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17309 72ND AVE W
City of Edmonds
"kW 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.
Please submit a vicinity map alone 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 iny knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
/ 7 3o� 'Z2
Street Address
64"W"e-zi 1,14- C
City State Zip
-2 5— �e 06 7
Teleph
Signature
S-Afl,�'7
Date
c:recepfion\jana\cac1.doc
Applicant Representative:
Name
Street Address
City State Zip -
Telephone
Signature
Date
(over)
CAFILENO.
Critical Areas Checklist
---------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 17362 75� Ole "f Z,-,
2. Property Tax Account Number: V 0 0 c, 'po 2 C.; -jr-
'JI
3. Approximate Site Size (acres or square feet): '7/ 11-8 572
4. Is this site currently developed?
,Zyes; _ 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). 7 -14t� , 5- e-7-
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).
I
Oilier (please describe):
6. Site contains areas of year-round standing water: 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 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? L-V Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc) I--
11. Obvious wetland is present on site: P a-
Environmenta y ensi ve A*
SAe:desig*nated':bn: the ti* reas Mdp?
DETERMINATION
L (au-c
APPLICATION
for
W The City of Edmonds SEDE SEWER PERYaT
EASEMENT No . ..................
W CONSTRUCTION REPAIRS
Z—
OV*rNER ..... ......... ............................................ CONTRACTOR .......... ........ .
...... K16 ... ................................................... PERMIT N . . ......... .
ADDRESS --- ------- - 7.2 4 �,e-
........................................................................... LEGAL DESCRIPTION: LOT No . ............................................... BLOCK No . .............................................
S0,71 70' cir 6e
NAME OF ADDITION ---- 1-36 ----- . .........
L-Y--
7
0
0-
-Lpprovea-.
..... . . . .............
DATE..e...- OZT.n..2-0 .........
.... . ..... .... ....
N. .
CITY OF EDMONDS
Call pRospect 6-1107 when work
CIVIC CENTER — WATER�SEWER DEPARTMENT is ready for inspection. (No InsPee- N2 3810
tions Saturday, Sunday or holidaws.)
SIDE SEWER PERMIT
17309 - 72ND AVENUE WE S T ........................... . ....................................................................
- - --------
ADDRESS ----------------------------------------------------------------------------- :N BACIME SERVICE
BOB AKLI
'TOR z=xzxnW2xxxF-W2x
OWNER----------------- ---------------------- CONTRAC ................................................................. --------------
EXXX
19.70 for ........................ days to REPAIR or CONNECT a side sewer
permission is granted --- AUGUS-T-21 ------------------ ...
with City Sewers in accordance With application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
NOTE No. 1—The owners
be employed to construct side sewer in street axea. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full information regarding ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top, of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; m inimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trench es in street must be water settled and surface of street restored to original condition. Contractors shall be respons ible for
failure due to Improper w ork which may develop within one year of completion.
No 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or Its appur-
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tenances except to insert the pipe into the wye.
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