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PLANNING DATA
NAME: �&Sr-Z-VOCI DATE:
SITE ADDRESS: a.1 Q RLI 0iC)-1__q_ j�,452 PLAN CHK#: C);.a, -
PROJECT DESCRIPTION:
REDUCED SITE PLAN PROVIDEDJ�/ No
MAP PAGE:��� . CORNER LOT: FLAG LOT: (nams
Z ONING: CRITICAL AREAS DETERMINATION #:'C>P'L- ILI I
Ll Studv Reauired:
aWaiver
L3 Conditional Waiver
SEPA DETERMINATION:
UFee
U Checklist
U APO list w/ notarized form
Q (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
WEExempt
SETBACKS:
Required Setbacks: I f
Street:cjNj' Left Side: -7 Right Side:. -7 Rear:
Actual Setbacks:
Street:40' Left Side: ( n Right Side: C) Rear: -
Street map chocked for additional setback required? (Yes / N2(M%
L3 DETACHED STRUCTURES:
U ROCKERIES:
LJ FENCES/TRELLISES:
13 BAY WINDOWS / PROJECTING MODULATION:
LJ STAJRS /DECKS:
PARKING- Required: Actual:,Q,
LOTAX:9X
LOT COVERAMr-.-
Calculations: EE-Al On tU R_Q5=,
BUILDING HEIGHT:
Datum Point: P-A.-Ora or ?C' cA Datum
Maximum Allowed: lays, ( I a ' Actual
A.D.U. CREATED?: (No / Yes) t-40 - 'P
SUBDIVISION:
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20TH ST. S.W.
City of-Edmokids
Development �eryices Department
Planning Division
Phone: 425.171.0220
Fax: 425.771.0221
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 the application 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
' f
available rom observations of the site oi data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date'kec6ived:
P!ty Receipt
c W
eitic'�a, I 4i'
�Criqc* Arpels Check!ist Fee,:_ $45M
Dtkte-lWtiildd-ici'A'p'p'�iica"nt:
A,,propprty owner, or his/her authorized representative,
mustfili:out' the -clie�ckli�i,' sign- anadate,it,'a�id'iu6mit it
Tpview,tbe. che klist,:make a
Jo, - the -,City. T-he City, wi cl.
prepurso.ry site and make a determination of the
'subsequent steps necessary 16: complete a development
peprii4pplication.
Please submit a vicinity map, along with the signed copy
,of, this, form to assistCity staff in- finding and locating the
sp6c'ific piece ot property described on thig'form. In
addition, the appiica'nt* shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in con
junction with this, Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and histher/its heirs, arid assigns, in consideration on the.p 0 essing of the application agrees
to release, indemnify, defend and -'hold the City of Edmonds hi�4�ess from any and all darna . ges, including reasonable
attorney's fies, arising from any action or infraction based in whole or. part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its agents o r employees.
By my signature, I certify that the information and exhibits herewith* submitted are true and c.orrect to the best of my
knowledge and that , I am authorized to file- this application on the behalf of the owner as listed below.
DATE 47Z3A Z_
SIGNATURE OF APPLIcANT/AGENT 2&2
10 0, 011
Property Owner's Authorization
By my signature, I cer* that I have'authorized the above Applicant/Agent4b apply for the subjectland use application,
and grant my permission for the public officials and the staff of the City of Eai�onds toenter the subject p'r o-pert'y for the
purposes of inspection and posting attendant to this application.
DATE
f ZP
SIGN ATURE CiF OWNER
Owner/Applicant:
Name
Z-14101-11
Street Address
city State Zip
Telephone:
Email address (optional):. 0,W,61v. eff
,Applicant �epresentative:
.Name
Street Address
City State zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
Critical Areas Checklist CA File No:
Site Infoiihation (soils/ topography/ hydrology/ vegetation)
1. Site Address/ -Location: 'V 00
2. Property Tax Account Number: 4/cp<D
3. Approximate Site Size. (acres or square feet): 7 15
4. Is this site currently developed? X yes; — no.
If yes; how is site developed? �',;ve4e
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-�r6tind standing w ater: Approx. D epth:
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
I _X �, 7
urbah`Iandscap6d.0,awn,shrubs etc)
11. Obvious wetland is present on site:
Critical Amas Checklist.doc/3.19.2001
ROSEWOOD'
CITY OF EDMONDS ; SNOHOMISH COUNTY, WASHINGTON
TIFICATE
L and 5urveyor, do
o an ac uo
)at monurnen15 hove
Me ground as shown
00
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LAND SUAVEYOR
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lock 6, Alderwood Manor
In VOIU177e /0 Of01015, co
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"Ound'Nod
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-NT5 1hol we, 1he under -
of The land
'o and oledicale to 1he
and ec5emenI5 or whal-
�he,olal ond The 05e lhereol
1he right �o make 0//
1he /o/.5' bloCA- 5, 1roC15, ek,
,7al gro,ding of all 1he
1?ereunla 5el our hond5
'-7— -1939—A.-D.
5ecreldrq
-MENT
1959,-,6elore
,per.5012011y 0,bpiecred P.A.
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n corporation, to Ine Anown lo
n ol e di c a t i c) n, and achno wle2qed
C 5017le 05 112e;r volualarq ac�
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