23225 HUMBER LN.PDFiiiiiiiiiiiiii
11790
23225 HUMBER LN
0
0
ADDRESS:
TAX ACCOUNT/PARCEL NUM13ER: 67) 3 002- OOU 07,
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: 0 1 — �-3 DETERMINATION: F1 Conditional Waiver 0 Study Required Owaiver
DISCRETIONARY PERMIT
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:
LOT:
LID
BLOCK:
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #:
SOILS REPORT DA
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Forms\Street File Checklist.doe
'Air
Critical Areas Checklist CA File No: 0I
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: klu t&=� okw=_
2. Property Tax Account Number: 5-713 00L W(p 0--L,
3. Approximate Site Size (acres or square feet): 10 S-0 �WEJ
f
4. Is this site currently developed? Y yes; _ no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
CY 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: ; 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 water course.
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?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) IX3C;>
11. Obvious wetland is present on site: go
G:\Share\Library\Planning\Fonns\Public Handouts\ Critical Areas Checklist Doc/1-16-2001
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City of'Odmonds
Development Services Department
Planning DivisiorRECEIVE
Phone: 425.771.0220
Fax: 425.771.022MAR 0 7 2001
DATED RECEOD: —Z; —
CM RECEIFr-#: ' 1-71o±
Critical Areas File #:
)Critical Areas Checklist Fee: $45.00
DATE MAILED TO APPLICANT:
BUILDING DEM
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/or 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.
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 property 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.
I have completed the attached CRITICAL AREAS CHECKLIST and attest that the answers provided are
factual to the best of my knowledge (fill out the appropriate column below).
wner/Applicant:
Nam�
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Street Address
all.
Signature
Date: (2'j; — C) '8 — 0 1
Applicant Representative:
Name
Street Address
ity State Zip
Telephone:
Signature
Date:
G:\Share\Library\Pianning\Forins\Public Handouts\ Critical Areas Checklist Doc/1-16-2001
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Statutory Warranty Deed FORM L1111
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THE GRANTOR JEAN ALISON JENSEN
AS HER SEPARATE ESTATE
foramodhicomiliderallonof TEN DOLLARS AND OTHER VALUABLE CONSIDERATION
PI111!, conveys and warrants to CHARLES R- PUSSELL AND KARLA' K. RUSSELL
a HIS WIFE
the Ulowing described real estate. situated In . the County of
Washington:
THE WEST 02ol OF LOT 6#AND THE -NORTH 36 FEET OF -
THE WEST 82.5,FEET OF LOT 7#BLOCK 2,SHERWOOO VILLAGE,
ACCORDING To PLAT THEREOF RECORDED IN VOLUME 114' OF
PLATS@PAGES Of AND 82*RECOROS OF
WASHINGTON, SNONDMISH-COUNTY,
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Dated 14TH
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STATE OF WASHINGTON,
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On day personally aPpeared before nor Joan AUal X16b7
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP
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REQUIRED DEDICATION— FT
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LINE SIZE
NO. OF FIXTURES
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ADDRESS
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REMARKS
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THIS PERMIT AUTHORIZES ONLY'fHE'W'IOFik NOTED, THIS-P&Ii-T CO VERS WORK TO'
BE,DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALK$, DRIVEWAYS, MAROUEES, ETC.) WILL'RgOUIRE. .
GRADING/FILL
SEPARATE PERMISSION. . i * .
STATE SURCHARGE
07
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PERMIT APPLICATION: 180 DAYS
CL
PERMIT LIMIT. 1 YEAR - PROVIDED WORK It! STARTED WITHIN -1 80--DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, . ASSIG NS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2
EDMONDS, WASHINGTON, ITSOFFICIALS, EMPLOYEES, AND AdENTS FROM ANY AND
LANDSCAPING
ALLCLAIMS FOR DAMAGES OF WHATEVER L NATURE, ARISING DIRECTLY OR INDIRECTLY
INSP ECTION FEE
9
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OFTHIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIR - EMENTOFAN YCITYORDINANCE
I
PLAN CHECK DEPOSIT
RECEIPT
x
NOR LIMIT IN ANYWAYTHE CITY'S ABILITYTO ENFORCE ANYOROINANCE PROVISION.'
TOTAL AMOUNT DUE
R CEIPT
5_3 q. 50'.
.
I HEREBY ACKNOWLEDGE THAT I HAVE READ T*HIS.APPLICAT . ION; . T
HAT THE INFORMATION
GIVEN IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
MWWVk I: —
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TIOW AND I D
. N DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This application is not a permit until signed by the
.
IN VIOLA?T5.0F I
OF. fHE LABOR CODE OF.THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid. and
re�eipt is acknowledged
WORKMg S
S ENSATION INSURANCE AND RCW 18.27.
in space provided.
ItVINERTRAGENT)
DAT�El��
'C !&�C��
I/GPE DATE
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771-0220
ATTENTION
EXT 333
RECEASE BY f DATEV
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11�t, UNLA WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ydenm &
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFk.,
771:
—
CATE 6F"OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109.
ORI&NAL-FI&A YELLC;�INS4CTOR
FAX PINK
5/98
-OWNER - GOLD -ASSESSOR