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19017 83RD AVE W
of U& Date Received: OG I I -A / SOO-9
Oki"
'041M City of Edmonds
Development Servic
, Wca tv E a� City Receipt#:
Planning Division Critical Areas File M GA. 65�Oq I —
Phone: 425.771.02�O JUN 2 12005 Critical Areas Checklist Fee: $135.00
-Date-Mairled-te Applicant: JAfL-2,006
%gri Fax: 425.771.0221... — !F�41 1 1-5 I&t
The Critical Arras 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 the application to the City.
The purpose of the Checklist is to enable City staff to
deterrnine whether any potential Critical Areas are, or
may be, present on the subject property. The i ' nformation
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).
A property owner, or his/her authorized 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns., in, consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or *part upon -false, misleadi , inaccurate or
Ing
incomplete information furnished by the applicant his/her/its agents or employees. -
By*my signature, I certify that the information and exhibits herewith submitted are true.and correcit.to the best of my
knowledge and that I am authorized to filefl4is application on the behalf of the. owner as listed below.*...
IATE
SiGNATuREoFAPPLIcANT/AGENT
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply f6r the s�itject land use application,
and grant my.pem-dssion for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to is 4pplication.
-7
SIGNATURE OF OWNER /a� s4A�(
DATE 4141
Owner/Appficant-.
1-14
Name
.Street Address
Z�Dlq6 A10 J P-4
City State Zip
Telephone: iIZ5-- ZZ-Z-�',57
Email address (optional):
Applicant Representative:
c 66w6AIJ
Name
/�?d/ 7
Street Address
City State. ZIP
Telephone: �Z/
72- 7— �'6
Email Address (optional): <VCI��Llews& d>zf
Critical Areas Checklist.doc/4.22.2003
Critical Areas Checklist CA File No.
Site Information (soils/ topography/ �ydrology/vegetation)
1. Site Address/ Location. 7
2. Property Tax Account Number: 6z��) lea' 0 0-5-0 q60 &�;-o -30 0
I Approximate Site Size (acres or square feet): Z4
4.1 Is this site currentlydeveloped? _yes; ��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).
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: Approx. Depth:
7. Site contdris areas of seasonal standing waten' J0 App riox. Dep th' :'
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 ffie groun ds.surface? Flows are year-round?
AIA Flows -are seasonal? (What time of year?.
10. Site is primarily. forested 0 . rn . eadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) �10q)06
11. Obvious wedand is present on site: A/0
�b 01�p
---For City Staff Use Only
1. Plan Check Number, if applicable?. N p n4e/ Aivm-
2. Site is Zoned? P- 5 10
3. SCS mapped soil type(s)? E5* A� civywood Uyelo" L-and LOMPle4— 1— 9 q. 6.
4. Critical.Areas inventory or C.A. map indicatesCritical Area on site? N Me., 6VIOWA -
5. Site within designated earth subsidenc e landslide hazard area? No. 51.464Aq OfiiGiM tD
May-c; finA.l df,�-Pwm I n a-h on
,DETERMINATION
STUDY REQUIRED WArVER
Reviewed by. j2d Aj�44 " t Date: 0::� D I I/V 0'5
Critical Areas Checklist.doc/4.22.2003
APPLICATION
The City of Edmonds STREET FILE for
SIDE SEWER PE IT
NEW CONSTRUCTION 7MREPAIRS
,:�- y
OWNER ...... #
............................
ADDRESS ... ............. 53? .... 1q.. ... .......... /I. ... ) .... C.s ......
E
0
LYNN PLANT
EASEMENT No . ..........................................
10
CONTRACTOR ..... lr2
......... . V.-OAP.,ro-Al ---------_--- PERMIT No.
/ i ( ? .. ft
LEGAL DESCRIPTION: LOT No . ....... ... ltf ........... BLOCK No..... ED -------------
A R
NAME OF ADDITION .... ........ ..... I.Y7.6— .4
"Ic - $67 .............
-500(4,649-Al 7',?PctJ 19 Alci
067S7—
Approved:
DATE............... By ......................
NOTICE:
Nb--warranty--OT -a. c .:d (-., Y
The Jinformation'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e City of �Edm.qnds does not . wa rra nt the
accuracy of anything set forth on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
-t-Fe -m a p (s) , including, but not limited to,
th'e lociation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the �ity of Edmonds nor its
emp-l-o-yee-s o-r office,rs -sh-a-1-1 be lIa-b-1--e for the
i n
information give on this ma p(s), nor for
any one representation provided based
upon . said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER— WATER -SEWER DEPARTMENT is ready for inspection. (No inspec-
tions Saturday, Sunday or holidays.) N2 2031
SIDE SEWER PERMIT
H.C. Stevenson
ADDRESS................. ...................................
OWNER ..................... 190.1,7 ... 8
.3.r-d ... kvajauv .. Xe_at --------- cONTP.ACTOR.RU.a,,9-el)----JQ-jlrl5.QXL ..................................
PerInission is granted ...... Apri ' 1 - 1 - 7 ............... ......
------ ** ..... 1q..67, for ------ ----------------- days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a Permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. 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; minimum grade of 2%.
No bends in grade shaxper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE; No. 5—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-
tenances except to insert the pipe into the wye.
Z
U
CITY OF EDMONDS Permit No.
COMMUNITY SERVICES DEPARTME Issue. Date
RIGHT-OF-WAY CONSTRUCTIONpi TIREET FILE
A. Owner: Washincrton Natural Gas Co B. Contractor:
Name
805 156 AV NE
Mailing Address
Bellevue, WA 98007
city State Zip
Address or Vicinity of Cobs1tructi,oW. Z!�l
Type of Work to be Done!v,",�� Insta
Same
Name
Mailing Address
City � State Zip
State License Number
Work in Connection With: 11 Sub or Plat 0 Single Family
0 Commercial 0 Multifamily
Pavement Cut: 0 Y 0 N
APPLICANT TO READ AND SIGN
447-0700
Telephone Number
0 City Projects
29 Utility
F�
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the, City of Edmonds
>, harmless from any injuries, damages, or claims of any kind or description what§oever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this perniii.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
0"`YEAIU�1701]LOWING -T'HE=�FINAL�-INSPECT�ONzA-ND4A-C- CEPTTAN.CRE4 OF--T-,HE-,WORK-;:.-
0
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit' ot.cre'ilivwilfbe processed for issuance to the applicant.
0
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept.clean at all times.
• Traffic Control to be in accordance with City regulations.
.0 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature. Date: 12Z15/88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
>� ISSUED BY: (_//J - PERMIT FEE: � J 0 - & 0 �-A /"(- AC-66e
Z Time Authorized: Void after Ee"? —days. Security Deposit:
0
Special Conditions: Receipt No.:
Fund I I I Fee:
Amendments: Street Cut Dimensions:
U
W. X
0
"4
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
41
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
I Diagram:
0
CONTRACTOR CALLED FOR INSPECTION D YES 0 NO
Partial Work Inspection by, P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
cng. uiv. it
a ET 161.68
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