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23327 92ND AVE W
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ADDRESS: cg Of
TAX ACCOUNTIPARCEL NtMBER:- C) 0 L�ff "r) ,j (Doi OQ 3c)
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: AW& DETERMINATION: 0 Conditional Waiver �Ktudy Required [j Waiver
DISCRETIONARY PERMIT #
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): R007-oo?qoMal9i
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
wil
LID
LOT: BLOCK:
LATEMP0S'Ps\Foffns\Sb=t File Checklist.doc
STREET FILE
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: 5.�t -4 A-ve- 0.
2.
3.
4.
Property Tax Account Number: 00 5 S S aZ) 0 1,0 0 -5
Approximate Site Size (acres or square feet): 10 -
Is this site currently developed? \/ yes; — no.
If yes; how is site developed? I - ey_lvsy"12� 6�
5. 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: iJ Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway do floodplain /�)O of a water course.
9. Site tains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? tJ/.4 (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11.' Obvious wetland is present on site:
0 r5 5
--- For City Staff Use Only
1.
Plan Check Number, if applicable? N Dvll-� �-'V) 0 WV1
2.
SiteisZoned? P--c--9 -
3.
SCS mapped soil type(s)? ET' A 161 C~00 Ct - V V 0 AM I a V1 6( Co
M 12 le K 2-- 9 1- C-1 10 e,!E:1
14.
&Zvw 0 0 CA - U y10 4 vi d LD:M 121
fa 9 - I E5 Y - Ell 0 11S e7 -
Critical Areas inventory or C.A. map indicates Critical Area on site?
-e,yv C) U&A' yya�� aA-CA-,
5.
Site within designated earth subsidence landslide hazard area? F, LA (A i V) f fl-i Gi C4 fD M 6t V-e--
fiV'141 CAtj1rYVV\.�V1t4_h".
elm 15 Lov\, V1 0-"v" ") DETERMINATION
X
- STUDY REQUIRED
WAIVER
Reviewed by- G CL.' C, 0 C' 6 0, Date:
11- 1-'00 (0
Critical Areas Checklistdoc/2.17.2004
#P20
of E114f
City of Ed
1P
Development Service
Planning Division
Phone: 425.771.0220
IsqC3
Fax: 425.771.0221
monds
s Department
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, 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).
Date. Received: It I ;b 0 1 VQ0(0
City Receipt #:- 0 4 3115(e
Critical Areas File#: (RA-1,0Qio- 01U -1,
Critical Areas Checklist Fee:- $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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
pen -nit 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 con unction 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 processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, 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 Q his appli n the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE Z C)
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent 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-ff9ting atten4ant t9 this application.
SIGNATURE OF OWNER
017ne
'YApplicant-
14ar&
Street Address
IN) hJ M C/ 3
C,11� . State Zip
Telephone: C>-/C-'� ? 6 7 "f) �' 4 0
Email address (optional):
//L�Lo-o
DATE c
Applicant Representative:
Name
13000 H,,y S-1 S,,Ak
Street Address
7,Q,
city State Zip
Telephone: H1!5--3S(o-X)v0
Email Address (optional):
"Nothing in this t approval proem shall be
interpreted as allrw7ingiar permitting the
maintenance of any currently existing illegaL
nonconforming or unpermitted build4 structure
or site condition which is outaidt the scope of the
miit application, regardless of whether such
u,, g' structure or condition is shown on the
site plan or drawing. Such building, structure or
condition may be the subject of a separate
enforcement action."
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APPROVED BY PLANNING
00
OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSION CONTROL AND DRAINAGE
I (A 4 V-0 4 0-
.No. -On
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RESUB
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UJ
APR 2 3 2007
sum; of; &WNW
ke- Y �e--5
24 HR. NOTICE REQ.
FOR INSPECTION
MAXIMUM DRrVEWAY SLOPE
7UOVIED 14%
7
NOUSM AUTW
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AS NOTED
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NOTICE.
-------------
n v ... o -a c- ry
N'O"Wa r-r a I - Y ... of -a - ra
The -information *shown on the attached
iled for use by the CItY Of
map(s) was com ' p
Edmonds/ its Empl-oyees and Consultants.
Th,.e City of. *Edm.onds does - not * warrant the
these -
accuracy of anything set for.th on
m a p (.S-'-) - A n . y person or entity -requesting a
copyshould conduct an Independent
ion shown* o
inquiry regarding the informat
a p (s), including, but not i1mited to,
the location of any sewer stub shown. Suc
sewer stubs may or may- not e.xist and may
or may not exist at the location shown.
-ity of Edmonc-14<S, nor its
Neitheir the %__I thE
e M pto'yee's 01- off i-ce-rs'sh-a-1.1 be 1--i a-b-1--e for
this map(5), nor for
information g ven on Ided based
entation prov
any one repres
upon said map(s).