21310 86TH PL W.PDFIIIIIIIIIIII
8249
21310 86TH PL W
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
L` Site AddressfUcation: 19(off' Plcwe- U E:&-4-5, kjA , 9TO;ko
2. Propert*y Tax Account Number: �,n3b-60.T-016-0-7crt
3. Approximate Site Size (acres or square feet): 1 '90 )( 140
4. Is this site currently developed? (-�-yes; _ no.
If yes; how is site developed? Rcs , Jeyj4-('c,
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 less than 15% (a vertical rise of 10-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 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: WA Approx. Depth:
7. Site contains areas of seasonal standing water: 1A 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? NIA Flows are seasonal? _ (What time of year?
10. Site is primarily: forested meadow ;shrubs
; mixed
urban landscaped (lawn,shrubs etc) _ tl�.
11. Obvious wetland is present on site: Wo
'For City Staff Use Only
V Z'
Site,iszooned?
2**: mapped soil type(s)?
inventory or C.A. fnap indicates wetland present on site?.. f4cll
Critical Areas inventory or C.A. inap indicates Critical Area on site?
..Site within designated:earth subsidence", landslide hazard area?
:.�Site'designated on'the Envirournentilly-Sensitive Areas Map9 1��,
R� 0 1/04194
& 9 0 . 19 4 -
City of Edmon&
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. Ite
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 histher representative,
must fill out the checklist, sign and date it,
RECEIVED
DEC 1 5 1995
PERMIT COUNTER
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
phui, 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
—Rickend L,,�se
Name
D 1310 %0 q-� place W
Street Address -
Applicant Representative:
Name
I o,;L,3 0 wers Ide- CX,(**L/(!
Street Address
�-()VVIO^ds .9sagL(v
UA bo-WCU- G, A FO I
City, State, ZIP' Phone City, State, ZIP Phone
4ignature S ture Date
City of Edmonds
Critical Areas Determination
Applicant: I Richard Lohse Determination #: I CA-95-248
Project Name: Permit Number: F
Site Location: 1 21310 86th PI W Property Tax Acct. #: 1 3736-005-016-0709 1
Project Description:
Non -Project Specific
Determination: Study Required
Due to the presence of steep slopes on or adjacent the subject property, a study is required. The
purpose of this study would be to identify the impact of development on the steep slopes. Typically,
a 50 foot buffer is required from the top of steep slopes unless some geotechnical studies indicate
otherwise. If an applicant feels that their development proposal will not effect the Critical Area in
any way, they may request a Conditional Waiver from the requirement to prepare a Study.
The applicant is requesting a permit for tank removal at this time. For the purpose of tank removal,
a Conditional Waiver is granted from the requirement of completing a study. Conditional Waivers
may be granted on a project by project basis, and this Conditional Waiver applies to the tank
removal only.
Stephen Bullock January 8, 1996
Name 4Sign Oture Date
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER 960027
CONSTRUCTION PERMIT APPLICATION
JOB SUITE APT
ADDRESS A6
OWNER NAIVE NAME OF BUSINESS
e
LEGAL DESCRIPTION CHECKI
SUBDIViStON NO
LID NO
MAILING ADDRESS
w
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — REQUIRED DEDICATION —
PROPOSED
TESCP ApProved 0
RW Permit Required 0
Street Use Permit Req'd 0
Inspection Required 0
S.de.alk Required 0
CITY ZIP
Id-5
11,1.1�1`"UNE NUMBER
/ -;, '-�
Al,
NAME
METER SIZE
LINE SIZE
NO 01 FIXTURES
PRV REQUIRED
Q
YES 0 NO 0
ADDRESS
REMARKS
L)
M4
Z
CITY ZIP
TELEPHONE NUMBER
a
Z
NA�E
ADDRESS
IP 2
ENGINEERING MEMO DATED REVIEWED BY
CITY ZIP I
TELEPHONE NUMBER
I
E MEMO DATED REVIEWED BY
2
STATE LICENSE NUMBER EXPIRATION DATE
JI C 5- 1:')
SIGN AREA
ALLOWED I PROPOSED
SEPA REVIEW
COMPLETE 1EXEMPT
ADS NO,
SHORELINE
Legal Description of Property - include all easements
VARIANCE OR CU
PLANNING REVIEW
BY DATE
0
SETBACKS —FEET EIGHT
jLoT COVERAGE
z
Pr9perty
T xA
a..l Nocu
P.
FRONT SIDE REAR
Z
4
REMARKS
0 NEW RESIDENTIAL PLUMBING
[:1 ADDITION El COMMERCIAL MECHANICAL
ElREMODEL F-1 APT. BLDG. SIGN
`a_
C ECKEO BY TYPE OF CONSTRUCTION CODE
Zj(-Lx
V
OCCUPANT
GR P
GRADING FENCE
RE AIR CYOS. E] I x _FT)
P
M ODSTOVE SWIM POOL
DIE OLISH WO A
INSERT HOT TUBISP
GARAGE RETAINING WALL/
CARPORT L_J ROCKEAY RENEWAL
SPECIAL INSPECTOR JAREA
REC JUIRED
0 YES
OCCUPANT
LOAD
EMARKS
(TYPE OF US�,,.aiusl�ps OR WVITY) EXPLAIN:
PROGRESS INSPECTIONS PER USC 305
Z
IRE
Me
NU ER
-UM SIR OF
CRITICAL
8
0
W
OF
STORIES
LL,
IDWE NO
UNITS
AREAS
NUMBE
DEZfIBE WORK TO BE DONE (ATTACH PLOT PLANII
FINAL INSPECTION REQUIRED
VALUATION
FEE
FEE
PLAN CHECK FEE
__7LAZING
BUILDING
HEAT SOURCE:
%
PLUMBINO
Plan Check No.
-
A A
MECHANICAL
C L
Y
This Perm, t covers work to be done on private property ONLY.
-
-A F I L
ORADINGIFILL
N L
-T
Any construction on the public domain (curts, sidewpiks,
driveways, marquees, etc.) will require separate permission,
T R C H A
STATESURCHARGE
A S U
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 160 Days .
To.. A I " A
STORM DRAINAGE FEE
n
" Applicant, on behalf of his or her spouse, heirs. assigns and
0 I d
successors in Interest. agrees to Indemnify. defend and hold
I
harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit, Issuance of this permit shall not be deemed to
NO . r T
ENO. INSPECTION FEE
E S
PLAN CHECK DEPOSIT
Ox
modify, waive or reduce any requirement of any city ordln:nC:
nor limit in any way the City's ability to enforce any ordin nc.
provision."
TOTAL AMOUNT DUE
TOT C
I hereby acknowledge that i have read this application; that the
Information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and In doing the work authoriz. AUTHORIZES
ad thereby, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his/her,
Code of the State of Washington relating to Workmen's Companies. WORK NOTED Deputy; and fees are paid. and receipt is
tion Insurance and RCW 18.27. SP C acknowledged in space provided.
INSPECTION
SIGNED A
SIGN.�Y.14E�OWNER OR AGENT) DEPARTMENT
I CITY OF 5 So T RE DATE
e,, EDMONDS
CALL FOR RELEASED BY DATE
ATTtNTION INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNITIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
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