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TAX ACCOUNT/PARCEL NUMBER:-,eV4Vc/
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS ETERMINATION: [:] Conditional Waiver E] Study Required aiver
DISCRETIONARY PERMT #'S:
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)
SOILS REPORT DA'
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LOT:
LID
BLOCK:
LATEMP\DST"s\Fonns\Strect File Checklist.doc
ALL EXPOSED -SURFACES TO
BE COVERED WITHIN 2 DAYS
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SDR 35 MATERIAL -fA' CALL 425-771-0220 FIT. 1326 Ce ve:t)
SCH 40 FILE JUL 2004
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VIKING PROPERTIES, INC. w E
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P.O. BOX 1034 98 0. 10' 20'
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711 PLOT PLAN
BENCH MARK
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT THE
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE
PROPERTY.
ELEVATION : 200.00
DATUM : ASSUMED
APPROVED AS NOTED
BY EW-331NEERIN
Date:
FOR
Qry
LOT 5, VIKING HE1GH1§',',k,e,6sCr,,
OirDS'�
IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
CITY OF EDMONDS
SNOHOMISH COUNTY, WASHINGTON
�Iqmj Lovell—Sauerland & Associates, Inc.
En&em/Surveyors/Planners/Development Consultants
L�N 0 e—mak info@lsaen&eerizig.com - web: Isaengineering.com
JMW 33rd Avenue T, Suite 200 Lynnwood, TA 98036 - (425)775-1591 - (425)672-7998 tax
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ASSOCIATES, LLC
LAND USE PLANNING I CIVIL ENGINFRRING
1721 movitt Avwme 0 Wto 401 a Evwott. WA 98201
ph —a (425)252-28= ftx (425)252-9551
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----------------------
"AgAvvi-
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/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--Z I f 1/ 1 C5-7;7
City Receipt#:_ 1 "�-4 6,'�50
Critical Areas File #: --2 CQ'3-7W2-0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant: 4--V-03
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 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 *s 4pplication oaAJie beha1fof44e owner as listed below.
SIGNATURE oFAPPucANT/AGENT-,—/,-/1'//1— DATE --t--> AZ
Property Owner's Authorjdatiq)f
By my signature, I cer* fl* �� authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for ffie- 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.
SIGNATURE OF OWNER —DATE
Owner/AppHeant:
I —
"0* 1J Mlutym Z�J
14ame
-2 5 C 3 Z
Street Address
4;bwaW5
city State zip
Telephone:
Email address (optional):
AppHcant Representative:
C1 t/AJ
Name
/ -77,
Street Address
crr- 42/a
city State zip
Telephone: �T - 7-572- 2630
Email Address (optional): johrv,) o4xbt
V
Critical Areas Checklist.doc/3.19.2001
0
0
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/her submittal of the application to the City.
The pwpose 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:
City Receipt#:_
Critical Areas File #: -7003 -cX)2-1
Critical Areas Checklist Fe� - �45. 0 0
Date Mailed to Applicaft. �3
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 histber/its heirs, and assigns, in considemtion on the processing of the application agrees
to release, inderrmify, defend and hold the City of Edmonds hamiless from any and all damages, including reasonable
attorney's fees, arising from anyaction or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/hff/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 plication qw)ie behal e owner as listed below.
SIGNATURE oF APPLiCANT/AG DATE
Property Owner's Autho * ati
By my signature, I c i I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permissi for e 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.
SIGNATURE OF OWNER
DATE
I PLEASE PRINT CLEARLY ,
O"er/AppUcant:
"OW J)/
14ame
�Z 1; C 3 Z Z
Street Address
4;;5w,1JV4?5
city State zip
Telephone:
Email address (optional):
Appficant Representadve:
Name
Street Address
qT—
city State zip
Telephone: IYZ5' - 7-5-2-
Email Address (optional): )oht-0 okst-bt
Critical Areas Checklist.&0.192WI
City of Edmonds Date Received:
City Receipt#: 7U
Development Services Department
Planning Division Critical Areas File #: ;--crx:� — 00Z -2-
Phone: Critical Areas Checklist Fee: , $45.00
Fax: 425.771.0221 Date Mailed to Applicant -s1--rZ3
The Critical Areas Checklist contained on this forrn 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.
'Me 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).
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.
Ile 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 famished 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 nry
knowledge and that I am authorized to file oplicatio�94e bel!�][,,,, e owner as listed below.
SIGNATURE oF APPLicANT/AG DATE Zo fS
I /
or
Property Owner's Auth 7olr'nti
By my signature, I cer* AT re authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permmission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and post�ng attendant to this application.
SIGNATURE OF OWNER DATE
PLEASE PRINT CLEARLY
Owner/AppUcant:
0A1 &j �p 44 Z J
Name I
12 :5 C 3 Z
Stred Address
,�;bvN?5
city State zip
T elephone:
Email address (optional):
AppHcant Representadve:
Name
1 -70 / Alc;w-1 7T— LEE
Street Address
cr—
city State zip
Telephone:
Email Address (optional): )oh1-Rj o4p-bt
U W
Critical Areas Checidist.doc/3.19.2001
Critical Areas Checklist
------------------------------------------------ ------
Site Information (soils/topography/hydrology/vegetatio]R)
1.
Site Address/Location: 800-L 21414A S2- sw. f&eh hS 4d
-7 V
2.
Property Tax Account Number:
3.
Approximate Site, Size (acres or square . feet): 3SV5�
4.
Is this site currently developed? _&�yes; no.
If yes; how is site developed? 5,13 eAl -S,,5- AXn�ld J/� IXJ��
5.
Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
AI.IA-_ 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 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6.
Site contains areas of year-round standing water: MOA40— Approx. Depth:
7.
Site contains areas of seasonal standing water: Al"1�7 Approx. Depth:
What season(s) of the year?
8.
Site is in the floodway Ajo floodplain jQ of a water course..
9. Site contains a creek or an area where water flows across the grounds surface? Flows are,year-
round? AIOIV25�— — Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) I�Ud7W t;�2
7V
11. Obvious wetland is present on site:
--------------------------- ---- — --- ---------------- For. City Staff Use Only ----------- -- — ------ ----------
SiteisZo.nedlem
. .. . .........
SC mapped soil type(s) AIA
W
etland inventory or C.A. map indicates wetland present on site?
.4. Critical Areasi-inventory or C.A. map indicates Critical Area on site4
5. . Site within designated earth subsidence landslide hazard area? tdo
.6. Site designated on the Environmentally Sensitive Areas Map? 00
...............
`DETERMINATION
PY REQUIRED
Reviewed by:
fta—chk.doc: Rev 10/03
CONDITIONAL WAIVEk:
City of Edmonds
RECEIVED
JAN 0 6 i9nig
COMMUN11Y SEWICES
CRITICAL AREAS.CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any per son 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-aldevelopment
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 infor in-ation (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 Areas Checklis4 and attest that the ais�wers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
. -7_ooj!U A &"r
Name
Z
Street Address
-S
City State Zip
Applicant Representative:
Name
Street Address
I
city State Zip
q
Telephone Telephone
Sign e
------- 77
D ge
Signature
Date
(nver)
PERMIT NO.:
City.. of Ed.monds,
PERMIT EXPIRES 1,Z)1A1,1)
SIDE SEWER.PERMIT.
Address of Construction
Property Tax Account P;
Attach copies of all accessan(fttility . easements e` Verified and Approved- b
Owner and/or Contractor: I
b-7 7
Contractor License V Building Permit
P"Kingle Family Invhsion into City *Right -of Way: Elyes
2<0
F-1 Multi -Family (No. of Units *RW Co ristruction P e'rmit #
F] Commercial (No. of Units Cross other **Private'Property:' El . Yes 'EJ<o
Public Attach legal description and copy of recorded easement.
Owner/Contractor
_j ��i/
Owner or contractor signature and acknowledgement statement:
Date/
By si ning for this permit I certify that I have read the City's public handout entitled
9
""�'ide Sewer Specifications, and shall comply with all Cityrequirements outlined therein
W CALL DIAL -A -DIG (1-800-4239(15555) BEFORE ANY EXCAVATION W
FOR INSPECTION CALL 425-771-0220 extension! W
24 HOUR NOTICE REOUTRED FOR ALL INSPECTION, REQUESTS,
.......... .......
......... . FOR OFFICE USE ONLY
.......... ..... . ..... .
........ ...
Repair Fee $ Issu
Permit Fee $ e.d By:
Trunk Charge $ Da.tflssued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee A5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR. INSPECTION WHEN
INSPECTOR. ARRIVES A $45 RE7INSPECTION. FEE WILL BE CHARGED.
Job Site Ready YES NO .'—Date: Initiak
Partial Inspection: Date:.1&k Initial:
Partial Inspection: Date: —initial:
FINAL INSPECTION APPROVED: Date: �.As-builtto Street File: E]
1,� PERMIT MUST BE POSTED ON- JOB SITE f�
White Co Applicant
py: File Green Copy: Inspector Buff Copy.
L;temp;bldg;fonns;sspennitjlg4/00