21515 86TH AVE W.PDFIIIIIIIIIIII
8149
21515 86TH AVE W
CA F[Lr-- NO- 'Lo
Critical Areas Checklist
Site Info �rniation.(soils/toi3o2raphy/hydrol6gy/vegetation)
I. Sii X��;�s, on:
2. Property Tax Account Nifinber: o 7 00 — 0
'3. A roxiinaie Site Size (acres or square feet): -7_�5
pp
4. Is this site currently developed? __,��_yes; no -
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation diange over entire site.
Rolling: slopes on site generally less thari 15% (a vertical rise of 10-feet ovier a
horizontal distance of 04eet)-
Hilly: slopes presim on site of more than 15% and less than 30% a vertical rise
of I 0-feet, ISver a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present an 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: Approx. Depth:
7. Site contains areas of seasonal staWing vrAw. Approx- Depth:
What season(s) of the year?
8. Site is in the floodway -,V'o floodplain Wo 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 Al,�-)
meadow ;shrubs mixed
urban landscaped Oawn,shrubs etc)
11. Obvious wetland is present on site:
City StaffUse Only
'Zoned?
S te
I Its
2�';. :'mai
.... .. pped soil type(s)? (464,11 14L IeX
3.,�-* invento or C-A. map indicates wedand present on site?.
TY /11/0
tic -al Areas inventory or C.A. map-indica
Critical Area on site?
w-thin designated earth subsidence landslide ha�iid am? /VO
-6.... site eognated on the Environmentally 5ensitive Areas Mao. ILA)
REQUIRED
CONDMONALWAIVER
VAIVERZ
-Revie�ed by: - ......
Pla7f Date
RevO1104194
OCT
Ii
-0-0 .-D
V E
OV 095
City of Edmonds
Critical.
-''Checklist,
-4NNG
Area s
ne Cfifical Areas Chedidist contained on
and submit it to the City. The City will-
this form is to b� filled 61t 6y''any-p' er-'sioin-r
revIew the cheddist iT� a recursory site
preparing a Development Permit
visit,'and malaia determination of the
Application for the City of Edmonos'prior-
subse4pent steps necessary to complete a.
to his/her submittal of adeveIopm�fit-'::-".-'6:,-"
development permit application.
permit to the City.
Mlith asignedcopy of this form, the
The purpose of the Checklist is to enable
appricant should also submit a vicinity map
City staff to determine'Whetlici any
or plot plan for individual lots of the parcel
potential'Critical Areas are ornmy'be' -'-with'enough
detail that City staff can find
Ib
present on the subject property'. e
A,� q"Cl
and identify th� sub"j-ecit'rercel(s).
information needed to complete the
addition;,the appUcant shaU indud4t.. v-;,
Checklist should be easily available from
other pertinent infonnation (eg. site.
obsemfions of the site or data availaW at
pL* topography niap, etc.) or studies in.
City Hall (Critical Areas inventories, ma4m, -
conjunction with this Checklist to assist"
or soil surveys)' .�
staff in completing their preliminary
assessment of the site.
An applicant, or histher representative,
must fill out the checklist, sign and date it,
I have completed the attached Cni"tical Area Checklim" and i6�it thai t'he'ans"wers pTovided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner I Applicanti . ..... Applicant Representative:
DAY,&
Name
,,Q / �Q �- L (, -t�� V-v-
Street Address
7 A�.
Phone City, State.- ZIP
Date
Signaftwe
Phone
Date
E-1
Z
U
0
U
0
Z
0
CITY OF EDMONDS OMEFOT F1 E
PUBLIC WORKS DEPARTMENT 01
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
(?
0 Owner: -1,
Name
Mailing Address
14�� ' ' 1 912!!44 'Z ,
City, . State, Zip Code
e Contractor:- 4::� 4411- 1/ /,;l ta
Name
'4&Z2'C_ - 60
Mailing Addry V
City, State, Zip Code
Permit No. �b Z' - ?-) �
Issue Date SOIS2-
9 PermitIssuedTo: 4)ckrreH --�)an&ers
* Type of Work to be Done: DRi'Ve L4,,,�/
e Work in Connection With:
0 Sub or Plat )< Single Family
El Comml. / Ind. El Apt. Condo.
9 Pavement Cut: 0 Yes K No
4
State License Number
7 7
Telephone Number
I
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of its departments or el�ployees, including or not limited to the defense of any legal
proceedings including defense costs,icourt costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is. responsible for workmanship and materials for a period of one year
following the final inspection and'acceptance of the res4oration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration ifee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance eo the applicant.
Work is. to be inspected. Restoration to be in a ccordance with City Code. Traffic Controtto be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 -- hour notice is required for inspection by Engineering.
Call 775-2525, extension 220.
I understand that this permit must -be available at t)hne idb �ite for inspection purposes at all times.
Signature: Date
net or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. issued By:
Time Authorized: Vold after ITC) —days
Special Conditions:
Ammendments: k
Permit Fee: $30
Security Deposit:
Receipt No.:
Fund III Fee:
Stree.t Cut Dimensions
� X
MY
�NO WORK TO BEG1NPkib'R.T0- PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES
(Fund 111 - Route conv to Street Dent.
rnmMean +- c-- -
Diagram:
Contractor called for inspection Yes
T
.Alork DisaT)proved By: Date:
Work Approved By: Date:
No
By: Date:
Inspector:
Enq. Div. December 1978
APPLICATION
The City of EdmondsM FtE for
SIDE SIEWIM pMMMr
NEW CONSTRUCTION REPAIRS
A
OWNER ........ ...... ........ &MTRACTOR ... 1,4W.
ADDRESS --- 43 ...... ............... 1.4 ..... ... . ....... ......... LEGAL DESCRUMON: LOT No . ........ ------------
NAME OF ADDITION ..............
MASEAUENT No . ............................
t-lb /
...... �PEPJWIT /1,jo-
No.
.... NL409K No . ...............................
NOTICE:
y 6ME-ura:
-N�o- Wa r rr a n e a-ttached
The -information shown on th
Map(s) was compiled for use by the City Of
Edmonds, its Employees and Consultants.
Th.e City of Edm.qnds does not ' wa rra nt ti
accuracy of anything set for.th on these
map(s"-). Any person or entity a
copy should conduct an independent
inquiry regarding the inform-ation shown -on
-th-e -rn a p (s) , including, but not limited to,
th'e loc'ation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neitheir the City of Edmonds nor its
empto-yee-s o,r office*rs -sh-a-1.1 be 11a.b.-I.-e for ti-he
information given on this map(s), nor for
ov'ded based
any one representation pr I
upon said map(s).
CITY OF EDMONDS
Call FRospeet 6-1107 when work
CIVIC CENTER — WATER -SEWER - DEPARTMENT 18 ready for Inspection. (No Inspec, N? 2615
tions Saturday, Sunday or holidava.)
SIDE SEWER PERMIT
ADDRESS........... 91a.-m-A.6 --- th-.2-lace --- S-cutb .................................................................................................................. ------
OWNER ................ C.Uf ford-1luebuer. ----------------------------------- CONTRACTOR ......... Woaley.'.s --- Pipe ... and_.Sewer .........
Permission is granted .... ...... Decembe_r ----- 8 -, 19..�7, for ------------------------ days to REPAIR or CONNECT a side sewer
------------------ ---- ---
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—Tbe owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been Inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
N('--,No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NO,�r.; No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to Improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the main sewer or Its appur-
tenances except to insert the pipe into the wye.