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20820 80TH PL W
.Cr i - ficall Areas Checklist CA File No:
Site Infoimatibn (soils/ topography/ hydrol6gy/vege"tAtion), 004,4��
1. Site A I ddress/ Location: Pt, W I
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this'site currently developed? �yes; — no.
If yes;,how is site developed?
5. Describe the general site topograp�y. Check a'ff that appl
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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 UJL 10-feet
over a horizontal distancriwf6 I =.I=
Steep: grades of greater than 30% pres ite (a yT
distance of less than 33-feet)'.i', 14e qhosizontal
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Other (please describe):
6. Site contains areas of year-round standing water:_ Approx. Depth:
7. Site contains areas of seasonal standing, water; 'tJD 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?
P-) 0 Flo'w'! s are seasonal? (What &4ie of year?
10. Site is primarily: forested meadow, shrubs mixed
urban landscaped Oawn,shr�ubs etc)
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11. Obvious wetland is present on site:
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Critical Areas ChecklisLdoc/3.19.2001
City of E-dmon'd&,.
Development Services Dep, artmept�
Planning Division
Phone: 425.771.0220 %k"
Fax: 425.77l.022l,_,_:,,_,
.-'.Date Received: I-IcA-D'Z-
City Receipt #: qJc;2 J
, C ri ica 'A -File#:'
"r6a s'
,Critical'Ar6a's Checklist Fee:, $45.00
-tbat Ma'iled*t6ADD1-i,cant:
The Critical Areas Checklist contained on- this form i's to .;.A property owner, or his/her authorized rppresentative,..
be filled out by any person preparing a Deve'lboment- `.�.'rfitist fill, 61d the checklist, sign - and date it' ''and submit it
Permit Application for the City of Edmonds priqT Ap ,to;the.,�ity
The City. will review the checklist, make a
his/her submittal of the application to the City. precursory site visit, 'and make a determination of the
The purpose of the Checklist is to enable City st;aff io`_ "Subse4iient steps* necessary -to complete a devielopment
determine whether any potential Critical -Areas are, -or Permit a
ppl�ication.
may be, present on the subject property. The,information Please submit a vicinity map, along with the signed copy
I
)rm to assist City staff in finding and locating the
piece -'of property described! 6'n this -form. In
the �applicaht shall include other pertinent
surve #IUAIU;
information (e.g. -.5itee plan,, topography map, etc.) or
S/In I'/ J tudies in conjunction with this Checklist to assistant staff
rj�7' leting 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 liarniless'froni'any and a'lidamigds, including reasonable
attorney's fees, arising from any action or infraction based in whole or.part upon false, mislea,dmig, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhi bits 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 1 02--
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicaxit�Agent to apply for Oie su�ject land use application,
and grant my permission for the public officials and the staff of the City ot Edm6nds to enter the subjec't property for the
purposes of inspection and posting attendant to this application.
7 1 111
SIGNATURE OF OWNER DATE
Owner/AppUcant:
Name
Street Ad(;�ess
dwh
City State Zip
Telephone: (Lign liq -kvj
Email address (optional):
iP� V� AA)
Street Address
city §tat zip
Jelephone: -1-M-t005L1
Email Addiress (optional):
Critical Areas Checklist.doc/3.19.2001
PLANNING DATA
NAME: -DATE:
SITEADDRESS: '.241'520 - VC4-(-% T'l LV
PLAN
PROJECT DESCRIPTION:
REDUCED SITE PLAN PROVIDED?: (Yes / No
MAP PAGE: ;?10(-P CORNER LOT4tj!j�o) FLAG LOT: ffn�
ZONING: CRITICAL AREAS DETERMINATION
U Studv Reauired:
QF-Valver
UConditional Waiver
01
SEPA DETERMINATION: 6z,
Fee
Checklist
U APO list w/ notarized form
:��13 Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
empt 2:5-7
SETBACKS:
Required Setbacks: ss we- e 4
Street: 4,* WrMde: ***7. RioWside: -7- O�'
Actual- Setbacks: f
Street: I 0�' Left Side: 15"757 Right Side: Rear -
Street map checked r additio-ZIP setback required? (Yes / No / DN
.TU
LIDETACHED STRUCTURES:
U ROCKERIES: CX4 -�:rh Ar�
U FENCES/TRELLISES: V
13 BAY WINDOWS / PROJECTING MODULATION:
USTAIRS / DECKS:
PARKING: Required: Actual:
LOT AREA: -71�'00
-77
LOT COVEui��f
Calculations: 16,
BUILDING HEIGHT:
Datum Point: MA41 lhple-- Datum Elevation:
Maximum Allow ed:**- Ac tual Height:
A.D.U. CREATED?: (No /,Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes / No
OTHER:
P7
Plan Review
NewBPPlanningDataForm.DOC