24118 76TH AVE W.PDFlill iiiiiiii
6462
24118 76TH AVE W
ADDRESS:
TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
-7 la
CO C) 0 0 0 oci CL
CRITICAL AREAS: 5 -7 DETERMINATION: 0 Conditional Waiver F1 Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:-
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DS'l7s\Fonns\Street File Checklist.doc
OV ED #P20
City of Edmonds
'P 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).
0
Date Received: 4- o2-'5-- -2-606"
City Receipt #: — chZ 4 2-W
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed to ADDlicant:
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 reasro—nable
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 certif� 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 gn the behalf of the owner as listed below.
SIGNATURE OF APPMANVAGENT DATE 6, -Y �O
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subj'ect land use application,
and grarit my permission for the public officials and the staff of the Cit-
y of Edmonds to enter the subject property for the
purposes,of insp ection and posting attendant to this application.
SIGNATURE OF OWNER DATE
Owner/Applicant:
0?
Name
41419 1/6 14rw C."-)
Street Address
inDnl
City State Zip
Telephone: Z/ 9- 2--772-
Email address (optional): 6t—;)
lq-04-, C0*1
Applicant Representative:
k
,bA�i 5e- ki 0-, 1 T Z-
Name
11) S-(� -�- S- I I- hf- �J F-
Street Address
LA�4, ��J--ST ?A1-V '(,iih /S-5-
City State Zip
Telephone: '24 �- - 1 -1
Email Address (optional):
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 2-9 11 !� -2 6 " A , F_ L,)
2. Property Tax Account Number: 0 0 Ll I I 1 0 0 0 0 0 Cf 1
3. Approximate Site Size (acres or square feet): sz_� 11
4. Is this site currently developed? K yes; —
no.
If yes; how is site developed? S I J�o (,-t-V FN\-k%%_T f—&5(XAdT1 4(-
5. Describe the general site topography. Check all that apply.
X Flat: less than 5-feet elevation change over entire site.
CA File No: 06 __5,1
Rolling: slopes on si ' te 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: ; 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 creek 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 (lawn/ shrubs etc) K
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? 441,
3. SCS mapped soff type(s)?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area? k_' 6+ _X CAL L).
0
DETERMINATION
STUDY REQUIRED X WAIVER
Reviewed by_S4,1,,, ___ (__3 Date:
Critical Areas Checklist/3.25.2004
APPLICATION CARD No . ...................... .......
The City of Edmonds for
SIEDE SEWER PERMff
EASEMENT No . ............... .. .........................
-"*'&TSIDE 0
INSIDE 0 REPAIRS 0
.V . ..... . ......................... ...... CONTRACTOR ................... ........................... .................. .. .............. PERMIT N
OWNER ....................... STREET -.C// -A,
HOUSE No . ............. . ....... ........ I ............................. AVENUE LOT No. '!...Z5-V .......
�BLOCK No . ................... ................. .......................
NAME ADD ........... fllt-Q ........... .. ........... s7r--.� . ......... ...... . ...... ..........
ool
Date
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ......................................................
SEWER WORK ORDER ISSUED .............................. .................
. -0
\
t
APPROVED
1962
Approved:
BY ..... .. . ........... ........... ..............
DATE ....... .................
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(s). Any person or entity requesting a
copy should con ductanindependent
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 shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
M746r"SM10 COMM [Espord nER9 CE
DATE
SUBJECT
i� LO'i*-h +KP-- Oct
-6\urs- -7j-,7-5-t-qr\k3o-re- owo-'JaJ,�t- 'Coy-
N�G-� Rort oy)
Lo
31�19 pout A "IRIK
BY
TOPS? FORM 1232 FVER13AL ORDERS DON"T 00 LITHO IN U.S.A.
9
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0
0 0
CITY OF EDMONDS C-01M
PUBIJC WCPJM EMINEERING
'Neer ACTION REPORT
Piz N? 3093
SUSPENSE DATE:
Date: ILZ3 .4
Time: 401A . Fi I e #
t/ A++
REQUESTOR: N111: LP _)
ADDRESS:
PHONE:
REQUEST RECEIVED BY:
RECEIVED BY:
rrow;
Ir
It
TELEPHCNE
CONTACT IN OFFICE,
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OTHER:- r --- I
t
All Concerned Notified
Action COmPleted/File