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MAY 0 8 1996'
pERMIT COUNTER
APPROVED By PLANNINC -i-V'
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Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. .--Site AddressALocation:
2. "Property Tax Account Number: lQ447--c�oo-oocl-cwoY
3. ApproximateSite Size (acres or square feet): 102zq S 0 F:#T-
4. 'Is this site currently developed? -X—yes; no.
If yes; how is site developed? F C 6 j 9>9 &�4C
5. Describe the general site topogra�h��.'Chieck'-ail 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 verti�al 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: Mo A) d' _; Approx. Depth:
o ,
7. Site contains areas of seasonal staInding water: Ald Al Approx. Depth:
What season(s) of the year?
8. Site is in the floodway M 0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ko p C Flows are seasonal? _ (What time of year?
10. Site is primarily: forested ;ineadow —;shrubs mixed
urban landscaped (lawn,shrubs etc). "/, .
11. Obvious wetland is present on site:
For City Staff Use Only
-1.'*:�'��:':: �Sl
te
S
2.`�-:.:. ..:S.a'niapped soil type(s)?
inventory or C.A. map indicates wetland present on site?
4;'11._-.---*-*Criti6al Areas inventory or C.A. niap-indi6ates Critical Am on site?
ftcv 011M4
1, 41
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City of Edmon&
Critical Areas---Che'cklist
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 a development
permit to the City.
Ile 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).
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.
.4
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shaU include
other pertinent information (e.g. site
Plan, topography map, etc.) or studies in
coqjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
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 / Applicant: Applicant Representative:
F0 e-tg 17 C- IC
- :2 3? 0 f- )U I ST'AV tr. V/
Street Address
OAAWO '10020, 143
Qtate,.ZIP Phone ----
Signature Date
Name *- - - -
Street Address
City, State, ZIP Phone
Signature
Date
-1
PLANNING DATA
SITE ADDRESS: 23 -70,� - 10 1 " Ate 0 -DATE:
ZONING: �_5 - 9 PLAN CHK#: 96 -If-f
PROJECT DESCRIPTION: g4:tt A 155-2 1' �,.n f,� 4 SF res,A,,,t,
SETBACKS: ,
Required Setbacks: -7 ,
Front: LeftSide: -/'/Z' RightSide:_ Rear: 15'
Actual Setbacks:
Front: 9 2�' Left Side: Right Side: 35' Rear:
CORNERLOT NO —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED AJ (Y/N)
LOT COVERAGE:
Maximum Allowed: 35-q. Actual: 20,1
BUILDING HEIGHT:
Maximum Allowed: 17-51 Actual Height: 12-
Datum Point: 54n,�v� 5&v(z Datum Elevation:
A,<-. 0,
SUBDIVISION:
CRITICAL AREAS #: 9b - 7& - (JA-Vtr
SEPA DETERMINATION:
LOT AREA: 101 ?, 7-2—
OTHER:
Plan Review By:
CA Fl LE � No. C�
Critical Areas Checklist
Sito, Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 2370G — 101 4ui� LAJ
2. Property Tax Account Number: I-IL�6.7
3. ' Approximate Site Size (acres or square feet): 1022LI Sor-1-
4. Is this site currently developed? '<
--Yes; —no.
If yes; how is site developed? �5 - C 'S i Pg! Adc C
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: A)o A) 4C - ; Approx. Depth:
7. Site contains areas of seasonal standing water: A1Q#C_; Approx. Depth: _
What season(s) of the year?
8. Site is in the floodway A/ 0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
r ound? �Uo p 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: U i�
—For City Staff Use Only—
L. Site is Zoned?
2.. SCS mapped soil type(s)?
2-
3.:;�:-:.�,..::..Wetland inventory or C. A. map indicates wetland present on site?
4.:.�-� ::'.'Crifical Areas inventory or C.A. map indicates Critical Area on site?
hi designated earth subsidence landslide hazard area?
ite wit in I
on the En'vironmentally'Sensitive Areas Map?
0190 - 199 -
City of E&mon&
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 Edmonds prior
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. 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).
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
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcei(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 preliminary
assessment of the site.
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 / Applicant:
- 70P>MT ?� S
Name
2 37 6 4. )t) I S" .4,J VY
Street Address
E(�MWO� v�- 5Y&-3 t13
Ci tate, ZIP Phone
Signature Date
Applicant Representative:
Nam
Street Address
City, State, ZIP Phone
Signature Date
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CITY OFIDIVICINDS
USE
ZONE PERMIT
CONSTRUCTION PERMIT APPLICATION
6 �� S — ' . .. NUMBER
ADDRESS SUITE/APT 7
i � )F
OWNER NAME/NAME OF BUSINESS
R L
cr
A 0-
/
LEGAL DESCRIPTIUN CHECK SUBDIVISION NO. LID NO.
W ILING ADDRESS
Z
r30 er-,.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP kpproved 0
U I y ZIP
TELEPHdt4"U MBER
q A 0
P5 4 (v 3
EXISTING —REQUIRED DEDICATION — RW Permit Required 0
Street Use Permit Req'd 0
PROPOSED Inspection Required , 0
JNAME
Sidewalk Required 13
METER SIZE cc
W
1 11 1 12 1 PRV REQUIRED F_
4DDRESS
U0j
0
REMARKS 0
9
a:
Lu
cc
CITY zi P
TELE E NUMBER
Z
uj
NARE
iv re e-
CITY ZIP ITELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - include all easements
L01 4 oil r 6,400U,25
I
J�JC,5'x a"Com
-fID J)L Af Pexv
0C.(.u._,-),7_4TUh
+
j W 16 TG�A:j
Property
Tax Account
7— 0
arcell No.
EI- NEW V_m4, RESIDENTIAL
PLUMBING
KADDITION D COMMERCIAL
MECHANICAL
REMODEL APT. BLDG.
El SIGN
GR
REPAIR r_1 CYDS.
FENCE
X _FT)
DEMOLISH WOODSTOVE
F1 INSERT
SWIM POOL
HOT TUB/SPA
FGARAGE M RETAINING WALL/
ICARPORT LJ ROCKERY
RENEWAL
(TYPE OF USE, ELUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
/Z
NUMBER OF
DWELLING
CRITICAL
AREAS
STOR. I..
UNITS QP E
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE
ADB NO.
:VA:R:1AN:C�E �OR CU
PLANNING REVIEW BY
------
DATE
SETBACKS — FEET
HEIGHT U( T COVERAGE Z
FRONT SIDE -7
REAR G Gj
Z
Z
REMARKS
5
CL
G -6- G-0
ROU,
1 17,
PECIAL INSPECTOR AR9A 0 CUP"
REQUIRED OCCUPANT
C
Lo D
REMARKS YES LOAD
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
=====I VALUATION
PLAN CHECK FEE
HEAT SOURCE:
bLAZINGZ)1'�1,
37-- %
BUILDING
PLUMBING
Plan Check No.
q (�_, __ /,/
MECHANICAL
This Permit covers work to be done oi�_prlvate 'Property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require. separate permission.
GRADING/FILL
STATE SURCHARGE
Permit Application: 180 Days
I
Permit Limit: I Year - Provided Work Is Started Within 180 Days ,
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
o successors in interest, agrees to indemnify, defend and hold
2 harmless the City of Edmonds, Washington, its officials,
E employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to.enforce any ordinance
provision."
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
; 6 1 hereby acknowledge that I have read this application; that the
n ormation given is correct; and that I am the owner, or thie duly
authorized agent of the owner. I agree to comply with city and
ATTENTION
APPLICATION APPROVAL
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed in'violation
THIS PERMIT
AUTHORIZES
This application is not a permit until
I
of the Labor
Code of the State of Washington relating to Workmen's Compensa-
tion Insurance
1
ONLY THE
WORK NOTED
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
and RCW 18.27.
1 NSPECTION
acknowledged in space provided.
;IGlyAiruRE (OWNER OW T)
DATE SIGNED
t", �u
1
DEPARTMENT
OFFICI L: IG RE
0,
CITY OF
PlIkAnKille
le, 11 DA E
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUI I LDING.PR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AN15'APPROVAL OR
A CERTIFICATE 'OF OCCUPANCY -HAS BEEN GRANTED. UBC
CHAPTER 3.
102-87
E /A !S. ISY/ '/1E
CALL FOR LR��LE DATE
INSPECTION
771 - O�20 ORIGINAL — File YELLOW — Inspector
A� O)A06 PINK — Owner GOLD — Assessor