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TAX ACCOUNT/PARCELNUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:-
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
E] Conditional Waiver El Study Required
BLOCK:
LATEMP\DST's\Foffns\Street File Checklist.doc
ALL EXPOSED SURFACES f
PE COVERED WITHIN 2 DAYS
MAINTAIN PLAT INSTALLED EROSION CONTROL
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F810 HANCOR
OWNER/CONTRACTOR
VIKING PROPERTIES, INC.
P.O. BOX 1034
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711
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 ENGINEERIN
Date -
WATER & SEWER
INSPECTIONS REaD.
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PLOT PLAN —1 V-1
OCT 2,
FOR D c Vct 4,2004
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IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
CITY OF EDMONDS
SNOHOMISH COUNTY, WASHINGTON
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�WWW Lovell —Sauerland & Associates, Inc.
En&em/Surveym/Planners/Development Consultants
L�m m e-maik info@Luen&eering.com - web: Isaengiueering.com
INN 33rd &venue Ir-, Suite 2DO LPAW00d. WA 96D36 - (425)775-1591 (425)672-7m fax
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113 HIGA-BURKHOLDER
WASSOCIATES, LLC
LAND USE PLANNING I CIVIL ENGIMPERINIll
172.1 HWtt Avwnm 401 111 9"rett. WA 95M
phone (4n)252-28211 fox (425)252-9551
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:
City Receipt#:
Critical Areas File #: --2 00'3--W2-0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant—,V—//-03
A property owner, or his/her authorized representative,
must fill out the checklist, sip and date it, and submit it
to the City. The City will review the checklist, make a
precursoiy 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. lh
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, indernnify, 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 plication o he behalf e owner as listed below.
SIGNATURE oF APPLicANT/AGENT -s
DATE zo—
Property Owner's Author* ad
By my signature, I cer* I authorized the above Appl icant/Agent to apply for the subject land use application,
and grant my permissi on 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
Owner/Applicant:
0A1
Name
DATE
Applicant Representative:
Z 11>/T
Name I
1-701
Street Address Street Address
4;�IwOW!5 Y(;A 0:�>Z (11 —
city State zip
Telephone: '-�' C17 _
Email address (optional):
city State zip
Telephone: 7-572- -
Email Address (optional): joh4,V )'o.4Pbt
V W
Critical Areas ChecklisLdoct3.192001
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 inforination
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: V I 0-,�2
City Receipt#:_ c�
Critical Areas File#: -200-3-(-002-i
Critical Areas Checklist Fe�, �45, 0 0
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 th e application agrees
to release, inderrmify, 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 t is plication o L#ie behalf e owner as listed below.
Z, SIGNATURE oF APPLicANT/AG DATE
Property Owner's Authori ati
By my signature, I cer* I authorized the above Applicant/Agent to apply for the subject land use application,
and gmnt my permission 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
PLEASE PRINT CLEARLY
Owner/AppHeant:
410L�/ 1J )I W04$ V
Name
7 5
Shvet Address
4;�Dw,'V,95 YCA
city State zip
Telephone: c/, cr7 — !��Ve;5
Email address (optional):
DATE
Applicant Representative:
")Cwk)
Name
1 -77, )4c/-;r -9
Street Address
city State zip
Telephone: 1Y 7-5'0 22�10
E mail Address (optional): )ohtlp okp-bt
V
Critical Areas Checklist.doet3.19.2001