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21522 98TH AVE W
#P20 CA File No: cAA -?M-7 -DD5q
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/Location: al�sAa qvb- f-we- tAJ F-6tyv
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? ZYes; — no.
If yes; how is site developed? wcsi'c��e'-Yce
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: 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 contam''s a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10). -pirim4arily: for - mixed
meadow -shrubs
�A!=a'n landscaped (lawn, shrubs etc
11. Obvious wetland is present on site:
--For City Staff Use Only
1. Plan Check Number, if ap licable?
2. Site is Zoned7 �S�- �
3. SCS mapped sod type(s)? 5 - A I wo o d- n r 6\ 1,m J ((JM 0��k' 9 10 K5
4. Critical Areas inventory or C.A. map indicates Critical Area on site?.
5. Site within designated earth subsidence lands lide hazard area?
DETERMINATION
STUDY,REQUIRED WAIVER
Reviewedb�v: /11, Date- < i lo'-7
Critical Areas Checklist/3.25.2004
of ED #P20
City of Edmonds
Development Services Departmeat
Plannin Division
Phone: 425.771.0220
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
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Receipt #:
-al Areas File #: CO - 01 15
,.al-.A,Teas Checklist Fee: $135.00
,,Mailed to ADDlicant:
A property owner, or his/her authorized 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
subse i quent 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 locatingthe
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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, " eluding reasonable
in
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and - correct to the best of my
knowledge and that I am authorized Ztolle this appli tion onthe behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT J DATE q - q-6
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF
0 JerApplicant:
f-C11 1,tfV,)h,k
Name ( Ili
d5,-�kg LWU�l Ater
Street Address
&1070plds
City State zip
Telephone: 4Y,;6 - 7_7 T—,57 qe�
Email address (optional):
DATEX_*LJ1b__7_.
Applicant Representative:
e-� 'T(-?/? �/-
Name ',J
P40 J i� Y_ -7 -7 5f,-) 'I
Street Address
��kf_ A) 2 2
City State Zip
Telephone:da, - — q6&
13r&
Email Address (optional):
--munw— C� Q5
9 0 - 1 9
City of E&mon&
EET1'F-WAY CONSTRUCTION
e. PERMIT
Permit Number.
Wue Date:
A. Address or Vicinity of Construction: 21522 98 Av W (9401113)
B. Type of Work (be specific): TnFit-.all New Sp-g.vice
C. Contractor: —Washington Natural Gas Compi Contact: '�rank Swan
MailingAddress: 815 Mercer 5tr, Seattle, WA Phone: 224-2278
State License #: Liability Insurance: Bond:$
D. Building Permit # (if appli6able):
Side Sewer Permit # (if applicable):
E. Commercial Subdivision El City Project [N Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family 0 Single Family
] Other
INSPECTOR: INSPECTOR: Wk;+w+t
F. Pavement or Concrete Cut: 0 Yes [�No G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AND I
"'rfEdmondsharml1s1frJiFq mages,or
INDEMNITY. Applicant understands and by his signature to this application, agrees to h City
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad t the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR.4 PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION,FEES_WILL-B,� HELD UNTIL T1&F1RAL'$i#EET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPI ICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements andthepink copyof thepermit willbe
available on site at all �ti for inspection purposes.
Signature- &zz L 4 Date: Nolvember 1, 1993
�;'--"TCdhtraciorZt:��ge'n'll��
eALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I -A In; kJ� RIGHT OF WAY DEPOSIT
TIME AUTHORIZED': VOID AFTER DAYS
SPECIAL CONDITIONS: 40-
COMMENTS:
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: #3 A/,
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. I)iv. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund f i 1'- te..'Co" -Street Dept.)
El YES El NO
Date:
Date:
11/01/93 12:54 N.O.B. WASH. NAT. GAS. 004
mb
Avafteb bWqVc&VMV
Addendum to City of Edmonds
Right of Way
Permit Applicaiion,
...Sublu�ttcd by.- Guyla conuors
Engineering Aide
Washington Natural Gas
521-5248
J, V,
Z�4—
PINJF,
N/A WNG to window
'17� unknown
N Water main depth
gas login
U
( �jo
:--:> L-o
—w— W"&.=&
-q- gas -
-as- sewer
-e- water hydrant
0 water valve
II3MaccrSt.MO.bcxl$69),S=n WA"1D(M)fi=-67G7
0-
The City of Edmonds Water Service Drawing EASEMENT NO . ........................ ...................
NEW CONSTRUCTION E] REPAIRS Pq LID NO . .................. . ASMT. NO . ..................
OWNER................................................ ..................... ......... ............... CONTRACTOR .................................................................................... PERMIT NO . ..........
JOB ADDRESS .... ZLS.2.2 ............. 5.!57.$4 .... ^.�.4. t. - W-. � .... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
.............................. ............... ......................... .................................... ............................ ..............
NAMEOF ADDITION .-: ................................................... ................................................................
,zl5zz 981,
2 0
2.5 , or
NO
I
V, 1(00 P.S.I. M.
Is u PGA %w*04 (-��
W/TQAC-&Q
A / I
PWW-0001-1 1175 (REV.1 1/78) 98 TkA AV. W.
Approved:
DATE MJkr4l;.ki .... .........................
NOTICE:*
N 'r
... o r. - —a*. uc-u- -'Y. ...' - - - - - - - - " "
The information on the attached
Hed for use by the CitY 01
Map(s) was com ' P*
Edmonds/ its Empl-oyees and Consultants.
Th,.e City ofEdrn.onds does. not. warrant the
accuracy of anything set for.th on t. ' hese
Map(s). An . y person or entity -requesting a
copy should conduct an independent
orm-ation shown-c
--inquiry regarding the inf'
-m a p (s), including, but not Jimited to/
the lotation of any sewer stub shown, Su(
sewer stubs may or may- not exist and ma�.
or may not exist at the location shown
t y c f E d rn On (J.4 S. nor its
Neither the
e M p. oy e e-s 0 -r o ff i -c e r s -s h. a I- I b e Vj a.
n on this Map(5), nor for
infor . mation g Ve ov'ded based
any one representation pr I
upon'sald map(s).
APPLICATION
The City of Edmonds for CARD No . ......................................
z" )TREw"' 0'"' SIDE SEWER PERMT
t: I N=
OUTSIDE INSIDE Ej REPAIRS E] EASEMENT No . ......................................
OWNER ........
------------- --------
Y ------------------------------ CONTRACTOR .......
A/ ...... ................... Prl;
RMIT No.
STREET
HOUSE No . ..... . .........
J.—. AVENUE LOT 'No . ................... . ................................................. BLOCK No . ..........
-11
NAME ADD - ---------------- .....................................
..........................................................................................................................................
Date
'-')RK ORDER ISSUED ................
..........
DER ISSUED
DEPOSIT, $ ..............
Approved:
--------------------
.DATI --- ---------
.................................... By ...................................................................