20426 86TH PL W.PDFIIIIIIIIIIII
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20426 86TH PL W
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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 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 infor m-ation (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 my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
Street Address
city State Zip
Telephone
Signature
'--y- /'-� e-IZ2
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
0
c:rccepdon\jana\cac1.doc
(over)
CARLEN0.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil s/topo graphy/hy drol o gy/vegetati on)
I .
Site Address/Location:
2.
Property Tax Account Number: 000 _0 0 00
3.
Approximate Site Size (acres or square feet): /2,000
4.
RQ
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.
L,--�Rolling: slopes on site generally less than 15 % (a vertical rise of I 0-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 I 0-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 a reas of seasonal standing water: AleO 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? 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:- A=10
- ---- — ------------------------------------------------ For City Staff Use Only ---------- m�� ---- ---------- ----------
I. Site d� 11 j
..is Zone
SCS mapped soil type(s)l P 41 1� d
:3. Weiland ihventory'or C.A. map indicates W'etland present on site� L)
.4. Critical Areas inventory or C.A. map indicates Critical Area on site?
.. . .........
:�5i Site:within: designated earff subsidence:landslide hazard: area?
:.6. 'Site designate . d o . n . the . Enviro . n . mentally . S ensitive Areas Map? /V
�0_chk,doc; Rev 10/03/97
PLANNING DATA
NAME:
SITE ADDRESS: DATE:
ZONING: PLAN,CHK#:—
PROJECT DESCRIPTION -
CORNER LOT— 1Jb (Yes/No) FLAG LOT AL (Yes/No)
SETBACKS:
Required Setbacks:
Front: Left Sided 0, Right Side:1(6) Rear247
Actual Setbacks:
Front: Left Side: Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
LIEGALNO NCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed:- Actual:
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?:
CRITICAL AREAS #: it�7 WRA AIRA"
SEPA DETERMINATION: IV]-7f
RECEIVED
City of Edmonds APR - 51999
DEVELOPMENT SERVICES CTR.
1,�W CRITICAL AREAS CHECKLIST i P T ur cumvrwo
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 Pnyicinity map along with the si d
gne
i fo
copy of this 0 staff in finding and
locating the sp ciric piece owroperty described on
this form. In addition, the applicant shall include
other pertinent infor m-ation (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 my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
IZ9
/ - 0 ;Eox
Street Address
AFXIJRO��'
City State Zip
Telephone
Signature
Date
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
c:reccpdon\jana\cac1.doc
(over)
Criti c*al Areas Checklist
----------------- --------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address[Location:
2. Property Tax Account Number:�_�Z/ V-
3. Approximate Site Size (acres or square feet): 12, 0 0c, t:T
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.
4:::��Rolling: slopes on site generally less than 1.5% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
han 30% ( a vertical rise of
Hilly: slopes present on site of more than 15% and less —t-'--
I 0-feet over a horizontal distance of 3' ) 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: 1(_Ie�) 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 erounds surface? Flows are year-
round? �&C) 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: &,�o
-------- — ------ — --- - ----------
For-City -Staff Use Only --- — ------ — - ----------
:I:. sitels'zonedl
.1. SCS mapped. soil. type(s)? )e
�3. Wetland inventory . or C.A.'mdo indicates we'dand pres eint on site? Z>
4. Critical Areas inventory of C.A. map indicates Critical'Area on site?'
Site within designated earth subs idehce landslide. hazard area?
Site -designated on the Environmentally Sensitive Areas Ma"
DEMMINATION
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ItECEIVED
By F A NING
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APR - 51399
DEVELOPMENT SERVICES CTFL
CITY OF EDMONDS
S Tj R E 1T,E,- FILE
Cc
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
FAKI c
STRUCTION El REPAIRS E] LID NO - ------------------ ASMT. NO - ------------------
OWNER ---- (qAkV-lN ...... I -&--
.a ------------------------------------ CONTRACTOR ---------------- --------------------------- --------------------------------------- PERMIT NO - --------------------
JOB ADDRESS --- 2,04-2.(0 ---------- 8-67-V4 ----- PL, -------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO.
--------------------------------------------------------------------------------------------------------------------
NAMEOF ADDITION -------------------------------------------------------------------------
9 9
7-G2S-7'(-=_D 0" C;e\jAJE, R,
Approved:
PWW-0001 -11/75 (REVA 1/78) DATE ------------- ------------------------------ By --------------------------------------------- ------------
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CITY OF EDMONDS qW o EV FLE
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PUBLIC WORKS DEPARTMENT n
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
0 Owner: m6ei", A Za P
Na;ne
120 1 eld- t/1
I A ess
— � � -19-4— —
City, State, Zip Code
0 Contractor:
Permit No.
Issue Date
0 Permit Issued To:
9 Type of Work to be Done:
• Work in Connection With:
0 Sub or Plat X- Single Family
0 Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: E] Yes El No
Name —r—
M*i , Addreeps S.tate License Number
Afteor �s W
City, State, Zip Code Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's 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 permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permi ust be avai4IS at te job site for inspection purposes at all times.
1 2M "� ;� _, F
Signature: - - - 11 — I - _ _" -�o 0 Date ��JaLr
Vwfner or Agent 74
THIS PERMIT MUST BE POSTED AT THEJOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By
Time Ault�®rizecl Void after —rn,?�days
Special Conditions:
Ammendments:
Permit Fe - J �c
Security Deposit:
ReceiptNo.:
Fund I I I Fee:
Street Cut Dimensions
— --- X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
Ilk
,,o,61LDING DIVISION W . Applicant Fill
PERMIT APPLICATION Inside Heavy Lin
E JOR NAM OF BUSINESS)
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CITY _��TELEPHONE NUMBER
NAME
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ADDRESS
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M CITY TELEPHONE NUMBER
N A��F
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CITV�'
T.CLEPHONE NUMBER
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U STATE LICENSE NUMUCR—CITY LICENSE NUMBER
7Legal Description of Property (Show Below or Attach Four Copies)
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--W,� M I T
ZONE NUMBER
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JOB
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L LEGAL
E�-AL DESCRIPTION I SU13DIVISION I SHORT SUB No, r
NEW
RESIDENTIAL GAS
11
El NON-RESIDENTIALI
LINE
1:1 SIGN
ADD
DEMOLISH
RETAINING
DWALL
ALTER
EXCAVATE
R OR FILL
FENCE
I_ X_FTI
REPAIR
PRE -MOVE
1:1
INSP.
swim
POOL
Z NUMBER OF STORIES
NUMBER OF
J
DWELLING
UNITS
NATURE OF WORK
TO BE DONE
it
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, PLOT PLAN
In "Applicant, on behalf of his or her spouse, heirs, assigns and
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.J successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and
agents front any and all claims 'or damages of whatevcr nature,
I arising directly or indirectly from the issuance of this permit. Issu-
0 ancc of this permit shall not be deemed to modify, waive or reduce
.j
0 any requirement of any city ordinance nor limit in any way the
I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED
Ej
DRAINAGE PLAN REQUIRED
1:1
UNDERGROUND WIRING REQUIRED
0
CONNECTION TO SANITARY SEWER
El
SEPTIC TANK PERMIT REQ'D C1 NO.
ELEVATION OF PROPERTY CORNERS
0
& FOOTINGS REQ'O
SEE ENGINEERING MEMO DATED--4-7--go
CHECKED BY
ING SUPPLY SIZE
SIGN AREA ENV. REVIEW ADB NO,
ALLOWED PROPOSED COMPLET] EXEMPT
SHORELINE
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY I DATE
YARDS ILOT COVERAGE
FRONT SIDE REARI
E ITYPE OF CONSTRUCTION ICODE —THEIGHT
SPECIAL INSPECTOR OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
0 YES 0 No 14 1
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
PLAN C-HECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION I FEE
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'ro: Building Djvi..,;j.()j,
Community DevelopmenL-DeparLmenc
FROI-1; E
,�ineering Division
J"ublic Work's Department
SUBJECT: Lo e, . ,
AELer revie,.,, of the Subject building permit aPplicati
the follo�,:ing comments: on. v�e have
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accoldiliq to 0W J)lat. thereof rucol'dCd ill VO I U1110 12 of Plats, l),19c 33,
of Snohomish County, Washington;
EXCEPT the cost 10.00 leet thereof for road;
EXCEPT the south 85.00 feet thereof;
SUBJECT TO a.fIve-foot utility easement over, under and across the south 5.00
feet of tile above -described parcel;
TOGETHER WITH an easement for the installation, mainte nance a ' nd repair of a
sanitary sewer line over the following described tract of land:' Beginning a . t
the northeast corner of, the west 1#111.32 feet of said Lot 7; thence east along
the north line of said Lot 7, a distance of 99.07 feet to the west line of tile
cast 1114.00 feet of said Lot 7; thence south along said west line, 10.00.fe-et;
thence west parallel with said north line 79.07 feet; thence southwesterly to
a poinL on.the cast lille'of said west 414.32 feet distant 33.00 feet from the
point of beginning; thence north along said cast line, 33-00 feet to the point
of beginning;
Situate In S1l0hQMISh County, Washington.
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122
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P L C WORKS DEPAR'DIENAECKLIST
MING PER'= REVIEW
;Z -
Ta dress) (date)
%_1 Street Right -of -Way Exist*
Z
H Access Easements Existin REQD
c4 Utility Easement Exist*
W Lot Per Subdivision Plat. Assessor Map
W Site Plan Checked for Accura
Z
H Underground Wiring Reqd.
U Check Accuracy of Legal Description
Z Review b Date
X
C4
0
Existing Water Main Size
Water �bin Required
Service Line Required
Hydrant Size Existin�
Hydrant Reqd Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspectio�
Fire Department Comments
Size
0 vrz D V c V'T'l ��"
E r3 1 r3 -. — I T__ 0 pf—'r 66,6ch
'Zi�_4D TZ" P--- APPROua
Water Meter Charge Reqd.
Review b W
" ct-�:(T'jo _ rr s - 7g, Date
Septic Tank Design Approved
Septic Tank Permit Reqd.
Sanitary Sm,7er Availability�
Drawing No.
Side Sm,7er AvailabilitX_
Sanitary Sewer Connection Fee Reqd.
Review by�_
File No.
Date
—Date
—Permit No.
Proi
Open Ditch Exist
Culvert Reqd. —Size
Catch Bas ' in Reqd. Indicate on Site Plan
Shoulder drainage maintain collection on swale open runoff
�kihole reqd. Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review b
Date
Revised: lvlO-1977
-;A0
%
UELI CIT Y OF EDMONDSO 0
-P C WORKS DEPARTMENTj ENGINEERING DIVISION
APPLICATION FOR RIGHT—OF—WAY CONSTRUCT
]=P� F1
%f I I T&MV,
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECT.ION PURPOSES
Applicant to Complete Parts A and B
As Permit to be issued to:,. (�7
For Work -at:(address or vicinity) .,;p
'-'� D
Tvz 0 C-A tj
Type of Work to be done:
(attach drawing when applicable)
Time Required Start:
Finish:
Owner: 0
-P
C6 V
Name
Mailing Address,
V U) D t)PN
34�
City State
Zip
Telephone Number
Contractor:
Name
State License Number
Mailing Address
City State
�Zip
Telephone Number
B. INDEMNITY: Applicant understands and by,his signature to this application, agrees
Ao hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edm ' onds, 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 permit.
Upon issuance of this permit, the contractor is responsible for workmanship and'
materials for a period of one year following the final' inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
,the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City.Code. A
A -hour notice is required for inspection by Engineering. Call 775-2525, *ext. 220.
I understand"that this permli ust be ilable at the job site for inspection
purposes at all times.
Signatur�:, Date:
Owner'or Agent
TO BE COMPLETED BY I-SSUING AGENCY:
Date Issued: 2:;/ -,,;2 5� Permit No.
Fee -
Security Bond:— Ili 11q
Time Authorized:
APPROVED BY
I [I - I I I %, ( P--f -A I
Date:
1018
Rev. 10, 7
BLKS�LITY.DISTRICT No.1,of Sr mish. ty
0. Co Lpt..3 T AREA
't 'TO 'q7
Location
Dot
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W.O. a.
5 W 1/4 19 S_2�'l
T R
Revision
Scale Z.O
Reason for work k �sl S
1.
Engineer
—As Built
D L.,:
U.G. File No.
A rovals
PERMIT REQUIRED ---FQ_IREIGN CONTACTS
Type— S Company
I-IRN.No.
EASEMENT ENVIRONMENTAL -A NALYSIS
Exempt underMistrict SEPA
— I procedures, kection .11 I -A 17-
Date Granted Fees required 'Yes[Z DNoO Grantor. Paragraph Item
Date Granted Date By
L
Log Posted I I inventory U SV C_
t. Type Interpretation Referred To:
Date
Transf.Cardl jPole Dept. A, � a u 'n'�
Ao
Map Pas" I Circuit Ylae Date Released For Construction
Date BY
Date Work Completed Fore an O.H. U.G. Cond KV.
Circuit Number 1 3 4 ko, Substation VIZ U
Add _Ckt Ft 'PH
Remv_Ckt Ft_PH
Net—Ckt Ft
Water
ST, S\Aj. Sewer
Gas
Backhoe
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WO. No.—