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23907 80TH PL W
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hydrology /vegetation)
1. Site Address/ Location: -2 IZ-0 ,a / (,u Cb;nt) n,,& ct �ro,-7,
2. Property Tax Account Num ber: 0<0
3. Approximate Site Size (acres or square feet): -1Q),, CXK) g
4. Is this site currently developed? -4yes; no.
If yes; how is site developed? le
5. Describe the general site topography. Check all, that apply.
Flat: ' less than 5-feet el�vation 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: Ac5hr ;Approx.Depth:
7. Site contains areas of seasonal standing water: LOZIC ;Approx.Depth:
What season(s) of the year?
8.. Site is in the floodway floodplain o f a water course.
9. Site contains a creek or an a*rea where water flows across -the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10. Site isprimuily- forested meadow ;shrubs mixed
4 ---u—r �ba n M n d s c a - e-d- -(-I aiwin—, si ff _aFs—eTcj
p
11. Obvious wetIand is present on site:
Critical Areas Checklist.doc/3.19.2001
Q
S. City of Edm'on&
Development Services Department.
Planning Division
Phone: 425.771.0220
'14 C. 1 991� Fax: 425'771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Deve ' lopment
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: �31,:
City,,Receipt #: IFI,2
'Critical Areas File #: C��-6(—QLA
Critical Areas Checklist Fee: $45.00
Date Mailed to ADDlicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and'daie 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, misleadmig, maccurate 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 this application on the behalf of e owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
-7
Property Owner's Authorization
By my signature, I cer* 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.
SIGNATURE OF OWNER (,/� & 1�6� �-)� /o/
/ 11 - DATE
Owner/Applicant:',
Name
Street A�dress
ot-,�k
City State Zip
Telephone: L Z f: 2 r, -2 T - 5&�, ey(3
A plica
_ p - n� ]Kepres6ntailive:
Name
Street Address
city State Zip
Telephone:
Email address (optional): � eu!�14 -1,e -- a A4 Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
2- ILE APPLICATION
for
The City of Edmonds F SIDE SEWER PERMT
4�A -Z - A OUTSIDE [:] INSIDE E] REPAIRS
CARDNo . ......................................
EASEMENT No . .................. ...................
-LIP -/6'P
OWNER ...... ........................................................................ CONTRACTOR ..... �X. ............................
PERMIT No.
STREET
HOUSE No. 7 ........ 9.0 .... w ............. ............................................. AVENUE LOT No . ...... 1� .......................................................... BLOCK No . .......................
NAME ADD . ....... /V&��2.ZX4F!:.V5 ------ 4qA(d.� ........................................ - ------- .....................
7-
4
0 .
0
Dafe
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $.. ...........................................
SEWER WORK ORDER ISSUED ..................... - ...................
N
APPROVED
7291963
L
Approved:
......................
D ATE le.. Ir. ...... By
,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(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
t e -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
emp-l-oyee-s o-r officerS Shal] be lla-b-te for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).