22807 76TH AVE W.PDF111111 lill 11
6376
22807 76TH AVE W
APPLICATION CARD No . .................................
The City of Edmonds for
SIDE SEWER PERYaT
[j INSIDE 0 REPAIRS EASEMENT No . .................... .................
................... CONTRACTOR ........................................................................ — ......................... PERMIT No . ..................
OWNER ............................................................................ ��p
2-2-�W 7 — ZZY 94!�= STREET
HOUSE No . .............. ..... ....................... ....................... AVENUE LOT No - ---------- .................................... ...................... BLOCK No . ......... ...............................
---------------- ------ -----------
Av,
NAMEADD . .................................. .........................................................................................................................
1, 0!
229- S-, J
0
1� A fNT2*MTT T TXFr%� Tr �� r%��
�00u�� ................................... ........................................
SEWER WORK ORDER ISSUED ..........................................
I
DATE................................. --------------- By .....
CA FILE NO. qb / 4 Z�
Critical Areas Check, list
---------------------------------------- --------------------
Site Information (soil s/topography/hydrol ogy/vegetati on)
I Site Address/Locailon: _ag- S' 0? 66, Lr�
. . :1 . '.�' - �... � T" 1... .11'.'
0;
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): C; )0_4 1)4 jz'nco
4. Is this site currently develoved? _ZyPs; no.
If yes; how is site developed? 5- 1 Z
5. Describe the general,sife topography. Check all that apply.
Flat: less.than 5-feet elevation. change over entire site.
V//'_Rolling: slopo�'oh- site.g . en : eral 11 y.: 1, pss than . 15% (a vertical rise of 10- . feet over a
hori2ontal distance of 66-feet).
�Iilly: slopes present on sife"6f mor6'thah'15% and less than. N% a vertical rise -of
'feei over ab riz a ance' 3�to* 66-fe6t).
0
0 ont I dist
Steep: grades of greater than 3,Q% present on site (a vertical rise of 107-feet over a
h'on'zontal distance of less than 33rfeet).
91#qr (please describe):
6. Site contains areas of year�ro I u I n d-standing* Water: IV
Approx. Depth:
.7. Site contains areas of seasonal standing water...... 7,,&j 0, Approx-..s Depthe-
What season(5) of the year?
8. Site is in the flood,way /�,J� floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ',_�AJS Flows a seasonal? (What time of year?
10. Site is rimarily: f6r6s: meadow shrubs
p
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: 2`,/1F_
soil tM(s)!
Weiland ijiviritory- or.:CA*,� m�p: indicates wetland pi&s6t- oh sitO
J�
indi e a e
4. Critical Ar�as icat s �riticoal* Are' ob'siti ?.
'946. W'Ithin.deslpated earth subsidebde . lands li . de hazard'area?
Site desigftat�d on the. Envir n' I
o medta .1y SenMive Areas Map?
DETERMINATION
ft�_chk.doc; Rev 10/03/97
irle t_nucai i-ixeas t_necKusT containeci on misiorin is
to be filled out by any, person pre a
paring
Development Permit Applic�fion for the Ci of
ty i
Edmonds prior to his/her submittal of a develop ment
permit to the City.
The purpose of the Checklist is to enable City staff.to
determine whethd r" 'an" potenti�d: Critical Areas at 0% o�r
y
may be, present on the subj . ect 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
I pr ecu . rsory the visit, and make a determination of the
subsequent .'ps neces . sar to complete a development
§te y
.:permit applicdtion.,
,Please submit a vicinity map along with the signed
.co of this'fio
rm. to assist City staff in finding and
o c
' ating the specific piece of property described on
this f6rrn ' In addition, the:*'a�p . plicant shall include
o ther pertinent intiotird:iion. (e..g., site plan, topography
map i'tion with this Checklist
ew.) or studies in conjuac
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critica.1 Areas Che,qk.list and at -test that the answers provided are factual, to the
best of my knowledge (fill out the appropriate cQlu mn below.).
Owner/Applicant:
/3/2 YqAl 12, 5�:T,
Name
,-2c2,--5'-'o 7
Street Address
VK 0 v� C? -2-
city State Zip
Telephone
t-A
Signature
4�
Date
Appheant.Represen.tati've:
A/
Name
,street Address
city State zip
Telephone
Signature
Date
c:receptionyanakad.doc
(over)
1112 C . 1 .8 ') 11
Bryan R. St. John
2280776 th Avenue West
Edmonds, WA 98026
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works a Planning/ Building & Parks and Recreation e Engineering - Wastewater Treatment Plant
May 27,1998
Subject: Determination regarding Critical Areas Checklist # 9& 142
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 Crit I ical Areas Checklist "DETERMINATION" for your records.
IMPORTANTINFORMATION T6 BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONALENTAL CHECKLIS OR CRITICAL AREAS ST
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must,submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL .40
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:ReceptIon\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Sharla Graham
Acting Planning Secretary
* Incorporated August 11, 1890 a
Sister Cities International — Hekinan, Japan
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independe * nt
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
'APPLICATION CARD No . .................. ..............
for r. 7
The City of Edmonds SEDE SEWER PERMff - 17 ........
OUTSIDE 13 INSIDE 0 REPAIRS 0 -EASEMENT No.
___Al 12 / 0 f
--waft-
OWNER ... ..................................................................... CONTRACTOR *0�v
......... PERMIT N
STREET
HOUSE No. AVENUE LOT No.
.... .. .. ... ..... ........................................................... .......................... - _-3. ... .... BLOCK No . ......... ...... ................ ..................
N ADD Plf.7 ....... 0,f. ....
eF
mom OF %J
w-I
77t
.0
%
43
J
Date
BACKFILL WORK ORDER ISSUED ...........................
SEWER WORK ORDER ISSUED ...............................
DEPOSIT $ ...............
Aof N,
00Y
�PPROVEJD
trill -
*k 16 02
Approved: "'IN