20628 80TH AVE W.PDF111111111111
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20628 80TH AVE W
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City of Edmonds
.......... ..
Development Services Department
. . . . . . . . . . . .... ... Planning Division
Phone: 425.771.0220
1 C. I S91) 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 from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: -1 11 q 10-6
City Receipt#:
Critical Areas File #:CF, 4210 0 %'00 9_�—
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
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 arn authorized to Jfilei app I ati on t b alf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE 7
Y �0
Property Owner's Authorization
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 o�Ab City of Edmonds to enter the subject property for the
Purposes of inspection and postirg-@,ttendlh to t!)i <ap icatXn.
Owner/Applicant:
<�+v v e vk G v, o c4-e-v- 3
Name
Street Address
-CAVVio'las va
City State Zip
Telephone:
Email address (optional): SkOf C(l) �kixw(O Op -,-cm
DATE 71N / 08
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist CA File No: 06
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site A ddress/ Location: �_o (o 2- qwa, A,,�e vi,
? Property Tax Account Number: Q 0 10 1 '1 �3' 0 0 0 0 7
3. Approximate Site Size (acres or square feet): 110000
4. Is this site currently developed? K yes; — no.
If yes; how is site developed? kcs I d4+1fi &
5. Describe the general site topography. Check all that apply.
Fla L: 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).
I-Wly: slopes preselit on site of more Lhaxi 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: k)00k- Approx. Depth:
What season(s) of the year?
8. Site is in the floodway — floodplairt of a water course. GO
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- d?
Flows are seasonal? — (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) V
11. Obvious wetland is present on site: ov�Q_ cfj /"a)
- -------------------------------------------------------- For City Staff Use Only-- ----- --------------- - - - ---
1. Plan Check Number, if applicable?
2. Site is Zoned'? R%-,R
3. SCS mapped soil type(s)? 5-AlckcQc��- Ur Ina!Lck 6^ej 9,v :in P, �K ovcz�,G
�X`% - M_ IX - --- - ,a (i - . C.-d- I -, - , i aa-�, -, I - _-
4. Critical Areas inventory ol-t.A. maplindicates Critical Area on site? *ev,--,-,j r_f,-N�,
5. Site within-clesignated earth SUbsidence landslide liazard area?
DETERMINATION
WIRED
Reviewed
Date:
WAIVER
C06cal Ai-eas Checklist.doc/2.17.2004
NOTICE:
No warranty of accuracy.
The information 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(s-). Any person or entity -requesting a
copy should conduct an independent
--inquiry regarding the information shown on
-fh-e -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
emp-l-oyee-s or office-rs sh-a-11.1 be lla-b--I-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
JW~12§mwwwpw Now" ow for
The City of Edmonds bobw a la SIDE SEWER PERMT
OWNER '
ADDRESS
M
f
V I - - I&MINNIaw CONSTRUCTION E] REPAIRS f-I
,�-L-Y-NN PLANT 1174,
�_]P�,ASEME No . ...........
4 / I>
.............. .... CONTRACTORI PERMIT No.
... 101 ---------- i- r - - ---------------------------
.......... ...... le .... . ............... LEGAL DESCRIPTION: LOT No . ...................... — .................... BLOCK No . ....................
...........
NAME OF ADDITION ..........................
APPROV
MAY 1
Approved:
D
d
DATE ........... BY ioel��e ...........
CITY OF;_EDMONDS
CaJI PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No inspec-
SIDESEWER PERMIT tiong Saturday, Sunday or holidays.) N2 2158
20628-80th Aveune W.
ADDRESS ................ .......................................................................................................................................................................................
OWNER ................................ J.o r .1. i- e. f .... L.e-r.e.m ........ TTRACTOR ......... ;��.e..Wooley
................. CON ... ............... ..........................................
Permission is granted ..M.a.y .... 1..Y* ......................... 19 ... j6_7 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 sharper than % will be permitted.
E 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.