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22429 96TH AVE W
WA FILENO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil s/topo graphy/hydrology/vegetation�
1. Site Address/Location: :::�:
2. Property Tax Account Number:
3.
4.
Approximate Site Size (acres or square feet): 1 %0 C
Is this site currently developed? yes; _no.
If yes; how is site developed? g,
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 I 0-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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-&et).
Other (please describe):
6. Site contains areas of year-round standing water: nQ _; Approx. Depth:
7. Site contains areas of seasonal standing water: n C-) ; Approx. Depth:
What season(s) of the year? 1
8. Site is in the floodway nC) floodplain- r,�Q) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? V-)O Flows are seasonal? n C3 (What time of year?
10. Site is primarily: forested meadow shrubs. mixed
urban landscaped (lawn,shrubs etc) 11 �Vcxn
11. Obvious wetland is present.on site: nO
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City of Edmonds
-'%,W 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
th� 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 infor mation (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 Checl�ist and attest that the answers provided are factual, to. the
best of my knowledge (fill out the appropriate column below)..
Owner/Applicant:
4VI(a C Q-,
Name
LA
-.1 1 q U_ Wez
Street Address
(�__Ao_�Wds �_6pr (�,:�6ca��
"ity State Zip
4 2�5 - __? -7 Ll - -7
relephone
35ignature
0
)ate' I
Applicant Representative:
Name
ICA210- L�5_2&f 7-
Street Address
I
1c, ��b VA q%2:1S
city State Zip
L�2�5 - -7 ��7S`�S
Teleph(?ne
Signature
3/_7 1 2CC-) ("11%
Date
receptionyana\cad.doc
(over)
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ATA
NAME:
SITE ADDRESS: DATE: 241
ZONING: —PLAN CHK#:
,9
PROJECT DESCRIPTION: h* low -4 �14 '40
CORNERLOT (Yes/No)
FLAG LOT (Yes/No)
SETBACKS:
Required Setbacks:
Front:-25-' Left SIde:_7__�9_RIght Side: _7?�' -Rear:
ActuaLB-etb
ggkL
Front:
'- .21E Left Slde:_A�7' Right Side: / ZR
Street map checked for additional setback required? Z ear:__/,?:L_
----.(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE:
MaxImu'rn Allowed: Actual:
BUILDING HEIGHT:
Maximum Allowed: -----------Actual Height: —
Datum Point:
—Datum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION: A)
LOT AREA:
0 t. - -i.-k (
tt
OVA 0
L,-OC q
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A
4-1 a 6)
+^ 100 - OWNER/CONTRACTOR I RI
t- 10+ EROSION CONTROL At
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1-0 lu v,1'r � VA,�� L, � �A
-150 &A
0
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ENGINEERING
DRA
CEIver)
R 0 7 200o
IENT SERVICES CTR.
'OF EDMONDS
REQUIRED
own
AS NOTED
00
A- 4111100
t2 P.
NOTICE:
..-w-ar-rani-y ... 0.. a
N-b
on the attached
The Information
map(s) was compiled for use by the City 01
Edmonds- its Empl-oyees and Consultants.
nt the
Th,e City of 'Edmonds does. not. warra
accuracy of anything set for.th on t - hese
nt-ty -requesting a
Map(s). Any person or e. I
copy should conduct an independent
arm'ation shown-c
Inquiry regarding the infi jmIted to
including, but not H
th-�� -map (S),
-er stub shown. Su(
the location ofanysew
y or may' not exist and ma�,
sewer stubs ma
may not exist at the location shown.
or
�jty of Edrnon(js nor its
Neitheir the
emp`o,yee's 0,r off icers -sha-H be 1--lia-b-Ife for th
information given on this map(s), nor for
d
e.ntation provided base
any one repres
upon said map(S'
4 ATE RECEIVED
01
--ses...
'.PERMIT EXPIRES
CITY OF EDMONDS
I C
USE PER IT -
ZONE
F7C7ONSTCRTUCTIOIN
NUMBER
PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS 0 OZ V,2 Cr qbLON 41r L4/
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO. jo V IL)
LID FEE $
F_'1 - Fj- -, -', 1A) A 84 C
Cc
W
MAILINGADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RN Permit Required 0
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il:
ft
-2.1 Ll �t' 96— Ave, ti)
0
EXISTING — PROPOSED
Street Use permit Req'd E]
Inspection Required W
Sidewalk Required 0
CITY ZIP
TELEPHONE
1-7-714 -7-5-76
REQUIRED DEDICATION— FT
Underground
wiring
I-0,
Y"o Olds
required 0
NAME
METER SIZE
LINE SIZE
NO. O�
PRV REQUIRED
�FITUPIES
YES 13 NO
Lu
ADDRESS
REMARKS
z
z
3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSJO� PgNTROUDRAINAGE
z
7'V'5Pe-7_7;D —'V
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CITY ZIP
E
rW A -(--
NAME
37136:ti
Lg
M
EADDRESS�
ENGINEERING REVIEWED/DATE
4
.4
FIRE REVIEWED BY DATE
Lu
CITY ZIP TELEPHONE
I
z
Ix
LL
0 0
-ILI C-� cin 0
/4 /tc 19-27t U21-
VARI , ANC I EORCU
SHORELINE OR ADB#
INSPECTION
REO'D
BOND
IPOSTED
sees
u
STATE LICENSE NUMBER EXPIRATION DATE CHE9KED BY
I
2A) C / K
--LTTIz5_ U NU
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
-4
PROPERTY TAX ACCOUNT PARCEL NO.
Lu
L) 00 - j0q onn 9
EXP ------ 7
LOT COVERAGE
ALLOWED p p
RO 0 ED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSJDE REAR
_j
0 NEW RESIDENTIAL PLUMBING MECH
y
to
0 ADDITION COMMERCIAL o COMPLIANCE OR
77
j eol� e� 7 S
I.W'n
CHANGE OF USE
REMODEL C] APARTMENT C] SIGN
PARKING
REO'D PROVIDED
I/
LOTAREA
E ED BY E
0 REPAIR 0 GRADING Cj FENCE X
CYDS ( FT)
REMARKS
E] DEMOLISH 0 TANK OTHER
.1
7,
GARAGE RETAINING WALL 0 RENEWAL
CARPORT 0 ROCKERY
z
(TYPE OF USE.PUSINESS OR ACTIVITY) EXPLAk.
CHECKED BY
TYPE OMTRiUCTION
CU OCCUPANT
GROU:&Mj_
NUMBER
0?
NUMBER OF
CRITICAL
Lu
SPECIAL INSPECTOR JAREA
OCCUPANT
0
111
OF
DWELLING
AREAS
o
STORIES
UNITS
NUMBEPQ
REQUIRED 0 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS.
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
-ho 'e 0 < -r/ 4 �rl' L' C-1'- j"P
o
-1-7 1
YALLIATION
FEE
PLAN CHECK FEE
09� SOURCE GLAZING %;ett LOT SLOPE %
ITHER#20PON
�BQILDING
t)Arr
*1L D F—"—q7-
V E
PLAN CHECK NO: STIED DATE
I
PLUMBING
ou,
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. -ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
D
SEPARATE PERMISSION.
STATE SURCHARGE SID
PERMIT APPLICATION: 180 DAYS
w
IL
PERMIT LIMIT. 1 YEAR. PROVIDED WORK,S STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-40
U)
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESPRS
;N
ENG. INSPECTION FEE
lop, z
III
i
INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY
2
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
5.
x
FROM THE ISSUANCE OF THIS OERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
RE EIPT.
PLAN CHECK DEPOSIT
Z
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
5
0
X,
NOR LIMIT IN ANYWAYTHE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION.-
R CEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
61VEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WOfIKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
I
SIGN&URE T NER DATE Sl NED
III
(425) OFFICIAJEJ SIqjATURE 0 TE
wa, illn&_
771-0220
ATTENTION
FELEASE�/& E
EXT 333
��9
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW- INSPECTOR
FAX PINK - OWNER GOLD - ASSESSOR
5/98