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CA HOLE NO. -
Critical Areas Checklist
ldf"iLti'oh,(s'oils/iopography/hydrology/Vegetation):.�-
1. Site AddressALocation:
2. Property Tax Account Number:
3. Approximate Site Size (acres or sq�ar!jeet).. Y152
4. Is this site currently developed? -2cyes; no.
If yes; how is site developed? 51AII
&AAJ j, V
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,f Sitec6 areas of year-round'standing water: Approx. Depth:-
7. Site contains areas.of seasonal standing water: A/V Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain 109 of a water course.
9. Site contains a greek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? _ (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban land scaped (lawn,shrubs etc) #Sp#h 1-7-
11. Obvious wetland is present on site:
A
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AECEIVEP
o% PLANNING DEPT
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City of Ediftwids
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The Critical.Areas Che�klist contained on
and submit it to the.City. The City will
this form is to be filled out by any person
review the checklist, make a precursory site
preparing a Development Permit
visit, and make a determination of the
Application for the City of Edmondsprior
subsequent steps necessary to complete a
to his/her -submittal of a development -
development permit application.
permit to the City.
a signed copy of this form, the
The purpose of the Checklist is to enable
.-With
applicant should also submit a vicinity map
City staff 16 determine whether any�i
or plot plan for.individual lots of the parcel
potential Cfitical Areas are.or may b.6
with enough detail that City staff can find
pres�nt on the subjectyrqF�eX, The
and tidentify the sup
ject par�el(s) 116
inf h7i6i&d 10* complet� the,,:-
addition, the applicant shall include''
Chi6ldisish"o"ii id"i"
p '6sily available from ,...other
pertinent. information (eg. site,t...
the site"or.dauf 'available at'
topo'gr, a'phy map, etc.) or studies in
City Hall (Critical Aim inventorks, maps,
corUjunction with this Checklist to assist
or soil surveys).
staff in completing their preliminary
assessment of the site.
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
t
I have completed the attached Critical Area Checklist and attest that the'answers provided are
factual, to the. best, of my knowledge (fill out the appropriate column below).
Owner Applicanti. Applicant Representative:
Name V Nam
I/ -A -
Street Address:.
Street Address.
tate, Pho
Phone
V,
-Date Ye,�!W,,*Signature: - V� . .... k, 01i"* AN4 Date
41
, , 00
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).
61LE
the City of Edmonds;-
bIRMT I
APPLICATION
for
SIDE SEWER PERMIT
OUTSIDE 0 INSIDE 2"� REPAIRS 0
CARD No. � ............
EASEMENT No. � .................. ....... ................
OWNER ....... 7.4
..... ................................................... ......... .... CONTRACTOR ................. .............. ... PERMIT No.
Z�� STREET
116tSE No . ............ .... Z4 ..... P.E'AVENUE LOT No . ........ 1.1F ............. .................. ............. BLOCK No . ..... ....... ......
'�517 /- L --
NAMEADD .......... ........ 7-4 ............................... ............... ................ ..................
Date
L WORK ORDER ISSUED .............................. .............. DEPOSIT,
........... I ..................................
Approved:
14 In
DATE/Q-w��.. BY ......
ROVED.
el 9 1992
APPLICATION
"'TdRsEET FILE for
-��ne City of E'dmon s SIDE SEWER PERMT
NEW CONSTRUCTION E) REPAIRS 0 EASEMENT No . ..........................................
1) f"% a - el 1% 4n
.............................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
OVVNISR 15
ADDI:LESS -.23-7-7-04 ------- 1.10M% ---- ... W.- ----- ------------------------------
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
-JU-n-Q.-�- tq7ta
DNq,..7a5+ad On 5q-wQr
Approved:
DATE................................................ By ......................................................................