22608 95TH PL W.PDF11111111 lill
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22608 95TH PL W
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TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: 0 o� - i7n DETERMINATION: F-1 Conditional Waiver El Study Required XWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DA'
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LOT:
LID
BLOCK:
LATEMP\DST's\Fomis\Street File Checklist.doc
CAFileNo:
Critical, Areas Checklist
Site Information (soils/ t6poj#aph�./hydrolo /v p t
e e ation)
1. Site'Address/.Location:
2. Property Tax "Account Number: 4 4 09
3. Approximat� Site. Size'(aicres or`4quare' eet)-.
is
si
4. currently dei;v6 ed ? yes; no.
If yes; how' is 'site developed? 044 LO -41� Z/
5. Describe, the general site topogra0hy. Check all. that -apply.
____%'L"'o'Flat: less tha ' n 5-feet elevation ch�nge over entire site.
O��Roffing: slopes on site generally' less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet)..
Hilly: slopes presenf on site of more than45%, and'16s 6-iAn-30% a vertical rise of 10-feet
over a horizontal digtah�e of 33 t&661feet).
%
Steep: grades of grea''ter than 30%ipresent on site (a vertical rise of 10-feet over a horizontal
distance of less than 3346et).,
Other (please' describe):
6.
7.
8.
9.
Site contains areas of year-round g,tanding water: Appio'k., De'' th:'
P.
Site contains areas of seasonal itariding.water: Approx. Depth:,
What season(s) of the year?
Site is in the flo6dway. !j ".D�to'fk of a water course.
Site contains.a creek, or an area W�ere watef""flQws-across the grounds surface? Flows are year-round?
Flows are,'seasona 77
Site is primarily: f or es"ted meadow shrubs mixed
urban landscaped (lawnshiubs.etc)
Critical Areas Checklist.doc/3.19.2001
City oPE A -inondg Date,Re'cMd:
Development 5.ervicds Depar"cMt'� PAY.Rec (1;1�0
Plaiining,.Rkyi
brftia&Areas'Ch6ck1i6U
Phone':-. -425.771.0226
651tamailprit in' d ionte
Fax:. � 23171.022.1
T!
The Critical Areas Checklist.c'
qntai� . 11 s. to., A-prope ty�',--,qwner, authorized re resentative,
�d,.qn..this. fdrm i , - I , r . 1 -1 :- ; ,
qp
be filled out by any person preparing a Development radst-Pill.out the checklist, sign and date it, and submit it
Permit Application for the City of Edmonds prior _to, fto" th6 -Cit'. , The,City will, review the checklitt,--niake a
'y
his/her submittal of the application to the City. site,visit, and make a determination of the
precursor
,y
�Vbs6qidot gieps -necessary 'to complete -a ddvelbpment
The purpose of the Checklist is to enable City staff to ennit application.
determine whether any �ot6tial Ciitical'Areas are, or' p
may be, present on the. subject property. The information Please'su,bmit'a vr'ibri mi; ity map; �,`a long with the sign . ed copy
needed to- com te -�ecklist should. -be easily�, -of to - issist,Cit�; it�ff in findme and 16"ti 'the
ple, , the
available from observations of the site or data available -at .,specific ipiece,,..bf Oroverty, described on this': form. in
City Hall (Critical areas inventories, maps, or soil addition, the applicant shall include other pertinent
information, (�!g: site plan,- topography map
surveys).
etc.) or
studies in conjunction -with 1h.is Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, ind-a'ssigns*',�*ui.cc)nsideration,o;itbp procq I §qVa&pf, the application agrees
to release, indemnify, deifind and hold the -City of Eftgncl,i'"ii�",J�o�il'i�y.and'611'6=ges,i including reasonable
f. a 'inaccurate or
or p hlsd;.,Tru 1� ding
attorney's fees, arising from any' 'action 6f infraction based a' ��rh6le ift 'upon S
incomplete information furnished by the applicant, his/her/its, agents oremplo�ees.
By my signature, I certify that the information and exhibits -herewith subniitted,,gd,,-true and correct to the best of my
knowledge and that I am authorized to file this applicationon�the'belialfof th� owner as� listed beflow..�
'4L 1� ! I
1
SIGNATURE OF APPLIcANT/AGENe DATE
Property Ownet's Authorization
By my signature, I certify that I have authorized the above A&licant/Agent to; apply for the, subject land w.,4pplication,
and grant my permission for the public officials and the staff - 6f ti.he City of Edmonds to enterthe subject property for the
purposes of inspection and posting attendant to this application'.:
SIGNATURE OF OWNER DATE 4140.,
-r/Applicant:
,owne
zo,%oo7ala
1006
.aol
eet Address V
f I ,
city
State
Telephone:
Email address (optional):
Zip
Apoficint'R'Tresentative:�
7 , -7
4
treevAdldiess'
State, zip
city,: 9.
Telephone:
Email Address. (optional):.,
Critical Areas Checklist.doc/3.19.2001
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3PRO E Y PLANNING
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SETBACKS.:
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STREET FILE
Site Plan
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PERMIT COUNTER
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