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21909 84TH AVE W
PECECI 'ED
N-
INTER-OFFICE COMM UNICATIONS
Apri 1 8
DATE 1981
TO PLANNING FROM
PUBLIC WORKS BUILDING
u eJ ECT: Blueprint Homes - 3 residences
21917 84th Avenue West 810033
8319 220th Street S.W. 810035
O.K. for final approval?
Suspense date:
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BUILDING PERMIT APPLICATION
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NAME (OR NAME OF NESS) ADDRESS
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ESCRIPTI�DNSUBDIVISION SHORT SUB NO.
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OF WAY PE F1 STREET MAP
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PUBLIC RIGHT
CITY TELEPHONE NUMBER
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NAME PROPOSED
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DEFICIENCY OF RIGHT OF WAY�_o
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SEE ENGINEERING MEMO DATED
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A'EWARKS
CITY TELEPHONE NUMBER
NAME
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
ADDRESS
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CITY TELEPHONE NUMBER REMARKS
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STATE LICENSE NUMBER CITY LICENSE NUMBER SIGN AREA ENV. REVIEW ADS NO.
ALLOWED PROPOSED COMPLETE EXEMPT
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Legal Description of Property (Show Below or Attach Four Copies)
VARIANCE OR CU PLANNING REVIEW BY DATE
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YARDS OT COVERAGE
FRONT SIDE REAR
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REMARKS
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NEW RESIDENTIAL PLUMBING
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
NON-RESIDENTIAL MECHANICAL 1
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ADD
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SPEC AL NSPECTOR OCCUPANCY OCCUPANT
SIGN I I
DEMOLISH r REQUIRED GROUP
LOAD
ALTER EXCAVATE FENCE D YES I
OR FILL X Fr)
REMARKS
PRE -MOVE INSP./ swim
REPAIR D COMPLIAN C EINS P. El- POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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PLAN CHECK FEE VALUATION FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FENCE
marquees, Stc.) will require sapamtO permission.
SIGN
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work 15 Started Within 120 Days RETAINING WALL
"Applicant, on behalf of his or her spouse, heirs, assigns and
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SWIMMING POOL
successors in interest, agrees to indemnify, defend and hold harmless
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the City of Edmonds, Washington, its officials, employees, and
agents from any and all ckiinis for dziniages of whatever nature,
0 0
DATE:
MEMO TO: , Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After revi'ew of the subject Building Permit application, we have
the following comments:
.1. Connection to City water system_required.
2.----C'o'nne'ction to City sanitary sewer system required.
3. Right-of-way Permit required for any work on City property.
4. Driveway slope not to exceed 14%.
5. Backwater valve required if doi,7nstair,,3__plkimbi.ng....is below
elevation Of Upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
Signature
Punic Wows DEPARDm CHEMIST
BUII1)ING PERMIT REVIEW
(ad dss) (date)
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Street Right -of -Way Exis.ting_�a
- A20 QD 6_0 11�,441_e_
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Access Easements Exist
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REQD
cd
Utility Easemmt Existing_______��_REQI�__
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Lot Per Subdivision Plat
Assessor MAP_S_L'_:%9
Site Plan Checked for Ac
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Underground Wiring Reqd.
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Check Accuracy of Leg Descrmt-i
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Review by_ V�Z/w
Date
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Existing Water Main Size W/
Water Main Required �L'A
,Service Line Required .3/// Ir
Hydrant Size Existing
9
Hydrant Reqd Per Fire Code. e4
—Size
Detector Check Meter Reqd. &,(A
Cross Connection Inspection /Y/A
Fire Departnmt Conments
,4ater Meter Charge Reqd. 4
+
Review by
Date
Septic Tank Design Approved
Date. %J I&
Septic Tank Permit Reqd.
Permit No. —
Sanitary Sewer Availability �4=
Proi
Drawing No. L- (0 Or)-
File No. YV
Side Sewer Availability �:(�
VeY,-qT_" U/.
Sanitary Sewer Connection Fee Reqd.
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Review by BAZX__O�
_Pate I. Z.&
42�:�...�Reqd.
Open Ditch Existing__Zo
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Culvert Reqd. 4414 1
Size
Cd
Catch Basin Reqd.
Indicate an Site Plan
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Shoulder drainage maintain collection
on swale open runoff
P
.9� A(lk ±11se
Manhole reqd. "9
— T4cii rate on Site Plan
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�oil Conditions and Ground Water Field Checked —
Review by.
Date f/
10, A :4 14fZ
Revised: lvlO-1977
Page 2 0 .0
Revised: lv 10-1977
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PUBLIC WORKS REVIEW ROUTING
4
SITE ADDRESS:
BUILDING I)EP`r- SUSPENSE DAI-E
TYPE: NISC. BUILDING PEPP11T (CHECK ONE)
IMUW1 ION/ SPRINIGE-R
FENCE
GRADING/Fill
DEMOLITION
RELOCATION
/-T,7-'FINAL APPROVAL FOR OOCUP,�N(-,-f
7—
ir ,
OFFICE ADMIN'
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MU
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DRAINAGE ENGINLER
�4ATER/SEWER DIVISION
DR]
STREET DIVISION
WORK ORDER COORDINATOR
UTILITY BILLING
OFFICE AU-M'11,')-Tf�:�TOR -- IM, OU
RECORDS (FILE)
OTHER:
COMMENTS:.
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SEWER PE'RMIT
PIGHT-OF-WAY PERMfl-
s-ru-i--r USE P-MIT
TREE
.�LPILq TAN'K DESIGN PERMIT
NFW METER/WATER SERVICE
I . S.
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVfEW
DRA T NAG E P L,'�.N
OUT
ky: Peviewed:
(Sr,o comments)
NALU 18 1
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CITY OF EDMONDS 1W
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of CoMstUnUff
Owner:
Name
Mailing Address
�t`ate, Zip Code
Contractor:
Name
Mailing Address
0 r'T 2. 8 1981
')jbljc Works
City, State, Zip Code
Permw.
Issue Date
9 Permit Issued To:
Type of Work to be Done:
• Work in Connection With:
0 Sub 'or Plat 9�ringle Fam' ly
El Comml. / Ind. 11 Apt. Condo.
• Pavement Cut: 0 Yes g-f�—o
State License Number
—7 -21
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court 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 restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to 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
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Signature: �il
6�_n�r_ or/A
g�nt
ble ai the job site for inspection purposes at all times.
THIS PERMIT MUST BE POSTED AT THE JOBSIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued BY:
Time Authorized: Vold after —days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.: .
Fund 111 Fee:
Street Cut Dimensions
X
0
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTOT NOTES*
(Fund, 1117w-" Route conv to Street Dei)t.
rnmmr-1nf- q -
Diagram:
Contractor called for inspection.. Yes NO
T Bv: Date:
,47ork Disa.T.3proved By: Date:
Work Approved Bv* Date:
Inspector:
Ena. Div. December 1978
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CITY OF EDMONDS A
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERM8crflEJET
OL
A. *Address or vicinity of Construction
e Owner: &&7-
Name
Mailing Address
City, Zip Code
0 Contractor:
Name
Mailing Address
City, State, Zip Code
IRIM ' 5?/-(0,;?-,
Issue Date
0 Permit Issued To:
e Type of Work to be Done: ookl—th-�y
0 Work in Connection With:
0 Sub or Plat 2-5ing'ie Family
0 Comml. /Ind. 0 Apt. Condo.
9 Pavement Cut: El Yes El No
x<e ;,-Z/ loaj
State License Number
!�z -71 E;g-y, ig-
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court 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 restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to 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 t be available at t1- Jo site for inspection purposes at all times.
I ;�Inr — "I
Signature: -Date-4 ---� 77V
Owner or A01ht
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: /N/old after days
Special Conditions:
Ammendments:
Permit Fee: 'A
Security Deposit:
Receipt No.: —
Fund III Fee:
Street Cut Dimensions
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
CITY OF EDMONDS AIWT INFORMATION SHEET
FILE,
NEW ASSET NO
ADDITION ADDITION TO ASSET NO.
RETIREMENT
(3 C 2-'Rt -713
DESCRIPTION
fTf? v,
SERIAL NO.
LOCATION DEPT. NO.
I _ oq 4Lli F ��- e,,�
*PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ARM ESTIMATED LIFE
WT
PROJECT N U M BER uj I -S,
PROJECT COMPLETION DATE
COST I
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SLIBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
21 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL- DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
tnp
--DFPA RTM ENT FILE
15
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CITY OF EDMONDS
FOR INSPECTION CALL
CI
PUBLIC WORKS DEPARTMEN* mit U, a
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
Fjkt4LMIT MUST BE POSTED ON JOB SITE
rNrEe'sTs of Construction
2. Property Legal Description (include all easements) / " � - I - 7y z-;-
3. Single Family Residence _�-" Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of -Way: No X Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.-_:;;-4.�i�
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full repcGAW494M each
installation for one year. -QUiMG (6
� C. Commercial establishment requires a minimWEGRE I
side sewer line. I ;89Pj7A�2&4Z§s
d. Side sewers may not be installed closer tha (30")
to any structure. /1 0
e. Side sewer lines must bevkaild-at a minimum -grade of 2% (1.15
- --d— ' 01
and maximum graddoff!�O % T45 )., /,/ /
f. No'tLn-ji,n we -05 o
j�si/dp_-
,/gjeat�dr,than 1/8,bend) is allowed
between cleanqo., Al-l- 90 turns must be constructed of a 450 (1/8
bend) and 'rw'y'� with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for iight-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
-7 X / I
DATE: � -1 -.1 " 'f
'f --' 'that I have 'read
ce 'ti,ly
K/
and 'ghaYl comply with the above
PERMIT FEE:��q,�S—_ DISAPPROVED BY: Date:
B Date:
CONNECTION FEE: ate
P4 APPROVED
D
0
PERMIT MUST BE POSTED ON JOB SITE
Side Sewer Drawing
9
Thgh r,*k#w ns ir-Annt%nAc
EASEMENT NO . .............. : .............. ..............
NEW CONSTRUCTION REPAIRS
LID NO . .................. ASMT. NO . ..................
OWNER ..................................... CONTRACTOR ...... CIO, .5
........................................ PERMIT NO. 61 ................
JOB ADDRESS .... A .. 1909-
...................... .. ........................... LEGAL DESCRIPTION: LOT NO . .......... 7-t ........................ BLOCX NO . ....................................
................................................................................................................................................. ........
NAME OF ADDI'nON ................. .... . .... 90
... ... ... ....
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PWW-OWl-11175 (REV.11178)
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Approved:
DATE ---- 5// 1
... .. ...... 0 ....
BY ..........
. ................
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CITY OF EDMONDS 11SO&M I t was
A lit No.
PUBLIC WORKS DEPARTMENT
Issue Date
,RIGHT - OF - WAY CONSTRUCTION PERMIT
A. eAddress or vicinity of Construct'
P� e' ki 1A)
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0 Ov er: L— v 1", eNr k,--�v !—I",
Name
Mailing Address
City, S ta te, Zip Code
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9 Permit Issued TwE
0 Type o rk to be Done: i -
� TV P Q
9 Work in Connection With:
7 Sub or Plat fif Single Family
11 Comml. / Ind. D Apt. Condo,
0 Pavement Cut: El Yes V" No
State License umber
7 2 4'- - ��'7 (f JJ
City, State, Zip Code Telephone Number
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NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLI!QANT TO REAL) AND SIGN
go
n INDEMITY: 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 it's departments or employees, including or not limited to the defense of any legal
:2 proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
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W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
go following the final inspection and acceptance of the restoration by the Engineering Division.
0
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0 Contractor I J,
Name
:4
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Ma,ilin-g Address
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to 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 th t this permit--mu;t be available at the �.o s
b site for inspection purposes at all times.
Signature:— Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT/THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after rp days
Special Conditions:
Ammendments:
Permit Fee: �- �: �'
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X
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NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
D E C 2 8 19)' 1
Eng. Div. December 1978
-,.FIELD INSPECTIOATES (Fund. ill -Oute'conv to Street"D'ent
Comments:
Diagram:
Contractor called for inspection- Yes No
Work Disapproved Bv:� Date: Bv: Date:
Work Approved Bv: Date:
Inspector:
Enq. Div. December 197P
10 8
REV 12/19 U-TtLity DISTMO no I df's"oheviyj1Ma�w"ty
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PERMIT RtQQI
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-MAP PAGE,
WO, No,
PLANNING DATA
SITE ADDRESS: ATE:— 7 /1 qzl�z
ZONING: PGRUIT.
PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks:
Front:-2��Left Side:-2k,;��Right Side: Rear:--LS�'-
Actual Setbacks:
Front: Left Side: Right Side: t7 Rear: -7
FLOOR AREA:
LOT COVERAGE:
Maximum Allowed: 0 -636VActual: I aqz cl-a/0
BUILDING HEIGHT:
Maximum Allowed: Actual Height: zj--.
SUBDIVISION: '.5 -�/ - 0o
CRITICAL AREAS #: 44- // I
SEPA DETERMINATION:
LOT AREA: /;� (e 0 ?1
OTHER:
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER N7,EINA� OF BUSINESS
IV, h, dcl:,4
MAILING ADDRESS rA
" /f 0 ? 4w - IJ
CITY zip TELEPHONE NUMBER
f111.111111 %4261 -77J/3611
17 t 60
USE PER T
ZONE NUMMBIER 940476
JOB �< Z"�Tl
ADDRESS
"?/gag ?v
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved
RW Permit Required 0
— REQUIRED DEDICATION —
street use Permit Req-d 0
:XISTING
InspeCtidn Required 13
.ROPOSED
Sidevvalk Required 13
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
I I
YES 0 NO 13
ENGINEERING MEMO DATED
Cl;4QL/0 AXY1F-Anqr,1LA.J- d;fl
CITY ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION JDATE FIRE MEMO DATED
SIGN AREA SEP)
AL___A ED ------- COMPLETE
Legal Description of Property, 7 include all eesement.
14 EXPI
1�_.RIANCE J59 W I
_rax_Z'c`qunf
Parcel No, -70114-0-70-000.9
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. El SIGN
D REPAIR GRADING FENCE
CYOS. L_ x _FT)
DEMOLISH WOODSTOVE SWIM POOL
INSERT HOT TUB/SPA
GARAGE r7 RETAINING WALL/
CARPORT " ROCKERY RENEWAL
1 0 UMBER OF CRITICAL
01 NUMBER N
OF DWELLING AREAS
10* STORI 0ye NITS INUMBER
-1 DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FRONT SIDE
CM CKED BY Y
,(J BP-
ECIAL INSPECTOR AREA OCCUPANT
[..M'E,QUIRED CIYES LOAD
MARKS
P p
ROGRESS INSPECTIONS PER LIBC 305
iLlemmi, &At /,?f 4
FINAL INSPECTION REOUIRED
lir.
PLAN CHECK FEE
17H
BUILDING
9-267-3
74�-
GLAZING
/0,/2- %
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curts, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
so
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse. heirs. assigns and
ENG. INSPECTION FEE
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successors in interest, agrees to indemnify, defend and hold
0.
harmless the City of Edmonds, Washington. its officials.
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
PLAN CHECK DEPOSIT
/
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinan 9
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nor li mit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
2V�S
provision.
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION AP PROVAL
Informal ion given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
'
This application is not a permit until
late laws regulating construction; and In doing the work authoriz.
:d
AUTHORIZES
THE
signed by the Building 0 i.lal or his/her
thereby, no person will be employed in violation of the Labor
Code of State of Washington relating to Workmen's Compensa-
ONLY
WORK NOTED
Deputy: and fees are paid, and receipt is
tion Inslaence andA-CW 18.27.
INSPECTION
acknowledged in space provided.
ER
DEPARTMENT
OF I IAL*S SI U
-7-43- .90(
U:�
CITY OF
'A�Tl .IOWIER�Rj,�ITI,,
EDMONDS
CALL FOR
ATTENTION
INSPECTION
2 ]�g2DATE
71
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
7
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPRO VAL OR
771-0220
ORIGINAL File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
4
STRIEET FILE
, CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Locadon: q &e- &L2, "aim a/-s
2. Property Tax Account Number: -2- -70 14 —1 — o 7 0 —,,2 0 0 2-
3. Approximate Site Size (acres or square feet): 12 a 0
6(4-1 n
4. Is this site currently developed? X yes; no.
If yes; how is site developed? -"5t'a!31e- - Fa ne, pe-,s I'de-Ace-
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-f6et 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 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
urban landscaped (lawn,shrubs etc)
11. Obvious wedand is present on site:
b.
RevO110094
90 -194-
City of Ednon&
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,
RECEIVED
JUN - 3 1994
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 forindividual 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 pertment 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:
11'Ah
Nam
)Jw
Street Address
&,,I, JA
City, State, ZIP Phone
//A;
Signature Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature
Date
. . . . . . . STREET FILE
e C3
890 .199
City of E&mon&
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/fier submittal of a development
permit to the City.
The purpose of the Ch ' ecklist 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,
RECEIVED
JUN - 3 1994
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 pertment information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
a ssment 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:
-P74L
Nam
)-mef 241 A- '4 - J
Street Address
�dmo,,�, JA Qd'�& 77J/34,11
City, State, ZIP Phone
Signature Date
Applicant Representative:
Nam
Street Address
City, State, ZIP Phone
Signature
Date
CA FILE NO. '(4-1 (Cl
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: --3-Kf0q-
2. Property Tax Account Number: d W 7- -70 L4 —1 — o 7 0 —,-10 O:z-
3. Approximate Site Size (acres or square feet): 12 f9 qG
4. Is this site currently developed? X yes; no.
If yes; how is site developed? 5,'n!31e--Fae"; La Pe-s,-cle-tucc-
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-f6et 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 tha n 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: S2� 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 contains acreek 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
urban landscaped (1awn,shrubs etc)
1 L Obvious wetland is present on site:
Rcv01/004
. 890 . 19 C� -
CITY OF EDMONDS
250 - 5TH AVE N. - EDMONDS. WA 98020 - (206) 77.1-0220 -i FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning * Parks and Recreation * Engineering
LE1717R OF TRANSMMAL
Date: June 8, 1994
To: Mr. Mike Chaddenton
21909 84th Ave. West
Edmonds, WA 98026
Subject: Critical Areas Checklist
Transmitting:
LAURA M. HALL
MAYOR
For your information: xxx
As you requested:
For your file:
Comment and return:
Note attachments:
Comments: Please bring in a copy of the Critical
Areas Checklist when applying for a building
permit.
Planning Division
Diane Cunningham
Incorporated August 11, 1890