21723 97TH AVE W.PDFiiiiii iiiiii
9544
21723 97TH AVE W
City of Edmonds
-1tv 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).
C.
IV E,
U L
0111141
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 checklist, 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/Applicant:
Name
Street Address
City S tate
Telephone
Signature
Date
c:reception\jana\caddoc
Zip
Applicant Representative:
Mlkg.- N�6'ss:%y
Name 1-1
-59-0-7 :5 1,)
Street Address
r--eA VV\'0 -\As f W)�
City State/ Zip
—7+.-�-- 1 S-7-7
Telephone
Signature
—711 /-7-7
Date
(over)
?4Z-15-2 � SD �
C-AFTLENO.-
Critical Areas Checklist CA
---------------------- 7 ------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ tocation: A v WA
2. Property Tax Account Number: 2734,
3. Approximate Site Size (acres or square feet): A <_,,e__S F4�
4. Is this site currently developed?
yes; no.
If yes; how is site developed? s
5. Describe the general site topography. Check all that apply.
>e_ Flat: less than 5-feet elevation change over entire site.
Rollina: 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% an d 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 1 0-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: N 4- ;Approx. Depth:
7. Site contains areas of seasonal standing water: N Approx. Depth:
What season(s) of the year?
8. Site is in the floodway__t�� - floodplain N D of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? No Flows are seasonal? N <>
(What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) Ll�
11. Obvious wetland is present on site: N Z�>
APPLICATION
for
The City of EdmondsSMEU FILE SIDE SEWER PER . MIT
11 T UCTION F] REPAIRS EASEMENT No . ..........................................
OWNER... ....... .......................... CONTRACTOR ...... I ........... I .................. V ...................................................... I.,.... PERMIT No . ......................
ADDRESS ... ....... 41) ... ... ............................ LEGAL DESCRIPTION: LOT No . ..... ........................................ BLOCK No . ............................................
NAME OF ADDITION .....
—7e --c/ cry) a2e5
Ma,-1 / 9 7�L,
Approved:
DATE................................................ By ............................................................... _...
gREET FILE
REGARDING: 21723 - 97th Avenue West j 6 1?
(address)
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME, PHONE NO., & COMMENTS
ADDRESS of.CALLER
5/l/74 Raymond Runninger Certified Letter No. 406165 sent
requiring hook-up within 60 days.
5/6/74 Knows property is connected. Will
call and make dye test appointment.
5/7/74 Please dye test 5/9/74 between
3 and 4:30.
5/9/74 D.T.N.O.S.
5/15/74 Not satisfied with dye test results.
Please retest.
5/17/74 Dye tested twice. First time, N.O.S.
Second test showed on sewer.
S/20/74 D.IX.51
4V
SENDER: Be sure to follow instruefiart-q an nfhor .;4.
PLEASE FURNISH SERVICE(S) INDICATED BY CHECKIED BL_0_
(Additional charge8 required for thcse scrviccs) CK(S)
Show address Deliver ONLY
where delivered X to addressee
KLUtIrl
Received the numbered article descr;12P,4 hot—
ACTION TAKEN
Letter received.
Scheduled S/16/74 between 12 and
4:30.
INITIALS
TE
TE
TE
TE
TE
TE
TE
RECEWT FOR CERTIFIED MAIL-300 (plus postage)
109-03700
MARR-,
'�TNATE
X0,
RUNNINGERt RAYMOND
Apo
P 0 BOX 583
3
30
T--i
LYNNWOOD9 WASH.
98036
19
1974
CD
OPTIONAL SERVICES FOR ADOITIONAL FEES
U 5!j
0 om
RETURN t, 1. Shows t wh and date delivered 150
R With delivery to addressee only 650'--
ECEIPT M 2. Shows to whom, date and wh:re delivered.. 350
S ERV CES F With delivery to address e only ............ 85#
DELIVER TO ADDRESSEE ONLY ........ . .. . ........... sod
.......................................
SPECIAL DELIVERY (extra fee requi'r"e*'d'*)
z
PS Form NO INSURANCE COVERAGE PROVIDED—
3800
(See other side)
Apr. 1971 NOT FOR INTERNATIONAL MAIL
6 CPO; 1070 0-397-456