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24005 76TH AVE W.PDFlill 11111111 6453 24005 76TH AVE W Critical. Areas Checklist Site Information (soils/ topograph-, Site Address/ Location: Property Tax Account Number: 49& 3. 4. /hydrology/vegetation) '7r. r1-1 N1,0- W Approximate Site Size (acres or square feet): is this site currently developed? _ yes; _ no. - e-_� CAFileNo. P � If yes; how is site developed? 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 horizont,al distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: Approx. Depth: Site contaim 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 con" eek or an area -where water flows across the grounds surface? Flows are year-round? Flows are.seasonal? (What time of year? 10. Site is primarily: forested, meadow ;shrubs mixed urban landscaped (lawnshrubs etc) >< 11. Obvious wetland is present on site: Critical Areas CheddisL&63.191001 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). 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, 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, n-dsleading, inaccurute or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I cer* that the infbrjmrhpn and exhibits IereVth b nj �edd are true and correct to the best of my su I knowledge and that I am authorized to e ap li eb a er as listed below. SIGNATURE OFAPPLICANT/AGENT DATE Property Owner's Authorization LIZ 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� "sg otendant t application. SIGNATURE OF OWNER DATE a-:— )-00 3 PLEASE PRINT CLEARLY Owner/Applicant: Name � L11--) 0 -76 1 Ve - TL-1 Street Address MVV&0QA OR 1-UL-1:20 city State zip Telephone: �6� - I /V - Email address (optional): ADDUicant R �resentati * Kol,,Mp Name --90 Street Address 1?(,i k10 J�2- Wlq city State ZiD Email Address (optional): Critical An= Chocklist.doc/3.191001 Critical Areas Checklist CAFileNo. Site Information (soils/ topography/hydrology/vegetation) A?6 J'ff, �Ve 1. Site Address/ Location: 2. Property Tax Account Number: !!��'VO —006 JPA-n 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? _ yes; _ no. If yes; how is site developed? 5.' Desaibe the general site.topography. Check a 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 ,or 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 horizon�d distance of less than 33-feet). Other (&ase describe): 6. Site contains areas of year-round standing water: Approx. Depth: 7. Site contains areas of seasonal standing water: AJA Approx. Dep th: What season(s) of the year? 8. Site is in the floodway floodplain of a water course. 9. Site conttncreek or an area where water flows across the grounds surface? Flows are year-round? Flows are seasonal? (What time of year? 10. Site is primarily: forested meadow ;shrubs n-dxed urban landscaped (lawnshrubs etc) >< 11. Obvious wetland is present on site: W P� . . Critical Areas Cheddist.&0.192WI 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 detern-fine 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, alongwith the signed copy of this form to assist City staff in firiding 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 considerution 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 furnished by the applicant, his/her/its agents or employees. By my signature, I cer* that the infor -b- sub ed are true and correct to the best of my .PmWn and exhi its knowledge and that I am authorized to e ap �Ijia eb th wner as listed below. SIGNATURE OF APPLicANVAGENT DATE 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 inspechion and g.4ttendant toMs application. "s SIGNATURE OF OWNER DATE PLEASE PRINT CLEARLY Owner/Applicant: L Name aqoo5- hVe W Street Address MVVZ0Q city State zip Telephone: 42,5-- 7�64� 3c� Email address (optional): ADDUicant R resentati vil, Name <70 Street Address _J::%A k4n J�2- Wr-t city I State Zip Telephone: W-5- — 3J4q — Email Address (optional): Qifical Areas Checklistdod3.191001 City of Edmoncts GHT-OF-WAY CONSTRUCTION PERMIT Permit Number.,? 3- IL( 0a OF 21 3 Issue Date: A. Address �oticinity of Construction: 24005 76 Avenue West (9318759) B. Type of Work (be specific): Install New Service 8 9 0 0 C. Contractor: -Washing ton Natural Gas Company Contact: Frank Swan MailingAddress: 815 Mercer Street, Phone: 224-2278 State License #: Seattle, WA 98111 Liability I=rance: Bond:$ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. E] Commercial F ] Subdivision El. City Project go Utility (PUD, GTE, WNG, CABLE, WATER) F1 Multi -Family K] Single Family F] Other INSPECTOR: INSPECTOR: NA0-C'J+t-- F. Pavement or Concrete Cut P!] Yes ONo (2) G. Size of Cut- 2 x 4 H. Chargq_$ APPLICANT TO READ AN I D-SIGN ­)-_773, INDEMNITY. i) the City ofEdmonds harml Applicant understands and by his signature to this application, agrees .41 e88 from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad4� against the City of Edmonds, or any of its departments or 0 employees, including or not limited to the defense of any legal proceedings including def t8, and attorney fees by reason ofgranting thispermit. -0 3 THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS'FO A -PERIOD OF ONE YEAR LL WING THE FINAL F N INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIO E.5 Wl&, BE HELD UNTIL TI[k'FI1VA,,7iFJ?EET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engiifeering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required 1�7y the City- Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. Ihaue read the aboue statements and understand thepermit requirements and thepinkeopyof thepermit willbe auailable on site at all tim or inspection purposes. Signature: Date: -Jun*e 28, 1993 (Contractor or Agerit) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY TIME AUTHORIZED VOID AFTER SEC 20 DAYS RIGHT OF WAY DEPOSIT, DISRUPTION FEE/FUND III: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1691 FIELD INSPECTION NOTES Comments: I Diagram: (Fund 111 7-Ro ute copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION El YES El NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: S Naltmrii dw—f— Addendum to City of Edmonds Right of Way Permit Application Submitted by: Guyla Connors Engineering Aide Washington Natural Gas 521-5248 24 ooc5 -7( q &,j. j* I �-'s 111,.i.iii.r WNG to window Water main depth unknown 2--l' gas main -w- water -9- gas - -sS- sewer -19- water hydrant 0 water valve 815 Mercer St. (P.O. Box 1869). Sc4ftk. WA 99111 (206) 622-6767 The City of Edmonds APPLICATION for JQ11D'E S-ENVER 'PERA"T �Fg�� 1 r OUTSIDE E] INSIDE E] REPAIRS ' A x --7 OWNER............ ........ ................................................. CONTRACTOR ............... tl:21V&,4� ........................................ ..................... PERMIT No. p ?w / STREET ....... ......... ---------- 13LOCK No . ............................................... HOUSE No . ..... .. . .. 4,��T- AVENUE LOT No . ................. .................................. NAMEADD . ....................................................... -------------------- ................................................................................ sk io Date BACKFILL WORK ORDER ISSUED SEWER WORK ORDER ISSUED ..... DEPOSIT, $ ............... CARDNo . ...................................... 1 EASEMENT No . ...................................... Approved: DATE........ By .................................