23715 77TH AVE W.PDFIIIIIIIIIIII
6522
23715 77TH AVE W
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
"3/CRITICAL AREAS: —
DISCRETIONARY PERMIT #'S:
tf 7 DETERMINATION: E] Conditional Waiver Ej Study Required *aiver
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S),#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LID #: Idy
LOT: BLOCK:
LATEMP\DSTs\Forms\Street File Checklist.doc
#P20
Critical Areas Checklist
Site hdormafion (soils/topography/hydrologr/vegetation)
1., Site Address/Location 2 3 7 1 -5- -7 -7
2- Property Tax Accomt Number.
I Approximate Site Size (acres or square feet): Ze2'
4. Is this site currently developed?,Zyes, — no..
If yes; how is site developed?
CA File NoM ,, Z�l
5. Describe the general site topographi. Check all that apply'
A' Flat: less than 5-feet elevation change over entire ate.
Rolling- slopes on site generally less than 15% (a vertical rise of 104eet over a horizontal
distance of 66-feet).
HiUr- slopes present on site of more than 15% and less thark 30% (a vertical rise of 10-feet
over. a horizontal distance of 33 to 66-feet).
Steep. gr ades 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): 100�7_
6. Site contains areas of year-round standing waten 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 cr-eek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? — (What time of year?
10. Si meadow
;shrubs mixed
(:��b�ndsca�awn, shrubs etc)
11. Obvious wedand is present on site:
1. Plan Chedc Number, if applicable? For City Staff Use Only
2. Site is Zoned? &a- R
3. SCS mapped sa type(s)? Ca
4. Critical Amu inventory or CA. map indicates Critical Am on site? t-le, 0 C% r-
A
V
5. Site within designated earth subsidence landslide hazard area? A10
DETERMINATION
MUDYREQUIRED -WAIVER
Reviewed �br�., Date:
/--a 060 7
,* #P20
City of 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&er 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: �31(610-4
City Receipt #:_ VJ,,0e -7 �P+
Critical Areas File #:rPA- Qop-7 -oo3y
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, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infiraction 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 cer* 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 application on the behalf of the owner as listed below.
SiGwun oF APPLicANWAGENT DATE
Property Owner's 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 posting attendant to this application.
07e t:
Name-
4 3 7/5--
StrVet Address
city State Zip
ZV ') Y- ;�5—'
t� spt2
Telephone: 7 of 7 :Z tj 4,
Applic t Representative:
Name
Street Address
City State Zip
Telephone:
Email address (optional): Email Address (optional):
e.;� 4g5; 74--:;, — e'->-5-75
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 ofEdmonds 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 s-ha-I-I be lia-b-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
CARD No. ............. .. ... ...............
STREET FILE for
The City of Edmonds- SIDE SEWER PERMff EASEMENT No . ................ .............. ............
OUTSIDE 0 INSIDE 0 REPAIRS 0
. ........ . . ......... ........................................................... -CONTRACTOR ..... ......
OWNE 'wr . ................ 6..'ICERMIT
O�
<7�
STREET
-7 -7 "-+-- UJ
HOUSE No. AVENUE LOT No . ........ ......................... ......................... ....... ....... . BLOCK No . .................. ...................
.................. 77-'? ...... . ...............................................
DD............... ....... ...... .... . .. ........ ....... ..... ....
'71
Av et,
Date Approved:
B,ACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ................................... ..................
SEWER WORK ORDER ISSUED ............ ................................... DATE,,,,, . . ..... ..................................