24222 104TH PL W.PDFlill iiiiii
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24222 104TH PL W
Crifical Areas Checklist CA File No:
Site Informflon (soils/ topogr�phy/hydrology/vegetation)
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1. Site Address/Locati ' on: _. , ?I (A)
2. Property Tax Account Number: 54v4cl dDLA 07,3 (-'70 01
3. ApproxunateSite'5iie�(acre-so'r'-s'q"uarefeet):'!"." A
CAL r-
4. Is this site currently developed? Zyes; no.
If yes; how is site developed? & MI r-f 51 KLA.-
5. D::T
.:�e the general site topography. Check all that apply.
Flat: less than 5-feet'elevation*diange 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
over a horizontal distance of 33
Steep:
grades of greater. than 30 present on -
distance of less �than 33-feet).
- Other (please describe):
6. Site contains areas of year-round standing waten: Approx. Depth:
7. Site contains areas 6f seasonal standing wate r: ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway, V 0 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.'seasona I I?
(What time of year?
10. Siteis primarily:. forested meadow, shrubs mixed
urban landscaped (lawnshrubs etc)'
11. Obvious wetland is present on site: J-In
OV ED4
'7
City of.Edmo
Development Services Department
Planning Division
Phone: 425.771.0220
1%(),� Fax: 425.77-1.0221
The Critical Areas Checklist contained on this form,is to -
be filled out by any person preparing a Developnient,
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 inf6rmation
needed to complete the Checklist should be easily
SamI ti d:a Wflahle-at-,
ar
APPUCAMN Pic
Date ReiZeived: -/I I I Jo-a-
Ch�keceipt#: -Y-0/2-6
-P,ritical-Areas: File
Critica reas Checklist Fee: $45.00_OL
Dit6mailed.to Applicant:
A� propert'y' � owner*, "6r`hi's/her' :authorized 'representative,
must fill out the checklisti,sign and date it,and submit it
.to the City. The City will review the checklist, make a
piecursory site' visit and make A det6niinatio'n of the
subsequent steps necessary to complete a development
iermit application.
Please submit a vicinity map, along with the signed copy
of this form to assisitity 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 n conjunction witli this Checklist to assistant staff
in completing their' preliminary assessment of the site.
The undersigned applicant, and his/her/it5 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
attomey'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 A applicatio o e behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE -7 A A-Z
i) ojvth
A 1��Z
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 thi plication.
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SIGNATURE OF OWNER - �) 0-2::% '1 0. DATE 7/ Z
.Owner/Appficant:
LJC CA jA T-M I Me N
Name
0
Street Address
4W movI WA7
city State Zip
Telephone:
Email address (optional):
AppHcant Representative:
VX
Name U
— '1'3oy :Z -7 SS_Z_
Street Address
S-ea4fi k-
city State zip
Telephone: �Z*- �D&-
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
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 conduct an
independent 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 map(s), nor for any one representation
provided based upon said map(s).
Water Servi ce Drawing
The City of Edmonds EASEMENT NO . .............................................
NEW CONSTRUCTION E] REPAIRS LID NO . .................. ASMT. NO . ..................
OWNER � F-, WE .. P E 6; �Y. HP 4 M.'� ........................ ............ CONTRACTOR .......... P� ........................ PERMIT NO.
P .0
JOB ADDRESS 42-2-2-10 4'1-" PL k�J, LEGAL DESCRIPTION': LOT -NO . ...................................
.... BLOCK NO . ....................................
................................................ : .................................................................................................................
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4 PL,
PWW-0001-1,1175 (REV. 1V78)
NAMEOF ADDITION .........................................................................................................................
---- ------ -
2 PL,
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31 � ii
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YC ON F— F fEN
..........
41
Approved:
NO IZ-T 14
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DATE.... ..................................... By ...... ............ ........................................