19303 80TH PL W.PDF111111111111
7272
19303 80TH PL W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: -
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
DETERMINATION:E] Conditional Waiver 0 Study Required X'Waiver
SEWERLIDFEE$:- LID#:. 3-Y
SHORT PLAT FILE: LOT: BLOCK: -
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
L\TEMP\DSrs\Fomis\Street File Checkiist.doc
9 .0
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: I S -21 - L U_-�e 5+-
2. Property Tax Account Number: _W5 -1-z,-7 o0oc) t ot?
3. Approxfinate Site Size (acres or square feet): Soo--> pl-
V
CA File No: Q001 0
4. Is this site currently developed? _!��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: V1 0 Approx. Depth:
7. Site contains areas of seasonal standing water: 0 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Y)O floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawn, shrubs etc) >!�
N
11. Obvious wetland is present on site: V10
For City Staff Use Only
1 Plan Check Number, if applicable? 14A
2. Site is Zoned? !C��
3. SCS mapped soil type(s)?
4. Critical Areas inventory or C.A. map indicates Critical Area on site? &L,
5. Site within designated earth subsidence landslide hazard area? - an,
DETERMINATION
I&R,
STUDY REQUIRED
Reviewed
-WAIVER
Feb 21 07 12:08p UW-A Medicine/RETRO.LRB. 206-34,L&5237 p.2
#F20
City of Edmonds
Dcvciupmcnt So -vices Dqmftent
Planning Division
Phone-, 425.771,0220
It" w1w Fax, 425.771.0221
The Cntical Arcas Chcoklist contained on this form is to
be filled out by any person pmpwing a Development
Permit Applicatioib� for the City of Edmonds prior to
Wvlw submittal of the: application to the City.
7be purpose of the Checklist is to enable City buff to
deUnnine 'whether any puterAiRl Critical Areas an, or
may be, pmgcnt on the sub)cct v6perty. The information
needed to complete the Checklist should 1:�-- easily
available from obscmdons of the site orr data available tit
City Hall (CriticW arnu invc:nturim, maps, or soil
=WYS).
Date Received:—,-,,,V !Q / 0' -r-
City Receipt #: L7A i T- r g 4k.
Critkal Areas File$: —')M-7 OrJolq
Critica I Areas Checklist Fee: $136.DO
Date Mailed to Applicant -
A propetty owner, or hiOm authoriwd m-presentative,
must fill out the obcoklist, sign mid date ik and submit it
to the City, The City* will review the cherAlist, makc a
pTccursory site visit, and milce a dettrtnihation of the
subsequent steps necessary to complete a devclopment
pennit application,
Please submit a vicinity map, alongvith the signed copy
of this form to assist City staff in finding and locating the
Specific piece of propaty described on this form. hi
addition, the applicant shall include otber pertinent
infomtioD (e,g, 5ita plan, topography Trmp, etc.) or
studies in cvnjtmction with this Checkligt to as3istAnt staff
in completing their preliminny assessmtmt of the site.
The undcMpgd applimt, and NOwlits hwixs, and ussigns, in considention oft the pruccssing ofthe application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, "ing from any ncfiun or m-fraction based in whole or part uporn false, misleading, inaccurate or
incontplete infb=tion A=ishcd by the applicant, hi&therlits agents or employees.
By my signature, I certify that the information =d exhibits heremnth subn-dtted are true and correct to the best of my
knowledge and that I am authofized Ifabon on the bchalf of the owner as listed below.
Slompin oF A"LicANT/AoENT DATI
Property Ownees Authorization
By my signature, I certify that I have authorized the abow Applicant/Agent to apply for the st4cct land use application,
and grarit my peftWon for the public officials and the staff of the City of Edmonds to enter the subject proper-ty for the
purpom of inspection and posting attcndanA this applic4ron. /
Owner/Applicant: �� P, 11 VD
LLLLUI-- WA 44
-Z
,0 2,— -00 C4,,,
Street ��
L,— d vvt-o vJ> Y:��
city State Zip
Telephone: W -7
Email add;ress (optional):
Applicant Representative-
F---i I C'�> C(�'-> -�-' P, C-
Name - --
/-� --�
Street Address
City Stale Zip
Telephone: DO6 (-(7 Z.
Email Address (optional): _
0
6--09- -7"K-
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edmonds does not warrant the
accuracy of anything set for.th on these
map(�-). Any person or entity'reque sting a
copy should conduct an independent
inquiry regarding the information shown on
t-Fe -map(s), including, but not limited to,
the location 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 City of Edmonds nor its
employees or offi(cer-s -sha-11I be hab--le for the
information given on this map(s)', nor for
any one representation provided based
upon said map(s).
APPLICATION
for
The City of Edmonds SII)E SEWER PERMIT
Ale )5 C, NEW CONSTRUCTION REPAIRS
OWNER....... .....................
ADDRESS ........... ..............
10
0
M.Ml PLANI�*
EASEMENT No . ..........................................
CONTRACTOR --- I ...... (.",-P ....... I
-- ----- ..... ............................. PERMIT No.
LEGAL DESCRIPTION: LOT No. /."Y ............................. BLOCK No . ............................................
NAME OF ADDITION ........ - ------ �- ju .-.< ........
/0�0--k 3�
Approved:
I
DATE 017��196,7 . ....... ......................
/I —, .......... . .............. By
APPLICATION
0
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION M REPAIRS F1 LID NO - ------------------ IASMT. NO . ..................
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR .................................................................................... PERMIT NO . ....................
JOB ADDRESS ..................................... ------------------------------------------------ LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO - ------------------------------------
..................................................................................................................................................................
NAMEOF ADDITION .... .............................................. ------ ------------------------------------------------------------
Approved:
DATE............................................ By ............................................... ............
11/75
'�4
7
7
- C ITY'DF -'EDiVt0Nbt'
C�I, PRosp�cf-- 6-ft07 *lien*-,,w rk
CIVM'CENTER — WATER -SEWER DEPARTMENT .t � I � -. - I - ...o
Is ready �fior: ft!sp�ctlo . n.� IN I o. ifispee- 1904
tions Saturday,'Sunday or. -holidays.) N2
S I D E. S E W E R-:-� P E R. M IT'
80th'Placei-West
19303,
A-DDRESS.'
............................ : ...................................................... ..........................................................................................................
1. 0 & Judith Kennedy C.-E.Ui Constr.
OWNER.................... ................................................ ......................... �CQNTRACTOR ................................................................................
Apri.1.3, 67
Permission ls� granted . ...................... ...... I ................ V. 19 for .............. ; ...... days, to REPAIR or CONNECT a side sewer
7
with City Sewlers'lh:aecilrdanee with �ap�llqatlon on file and governing oid, triances.
ATTENTION IS CALLED TO THE -FOLLOWING:
NOTE No. 1-9�he owners of the property may obtain a..permit to. construct, sewer inside property line.! A licensed. Side Sewer Contractor must
�ecmployed to construct side sewer in street area: -Do not cover any portion. of -'sewer. -before it has been inspected.
NOTE No. 2—Obtain full Anformation regarding Ordinance 11.A.030 - and-Rejulations gove�rnlng side sewers.when you.get permit.
N&E -No. 3—Top � f'side sewer must have at least 30 inches- coverage at property. line- and 12-ifichei inilds -property -line; mint urn grade of. 2 56.
0 . _ . — - m -
No heads in grade sharper. than '/a willl be p rmitted.
'OTE No. 4—Trenehes In street must be water settled and surfa:ee of street restored to. original condition. Contractors shall be.responstble for
failure due to Improper work which may develop within one on.
year of complett
NOTE No. &--It Is unlawful to alter: or do any other work' than Is -provided 'for.in the.permlit, or to 'do any work on the main sewer or Its ap-
purtenances except to insert the pipe into, the wye.
7
OPUBLIC MRKS DEPATMIM CHECKL Date'
BUILDING PEK�T-r REVIEW
STREET FILE
W- Address
I 'Street Right -of -Way Existing .400 !F;, C,)
REQD NA'.
Access.Easements Existing
REQD x5 /2-:5 110
Utility Easement Existing
REQD
1,ot per.Subdivision Plat Assessor
Map
Site Plan Checked for Accuracy
51-2-25,170
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
Envirormientally Sensitive Area
0
Environmental Checklist Read.
J�lo
Z'
Flood Hazard Zone
-Shoreline M�nagement Area
0
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
NID
Existing Zoning Per.Code
Amenities Design -Board Approval Reqd. ADB #
Approval
Board of Adjustment Approval Reqd.
Review By: K� Ldhuka Date:
1
15/2,3 OP
! I
_,! 11 111 1
Existing Water Main Size
Ater Main Reqd.
S Line Reqd.
Hydrant Size ting
Hydrant Reqd. Per I de Size
Detector Check Meter Re
Cross Connec spection,
partinent Comments
Water Meter Charge Reqd.
Review by: Date:
Sanitary
ty
Drawing No.
Side Sewer Availability
Sanitary Sewer Connection Fee
Review By: f7�
Proi -
File -
Date:
h Lng
Open c . Exi s ting
�Reqd.
Culvert Reqd.
t e
Size
P4 Catch Basin Reqd. �:::�dicdte on Site Plan
0
Shoulder drainage mintaiii c on swale open rLmoff
Indicate te Plan�
Conditions and Groupd Water Field Checked
by Date
tre ving Re"qd.
Curb and Cut e d.
Sidewalk Reqd.
Curb Cut for Driveway Req*d...
c4 Right -of -Way Conistructi t.Reqd.
Bond Reqd. . f lic Irrprovemnts
S tr am, Sign Reqd.
ther Signing Reqd.
AAAA
Pre
it Site Inspection made on
0
F-1 F-4 BY: SE1,JTER.
WATER
STREET
ENGINEERING
Wr mr-mr mr W W W 7W mg W VW
W'lk- 1W
IMMALAIMMIA
XL Im
0.4 Special Requirements listed in mem to Commmit . y Development Departr�ent,
-4 Building Division
> BY__N__o t e
0 All item filled in on Building Permit Application
04 BY Date
44 Drmqings Stan-ned and Notations Made
BY Defte
Approved by Public 1%lorks DeparLinent:
Revised: IV 10-1977