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24309 87TH PL W
CAFileNo:
Critical Areas Checklist
Site Informflon (soils/ topography/hydrology/vegetation)
1. Site Address/Location: .- J,41_�)Olq 9,7 14j
2. Property Tax Account Number: 4>K(
3. Approximate Site Size (acres or square feet):
4. is this site currently developed? yes;
If yes, how is site developed? IM (o
no.
5. Describe the general site topography. Check all that apply.
Flat less than 5-feet elevation change over entire site.
.0
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 r�ore 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: A16 Approx. Depth:
7. Site contains areas of seasonal standing water: & Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Al() floodplain - of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
4-4) Flows are seasonal? - (What time of year?
10. Site is primarily: forested meadow- shrubs mixed
urban landscaped (lawnshrubs etc) 4 .
11. Obvious wetland, is present on site: _&Q
Critical Areas Chocklist.docJ3.19.2001
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 prepanng 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, map&,* or soil
surveys).
DaW Received:— //%/'7Z42a
qktY-RRceiPt# 6 29.
Celticia'I'Are'ad'Pile M . I
Critical Areas Checklist- Fee: $45.00
L.D!�*-Malled 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. TheCity 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 subn-dt 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 applic ' ant 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 histher/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, misleading, inaccurate or
incomplete information furnislied by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to fi s application on thf behalf of the owner as listed bel W.
SIGNATURE oFAPPLICANVAG:��71//" 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 inspection and pps#ng attendant to thisapplica§on.
SIGNATURE OF
Owner/Appflcant:
-4�e
Name
,g / 1/1
DOI F 7 P- e ti-,j
Street,Address
Ed vwo;�J S ( ),) A- -
city State zip
Telephone: 7 Z 7 70
r
Email address (optional): I�Ar-jr� 10 a)a 6 (-70XEmail Address (optional):
Appflcant Repre.sen-tad :
--ykey-eo-,c, .
Name
)- V56 q V 7 LJ
Street Address
EJM0 k�A J,;L6
city State zip
Telephone: q - 7 01
Crifical Amas Checklist.doc/3.19.2001
Untitled
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PLANNING DATA
NAME: ' I -A'L�, DATE: 10 L4 - 0,;'-
SITEADDRESS: QQ4Qq cj . . PLAN
PROJECT DESCRIPTION:'l -)f k-, e,.A- � A
REDUCED SITE PLAN PROVIDED?: (Yes / No , N-Z' )r <!:�� - '
MAP PAGE: CORNER LOT: ff—es-Z&j) FLAG LOT: ffejj�No
ZONING: Q'55-5� CRITICAL AREAS DETERMINATIONM
UStudv Reouired:
11,��Walver
QConditional Waiver
SEPA DETERMINATION:
Fee
Checklist
APO list w/ notarized form
(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
;;kExempt
SETBACKS:
Required Setbacks:
Street:_Qn Left Side: -1 .5 f Right Side: Rear: nj
Actual Setback :�, I
Stmt*s � Left Side: I Right Side: Rear:
Street map chocked for additional setback required? (Yes No / DNA)
DETACHED STRUCTURES:
U ROCKERIES:
U FENCES/TRELLISES:
LJ BAY WINDOWS I PROJECTING MODULATION:
L3 STAIRS I DECKS:
PARKING: Required: --- Actual: - Wo 0-h 0,��
a � V-% - r
J��
hlRg� I
CalculatfonEP,zi� 8eL4 47 4?, --p
-4;
BUILDING HEIGHT: -
n.& 0 1-6
U311 V : Yatum Elevation:
Maximum Aflowed: ,Sk-= 0�k C-- C,�
_______Actual Height:
A.D.U. CREATED?;I@) I Yes).
L,7-
SUBDIVISION:f0--el
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: LY-88-10j"OD
-4--
v,'- L— t, -. N-
Plan Review B c�, "'j,
New]3PPIanningDataFonrLD0C
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
CON
WNER NAMI
:rk
M M;
JU 0
AILING ADDRESS
C ELE
ZIP14,VdT , PHONEAPT-771(',
N NAM
AME
I'PERMITO(PIRES
4E
S PERMIT
ZONE NUM13ER
JOB
APT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
UD NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW fto RequIred
Bb" Use Pomit ROO
EXISTING — PROPOSED
kmppcdm PAqLdmd
SW*ws& f1squirod
REQUIRED DEDICATION— Fr
13
METER SIZE
LINE SIZE
No. 00'FIXTI�IR-ES
PRV REQUIRED
I
I YES 13 NO 13
REMARKS 0
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
CITY ZIP
TELEPHONE
NAME
Cal. 0
EN91NEERINO REVI-011) BY DATE
ADDRESS
-- ----
FIRE REVIEWED 13Y DATE
CITY W
TEL&HOhE
SHORELINE OR ADSf,
INSPECTION
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
I CHECKED BY
YES ONO IS
SEPA',REV1
MPLFTE
PR POSED
HEIGHT
LOWED PROPO ED
PROPERTY T4AX )UNT, PARCII�L "0.
�;z
t
E
NEW RES[ M H
ov
A LON''
OSED SETBACKS (Fr.)
ONT WRf7l REAR
f
ADDITION P COMMERCIAL CqMF"CE
C+UkNGE OF 0610
PARKIN E
jo
0 REMODEL X_1� . :z�l
FENCt";
REWR GRADIM."'.6. FT)�
elt
AEMAEL
Y4 3
[3 1ANK
13 DEMOLISH 0
o GARAGE RETAINIING WALL : FIRE SPRINKLER
ROOKERY-FIRE ALAR
A
CARPORT
ITYPE OF USE 86
HECKED
OCCUPANT
GROVP
NUMBE R RMP41
SPECIAL INSPE
REQUIk
W,`
OCCUPANT
LOAD
OF AR
UO
STORIES
j
DES&USE WOkK *0 BE D0NE'-,,',:,
REMARKS
thOC i0111/1FINAL
PROGRESS Ikii 01100ilk INSPECTION RECVD
��,Pw/ml alfidiai4., eme-, exliAlk
TALUAnON
7
encA Irsf Zi�
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�EE
D"CrIpt lon
FEE
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state Surcharge
HEAT SOURCE
GLAZING
pT --��LOT,*PPE %
City Surcharge
PLAN CHEC VESTED 04TJi Plumb6iig,,I/
ZA�
1.1= Mechanical
THISPERMITAUTHORM 0-11IFTHEINFORIC NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTVONIX ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMIUM (CURBS, SIDEWALKS. DRIVEVAY9. MIMIQUEES, ETC.) WILL REQUIRE
It- SEPARATEPERIIIIISSION.
Engr. Review
PERMITAPPLICATIOft INDAVS
PERMIT LIMM I YEAR - PROVINM WORK 18 STARTED WITHIN 10 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
19
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MOD" WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapainsp. Total AnTL Due
2: NOR LIMIT IN ANY WAY THE CfTrS ABILITY TO -ENFORCE ANY ORDINANCE PROVISION. -
I
. Recording Fee Receipt III
I HERE13 Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN 18 CORRECT� AND THAT I AM THE OWNER. OR THE DULY AIMIORIND AGENT OF APPLICATION APPR
THE OWNER. I AGREE TO CO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TM applicatIon Is not a WVM WO 81 . Wmd by the
MF CALL
TIOft. AND IN DOM THE WORK AUTHORIZED THEREfff. NO PERSON WILL BE EMPLOYED BWWQ OMW of NOW Da": and Fm are paid. arid
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Mono Is ackmMefted In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
..
OFFICIA DATE
a C!W9fOR AGENT) DATE SIGNED 1A0 .LS SIGNATUR
UVA15) VZ
/
771-0220
FIE ED 6 DATE
ATTENTION &klng' 10 #'4+1L M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. QBC SECTION log ORIGINAIL - FILE .. YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOVNTINQ
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