonal? l6
8. Site is primarily: forested 6LO meadow ;shrubs IV) ; mixed
9. Obvious wetland is present on site: A16—
YbAIVER: Critical areas swdy is. not required : .
Determination ;Number. CA 3 "' (0 Reviewer.--.....
Planner Date
Rev 3127/92
ig9
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&cr 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 Cheddist 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 checldist, sign and date k and
submit it to the City. The City will review
the chceMist, make a precursory site visit,
and make a detaminafion 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
of the parcel wid, enough dcfail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
Name
Title
�`I/� p
Street Address
C-A yyw 77 : -323
CA -it. State, ZIP Phone
Signature
Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP
Signature
Phone
Date
cl
APPLICATION
for
The City of Edmonds STREET FILE SIDE SEWER PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS ❑
CARD No. ....... ......... .... ...
EASEMENT ]No. .........................__ _...........
OWNER............................................................. /�..........-fit c?G: f� Y-...................... .
L,� 7 G;................�.../............................... CONTRACTOR ...........
HOUSE No.../ ./..../�....... /.....T.......✓cw T'/................................. AVENUE LOT No AF/5
BLOCK N
BACKFILL WORK ORDER ISSUED ........................................ DEPOSIT, $....
SEWER WORK ORDER ISSUED .......................................
No.(/ /��._% ..
............................................................................................................................. .
NAME ADD .......'L'......1R.
........... ...................... ........ ................... ......... .................... ................ ..........._.....
........
DATE.. .................. 4'.
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