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23301 FRIAR TUCK
LN
CA FILE NO. C-4- —M i I -Z_
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 2-3_�01 Frl-,�,- 7ack Z-,, &7dv,,,A
2. Property Tax Account Number: -5713002-01 c?0oo2_
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _�Zyes; —no.
If yes; how is site developed? ho^,- 1�
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
v1 Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present cn site of more than 15% and less than 30% ( a vertical rise of
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: /10 Approx. Depth:
7. Site contains areas of seasonal standing water: 1*7 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway ,;7 0
floodplain 1 .0 0 of a water course. 0/7 "�-O_ /9 Of k
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- /10,
round? _ Od o - Flows are seasonal? 4 c) (What time of year? '40
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc) v"
11. Obvious wetland is present on site: /10 n
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-.X: ED,&,
City of Edmo nds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: --C)C) 0 — 0 k-1 -2-
Critical Areas Checklist Fee: $4 .00
Date Received by Dev. Serv. Dept: -
City Receipt No:.
Date Mailed to Applicant: 1.0--Z-4-2-nob
CRITICAL ARX-E-JAS 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.
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 assist 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).
Owner/Applicant:
Name
FrJA'r
Street Address
E'dm 6)� 9002-0
city State Zip
(2,0& Z-6— 6610 rdez 4,5-
Te
Signa'�6re
/ 0 —1-9 —00
Date
d:receptiorLqanatCACLHandott.dor.
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Tt
MAILING ADDRESS
R . -rL) L A P4
CITY ZIP TELEPHONE
r:- C) T I o 5 i6o� G4 to 0 1 (d
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
ADDRESS
Z'7 Z Lo F? Z A k.)
CITY TELEPHONE
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190
STATE LICENSE NUMBER EXPIRATION DATI� I CHECKED BY
0
PROPERTY TAX ACCOUNT PARCEL NO.
�713 OD Z op? 00
NEW RESIDENTIAL C] PLUMBING MECH
0 ADDITION C 3 COMMERCIAL 0 COMPLIANCE OR
CHANGE OF USE
C] REMODEL APARTMENT 0 SIGN
REPAIR GRADING FENCE
CYDS 1:1 X FT)
DEMOLISH El TANK 0 OTHER
riolf GARAGE RETAINING WALL 0 RENEWAL
UN CARPORT 0 FIOCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
11% 4- 14 -�'D 2_ A,�
NUMBER NUMBER OF CRITICAL jV41I/eff_.
OF DWELLING AREAS
STORIES UNITS 0 NUMBER ;72_
DESCRIBE WORK TO BE DONE
Ex Por T I Lo^o5 c,-� r' j?0cqj-5
5--,pot-7 2- ltootos c2r- ckea., �_—,LA_
TS F_p;
PERMITEXPIRES
USE
ZONE AT 4
PERMIT
NUMBEq-C), �ia
JOB
ADDRESS
..
SUITE/APT#
I'dfif__
PLAT NAME/SUBDI'VI SION NO.
LOT NO.
LID NO.
ft1IF'zWL)0z7 UIL 'La
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
Street Use Pannit Req (3
EXISTING PROPOSED
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION—
FT
Underground
Wiring required 0
METER SIZ E
LINE SIZE
I
I
NO, OF FIXTURES
PRV REQUIRED
YES C3 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
&,5&/ 1,'vrx4w i
Lu
z
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Uj
ENGINEE RING x
RE�VIEW D/DAT
70-
FIRE REVIEWED BY
DATE LU
S
LL
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO&A
POSTED
I
laodiib�
0 YES 0
SEPA REVIEW
SIGN AREA
WIGHT
COMPLETE XEMPT
EXI]
ALLOWED PROPOSED .
ALLOWED PROPOSED
I
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED VROPOSED
FRONT SIDE REAR
-7%')r5'
FRONT LJR SIDE REAR
z
ra'
z
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PARKING
LOT AREA
PLA N G DATE
REO'D I PROVIDED
;RE rV 4EVDY
3
JI
REMARKS PEFF7,
EA� C)C '�E�o /(O,gC�650
(L) �ZFWZ�
$6T15INd< Wfr, IIF.6�
-1
-fWA14 rWY)t F012- D6TP4,WP,:P 0NViiGS,
CHECKEDBY I TYPE OF CONSTRUCTION I CODE I OCCUPANT
0 1 1 1 z__ Z GROUP
L K W, - 1 9Y_
SPECIAL INSPECTOR I AREA OCCUPANT
REQUIRED (—
_] YES LOAD
HEAT SOURCE GLAZINGt
'LOT SLOPE %
_�;
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
art APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W ;N INTEREST, AGREES TO NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDI NANCE PROVISION.*
zREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
- - 4 IS CORRECTAND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCo
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND ACW 18.27.
SIGNATURE (OWNER OfAGENT)j DATE SIGNED
o I
ATTENTION
IT IS UNLAWFUL TJ*USElbA 8CCUPY'!A BUILDING OR Sf'A`UC'Td�E�UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
St98
REMARKS
PROGRESS INSPECTIONS PER
1""
a
108/FINAL INSPECTION RECI'Dj Zo
nA - --Itil
VALUATION
FEE
PLAN CHECK FEE
LLI
BUILDING
(0
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
+
TOTAL AMOUNT DUE
REC IPT
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION . receipt is acknowledged in space provided.
(425)
'IALS SIGNATURE
OF DATE
LAj a LAW"
771-0220
I
_'DATE
�XT 333
SED BY
771
ORIGINAL - FILE YELLOW - INSPECTOR
FAX
PINK -OWNER GOLD -ASSESSOR