23015 102ND PL W.PDFiiiiiiiiii
199
23015 102ND PL W
NOTICE:-
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N'.'a'r.r a n. o f -a-:�c c7u. r.
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The information 'shown on the attached
'led for use by the City 0'
Map(s) was compi nsultants.
Edmonds, its Empl-oyees and Co
Th,..e City of does. not . warrant the
accuracy of anything set for.th on these
Ma P ('s'-). An . y person or entity requesting a
copy should conduct an.independent
1 8 inform*ation shown c
Inquiry regard'ng th
-te
tFe -Map(s), including, but not 11mi : d to/
c ion of any sew-er stub shown. Su(
the 10, at,
sewer stubs may or may -not e.xist and ma�,
he location shown.
or may not exist at t
C—ty of Edmoin'r-1-sl nor its
Neltheir the h
emp'fo-yee-s O-r officers
is map(5), nor for
Information given on th'
'ded based
any one represe-ntation prov.1
Upon*sald. map(S).
Water Service Drawing
The City of Edmonds EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS n LID NO . .................. . ASMT. NO . ..................
OWNER . ........ .... .... .............................................. CONTRACTOR .................................................................................... PERMIT NO.
............................ .
JOBADDRESS ............................ ........................................
N
I'll arn-S 5
LEGAL DESCRIPTION: LOT.NO . ...................................... BLOCK NO . ....................................
................................................ ; .................................................................................................................
NAMEOF ADDITION ..: .....................................................................................................................
I 7-e e, cqppe
&#-rc, 044LI C,
Approved:
F- 7-.ff ........ ... /$ --------------------------------
PWW-0001-1 1175 (REV.1, 1/78) DATE ......................... .... ..... By 77
STREET FILE
CA FILE NO.- q3 �2- 9
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
-at 1. Site.Address/Location: 2— -:�7 C1 ",4,9 Pf, k) , FAk,_�
2. Property Tax Account Number:
3. '.A'prbxi rna�te Site Size (acres or square feet): cFg9-e> e;,
p
4. Is this -site �urt'e'fi tly developed? b4 yes; * no.
If yes; how is site developed? /7�4/�;
4�6�el_p —
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 10-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 10-feet over a horizontal distance of 33 to 66-feet).
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: /4/0 Approx. Depth:
7. Site contains areas of seasonal standing water: .41',o Approx. Depth:
What season(s) of the year?
8. Site is in the floodway lVo floodplain A6.1
4 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? AIZ2 . . Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs
mixed
urban landscaped (lawn,shrubs etc) (W
11. Obvious wetland is present on site: Ala
—For City Staff Use Only
I. Site is Zoned?
2. SCS mapped soil type(s)?
:3. Wetland inventory or C.A. map indicates wetland present on site?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
6. Site designated on the Environmentally Sensitive Areas Map?
DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
Reviewed by: 12,11
� Plaq4rlX I Date
Rev M9/91
06) 3 W "- 4A "5; / 2 Apt I b a,, _�_
690 -199-
City of Edmon&
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 the checklist, sign and date it,
-s- "�- (C"(- tup-J'i
ACCEIVEL),
DEC 15 1993
PERMiT commi,
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.
With a -signed copy of this form, the
applicant should also submit a vicinity imap
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studi4!s in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers providedare
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
ee- .4
Street Address
Applicant Representative:
Naine
0 C)
Street Address
W4 1&-20 -776-0131 jFJ7&,��s IrIA C? %0 2e> -2 76, —e-v -3
City, State, ZIP Phone City, State,__Zl�p Phone
Signature Date Signature Date
'Z,04!� atlo&