204 4TH AVE N.PDFiiiiiiiiiiii
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204 4TH AVE N
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ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
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EM2
CRITICAL AREAS:- DETERMINATION: El Conditional Waiver F1 Study Required A'<aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): Cfy= -
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:—
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LID
LOT: BLOCK:
LATEMP\DSrs\Fomis\Street File Checklist.doc
APPLICATION
ST"'PET FILE 116r
The City of Edmonds SIDE SEVVER IPXRMW
NEW CONSTRUMON [] REPAIRS 0 EASFJ*na-rr No . ..........................................
114-ol45o
OwNER ........... RAu.1 .... Bu.r.ke ............................. ........................ CONTRACTOR .................. ...........
...... .. ...... ........................... .......................................... PERIM No. .— ..................
ADDREss ..... -2.0.4 .... 4.th ... ................................................... LEGAL DESCRIMON: LOT No . .......................................... _.. BLOCK No . ............................................
NAME OF ADDMON ............... ..........................
Dye Te*ted On Sewer 197?
Approved:
DAW................................................ .................... .................................................
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?,o 4- 4414 AvT, � Al
e Fence must be located on private proper-6r--
*Property owner responsible for determining
property lines.
11
eFence shall not enclose or prevent access to
any City maintained utilities. I I
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RECELWED
APP, 2 8 2005
PERMIT OUNTER
Ll
STREET FILE
CITY OF-EDMONDS
BUILDING DEPARTMENT
WORK
ADDRESS -
�t.,PRROVED DATE:
OFF1
NUMBER
#P20
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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. The information
needed to complete the Checklist should be easily
available fi-orn observations of the site or data available at
T 1- -1 fill- 6 --
Date Received: !4150�1
City Receipt #: J WP 7V Z—
Critical Areas File #: I
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant- ... I
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 pertinerit
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, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infi-action based in whole or part upon false, misleading, inaccurate or
incomplete information ftimished by the applicant, his/herlits agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to behalf of the owner as listed below.
SIGNATURE OF APPLIcANT/AGENT DATE
Property Owner's Authorization
By MY signature, I certify that I have authorized the above, ApplicantlAgent 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 -
Owner/AppUcant-.
Name
Street Address
C-7 0 A4 0 A) 10 S WA q�02-0
city State Zip
Telephone: 4Z-�; -ni5 IA-715
Email address (optional): Q+e-ve N e,; ko- i +,on
iVt-W1A17-;-U44
DATE 4-1-&-1 lob � .
Applicant Representative:
Name
Street Address
City State zip
Telephone:
Email Address (optional):
#P20
CA File No:. 05-5 9
Critical Areas Checklist
Site Informatioh (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 7-,o4, 4�+h AV-s �j
2. Property TaxAccount Number: - 00,4-34-4-000012-00
3. Approximate Site Size (acres or square feet): -79-74,
4. Is this site currently developed? � yes; _ no.
If yes; how is site developed? ?-6--s�0fVC-E
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 5 0� ld;' its &n3qj' `�k Al -nse of !C4eet*,,'
till it I
over. a horizontal distance of 33 to 66A.
Steep: grades of greater than 30% present on site al rise o&OM"Mo X1 lwri-imw
distance of less than 33-feet). k J I A
Other (please describe):
Site contains areas of year-round standing water: LJO ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway PO floodplain V 0 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)
11. Obvious wetland is present on site: U 0 0 t-:7
For City Staff Use Only
1. Plan Check Number, if appficable?
2. Site is Zoned?
3. SCS mapped soil. type(s)? S2,q, 0 G'� n' - !a 0""S
C-1 aa.&,C2 A
4. Critical Areas inventory or C.A. map indicates Critical Area, on site? t4(p
Site within designated earth subsidence landsfide hazard area? t�,r� �nr-r,�q t, t4
0
DETERMINATION
STUDY REQUIRED -WAI[VER
Revipwpd hv- —'V-1 Date: