23517 76TH AVE W.PDF1111 lill 1111
6430
23517 76TH AVE W
0 .. k " ( -,) 0
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: —
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR: —
PERMITS (
DETERMINATION:Ej Conditional Waiver E]Study Required []Waiver
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE S: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
OTHER:
L-ATEMP\DSrs\Form%Sueet File Checklist.doe
D L�Y
7
BUILDING DEPARTIVI
OWNER
APPROVED k
BLDG OFFI
q
c1c.-y—
L)
FILE
Zon
Geme
Setbacks Veguired
—Actual
elmY
Front
s"
C
Sides' 7-,
Rear'
Other
ECEIVI-13
Height Meek
DEC 0 6 2007
BUILDING DEPARTMENT
QTY OF EDMONDS
-ROJTO LY
PIMUC P:7!1T. OTC!, LIST MA Au&%A I
1.3,11ILDING. PYTI"UT —Ica vu.
E ---FILE—
Street PdFht-oE-1.-,'ay lixisting
Access Easemmits Existing
Utilit.-v Fascinent Existing P4$F
-.wow Plat ....
Lot Per Subdiv;sion Anscssor I'ap
Site Pl..-m ("!ccl:cd for Accurac--v
Undc'n,,rcund ""Cod. -Aw
Q&c-i- Ou.'aroul �,!,tp-acd ILI,� too —
GOOF I
Poruirl-d
Hydn'l!lt Siz,-, j sti,
lk,(Irant Perl""; red per.Fire ze
6
Dctector (11("cl: -C-Ler
P-p,
V;.Ite
C:�
0
)tic Tan,: !\1,T1rCjVCd
s2ptic perl"i't peouired-
ic
ic -p(,
Sidc Availabilip,
Sanitaly conn,cction FCC.- Pcolliml
Com,
Catch !1asill pe(itliro(l
C;
1.111" lole required
-7
Soil Conditions, F, - Id 1"'ater Field
11roi.
File '0.-
Size
TIICILC,ft�c oil �ii:e 111,111
111dic,111-r on Si
I'vite
�;trcc Paving
Rupirod
ftirb -u-id (zitt
SiOC17,111- Pcc 10-
rc c!
-Curl) (!it for
F)rivc,...,aN, RIcquired
Pi o I i t - o jl- Way
Construction
Pcn, Ii t fured
Bond 11c,quired
for Rib
1,11) rovcmen ts
'Strect Nm-,ic ''In
Rcciiired
r Signim,
Pcquircc!
-'t Sitc Inspcction mLacic on
PTo I
c
BY: Scwcr
Water
St*rcct-
Ynginccrinp
ccj,!i I�c
q ,,.i
-rci-ionts ii.stccl in mcmo to ing m.-Irtmic."It
filled ill 0, C- ation
n 11,
'14 1 (1 j 11 ,Iqit Applic,
L
Datc
"btatic"Is '-!,I(lc
By - Dato
r-, by ri-1,011C WoIT" Fxpartrmlt
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employee ' s 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).
The City of Edmo
APPLICATION
for
SEDE SEWER PERNaT
OUTSIDE [:] INSIDE 51/" REPAIRS 0
CARDNo . .....................................
EASEMENT No . ..........................
OWNER .......... . ........ . .. . . ....... ......................... .......... ....... - ........... ..... PERMIT No.
---- ----- CONTRACTOR ........... J"3qr .....
'0, STREET
AVENUE LO .... .. ..................... .......... BLOCK No . ..........................................
HOUSE No . ........... VJ-----7 ---------------- -------------- --------------- T 'No . ..... I
e7
NAMEADD . ..... ........ . .............. .......................... ............
0
w-
0
APPROVED
-'-AP,R 2 - 1963
Date
Approved:
BACKFILL WORK ORDER ISSUED .... .............................. DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED ............. ............... ............ DATE .. ... ----------- By
...........
- — — ----------- -------
#P20 -7
CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1.. Site Address/ Location: ( 1 -7 AGr6_ CJ 64 pvls� t,3
2. Property Tax Account Number: �q,)W 004t, I CQ±
3. Approximate Site Size (acres or square feet): Q
4. Is this site currently developed.,< yes; — no.
3
If yes; how is site developed?.- 0!�_2 :e__
5. Describe the general site topography. Check all that apply.
XFlat: less than 5-feet elevation' change over entire site.
Rollin : slopes on site generally less than 15% (a vertical rise of 10-fe�et over a horizontal
9
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: hn ; Approx. Depth:
7. Site contairL§ areas of seasonal standing water: R n ;Approx. Depth:
What season(s) of the year? I r\AC,4
8. Site is in the floodway f\0 floodplain 1.6 — of a watercourse.
9. Site contains a creek or an area where Water flows across the grounds surface? Flows are year-round?
- f\O Flows are seasonal? d'k if) (What time of year?
10. Site is primarily: forested go meadow 0 0 shrubs F�Q mixed R 0
urban landscaped (lawn, shrubs etc) ez
11. Obvious wetland is present on site: 6
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? 1� S__ f
3. SCS mapped soil type(s)? —A lArwood ul-6c-q (,,ud (jNrix. (2-.
4. Critical Areas inventory or C.A. map indicates Critical Area on site? NO
5. Site within designated earth subsidence landslide hazard area? /Vf
DETERMINATION
4 STUDY REQUIRED WAWER
RevipwPti hu. 1 -7 If 77
#P20
"D C. I % 9 11
Cif�'-O---T-Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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: IXI(,110
City Receipt#:
Critical Areas File
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
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.
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 file this a ication 97 the behalf of the owner as listed below.
-7
SIGNATURE OF APPLICANTIAGENT TE .
11 t 'Tt 0'
Property Ownerls 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 postinRAf�n�t to thisADDlication.
SIGNATURE OF OWNER".
PLEASE PRINT CLEARLY
Owner/Applicant:
4 a�
Name
-f2 7e�'4 4' garle-
Street Address
rl ca,-Wi k6t
City State' Zip
Telephone:-Z 4L2
DATE / P2 — -- -C�) -,-' .
Applicant Representative:
Name
Street Address
City State zip
Telephone:
Email address (optional):
Email Address (optional):