21002 78TH AVE W.PDF111111111111
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21002 78TH AVE W
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: CA 00— (-7?
Critical Areas Checklist Fee: U5,00
Date Received by Dev. Sery De t: Lo (1)
City Receipt No:
DdOdailttl-ta-Applicant: 4o
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 information. (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).
I PLEASE PRINT CLEARLY
Owner/Applicant:
Name
Street Address
Applicant Representative:
b (A b 6 C,-r *4-1V V— P&-1,70 W I -S�', N
Name
4
Street Address
/el'
3elll /Ve '?
City State Zip Z----�ity State Zip
Telephone
Signature
Date
/ D-0 �— o-1-3 3 A�*ecj Ve
Telephone
Signature
Date
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treceptior4analCACLHandout.doc RevhW 4/1 Or=
CA FILE NO.
Critical Areas Checklist
----------------- --------------------- -----------------------
Site Information (soils/topography/hydrology/veg.etation)
I Site AddressALocation: I C>o a — "78
2. Property Tax Account Number: 56 000 00--7 CO
3. Approximate Site Size (acres or square feet): 5ev Sq C4
4. Is this site currently developed? _Z� yes; — no.
if yes; how is site developed? -S f 5 Lo ic�, j a-eo
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 Iess 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
I 0-feet over aborizontal 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: /1/0 Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
Whit season(s) of the year? A-
8. Site is in the floodWay IVIA floodplai of a water course.
9.. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? .—IV - Flows are seasonal? —NO/, "-- (What time of year? /v) ),I-
10. Site is primarily: forested meadow -shrubs mixed
urban landsca lawn,shru s etc
11. Obvious wetland is present on site:
��-�46r 1 S4: -Use. :.fif
. . . .......
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:6EMMINAT
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A1;k_ChLdcq Rev 1WWM
APPLICATION
for
The City of Edmonds S I fittT PH SIDI; S1&VVM PERN"
5 I&MEUTSIDE K INSIDE El REPAIRS
CARDNo. ---------------------------------
BASEMENT NO. � -------------------------------------
9K
...... .... 1- ........................... CONTRAC
R ........ J --------------------------------------- ----- PERMIT No.
HOUSEN --- ...... STREET
------------ ..... ... ........ - ---- AVENUE LOT No . .................. ....................................... BLOCK No - ------------------------------------------
NAME ADD . ........
lo a 2. - e --------- a ---------------------------------- ----------------------------------------------- -------------------- -
q7
let col
0 1964
. .. . .. .......... . ..
Date Approved:
BACKFILL WORK ORDER ISSUED -------------- -------------------- DEPOSIT, --------------------- --------------
DATE - --- - --- --- 11-10
SEWER WORK ORDER ISSUED ---------------------- -- --------------- ......... �--- By
NOTICE:
No warranty of accuracy.
The information shown 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 forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), in . cluding, 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
employees or officers shall be liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CallmPR6S_Pect 6 -1107 24 hours (plus
Saturday, Sunday and Holidays) be -
CITY OF EOMONM" N? 900
CITY HALL — WATER -SEWER DEPARTMENT fore work is ready for inspection.
SIDE SEWEk-PERMIT ........
33d.93 A ............................ ........................... .......................
ADDRESS......................................................... ................................... .. ............
r"Coii' .............
OWNER .. De=ond 9i
CO &OR .......... ...... .... . ...............................................
-a side. sewer
Permission is granted . ........ for days-, to,REPAIR or. CONNECT
J........... .. ........... a
0 Ve nd governing ordinances.
rPance with application on
with City Sewers in acc
31040
ATTENTION IS CALLED TO THE FOLLOWING: A. licensed Side Sewer ContTaotor
of the property may obtain a permit to construct sewer inside property line.
f sewer before it has been inspected.
NOTE No. 1—The owners v
must be employed to construct side sewer in street area. Do not go er any portion o
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
at least 30 inches coverage at property line and 12 inches inside property line-, minimum grade of
NOTE No. 3—Top of side sewer must have r than �,� will be permitted.
2%. No bends in grade sharpe stored to original condition. Contractors shall be responsible for
e water settled and surface of street re completion.
NOTE No. 4—Trenches in street must b
failure due to improper work which may develop within one year of
NOTE No. 6--It is unlawful to alter or do any other work than is proyided for in the permit, or to do any work on the main sewer or its ap-
to insert the pipe into the wYe.
purtenances excep:t
I