22604 92ND AVE W.PDF8970
22604 92ND AVE W
CA FILE NO, q
CrIdcal Are4s - Chocklist .
- - -,-: ------------------------
--------------
Site blormation (soilsl
4
Site Addresa/LocAtio=
..,CW,
Pipperty Tax Acanmt Numb=
Approximte Site Size CaMs Or 5qum f�et�. 20' X OD
no.
jo tl� Dite currently dcvaloped?)� YM
If ' how is sits dpmlop�?
yes,
Desm'be the gmeral site tVogmphy. Check'aU h%e apply.
Flat: less than 5-feet elevatim dmge over enWe site.
RoUing.- gUqm an dw gener4yj6s 0= 15% (a verticol Asa of IU*et over a
hCACCAW 438tance of
HMy: glopes present an site of =we than 15 % and less than 30% (a vertical
rise of 1049at aver a h6rixgntol dbtarwe of 33 to 66-feet).
Steep-. grades of greater than3O.W.peserft an site (a verdW rise of 10-feet ovw
a hori=fti dbbww of low +Jmlmeet).
Other (please desc�be)-
6. Site =udw areas of year-round sumftr4 �Fsw- tO ApprOx. Depth- � i
7. Site eantdm arew of seasonal abading watm Am= DvttL
What seasm(s) of the year?
af a water comee.
S. Sdte is in the floodway �Plafr(—fOID
9. Site cmt&bw a creek or an wee w1hem water 11cwt sam the Sru=ds surface? IFL*,�vs vie
year-rumid? V�D Flu" we seawnal? —. (What tMW Of Ye"?
10. Site is prImarfly: forested mixed
UT'b� IMJAICA?ed aawnAmlm aft)
11. Obvim wetl=d is present on site: tn^
-z
%a ChILISGOWWOAMM
��� I t a-t+ k � Q-0--rD U� I --T f W,, �2� 1 4
City* of Edmonds,*
W�ffi NIF I - . . -. .
CRITICAL AREAS:: CHECKLIST
The Critical Areas Checklist cofttained on this foilri 15.: A'n spilicant, or - his/her representadve, musT fM out
to be filled out by any person preparing . a.: thd checklist. siizn and date " and!=bmit ft to the
Development Permit Application for the City qf*", 6'ty� ;T-ht City v�w review the aecklis� make a.
Edmonds prior to his/ber submitua of a deval cumoly $itt visit, and n�ake e, det�=inAtion of the
Pennit to the City. sjjbsDT=t steps liecessmy to complae a development
to '�ICW **submii a vicinity map along, with the signed
The purpose of the Checklist is to emble City sta
determine whether any potential Criti�4 Areas exe�� -c.o
or. p� of. this fonn to assist City smff in Anding and
may be, presaa = the rubjM Mpeny. Ilie'.'. Wating t�e specific piece.'of property described ot
Infonnation needed to compicto the Chcoklist should fd= h addition, the applicant aball include
be easily available from observations of the.site 6r' oi#er pertinent information (e.g., Site Plan, toMraphy
dau avidjAle at City Hall (Critical Areas inventaiies, �aV
. , etc.) or suidies in c=Juacdon v4th ibis Checklist
maps, or Sou SIUVOYS). �assjst staff in completing t�cir preliminary
j�xwsmwt of the site
I have completed the anachod Critical Areas checkun . d anest -that the smswen provided are factual, to the
best of my knowledge (fill out the appropri= col�= below).
Owner/Appliawt. Repre4entative:
cr A
LiXbf).
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Nmna
Sweet Addrem �Addrm
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City suite Zip zip
cqM-
Telepho
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Dip
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7 A A FFA a#TkTVTV.I-rU ef%7rtWdNTV,— <1;70—aV"OGOAV VV.T 0-r!4%T nUT 10?T 'ORA
.1�4 C. 18 q13
10-01-97
CITY OF EDMONDS BARBARA FAHEY
121 STH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 1 . MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning/ Building e Parks and Recreation & Engineering e Wastewater Treatment Plant
Gretchen or Dana Campion
22604 92nd Ave. West
Edmonds, WA 99020
Subject: Determination regarding Critical Areas Checklist # 97-180
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 MAYNEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDy.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You mu.4t submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINA TION INITHALL -400
PERMITAPPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Note Attachments:
* Architectural Design Board
C:ReCeptionUanakCRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
0 Incorporated August 11, 1890 9
Sister Cities International — Hekinan, Japan
C4,otEdmonds
RIGHT -.OF -WAY CONSTRUCTION
PERMIT
Permit Number.
mue Vate:
MAY 2 2 1996
A.Eftinftg1�W of Construction: 22604 92 Av W (9613573)
9 0 1 C� B. Type of Work (be specific): Install Service
C. Contractor: Washington Natural Gas
MailingAddress: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
i
E. 0 Commercial F1 Subdivision El CityProject kR Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] SingleFamily El Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes Mo G. Size of Cut: X.) H. Chargq_$
APPLICANT TO READ AN15. 616N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from 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 its departryients or
employees, including or not limited to the defense ofany legalproceeding8 including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CA-bIT'iV7LL�BE`PR0.6t�$$ED FO
V ICA
,§S,UAJC-��, EAPPL
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Iha ve read the abo ue statements and understand the permit requirements and the pink copy of thepermit will be
available on site at all tipes for inspection purposes.
Signature: Azlyd'l 49ZA61 Date:
Frtracior 6r- Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: J_Q1^'Af-2A RIGHT OF WAY DEPOSIT
COMMENTS:
DATE:
DISRUPTION FEE/FUND 111: -
RESTORATION FEE:
PERMIT FEE; -3 /), n r)
TOTAL FEE:
RECEIPT FEE-
ISSUED,BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES 1:1 NO
Date:
Date:
atwimGas I
vAzNrKAonEn&wCcn1MV Addendum.to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury.,
Engineering Aide
qVaphington E;a�tural Gas
Z(Z4 'al 1356-7500 X7596
L— <-- -'A I
R
0
Watermain depth
gas "in
ca o 4- V
C3 b 9 -3
N 0 CAJ:('
Key:
-w- Water.
-G- Gas
-SS- Sewer
Water hydrant
0 Water valve
tit. I i I j�
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
SA -IL M Poo pq M
Natwa!Gas"��
A VMO*Vlon Ererw Gdwxv-aw Addendum.to: City of Edmonds
Right of gay
Permit Application
00.
Submitted by: Mariamne Kingsbury
Engineering Aide
P,Vaphington 14tural Gas
IX IaT 0356-7500 X7596
2-2
0
Watermain depth
gas main
V
A)-V
2?�(-ao4- -92
q(.0i lbs-:F3
(\j 0 CA-k,-(- 15
Key:
-W- Water.
-G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
NaturilGas UMMIGO-d"
AVftNngIonErewCOnPffV
Watermain depth
gas main
Addendum.to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
,,,Vaphington Wural Gas
'Z q4 cal 0356-7500 X7596
-90
N 0 CA-Cr
Key:
-V- Vat er
-G- Gas
-SS- Sewer
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
I
NOTI. E:*
r
'0 -ar-ranty__0Va--c-C_u--
N W
The information shown on the attached
Hed for use by the UtY Of
map(s) was com ' pi
Edmonds/ its Empl-oyees and Consultants.
Th,.e City ofEdm.onds does ' not ' warrant the
these
accuracy of anything set for.th on
m a p (S"), A n . y person or entity -requesting a
copyshould conduct an.independent
-ation shown-o
inquiry regard*ng the 'nf, rm
including, but not Jimited to,
_ff�e -M a P (S)
the location of any sewer stub shown. Suc
sewer stubs may or may not e.xist and may
or may not exist at the location shown
�jty of Edmonds nor its
Neitheir the
emp`o-yee-s Of Office-rs -shal-1 be 1--ia.b.-If-e for thE
n on this map(5), nor for
information g' ve' d
entation provided ba.se
any one repres
upon said. map(S'.