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The City of Edmonds
Side Sewer Drawing
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EASEMENT NO . ............. .................. -----------
213-07900 NEW CONSTRUCTION 0 REPAIRS LID NO - --------- -------- - ASMT. NO - -----------------
OWNEP . ....... C-L.INTON ... F ....... GRAY ..... ---------------------------------------- CONTRACTOR .............
- -- ----------- - .. ............ ........................ ---------------------------------------------- PERMIT NO - ----------
joB ADDRESS ... 2-3-0 ... 3-RD..AVE ...... N ............................................ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
.............................................. ..........
NAME OF ADDITION ..............
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STREET FILE
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DYE TESTED ON SE14ER
Approved:
PWW-0001 -11175 (REV. 11/78) DATE I ......................................... - By --
CA File No: 2602 -
Critical Areas,, Qheckl i st
Site Informaidon (sofls/ to P�/hydr logy/vegotaldon).,
1. Site Address/ Location::
2. Property Tax Account Number: LI)97--bOF 49 -6 3- New
3. Approximate Site Size (acres or, square eet)t;-*
4. Is this site currently developed? -.Aes; no.
If yes; how is site developed?
a
5. Describe the general site topography. (��-t
Flat: les's "than 5-feet elev'aitioh'C,4i��ge over entire siW.'
Rolling: slopes on site generally; less tha'n": 15- -0� itcal rise of 10-feet over a'horizontal
ve...
distance.of,66.-fee:9.
Hill y*: slopes present on site of more than 15% and less than 30% -a vertical rise of 10-feet
over'a-horiiontal distance of 33 tc,;f664eet).
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: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a watercourse.
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? Y
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) X
11. Obvious we tland is vresent on site: XLf
�,,Sc5p�gpped—
to :su 11
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Critical Areas Checklist.doc/3.19.2001
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City of Edmonds
Development,ServicesDepariment--.,,'�.----
Planning Division
Phone:- 425.771.0220
,%C)Z Fax: 425.771.0221
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 the application to the City.
The purpose, of the Checklist is to enable City staff to
determine, whether any potential Critical Areas are, of
may be, present on the subject property. T11e 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).
Date Re*ceived:
�.Cit
y,Receipt,#:-
C r "
itidiii Areas- fil
-Critic,a,l.,,A,r.Oa.iChe,dklist�Fee: �,k`�$46.00--
Date Mailed to Ap licant:
P .....
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The Cit� will review the checklist, make a
precursory site visit, and, make a determination of the
subsequent steps necessar . y 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 propeity-described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the essin2 of the application agrees
proc
to release, indemnify, defend and hold the City of Edinonds harmles"'s fromany and all damages, including reasonable
attorney's fees, arising from any action or infraction based in. whole or part upon f2ilse, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
roperty Owner's Authorization
y my signature, I certify that I have authorized the above Applicant/Agprit to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to thisapplication.
Owner/Applic
Name
�Y,,F az&1A
I Stree�Address
17
0
City State Zip
-7 --
�'Telephone: ",_5 -7
Email address (optional):
11 Critical Areas Checklist.doc/3.19.2001
A pplicant Representative:
- T
aine
Street Address
City
Telephone:
State
ErnailAddress (optional):
Zip