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City of Edmonds
Critical Areas-�,�-,'Ghe-"'dklist,
The Critical Areas Checklist contained - on:), *jwc,�',�zafid stibmii it tothe-Cifty. -Iti City'.'W"'in
this form is..to be filled.out�q.,ppy, rso the.#ke I*s4,A.mkeAp==
L
r
preparing:a Development Permit -t" mmlmadeterminatio of the...
*VISI And. n,
Application for thcQ',t n',iWbsq t.stF 's necessary compIete*a.-.iA
W of Edmorids4i __qu�n _p
J"T311,
to his/her'submittal bf ;a� i p gm!fa.pplickti6i.'-�tt t�T_
permit to the City.
8 1,2-ts.0 V��t I 'Pei: 0 ri sign cdo
6d,,'- "'yof thistf
-"submiti
Ile purpose of the Checklist is to enabW, map
vicinity*
City staff to determine whether any .. or plot plan for individual lots of the parcel
potential Critical Areas.=.or.may be enough detail that City staff can find
present on the subject property. Ile and identify the subject parcel(s). Jn ,
informatiod" needed to complet6INF Vaddition� -the applicant shall,. hid
ude
Checklist should be easily available from 'other pertinent infonnation (eg. tite
observations of the site or data availabk at plan, topography -map, etc.) or stitdies in
City Hall (Critical Areas inventories re,;OR!unctionw*iththLsCheckUtst-,to-ass*ist
Kmaps,
or so'd surveys). staff in completing their pre�i.�
A§§m6ient of OW iiti�'
- �.7;77"
An applicant, or hisih 'represe'n"'
must fill'out the�checklist,,&* L -it
gn 4
IPWS 9 ch!
bN 2ttf!
I have comple;ed.thpA!3achedC�iticaLArea..CheckUist-and.attest,-thatthe,an "i)roWded."
swers are---
fimal., to- the best of my, knowledge#H!,,out. ihe�appropriate.column
'A plificant Represe4iiivil�'
Owner Applicant:
6
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Name Name
i'At Z -'eZZ0,
ifted A&�m
&red Ad&viss
TTA lam
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t� VM 0 Al aM
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CA FILE NO.
Critical Areas Checklist
-Site Informaflon (soils/topography/hydrology/vegetafion)
1. 1 1., 1 iW
1. Site Address/Location: 919'25—Y3 P(_,u1,65s-r
2. Property'Tax Account Number: - M5+76�0010-00'7—0007
3. Approximate Site Size (acres or square feet): Vro SeR ,F-*r-
4. Is this site currently developed? I" yes; _ no.
If yes; how is site developed?
'777 7
I . 7 _ .,
-5. Describe the general site topography. Check all that apply.
flat 19ss.*ap -��fqd Oevation change over entire site.
M=Rolli fls�slopi&�beetWjei"ly less dm 15% (a vertical rise- of 10-feet over -a'
ng.
"'Pif lo,-,-.ioi�,,ir,*i.�-�-horizontil-d4iaimte,of-66-feet).
up
s opesp s a
Hill --I resdit od irife bf more thafi'15% and les than �0%'( ri
se.
-10 '66
-feet over a"horii6tital distance of 33 to -feet).'
'0
Steep grades. of greater than % present on site (a vertical rise of W-feet over a
horizontal dis� of.less than 33-feet).
10their'
6. Site contains areas of year-round standing water. 0 Approx. Depth:,
Z7
7. Site contains �reas'of seasonal i ing' * water: Ald Approx. Depth:
What season(s) of the year?,
8. Site is iii the flo6dwij 6
floodplaitt A of a water course.
9. Site contaIns a-cieek ofin area". water flows across the grounds surface? Flows are year-
round?' Tlov�s are"' (What time of year?
10. Site is primarily: forested meadow shrubs
urban landscaped Qawn,shrubs etc)
11. Obvious wedand is present on site: Ajo
_Vorl
�N 4 4"ft,
N-IT't-
CITY OF EDMONDS SIDE SEWER PERMIT
18 90
- 1 9 C, PERMIT �,jo 8735
Address of Construction:
Property Legal Description (Include all easements):
Owner and/or Contractor:
ry-,'VS10
UEP1
t: L )AJ C
IV7�_,IZ:�;76
State License No. Building Permit No.
2f"Single Family
0 Multi -Family- -(No. of Units
11 Commercial
El Public
Invasion into City Right-of-WayZNo 0 Yes
RW Construction Permit 7N
Cross other Private PropertyA No 0 Yes
Attach legal description and copy of recorded easement
I certify thatf have read and-s�all comply with all city requirements
as indicated on the back of the Permit Card.
//// 7
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL 7714W2, PUBLIC WORKS DEPT.
W 00, 09M� -
Permit Fee: F Issued By JZ67
Trunk Charg Date Issued: P-1,q-
Assessment Fee: Receipt No.: -2 no-f
Lid No.:
Partial Inspection:
Comments
Date -Initial
Reason Rejected: Date -Initial
Final Inspection Approved: Datd,(-2 144- Initia2g;
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
The City of Edmonds Side Sewer Drawing P
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS
LID NO . .................. ASMT. NO . ................
OWNER .........................
....................................................................... -CONTRACTOR ................................................................ _17
.................... ......
2 PERMIT NO. 8
JOB ADDRESS ................ I ...... �-3 ......... .................... �4 LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
NAME OF ADDITION
5 A�r 4,� _L
iz I
PWW-0001-11/75 (REV.11/78)
5��
C_A� Vj t
3 1 Dc:..e
...................................... .....................................................
4L (e P
C -T pip Aw.,_ 9 10 514,- F &L e
Approved:
DATE -7
y ........... ..................
..............................
NOTICE,
Nowa r-ra n-iy ... ut
The inform ation'shown on the attached
for use by the City Of
map(s) was c0M ' Piled
Edmonds/ its Empl-oyees and Consultants.
Th,..e City ofEdrn.onds does ' n ot. warrant the
these
accuracy of anything set for,th on
Map(s). An . y person or e-ntity -requesting a
copy should c:onduct an -independent
orm'ation shown, o
inquiry regard'ng th8 inf' imited to/
including, but not I
t F� -m a p (s),
the location of any sew-er stub shown, Suc
sewer stubs may or may' not e.xist and may
-t at the location shown.
or may not exis
Neitheir the City of Edmonals nor its
ice-rss-hal-1 be 111 a. b-1--e f o r h
empto-yee-s o-r off
infc)rmation given on this map(5), nor for
entation provided based
any one repres
upon'sald map(S).
4
r a4. oo -
EET FILE
Z
Ti-
o A t /as
.4x
("V4
107
I ! i� ? I
0 3
PERMIT COUNTER Z a
. 2/92,3 9ao,,rpe
&VIew
OTE,S
z Ala
I-r0l-2 77e.-S607
ot 7 Pre v / a vv Ho,-,,, a.
Z3116A 1) i-A.-v 0,,VA.0 .. - - - - , -T
10"
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CA FILE No. QE; - f
Critical Areas Checklist'
Site Information (soils/topography/hydrology/vegetation)
.1. Site Address/Location: 91 q -2 f 399 pe-, luesr
_76'000-007-0007
2. Property Tax Account Number: �5 +
3. Approximate Site Size (acres or square feet): 9!�50 *9 -Pr,
4. Is this site currently developed? __!!:�_yes; _ no.
If yes; how is site developed? Fkl 5'T1A*
IPA!
5!�` Describe the general site topography. Check all that apply.
dT
Flat less than 5-feet elevation changeover entire site.
e df -a
3? kr�- e.-Wi 5j Rol I in�-. 6 si dm 151C(i-4 cal�" 464 o'veir
opes od site -ge& MY less
Q,44klu
,7 , .q-"*Vo -f �
-disiandebf667feet)..
50 PIG11MI15.1 �'i horizonW
Hill",, --isloodpresehOn iM Unwre diaA i�% lei�than 30%, Q,vertical rise-
J�;
istm 33i
f 1046ei'6v�CiVW i�� d ce of
5f
V Oil'ufflm
Steep:..,, -grades of gr thaziao%'present on' site (a vertical nse'of 104e�et over a.,-,.,,
�dess diazi 33-")
e
(pi
Other eas "d6i&&j
6. Site contains areas of year-round standing water. 0 Approx. Depth:
, . III I.. , , ancni
63 'n,
f Ald
7. Site areas o seaso Xjjrox. Depth:
What season(�) of the year?
Q
8. Site is inithelloodwiy7' Al�!-; fl -Aphin A -Of i'%-*v,*a*,t*e"r**66ur's�"e*.",.
9. Si water flows across the grounds surface? Fl� Ws are vear-
ear?
round? F1 am (What time of y
W
10. Site is primarily: forested i'.jauxedi,47
urban landscaped Qawnshrubs etc)
present on siW..
40
41 8 --blow— IZ
90 - 10
City of Edmon&
Critical Areas
Checklist
The Critical Areas Checklist contained on;
and submit it to th& City. 11i city win
this form kto. be, filled outpy ar�y..pe
, j'.- . - m
-a-p
review.1the ;#ccklist, make site
, ..' -
preparing a Development Permit
visit, and make a determination of the
Application for the ' City ofEdniondsprior..
subsequent steps,pecessary, . !9,complete a
to ids/he�ii6iiii6l-b!'f a'�' iiien(,
development permit
permit to the City.
copy of this
1-be purpose of the Checklist is to enab
:�pplicant should also submit a vicinity map
City staff to determine whether any
or plot plan for individual lots of the parcel
potential Critical Areas are or may be
with enough detail that City staff can find
present on the subject property. The
and identify the subject parcel(s). In
information needed to complete the
addition, the applicant shall include
Checklist should be easily available from
other pertinent inforination (e.g. site
observations of the site or data available at
pLI,4 topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps,
coqjunction with this Checklist to assist j,
or soil surveys).
staff in completing thew preli i
a m!ssment of the site.
An applicant, or -his/her rep
must fillout the checklist, i and date
sign
X
I have. completedthe attached Critical Area Checklist and attest that the answers provided are,. -
fac�, to-thebest of my knowledge (fill out the appropriate column below)..
Owner Applicant
Appficant Representative:
PociGhIA4 AIM&A-1
Name
Name
StreetAddress
Street AAdrew
ePAI 0 Al ?�S &14'� 7 4 -6'go
4
CitY1 �Ute- zlpi.11i�'.. f,:% V
City, State, ZIP
Signature Date
Z. D a
xvil I`
x 6
CA FILE NO._ q6 - 14T
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: Ricl-Z-3-7-3 po PL. a�.-r
2. Property Tax Account Number: 5+-76-0aV-0o7-ao07
3. Approximate Site Size (acres or square feet): fZ 5 �50 5M -r-r- . -
4. Is this site currently developed? I" yes; _ no.
If yes; how is site developed? 1FX151'//-4* je&191M-A&25
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: &b -; Approx. Depth:
7. Site'contains areas of seasonal standing water: Ald Approx. Depth:
What season(s) of the year?
8. Site is in the floodway A16 floodplain Lk 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 wetland is present on site: jVo
P.-v 0 1 /04(514
a, go - 1')9
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,
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.
Mth 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:
pocirnLh'5� Ve:'-'d'V
Rame
a I q::z3 - q%'rz. (4jesr
Street Address
. 15—PA10AI?�5 -7 7 & --56o -7
City, State, ZIP Phone
Signature
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
.WJ4 I �' . / L. A
Date SUlature Dail
PLANNING DATA
SITE ADDRESS: P q ?/13 '?J
0-V DATE:
ZONING:. - 1?;5 -b PLAN CHK#: t35-/09
1151111
P6 ii foi;�07,671"W�;,Ite�
SETBACKS:
Required Betbqcks:
Front: Left Side: Right Side: Rear: 15
Actual Setbacks:
Front: 00 Left Side: Right Side: -7'1,?-- Rear:-2,4
CORNERLOT
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE:
Maximum Allowed: 6�0.,54�ctual:
BUILDING HEIGHT: I
Maximum Allowed: Actual Height:
SUBDIVISION
CRITICAL AREAS #:
SEPA DETERMINATION:
LOT AREA: & -w
OTHER:
Plan Review By:
N
STRAPPL- AYION
E FILE for
The City of Edmonds SIDE SEWER PE
" X, z S , 60 OUTSIDE 0 INSIDE 7 REPAIRS 0
'D 1 7-)
OWNER ........ "—,. .. ( i, � ,
...... .... .............. . ..........
..................
HOUSE No..4.C�..G .............. ...... ......
CARD No . ......
.. .......... ...............
EASEMENT No . ......... .... -- ..........................
.... CONTRACTOR ..........
................. .. ... ....... PERMIT No.
STREET
.... AVENUE LOT No . ..................... 7 .................................................... BLOCK No . ......................
NAME ADD ........... ��..Y.
............. .... .
I fj)
-Tj
Date
A Approved:
... .. DEPOSIT, $: ................ ......
BACKFILL WORK ORDER ISSUED ......................................
..........
SEWER WORK ORDER ISSUED ....................................