300 12TH AVE N.PDF1111111111
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300 12TH AVE N
UA FILI: NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
I. Site Address/Location: 3bo i Ave ,,d.5 0A CiS024
- 0. e3q\p i
2. Property Tax Account Number: C���� 0C)o 924 o 04 7 Iq,9-7
3. Approximate Site Size (acres or square feet): 11 002- S :4E - . 1
4.. Is this site currently developed? vyes; _ no'- 'PERMIT COUNTER
If yes; how is site developed?__5:rA Le,
--- J__ _j
.5. Describe the general site topography- Check all that apply.
�/Flat: iess than 5-feet elevation change over entire site.
I
,Rolling: slopes on site 'generally less than 15 % (a vertical rise of I 0-feet -over a
horizontal distance of 66-feet).
Hilly: slopespresent 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 I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):--
6. Site contains areas of year-round standing water AIA Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year? Al Ar
8. Site is in the floodway—_,4LO floodplain of a water course.
9. Sitecontains a creek or an area where water flows across the grounds surface? Flowsare year-
round? — A 0 Flows are seasonal?. (What time of year?
.10. Site is primarily: forested meadow' shrubs �-M�i �xed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
I Site is Zoned? 7.
2. �CS mapped soil type(s)? A44ev4,4dk 5-6,4e
U, 6w L -.4
3. Weiland inventory or C.A. map indicates wetland present on'site?
4;.,. :-,Critical Areas inventory or C.A. map indicates Critical Area on site? Ye i -e-S
5.. within' designated earth subsidence landslide hazard area? Alb
6. ''Slitob aesiignated on the Environmentally Sensitive Areas-Ma0 A/P
-DETERNffNATION
':'�tUDYREOUIRED CONDITIONAL WAIVER
WAIVER'
Reviewed by:--
Plarorer Date
RZY01m4n4
6. 9 0 - 19
City of Edmon&
Critical Areas Checkli . st
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 a development
permit to the City.-
Tle 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 o - f the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).'
An applicant, or his/her 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.
With 2 signed copy of this form, the ,
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with c * nough detail that City staff can find
and ide ' ntify the subject parcel(s). In
addition, the a ' pplicant shall include
other.peWinent information (e.g. site
Plan, t10P0gr3PhY -map, etc.) or studies in
condunction with this Checklist to assist
staff in completing their preliminary
assessment,of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out t
he appropriate column below).
Owner / Applicant:
Name.
�treet Address
City, State, ZIP Phone
Signature Date
Applicant Representative:
I z: us
Name
3 o o — ( 2:T14 Av c_
Street Address
EAMe-ViS, WP, 9501LO (2-0(,)77/-33z5
kty, State, ZIP Phone
Date
APPLICATION
The City of Edmonds for
EASEMENT NO . ........................... ................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS [7] LID NO . .................. ASMT. NO . ..................
OWNER ..... . ....... it -IC -CONTRACTOR
--------------------_-------- ------------------------- ----------------------------------------- ------------------------------- PERMIT NO.
JOB ADDRESS �_5 ...... ...... k ... r- ........ P ------ N ... ...... �.. � LEGAL DESCRIPTION: LOT NO . .....
------------------ -------------- BLOCK NO - -------------------------------------
Is
11
NAME OF ADDITION ...... f -___ V` A V--=. F 2; 4% L - 1: D ----- ................................................
om
DATE ..... , .......... By --- ..........................
APKICATION
!""lFhar City of Eckl�ondstSTF*ZT FX-E for
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F�
EASEMENT NO - ---------------------- .......... ----------
LID NO - ------------------ AsmT. NO - ------------------
......... ------------ -
.................................... --------
JOB ADDRESS ------- ......... LEGAL DESCRIPTION: LOT NO - ----- --2-1 ........ .............. BLOCK NO - ------------------------------------
------------------------ -----------------------------------------------------------------------------------------------------------------------------------------
... . ......
NAME OF ADDITION ---- aol ..... //-/-K-Z -------------------------- ----------------
Z
RECEIVL.-t-
HC 2 0' 1974
Approved:
DATE ....
By------------------------------------------------------------
0
j 0
Rt-67 /
I_-I-o /
-kale-;
I
IWI.= 101
e -3 -S.- 1:
CITY OF EDMONDS — SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
STREET FILE
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION -------- 12VI Avnrtqe Ag.
..........................................................................................
PROPERTY LEGAL DESCRIPTION ....................... Lot 21 of Emprald Mils
. .............................. �t .....................................................................
b" �, "'19
........................................................................................................................................................................................................................................................
................................................................ OWNER AND/OR BUILDER ...... Hall Construction Inc.
.................................. . .................................. . .......................................................
Russ Johnsoa Swer & Plumbing, 16009 N. Readovidale Rd.
CONTRACTOWS NAME & ADDRESS --------------------------------------------------------------------------------------- . ............................. . ... .......................................................
`�cc
PArmission Is granted ------- D_ --qib��r 26 1934., for repaIr and/or connection of a side sewer to the city sanitary sewer
---- - ---- .................... . .. ............ I -
,em in accordance with City of Edmonds ordinances.
A,-, _�NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Righi-of-WaY Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line axid 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It Is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
� sert the pipe into the wye.
DISAPPROVEDDate --- By --_-_------- Date- -- - ---------- - . By ............. �_ Date ............... . ................... 'BY ----------------
APPROVEDDate ... ............................ By.. ... --------- : ........................................................................
Remarks: ....... . ...... . ........................
---- ------
........................................................ . ...................................... . ...................................................................
................. ------------ /_ _-) --------- a ----- - ---- . .......... ...................................................................... . .................................. . .......................................................
_B H rmit opi 9S ST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
F
vme ... of co . _. c Ing .. Fi . rm --- er __ or - ming Constr . uc ...... ) hereby certify that the side sewer instaJlation constructed under this permit
An ed in C40 d nce with all overning ordin c of the City of Edmonds.
19/7/
Dated this --- ............. ly of .....
.......................................
N1 V Check BEFORE you dig for: Water (-], Gas F], Telephone E], Power E], Sewer E], Other El V V