23514 78TH AVE W.PDF6691
23514 78TH AVE W
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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 Edmondsprior
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. 'Me
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
applican ' t should also submit a vicinity map
or plot plan f6r individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). 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 prelimhuiry
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
f-actual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
�- �7F " / �f6
Street Address
Applicant Representative:
Name
Street Address
Phone
City, State, ZIP Phone City, State, ZIP
4gynatZum
Signature
Date
CA FILE NO. qLt - 1,9
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
1. Site AddressALocation: 2357/q--?9�1 t4),
2. Property Tax Account Number: 000 9)08 OAC)?
3. Approximate Site Size (acres or square feet): —7, F�541
4. Is this site currently developed? �� yes; no.
If yes; how is site developed? &0 ct se-
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: 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 c k area where water flows �c oss the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested ;meadow _;shrubs
mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: /V 1A
RcvOU004
� -AD
sTREET FLE APPLICATION
for
The City of Edmonds SIDE SEWER PERNaT
OUTSIDE E] INSIDE [:] REPAIRS F]
CARDNo . ......................................
EASEMENT No . ......................................
A-lo laR,
OWNER .................................................................... ......... PERMIT N
/ .......... ...... CONTRACTOR .............
STREET
HOUSE No. .... . ...... 7 ......... ----- -- .......... AVENUE LOT No . .......... e ------- AddJJLJ-'0.r) BLOCK No . .............................................
NAMEADD . ............................................. ................................ ....................... ................................................
Qj Z��
A"ROYED
No v q
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .................................
SEWER WORK ORDER ISSUED .......................................... DATE ................................................ By
............ / ......................
NOTICE:
No warranty of accuracy.
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 requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).