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20719 82ND AVE W
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'City of Edmonds
Critical Areas Chec'klist
'Mm Critical Ar= Checklist contained on
this f
orm,s to be fined 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 Purposcof the Checklist is to =able
CitY sftff to determinewhether any potential
Critical Areas are or may be present on the
subject property.The information needed to'
complac the Chaddist should be easily
ilable fi-om observations of thcsite or
avai
data available at City Hall (Critical Areas
inventorics� maps, or soil surveys).
An applicant. or his/her representative. must
fill out the chocldisti sign and date it, and
submit it to the City. 7he City win review
the checidist. m2ake a precursory site visit,
and nuke a determination of the subsequent
stePs necessary to complete a development
permit application -
With a signed copy of this form,_the—
i � _
applicant should also submit'a---V-Ic:mIty map
m
of the parcel with criou
& =7�-1 �
staff can find and identify the =bjcct
parcel(s)- In addition, the applicant i
Is
encouraged to include any other pertinent
information or swdics in conjunction with
this Cheddist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided -are
factU31, to the best of my knowledge (fill out the appropriate column below) -
Owner / Applicant:
D I A+ 14=
Name
Title
20,-7 (�!)2 114::)
Street Address
City. State. Zip Phone
Signature Date
Applicant Representative:
-n\/E LA. -
Name
Title
Street Address
V
4-
City, State;� Zip
Phone
VVI
V
Signature Date
STREET FILE
Critical Areas Checklist'
Site Information
ProjectName. -�DIAQL--E OU C-A Permit Number.
Site Location: Q -7 1 �5 Z 'a VC Vi Property Tax Account Number.
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site be= cleared or logged? U 0 Date of most re=t action:
Soils/ Topography
.A— _ — t � 0
2- In the Snohomish County Soil what is the mapped soil typ S)?
3. 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-)
�lilly.- slopes prcscnt on site of more than 1�% and less than 30Yp ( a vertical rise
of 10 feet of horizontal distance-)
Steep: grades of greqW than 300/a present on site.
r--L-4-,-F
Hydrology/Vegetation. -
4- Site contains areas of year-round standing water
5. Site contains areas of seasonal standing water- rj —Approx. Depth:
6. Site is in the floodway floodplain of a water course.
VER: Crftk� areas.-,stu. yjs.not require
Determination. Number.
Planner Date
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APPROVED BY PLANNING
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DEVICAT.
APPLICATION
3
for
The City of Edmonds -IF SIDE: SIRWIM P EASEA(ENT No . ................... ...... .......
NEW CONSTRUC77ON &�79�REPIIRS 0
6
PERMIT No . .. ....
OWNER --a-WA164 ......... .. f�V ................. CONTRACTOR ..... -------------------------------------
lei
1�p , 440
ADDRESS -.).1f ............... LEGAL DESCRIPTION: LOT No ............... BLOCK No...,,..,,. ........
�39'
NAME OF ADDITION ..... ld�&�- j ... i2*,.A& ..... (Ji. �- ...... &
... / ---- ----------
PPJOVED
SEP
Approved:
DATE ..... ...... BY7:�: .. ...... ...... . . ... ........
CITY OF EDMONDS CajI pRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for Inspection. (No Inspec-
tions Saturday, Sunday or bolidays.) N2 3442
SIDE SEWER 'PERMIT
.................. I .......................................................
ADDRESS ............ ........ sani Safe
E............. CONTRACTOR ................................................................................
...........................
OWNER ................
Permission is granted .................... Se - D - t ...... 1 - 0 .... I iL9 ... �91 for ... I .................... 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: sewer inside property line. A licensed Side Sewer Contractor must
NOTE No. 1—The owners of the property may obtain a permit to construct
et area. Do not cover any portion of sewer before It has been inspected.
be employed to construct side sewer in stre 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 2—Obtain full information regaxding Ordinance o/
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. restored to original condition. Contractors shall be responsible for
NOTE No. 4—Trenches In street must be water settled and surface of street
failure due to improper work which may develop within one year of completion.
NOTE No. 6—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.
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