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20205 84TH PL W
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TAX ACCOUNT/PARCEL NUMBER: 0Q7&6b0c)U6c-)0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS DETERMINATION: E] Conditional Waiver E] Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE &
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S),#: (0 7!�Eq
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
LID #:
BLOCK:
L:\TEMP\DSrs\Forrns\Street File Checklist.doc
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Critical Areas Checklist CA File No:.C10 -2-DDi ' 00 110
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: ;2_0;?0_5_ 5r4le4 4 ce &lk-37L
2. Property Tax Account Number: ( )67 1 � /0000 14 0 0
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Ylyes; _ no. 6te 5*14,
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change ove,r entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 664eet).
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 contains areas of seasonal standing water: //0 ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IfId floodplain AV of a watercourse.
-9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
/UU - Flows are seasonal? /V 0 (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) X 9;-cr.55',,5 Avuj,2.1,
11. Obvious wetland is present on site:
----------------------------------------------------------
For City Staff Use Only-_M26Qj_P
1.
Plan Check Number, if applicable? -&/A
2.
Site is Zoned? ?�� 19
3.
SCS mapped soil type(s)?
4.
Critical Areas inventory or C.A. map indicates Critical Area on site? �jo
5.
Site within designated earth subsidence landslide hazard area? �4o'
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by: Date:
Critical Areas Checklist.doc/2.17.2004
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City of Ed
Development Service
Planning Division
Phone: 425.771.0220
s9z
Fax: 425.771.0221
monds
s Department
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 the application 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. Thp 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).
Date Received: i I A (og
City Receipt#: 11-Y � �AVY
Critical Areas File #: GV-P, -1W1— 0—
Critical Areas Checklist Fee:. 135.00
Date Mailed to Applicant: VA /aool
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, misleading, inaccurate or
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 correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE /—/?, --0 7 .
Property Owner's Authorizati6n
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission 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 this application.
SIGNATURE OF OWNER DATE
Owner/Appli�ant:
aqlkle,571 J a I,
Name
1� 0 20 z��14 CC_
Street Address
e047 on
city State Zip
Telephone: 7 A -5-- 731-1677 3
Applicant Representative:
Name
Street Address
city State zip
Telephone:
Email address (optional): Email Address (optional):
CITY OF EDMONDS
PUBLIC WORKS DEPART * T FOR INSPECTION CALL & Permit N? 6784
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
LU 1.
�j 2.
a:
la 3.
4.
PEP -MIT MUST BE POSTED ON JOB SITE
Address of onstruction
Property Legal Descri2tion (include all easements)
Single Family Residence
Commercial
Owner and/or Builder
Multi -Family No. of Units
W&Z�
5 Contractor & License No. "b"I UAr CW Z1 Rk
CO 6. Invasion into City Right -of -Way: No K Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
E-4 7. Cross other private property: Yes Nollc Easemej%je4gi d -
%44 W6URS
U attach legal description and county easement number
H BEFORE YOU DIG,`
0 READ THE FOLLOWING AND SIGN:
W - 562-.q4Z&
a. Property owners must obtain a permit to install side sewer
>4 their property' A licensed side sewer contractor must'be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
E-4 installation for one year.
W
0 c. Co.-mnercial establishment requires a minimum of a six inch (6")
a4
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade of 2% (1.15
0 and maximum grade of 100% (450). 0
E-4 f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice r red. RECENE"')
/ �( 74 VILA�� �ku�
DATE: NOV 19 1981 - - _= -0-
"I certify that I have rea
and shall comply With the above
PERMIT FEE: as_�, DISAPPROVED BY: Date:
UW ; By: Date:
tn S-,00
A4 �:) - e>? APPROVED By: Date:
0
44 PERMIT MUST BE POSTED ON JOB SITE
CITY OF EDMONDS
F)c]NEW
ADDITION
RETIREMENT
&ET INFORMATION SHEET
ASSET NO. c�> 3
TO ASSET NO.
STREET FILE
DESCRIPTION
111t v t c- of
SERIAL NO.
LOCATION DEPT. NO.
2-
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO. �(// —roo,
ESTIMATED LIFE z,5'
PROJECT N U M BE R tr"� I— ?/ 42
PROJECT COMPLETION DATE 12-31-61
COST 9 ? , 7-�—
INITIATED BY DATE APPROVED, BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
DATE
VE1110114D 13Y
PROCESSED.
BATCH N
INITIAL
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DEPARTMENT FILE