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23217 77TH PL W.PDF11111111111111 15196 23217 77TH PL W M, City of Edmon& Cr*t i ical Areas Chec'Mist 'Me. Critical Amu Chccklia contained on this form is to be filled out by any person picpanng a Development permit APP"catiOn for the CUY GfEdmonds prior to his&cc sUbmftW of a development permit to the cify� 'Lc PurPOse Of the Checklist is to enable CUY staff to determine whether any potential Critical Areas am or may be present an the Suldcd PrOPCELY. ne information needed to COMPlete die Chocildist should be easily available from observations of the site or data available at City Hall (Critical Areas invcntorics� maps, or soil surveys). -4n applicant. or hh-Acr representative. must fill out the chocIdist, sign and date it, and subm it it to the City. The City will review the cheddist. a precursory she Visit. and a determination of the sabseVent stcps necessary to complete a development permit application. Mrith a signed copyof this fOM3, the VPlicant Should allo submit avicinity xrt�p of 11he parcel with enough dc6il that: City staff can find and identify the =bject parcel(s). In addition. the applicant is encouraged to include any other pertinent information or sttidics in conjunction with this Chcc4dist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Area Checklist and attest that the answers provided -arc factuaL to the best of my knowledge (fill out the appropriate column below) - Owner/ Applicant: 0— _7117D Name (0 Title 11D Strect Addre= �6.Q --", wh- 9 00z 6 Uty. State. Zip Phone 0-*�> —+Date Applicant Representative:* Name Title Street Ad ress City, State, ZIP Phone Signature Date Critical Areas Checklist' Site Information projectName.- - (�AU-) UQE 1418kgk�5pmitNUMber- 0 Ce C> 2- Site Location: Z-3 Z/? 27f�UE- \A,/ Property Tax Account Number: 0 Approximate Site Sim (acres or square feet): -74) X I 5o Have you filled out a Critical Areas Checklist for a project on this site before? Geneml Site Conditions 1. Elas the site be= cleared or logged? Date of most recent action: Soils / Topography 2- In the Snohomish County Soil Survey, what is the mapped soil type(s)? 3- Dcscn-be dic general site tOP09M&Y- Check 2U that apply - Flat less than 5 feet c1citation change over entire site- _OA Rolling: slopes on site generally less than 150/a (a vertical rise of 10 feet over a horizontal distance of 66 feet.) slopes priesent on site of more than 15Y* and less dm 30Y* ( a vertical rise of 10 feet of horizontal odistance.) Steep: grades of gicater than 30Y* present on site. comments HydrologyNegetation. 4- Site contains areas of year-round standing -water 5. Site contains areas of seasonal standing water: Approx- Depth: 6. Site is in the floodway floodplain­_________9f a water course­ 7- Site contains a creek or an area where water flows across the grounds surface? flows are year-round? Flows are seasonal? 8. Site is primarily: forested :meadow _;shrubs _;mixed 9- Obvious wetland -is present on site: 7- 10. Wetland inventory or map indicates wetland present on site: -d' not require VER-. R6,ie Determination'Number-. Date Planner 'Ae� 3127/9) PROJECT REVIEW CHECKLIST 06ECto M E: -,)In to? �ob *LbAE S S: 2 7 2 , -1 kAW REVIEW D BY: In tial/Da te) I -PLAN. WATER I. COMMENTS FIRE � BLDG. SEWER STREET ... ENO.., Setbacks/Variance/Setback Adjustment - - - - - - - - - - - - - - - - - - - - ------------ - - - - - - - - - M. ----- ---- Conditional Use Permit ............... . .............. ADB Requirements 3 Other Zoning Requirements Underground Wiring Required Lot Slope 15% SEPA Environmental Checklist/Hydraulics Permit *,� ........... Tree Cutting Plan 8 Plat/Subdivision Requirements . . . . . . . . . . . . . . .... . . . . . . . . . . 9 Legal Description Verification L --- -- ----- .10. Quit Claim/Street Dedications ...... ...................... Easements - Public/Private ---------------------- ----- ----- .12 Engineering Storm Drain Review Fee F�� . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . XX . 1� ............... .. ........ .. ... ............... . . ............ . ........ .. ....... ... . ..... ....... ? ... . . .... ....... ...... . ....... ... .... 13`1 Engineering 2.2 Inspection Fee .... 14 Drainage Plan (On -Site) 15 Setback - Top of Bank, Stream, Water Courses . . . . . . . . . . . . . ...................... . 16: Setback - Storm Drain Line 17 Open Ditch - Existing . . . . . . . . . . . . . .......... ....... .... . . ............ .......... . ... . .... .. -7 18:1 Culvert Required . .... ...... Culvert Size ­20: Shoulder Drai�_age/Shale Open Runoff Catch Basin Required 22: Driveway Slope & Vehicle Access Sidewalk Required Curb & Gutter Required 25 Curb Cut For Driveway Required 26 Street Paving Required Right -Of -Way Construction Permit Required . . . . . . . . . . . ...... Street Name Sign Required ....................... ...... Other Signing Required 3 0', ...... Bond Required For Public Improvements . . . . . . . . . . . . . . . . . . . . .................. .......... FEMA Map Check/Water Table Side Sewer Availability ........... . . . . . . . . . . . . . . . ...... Calculate Sewer Connectibn Fee If No LID # 34 Create Street File 35 Existing Water Main Size '3 . ......... 36� Water Meter Size Service Line Size 13/41, Water Meter Charge Required . . . . . . . . . . . . . . . . 3776 Hydrant Required M Hydrant Size Existing . . . . . . . . . . . . . . . . . . . . . . . . . . Fire Line Charge Required - Sprinkler Street Cut . .. . ...... ...... .. :43': Miscellaneous Reviewed By: FIRE PLANNING ENGINEERING A-Z PUBLIC WORKS PLAN CHECK #:_7 �, 3 _//; 7 r%A-r= '7-q qT rn .n T7 EET,FILE IN= CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF SUSINESS P P 0 v/ MAILING 3%DL)Ht:bb Lk �0 \6 C) --TT—ELEP.0NE NUMBER CITY F, I �� D\-1 0 1 V 0_� ' 2- 0 7 7 :.�Vc-l< L-6_Z�-- ADRESS e! 7 /5 0 1 V L Zip TELEPHONE NUMBER �ITY 7c� 6 NAME 'Tn N Iii5W, CITY L01011"Jbl� STATE LICENSE NUMBER '31/ ±1--1 � /IF I TELEPHONE NUM 9�<'02-0 __L_Z?14 I I �?-) VQ I! �72' "' 5-r-operty - include all easemene Property TaxAccount mo— Parcel No. U USE PERMIT 'E Z 0 IBER JOB SUITE/APT # '0 E DC 2V ;z EGAL DESCRIPTION CHECKI L Ll SUBDIVISION NO. LID NO. tADDRESS T-160- UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. P PU TESCP Approved 0 0 RW Permit Required EXISTING _ REQUIRED DEDICATION Street Use Permit Roq*d 13. inspection Required P. PROPOSED Sidewalk Required 13 RE MARKS R ROMEILI "HIMMA IWO ENGINEERING M REVIEW BY METER -SIZE I=- P Y SIZE IES 'I 1;7EIAlIr 20 11 je V Ki nATE -00TAD"BNO. SIGN A EA SEPA REVIEW IP ALLOWED I PROPOSED COMPLETE IEXEN T NEW L4 RESIDENTIAL KI PLUMBING ADDITION El COMMERCIAL rzA MECHANICAL REMODEL APT.BLDG- SIGN REPAIR FZ7 GJ3ADINQ FENCE CYDS4W I_ x —FT)' DEMOLISH INSERT SWIM POOL HOT TUB/SPA GARAGE GA&WQNT RETAINING WALL/ ROCKERY RENEWAL (TYPE OF USE. BUSINESS OF ACTIVITY) EXPLAIN: NUMBER OF STORIES %3 F I O� NUMBER OF DWELLING ITS NITS U! _ - CRITICAL IT' AREAS 6? 7— Au TN DESCRIBE WORK T BE DONE (ATTACH PLO;tLAN) 1�9'vsz�-Uer- . -6/r, A �04y�w L7111'- SHORELINE N EXP ILI VARIANCE OR CU PLA NIVREVIEW BY A 7/ SETBACKS FEET HEIGHT LOT COVERAG <REAR/< — FRONT'?- SIDE REMARKS C. - E OF CONSTRUC N CHECKED BY WTI CODE HEIGH �Y ql SPECIAL INSPECTOR REQUIRED r'ew%v*.dA.e,,FS 'AREA - / T—OCCUPANCY L20 '6'q4j GROUP 122, I V--j OCCUPANT LOAD PROGRESS INSPECTIONS PERUBC 305 7114FIN414 Mc -,V/- FINAL INSPECTION REQUIRED PLAN CHECK FEE BUILDING HEAT-�QURrE: 13yqG PLUMBING Plan Check No. MECHANICAL This Permit covers work to be done on priV&t@ property ONLY. GRADlNGIFILL Any construction on the publlc domall'i (dWK 91dewolks, driveways, marquees, etc.) will requifq-�"nrbf() --gerr"h"Ission. STATE SURCHARGE Permit Application: 180 Days STORM DRAINAGE FEE Permit Limit: I Year - Provided Work Is Started Within 1180,00ya --7�pplicant, on behalf of his or her spousdi fi@lt6i ji§glgris And I ENG. INSPECTION FEE successors in interest, agrees to inderfihif Y; d§16hd and hold the City of Edmonds, WaWfidt6fi, fig 601dials, harmless employees, and agents from 'any and dil digift far dalf'116966 Of Arhf, p-10,A)AL - whatever nature, arising directly or indit6dily. hoffi th@ Isgutincs issuance of this permit §hdfl h6f 6@ doomod to PLAN CHECK DEPOSIT of this permit. modi a' .9r (ld_4ce any requiripm6ht of. ift'64V dtd1h&hd6 'vt , , - , " 06rit;6 46y d" r'd"in"a''n'66 y. td �66 nor If rn i4cWaVi"Mly's abilit" f6tAL. AMOUNT DUE I ihdt the. c?.r t, ij aiRM iC�nr' ih'-e- d-d1j, ATTENTION inforrT)"-,q 3� cotrdct.,an it, qf-t Pl� With cltV ind authork.zp,d,pqe,f, _ .1 state IaWs,raovla I' h ki ikr- THIS O�RMIT 4UTHORIZtS ONLY THE �d there�,,y no pecsof W e,vi . .". i WOMK NOttl!) .1 a � 6,6,,,6,0 t6 Wo 61i!jd6jWa 9 r GoM00bdi INSPECTION SIJNA)URE (OWNER OR AGE T) DATE G ;yI "JND DEPARTMENT y CITY E DMONDS CALL FOR ATTENTION INSPECTION It It UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771 A'3qA M r4b] APPLICATION APPROVAL This application is not a permit until signed by the Building Official or his/her Deputy; and fees are paid, and receipt is acknowledged in space provided. OFF C AL'S SIGPIATURE DATE AlAlf-, - 111KAK7 I q- 12-13 AELIfA— DATE C -7 4 UNtiL A FINAL INSPECTION HAS D'EN MADE AND APPROVAL OR ORIGINAL — File YELLOW — In.spector 4 CERTIFICATE OF OCCUPANC 11AS 13EEN GRANTED. UBC �k PttR 3. ,A PINK — Owner GOLD Assessor 102-87 WO -4' S3 SITE' P L A 1,,J: HE) C.-HT CA.LCLJ LATI-OWS-,. -L-T. k. C Lrf OF E7VH0l4V5, !jj: Pik W40140"ltbi C,0., 1P "NOW 441, C- -=7 ID -3 -7 Li. �7 -V�E:77WEST--- E7 T-OTAt- IT01.1 `4 '37T300-i NN vu. 17� T Liop'lo ky. H (7, N Y6 L 4�dn -C) w C-�k LT Ej C-S 1\ �o 0 �Fll- VNTU M F ,L.,Z) tl� E LC-V. 45- ��-76.05' W 13 7. , I -�j %k '> I cri K z 0 w Lft h CD okj .2n 00 C> C)6- >01 ILL w CD m 10 4-7� 27 '6.'- 'L -C. I rl k tA > , 7 - X 0 �C ' Av 4 RD ---I Car4OPdC3 =90 "iD '06-1 -CaN-V I tv-3 I ti -A.3 -�) t-4 I -1 -1 -1 ql h S N OIL -LY 0 LH-'D (.3H �NV*-ld 3-LIG 2-5!0 .4..4 pp Pbw Q*l KI cj C- V. -7;. 05 Z 1,3117. -.19, CORZ -4= EL 12 N 9 I _2 -Div L+ 0. -P w .i U. LU LJJ STREET FILE 890 .199-. City of Edmonds 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, 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 map of the parcel with enough detail that City staff can find and identify the subject parcel(s). In addition, the applicant is encouraged to include any other pertinent information or studies 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 provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner / Applicant: Narne Title i'l 77� Street Address I 6C11"eWd-5'. 21L�JT City, State, ZIP Phone Signature Date Applicant Representative: Name Title Street Address City, State, ZIP Phone Signature Date Critical.Areas Checklist Site Information ProjectName: IleL,5211-l' PermitNumber: Site Location: _�12 LZ —:Z 7a )!!)f W/ Property Tax Account Number: Approximate Site Size (acres or squaire feet): 70 X L_1�7 Have you filled out a Critical Areas Checklist for a project on this site before? &5 General Site Conditions 1. Has the site been cleared or logged? Date of most recent action: Soils / Topography 2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 3. 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 of horizontal distance.) Steep: grades of greater than 30% present on site. Comments Hydrology/Vegetation 4. Site contains areas of year-ro ' und standing water: 4LO 5. Site contains areas of seasonal standing water: �YC) .Approx. Depth: 6. Site is in the floodway floodplain of a water, course. 7. Site contains a creek or an area where water flows across the grounds surface? flows ,are year-round? _Y0 -Flows are seasonal? 1,YZ) 8. Site is primarily: forested meadow _; shrubs _; mixed 9. Obvious wetland is present on site: 10. Wetland inventory or map indicates wetla.nd present on site: 11. Critical Areas inventory or map indicates any Critical Area on site: - - -- — — --- — --------- — ----- — -- — - —For City Use Only----- — ---- — ---- — DY REQUIRED: Critical areas study is required. CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied. WAIVER: Critical areas study is not required. — \ /�� I/ , Determination Number _cA — CIO, — Reviewer Planner Date - -1 (Co— C)4 C-0 44— City of E ' dm'Onds Critical Areas Determination Applicant: I Belt Homes Determination #: Project Name: Permit Numben. Pin Ck # 617 Site Location: 23217 77th PI W Property Tax Acct #: Not assigned by the Assessor. Project Description: New Single Family Residence Waiver Criteria (all criteria must be found to apply): XX There will be no alteration of the Critical Area or its required buffers; xx The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; xx The development proposal meets the minimum standards of the Critical Areas ordinance; xx The above findings are based on the following conditions of approval: 1. The applicant must comply with all grading requirements of chapter 70. of the UBC 2. The applicant must comply with all other grading requirement of the ECDC including those requirements imposed by Engineering Division and the Building Division of the City of Edmonds Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby Waived, as authorized by Chapter 20.15B. 150 (B) of the Edmonds Communit Development Code. Name --signature 75ate M 9 STREET FILE M E M 0 R A N D U M August 12, 1992 TO*: Devon Drake, Treasury Clerk FROM: Sharon F. Nolan, Permit Coordinator SUBJECT: Permit #920502 Please prepare a refund check in the amount of $726.40 for Belt Harps. The receipt number is 16009 (copy attached). Theproject was not started, and, per the Uniform Building Code, the developer is entitled to 80% refund on the building Permit fee (80% of $908). Please send the refund check back to me so I can for -ward to Belt Homes - with a letter. Thanks, Sharon Nolan Permit Coordinator CITY OF EDMONDS USE ZONE PERMIT pf".- R NUMBER CONSTRUCTION PERMIT APPLICATION jo,3 SU17E)PT # ADDRESS OWNER NAME/NAME OF BUSINESS cg? L r 1-4a,71 ez LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO. W Z MAILING ADDRESS � L -f / -7 - 9rh 4ly e 0 0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET 1AP. TESCP Approved 13 CITY ZIP t-(11.110 TELEPHONE NUMBER EXISTING - REQUIRED DEDICATION AW Permit Required 0 Street Use Permit Req'd 1) I PROPOSED Inspection Required Sidewalk Requiled NAME 4/ eeysol 7-1;,y 7s- REMARKS 7i I It',14 U) 0 ADDRESS 7z, -2 ec( -5 7- S,-,, 7-e Zj Z W 0 CC, /& I ___rT_ CITY ZIP ELEPHONE NUM13ER MoKilTeo 9y; 7-6, 17 NAME 511r4 1,i e. /.�x 6) K/ /r e k- ENGINEERING MEMO DATED RE EW BY ADDRESS MET BUILDING S UPPLY SIZE NO. OF FIXTURES 0 l`_ L) < M VRIZE,, 14 M W CITY ZIP TELEPHONE NUMBER ,r Z 8 1 REMPAV R STATE LICENSE NUMBER EXPIRATION DATE 13i-1 -r J 7 e SIGN AREA SEPA REVIEW TaTo, ALLOWED PROPOSED COMPLETE EXEMPT Legal Description of Property - include all easements EXP 0. cr 0 16 CAI 99 A C/ -,r W 'o, VARIANCE OR CU LXNOWEVIEW BY JA DAT7� SETBACKS - F RAG .j FRONT _(1 REA Z Z Property Tax Account C-490- 0/ WD REMARKS Parcel No. NEW L,=P RESIDENTIAL VN PLUMBING EIADDITION COMMERCIAL MECHANICAL 1:1 E] APT.BLDG. REMODEL SIGN FENCE 1Z 7r ..1, REPAIR CYDS. X H Y TYP NSTINUCTION CODE HEIGHT DEMOLISH WOODSTOVE swim P 0 INSERT HOT PA LINSPECTOR AREA OCCUPANCY OCCUPANT IRED GROUP LOAD 13 YES GARAGE RETAINING WALL/ CARPO ARKS ROCKERY 0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: OGRESS INSPECTIONS PER UBC 305 Z FE IYe- it/ -s lclelyeof. D Co NUMBER OF STORIES NUMBLEIR OF Wa DWEL No OL UNITS DESCRIBEWORK TO BE DONE (ATTACH P LA FINAL INSPECTION REQUIRED /054v/� VALUATION FEE 6MOW(7 PLAN CHECK FEE BUILDING HEAT SOURCE: GLAZING -_3 PLUMBING eck No. 6) MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Z3 Any construction on the public domain (curbs, sidewpiks, STATE SURCHARGE driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days Permit Limit: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE ENG. INSPECTION FEE "Applicant, on behalf of his or her spouse, heirs, assigns and successors in interest, agrees to indemnify, defend and hold ow harmless the City of Edmonds, Washington, its officials, m employees, and agents from any and all claims for damages of at whatever nature, arising directly or indirectly from the Issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT 0 modify, waive or reduce any requirement of any City ordinance nor limit In any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE provision." 191,2_ I hereby acknowledge that I have read thisapplication; that the information given is correct; and that I am *e owner, or the duly ATTENTION APPLICATION APPROVAL authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until state laws regulating construction; and In doing the work authoriz- AUTHORIZES ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is tion Insurance. I NSPECTION acknowledged in space provided. SIGNATUI�E (OWNER OR AGENT) DATE SIGNED DEPARTMENT 0 ATURE DATE h, CITY OF 111h9 ;W EDMONDS 7 -,7 - CALL FOR AI�EAS ;"< Sy. DATE ATTENTION INSPECTION 7- IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-0220 UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. PINK — Owner GOLD — Assessor 102-87 7 0. 0/ Uo 5-144 ri UAL "17c T -3-7. Z. lIW -17; T- Ll %: N r- o *7 A.S --7 SC94.LIG !---LO-0 C. tyt,%.C-r. ,LIE A_ -3 11-7. 0 A.: c 3 -7 7.7 n 3 74f�'f 77. 07 mer" q6l.07 m4q�/ lie 7 7 "2r fjL. 317a.- 51TE- PLNLA -r 13 A. L U I �-S CE- rL 1-4 01 r�H'T- S Cl T MVP40 N-0'5 1vr C-0. Wis. 73ELT WOCAIE-o INC-. 4 17 -7 74. - ry STREET FILE S TREE-r FIL Critical Areas Checklist E Site Information ProjectName: PermitNumber: SiteLocation: —:Z'7ZZz f/)/. tt Property Tax Account Number: Approximate Site Size (acres or square feet): 70 A Have you filled out a Critical Areas Checklist for a project on this site before? )(Stj.5 I General Site Conditions 1. Has the site been cleared or logged? Date of most recent action: Soils / Topography 2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 519'014� 3. 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 of horizontal distance.) Steep: grades of greater than 30% present on site. Comments HydrologyNegetation 4. Site contains areas of year-round standing water: 4 5. Site contains areas of seasonal standing water: IQ�L) -.Approx. Depth: 6. Site is in the floodway floodplain of a water course. 7. Site contains a creek or an area where water flows across the grounds surface? flows are year-round? -.�Kl Flows are seasonal? _1W-1 8. Site is primarily: forested meadow shrubs — ;mixed 9. Obvious wetland is present -on site: U) 10. Wetland inventory or map indicates wetland'present on site: 11. Critical Areas inventory or map indicates any Critical Area on site: 0 890 - 199- City of Edmonds 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, 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. .1 With a signed copy of thi's f�rm, the applicant should also submit a vicinity map of the parcel with enough detail that City staff can find and identify the subject parcel(s). In addition, the applicant is encouraged to include any other pertinent information or studies 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 provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner / Applicant: . Neez- I— A e /V &,5 - Name Title �1'7 '— 9 77� Ailf-4 _5e) Street Address City, State, ZIP Phone /A Signature Date Applicant Representative: Narne Title Street Address City, State, ZIP Phone Signature Date City of Edmonds Critical Areas Determination Determination #: Applicant: Belt Homes Project Name: I - I'Permit Number: I Pln I Ck # 617 Site Location: 23217 77th PI W Property Tax Acct #: Not assigned by the Assessor. Project Description: New Single Family Residence Waiver Criteria (all criteria must be found to apply): XX There will be no alteration of the Critical Area or its required buffers; xx The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; xx The development proposal meets the minimum standards of the Critical Areas ordinance; xx The above findings are based on the following conditions of approval: 1. The applicant must comply with all grading requirements of chapter 70 of the UBC 2. The applicant must comply with'all other grading- requirement. of the ECDC including those requirements imposed by Engineering Division and the Building Division of the City of Edmonds Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby Waived, as authorized by Chapter 20.15B. 150 (B) of the Edmonds Communit D velopment Code. I&S -, M-4— Name "'_�Ignature Date 9 'RE ST"EET CITY OF EDMONDS 8 9 0 -1,) SIDE SEWER PERMIT PERMIT ��112 8533 Address of Construction: 2-) :7 -2 Property Legal Description (Include all easements): 14 1 6, 1 + l AA 1k) 02-9 RECEIVED Owner and/or Contractor: 1: 0 o 16 L-:L �=_z H 0 M [-�7- State License No. Building Permit No. [:Ksinole Family 'El Multi -Family (No. -of Units -E] Commercial El Public LIFT STATZ� Invasion into City Right-of-Way:N No El Yes . RW_ Construction Permit No. — Cross other Private Property: R No El Yes Attach legal description'and copy of recorded easement I certify that I have read and shall comply with all city requirements as indicated on the back of the Permit Card. .12- / � 2_/2 3 Date "'i CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION OFFICE USEONLY. FOR INSPECTION C_... PUBLIC WORKS DEPT. Permit Fee: 30, co 114,0220 Issued By Trunk Charge. Date Issued: Assessment Fee: 4120 Receipt No.: Lid No.: Partial Inspection: Date —Initial — Comments Reason Rejected: Date —Initial — Final Inspection Approved: PERMIT MUST BE POSTED ON JOB SITE White Copy: File Green Copy: Inspector Buff Copy: Applicant Revised 3!90 NOTICE: No warranty of accuracy. 1 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 reque sting a copy should conduct an independent inquiry regarding the'information shown on the map(s), including,! but not limited to, the location of any se I wer stub shown. Such sewer stubs may or m, ay not exist and may or may not exist at the location shown. Neither the City of Edmonds nor its employees or officers shall be liab-le for the information given on'this map(s), nor for any one representat on provided based I upon said map(s). Side Sewer Drawing I The City of Edmonds EASEMENT NO - ------------------------------------------- 1. NEW CONSTRUCTION EK REPAIRS F1 LID NO - ------------------ - ASMT. NO . .................. OWNER------------------------------------------------------------------------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO. �; ------- 3 --------- e� . LEGAL DESCRIPTION: LOT NO - ----------- -------------------- BLOCK NO - ------------------------------------ JOB ADDRESS ... P(— '\e4--. ..� --------- -7 -7 -1-- P (- , PWW-0001 -11/75 (REV. 11/78) ------------------------------------------------------------------------------------------------------------------------------------------------------------------ NAMEOF ADDITION ----------------------------------------------------------------------------------------------------------------------- VIA LIFT BALL/j\tC S -TA -rj co. 0 ;Z It Dee, Approved: DATE......... B, ..................