23514 75TH AVE W.PDF111111111111
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23514 75TH AVE W
Critical Areas Checklist
Site Information
Project Name: permit Number.
Site Location: 7-4--a Cm u-,, PropertyTax 'A untNumber- 416r_�)OV_010_61
Approximate Site Size (acres or square feet): 5;�9 -12
Have you filled out a Critical Areas Checidist for a project on this site before? Z)
General Site Conditions
1. Has the site be= cleared or logged? u mkcr,,,� - Date of most recent action:
Soils / Topography
2- In the Snohomish County Soil Survey, what is the mapped soil type(s)? (,--J C_Vht (e,
3. Describe the general site topography. Check all that apply. 15- 4.
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 sito of more than 15% and less than 301/p ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of gre;AW than 30% present on site.
Comments
Hydrology/Vegetation.
4- Site contains areas of year-round standing water-
5.
6.
7-
8.
9-
Site contains areas of seasonal standing water- ::2� o --Approx- Depth:
Site is in the floodway 22 /) floodplain 21 Q of a water course -
Site contains a creek or an area where water flows across the grounds surface? _1? o flows.
are year-round? h 0 Flow's are seasonal?
mixed
Site is primarily: forested : meadow
Obvious wetland is present on site: 170
-shrubs
10- Wetland inventory or map indicates wctland present on Site: )�d
f
11. Critical Areas inventory or map indicates any Critical Area on site: 71 r>
For--City..�Jse- Only
7 -7
Determinadon Number. Reviewer-:_? "4,
Phnner Date
Rey 3127f92
CRY Of Edmonds
Critical Areas Checklist
'Me Critical Awn Checklist: contained on
this form, is to be, JMcd out bY any pcmn
prcpadng a Dcvc1ppment permit
Application for tho Cill�yof.�Onds prior
tO histhcr submittal ofa development PcM3it
to the city-
I'hc PMPOSC Of the Checklist is to cible
City staff to determine whether Imy potcntial
Critical Areas are or may be present on the
subjeet PrOPcEV- 7hc information needed to
compictc the Cheddist should be easily
available from observations of the site or
data avm%b1c at City Hall (Critical Areas
inventories, mups, or soil surveys).
PAe-c'i�.Jv
Jul Jeb
PERA.,-151,993
colllqr?
An applicant. or his/her rcprcsctativ,,.
,. must
fill out the chccklist� sign and date it. and
submit it. to the City. Tho City will
rMcW
the chocldis�, niake a precursory site visit,
and =mix a dctcamination Ofthe subsequent
stcPs necessary to. complete a development
pennit application -
With a signed copy of this foxm� the
applicant should also submit a vicinity map
of the parcel with enough detail dw City
staff can find and identify the subject
Parccks)- In addition, the applicant is
encouraged to include any other pertinent
information or suidies in conjunction with
this Checklist to assist staff in completing
their prellmlna'Y assessment of the sitc.
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 appropnatc column below) -
Owner/ Applicant:
&keJ- E 11;'7
Name
/-) NXJ --2,1 �' I —
Title -
Street Address
U-)
City. State. Zip Phone
-7 13�
g� le�->
jSiatui'! ' ate
Applic2nt Representative:
Name
Title
Street Address
City, State, ZIP
Signature
Phone
Date
pp —
APPLICATION CARD No.
for
The City of Edmonds FILE SIDE SEWER PERMYr
I ;' L.ET OUTSIDE INSIDE 0 REPAIRS 0 EASEMENT No . ............... ..
OWNER .... /�.)O. r .................................. CONTRACTOR PERMIT No.(�7,�';e
STREET
7:�74 W
HOUSE No. ..23.3;7/4 ....... . ..... .... ......... Jr ... & ........................... AVENUE LOT No . ..................................................................... . .... . BLOCK No . ................ . . ............. ... -- ...... .. .....
Is
0
E..]
Date
NAME ADD .... ... Al .. ... R.5 .......
S?Jr
2
iPi
E E
IS
Q6
7-7
'A
3!
LLI
ci Lo (f)
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ...... r
SEWER WORK ORDER ISSUED . ...............................................
k
e?ROVED
I, IV 2 2 1963
Approved:
........................ ......
DATE.. BY,
........... .......... ..........