21414 98TH AVE W.PDF9645
21414 98TH AVE W
RECEIVED
City of Edmonds
JAN 2 6 1998
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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
p�rmit 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
info ' rmation 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 checkli st, 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).
Owner/Applica7t.
10 E L/ (�' -'i
Nhme
Street Address
r- V) VM 0 A) os OPG-ff, 1<020',�O
city State Zip
1-1�—
Telephone
!�igna e
te
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
(over)
creception\jaWcaddoc
CAFILENO. q8—_90
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Addres s/Location: __91kf16 6tlL�7-
2. Property Tax Account Number: ,),41 41' — 0 0 0 1?
3. Approximate Site Size (acres or square feet): 000 S2-
4. Is this site currently developed? -L-yes; — no.
If yes; how is site developed? - -51,1116z- F-- F11 M (L
5. Descr ibe the general site topography. Check all that apply.
VFlat: less than 5-feet elevation change over entire site.
17 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 I 0-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: tu)o ; Approx. Depth:
7. Site contains areas of seasonal standing water: 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? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawnshrubs' etc)
11. Obvious wetland is present on site:
--- For City Staff Use Only-----'--'
Site is Zoned?
.. ... ..... . .... . ..
I SCS mapped soil type(s)? TT
t
3. Wetland inventory or C.A. map "'indicates wedand prese
nt on site? C
4..,,,.,...Cri cal Areas.in.. o.r:C�A..::m.a.p.4.i,o.i,c,atps.C.ri.t.i,c,a.l.,.Ar.ea site /0.:.
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Site within designated earth subsidence landslide hazard area?
;:6. Site designated on the Environmentally Sensitive Areas Map?. —
A ca_chk.doc,, Rev 02/11/97
APPLICATION
ILE for
The City of Edmonds SEDE SEWER PERMT
NEW CONSTRUCTION 0 REPAIRS 0 EASEMENT No . ..........................................
109-08300
OWNER............. Tom .... C Foly-l-d-s --------------------------------------------------------------- CONTRACTOR ................................................................................. ................ PERMIT No.... ...................
ADDRESS ........ 21.4.1.4..!n ... 9.8t[i ... Ave....14 .............................................. LEGAL DESCRIPTION: LOT No . .............................................. BDOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
40
DYe Tested On Sewer 1972
Approved:
DATE.............. ................................. By ......................................................................
CITY OF EDMONDS
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zo PERMIT
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS S TE/APT #
OWNER NAME/NAME OF BUSINESS
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
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MAILING ADDRESS %f I
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
RW Permit Required 0
0
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LEPHONE NUMBER
EXISTING — REOUIRED DEDICATION ------7-
Street Use Permit Req'd 0
r7 V) F"X) AJ
PROPOSED
Inspection Required 0
NhME 11195
Sidewalk Required 0
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METER SIZE
[ LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13
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ADDRESS
REMARKS
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TELEPHONE NUMBER
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SERA REVIEW
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ALLOWED I PROPOSED
ALLOWED I PROPOSED
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LOT AREA
PLANNING REVIEW BY
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Tax Account
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Parcel No.
NEW RESIDENTIAL PLUMBING(MECH
REMARKS
COMPLIANCE OR
El F]
ADDITION COMMERCIAL CHANGE OF USE
FIREMODEL El APT. BLDG.
SIGN,
HECKED,$Y
TYPE4VtONSTRUCTION
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WOODSTOVE SWIM POOL
DEMOLISH El INSERT HOT TUB/SPA
SPECIAL INSPECTOR
OCdUpA*r
REQUIRED YES
LOAD
GARAGE M RETA'INING WALL/
FICARPORT
ROCKERY RENEWAL
R MARKS
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 108
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NUMBER F ' N[IMBER OF CRITIC
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OF DWELLING AREAS
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Si76RIES UNITS N
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DESCRIBE WORk TO BE DONE (ATTACH PLO I FLArvj
I(INAL'INSPE(CTION REQUIRED
VALUATION
FEE'
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
__37
This Permit covers work to be donTeon private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewpiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
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successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
X.
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
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of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of anrcity ordinance
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norl . imit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that t6e
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
state laws regulating construction; and In doing the work authoriz- AUTHORIZES T his application is not a permit until
.
ed 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 Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance aria RCW 18.27. INSPECTION acknowledged in space provided.
SIGNATURE JOWNER OR AGENT) DATE SIGNED DEPARTMENT
OFFICIAL's SI A URE DATE
CITY OF
cph3 EDMONDS
CALL FOR E "A�� DA;,L,
ATTIINTION
INSPECTION a
1\7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 O_R�IN'AL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS 13EEN GRANTED. UBC
SECTION 1.09 PINK — Owner GOLD — Assessor