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21622 86TH PL W
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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 Edmondsprior
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. 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).
An applicant, or his/her -representative,
must fill out the checklist, sign and date it,
7"'&--CE1VE:D
rKIZ
MAR 16 1999
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
developmentpermit 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
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- Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
lwu
Name
Street Address
,5- 1) V\-D A-) V(a 3
City, State, ZIP Phone
Signature D afe
Applicant Representative:
Narn�
I/ ys�
Street Address
2-,,,
City, State, ZIP Phone
Signature
Date
CA FILE No. Q, q-, 69 5
Critical Areas Checklist
Site Information (soils/topography/hydrology/ve etation)
1. Site Address /Location:
2. Property Tax Account Number: 5354 nop ctp
3. Approximate Site Size (acres or square feet): 00 C) *�CrK
4. Is this site currently developed? L/ yes; no.
I f yes; how is site developed?
5. Describe the general site topography. Check all that apply.
c_� 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 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 standing water- Approx. Depth:
What season(s) of the year?
8. Site is in the floodway __ (a�flfloodplain of a water course.
,Z
9. Site contai k n area where water flows across the grounds surface? Flows are year-
round? Flows'are seasonal? - (What time of year?
10. Site is primarily: fqLe_�
urban landscaped tnno rubs etc)
11. Obvious wetland is present on site:
; meadow ; shrubs ; mixed
Rcv01/04t94
CAFILENO. QC?676
1; Critical Areas Checklist
Site Information (soils/topography/hydrology/ve etation)
1. Site Address/Location:
2. Property Tax Account Number: coQ cf-DY
2---
3. Approximate Site Size (acres or square feet): C;C) 0 2e
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 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.
,,O�
9. Site contai k n area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10.
Site is primarily: f99A�q
urban landscapedtnn,_�Irubs etc)
11. Obvious wetland is present on site:
; meadow ;shrubs ; mixed
-----For City Staff Use Only
Site is Zoned)
mapped soil type(s)? 2--id,17tu �111(,
..3 Wetland inventory or C. A. map indicAt wetland pr�w\ t on site'?
4. Critical Areas inventory or C. A. map indicates Critical Area on site?
-5. Site within designated earth subsidence landslide hazard area?
Site designated on the Environmentally Sensitive Areas Map? [I )n
DETERMINATION
ZSTUDY REQUFRED
L/ / . i
WAI ER
Reviewed by:.
Planner'
Rcv 01/04'94
CONDITIONAL WAIVER
Dat,1Z
6, go - 199
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. 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).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
RE:CEIVIZO
MAR 16 1999
PERMrr 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
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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Street Address
cF- J) JV\, D A-) b
4-- V16 3
City, State, ZIP Phone
Signature
Applicant Representative:
C3 WL is
Narn�
-,r-A
Street Address G
Ciiy, gimte, ZIP Phone
Signature
Date
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 29, 1999
Ethel Phinney
2162286 th Place West
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist # 99-68
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
..........
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED -TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHF��� OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 4*0
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADBO Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
*Architectural Design Board
Thank you.
Sharla Graham
Planning Secretary
C:ReceptIon\Jana\CRLTR.doc
Incorporated August 11, 1890
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Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds specs
2. Channelizing devices are 28" traffic cones.
0 3. Alert affected residents.
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C1 �D 4. All signs are 48" x 48" B/O unless
NOT TO
SCALE stated otherwise.
5. Work area is 20' e/o c/I 86 PL W
216 ST SW
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Job #106103532
8 Mar 03
Sheet 1 / 1
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CHANNELIZING DEVICE SPACING (FEET)
TAP TANGENT
20 20
F-LEGEND I
WORK AREA
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EXISTING TRAFFIC FLOW
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PROTECTIVE VEHICLE
OR WORK VEHICLE
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Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds specs
2.,Channelizing devices are 28" traffic cones.
0 3. Alert affected residents.
z 4. All signs are 48" x 48" B/O unless
NOT TO stated otherwise.
SCALE 5. Work area is 20'e/o c/I 86 PL W
216 ST SW
- - - - - - - - - - - - - - ---
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217 ST SW
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Pilchuck Contractors, Inc.
Job #106103532
8 Mar 03
Sheet I / 1
J. Buss
National Barricade Co.
CHANNELIZING DEVICE SPACING (FEET)
TAPER I TANGENT
20 1 20
I LEGEND I
WORK AREA
28" TRAFFIC CONE
EXISTING TRAFFIC FLOI
,Sz SIGN LOCATION
PROTECTIVE VEHICLE
OR WORK VEHICLE
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A.,
III GIM1111,7777-Mill,
—.7 — ;
F-WAY CONSTRUC1,10N PERMIT
A. Address or Vicinity of Com
B. Type of Work (be specific):
C. Contractor:
Permit No:
Issue Date;
. 5
Mailing '�Iddress: 1,�iO kiL I U %d 0 Phone: COO Co - Z4 I Ye-,� 3 9
State License'#: Hcz- 10 r M Liability Insurance: Bond:'$
D. Buildmiig Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F� Commercial E] Subdivision City Project El EUC (PUD, VERIZON, PSE, AT& T, OVWD)
F-1 Multi -Family F1 Single Family F� Other
INSPECTOR:
F. PAVEMENT CUT: YES G. SIZE OF CUT x
CONCRETE CUT: El YES [I NO
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
injuries, damiges 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 employees, including but not limited to the defense'bf -ah" I l'--'
ega procee ings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLORING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES 97LL BE HELD UNTIL THE FINAL:STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT W!LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
+ Traffic control and public safety shall be in accordance with City regulations as reggired-by the City Engineer. - Every
flagger must be trained. as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work sliill--�be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEP TIONS.
* Three sets of construction drawings of proposed work Are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR ib-B.EGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T, I MUS T MA KE THE PINK F THE PERMIT A VAILA BL E ON SITE A T A LL - TIMES FOR INSPEC TIONS
Signalute.' _,� I lk�N Date:' 3 1 13 L
(Contractor or Agent)
FOR CITY USE ONLY
Approved by: &L&W. Right-of-way Fee:'
Time Authorized: Void After Disruption Fee/Fund 11-1:
Special,;Conditions: eEemw Itpw n 0-(TU CUDAE:&I Restoration Fee:
OF A nF-7A Total Fee:' P'9-
Receipt No:,. a 42
Issued by:.
4
UPON COMPLETION OF PERMITTED WORK, AN.ENGINEERING FINAL
-INSPECTION IS REQUIRED. PER CHAPTER 18.00 OF THE EDMONDS
*COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext; 1326)
FINAL APPROVAL OFPERMITTED WORK.- 0ASi;,(6 0 1-1/ pe'Ini'l DATE: JOIZs-lb-7.
I J
Impector's Signature (
W
For inspection requirements see Engineering Inspection. Info ri'mation handout.
L-----------
1.
NO WOIZK SHALI, IUJAN I'MOIZ TO 1'E1ZMrr ISSUANCE
DAMy Documents\Forms\Engnmg\�OWpermit—.doc