403 12TH PL N.PDF1111111111
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403 12TH PL N
APPLICATION
STREET FILE for
The City of Edmonds SEDE SEWER PERMff
NEW CONSTRUCTION 0 REPAIRS n
OWNER................
ADDRESS..... --------- X-4 ...... ....... .................
EASEMENT No . ..........................................
C 0 N T R A C T 0 R C 2 ..... .... ............... PERMIT N
LEGAL DESCRIPTION: LOT No . ......... ? ------------------------------- BLOCK No . .............. ...........................
..................
NAME OF ADDITION ..... ............ —.z
'-,."PROVED
----------
A-) rlZ�4-,J e—K--
Approved:
DATE................................................ By ..................... ..............................................
#P20 CAFileNo:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1.. Site Address/ Location: 4�77;1%10/- Al
2. Property Tax Account Number: QQSO��;,_'�,004QQVa6
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _),4� yes; — no.
If yes; how is site developed?.
5. Describe the general site �,opqgraphy. Check all that apply.
"/"le5rNa�'!5�-�f6et'elevation'change over entire site.
j
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 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 cont-jins a creek or an area where water flows across the grounds surface? Flows are year-round?
'Y
4 1119 —Flows are seasonal? (What time of year?
10. Site is primarily: forested — ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: A�Al
_�hp _'n�
For City Staff Use Only 74
1. Plan Check Number, if applicable?
2. Site is Zoned? R G)
3. SCS mapped soil"(s)? S �kv '\-5%
4. Critical Areas inventory or C.A. map indicates Critical Area on site? ��Ae_
r- - - , % I j A
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
REQUIRED
Reviewed
WAIVER
#P20
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 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).
Date Receiv
P�,e 0
P/11-7 X,
City Recei�
Critical Areas F le #:
Critical Areas Checklist Fee: $135.00
Date Mailed 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. 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 ififi-action based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, histher/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 this application on the behalf of the owner as listed below.
SIGNATURE oF APPLIcANT/AGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject.land use application,
and grant my perniission 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 this application.
SIGNATURE OF OWNER DATE
PLEASE PRINT CLEARLY
Owner/AppHcant:
1r01_1i---K'7— �7_
Name
Street Address
a,4 .5?�o
City State Zip
Telephone: 62-:d '22?
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email address (optional): - Email Address (optional):
iNoWa fn this *Wt vp a ehill be
==allo*tng.-or ==
f any currently i6d
-nqnoo orimng.or-unpermi u11amgjTCruqWr
orisite, co6dition which is outaide.the 6&ij� of the
rmit-app ic
li:4ion!;-rejardleWof4het;her iudi
a U�
dir r6 or bondition. is'sho�vn on the
qg, structu.
eill—te—pli-ar—d— br
�r mi6g. SuWi badii�g, sCruciare
actio
dbrc�ment n."
LI'S
Zone__jjQL—j2 Comer_&Flag_A&
Front-
,.R6ar
i Other I
i 'HeiLhf. AME
A
:1 �v
0 -4
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PLANNING DATA
SINGLE FAMILY RESIDENTIAL
I=STREET
Name:
Date:
/I /aa
-5--
Site Address:
f
Plan Check aoo
Project Description: e-X 377�5 eZ, -C4. Werk.
Reduced Site Plan Provided: 0/ NO)
Zoning:
Map Page:
,�Oq
FcornerLot: (YES /0
Flag Lot- (YES
Critical Areas Determination #: CPA aCnSCCQiF
11 Study Required
JR Waiver
SEPA Determination:
Exempt
Needed (for over 500 cubic yards of grading)
11 Fee El Checklist El APO List with notarized form
Requified cks
Street: KE) -D 15 AY k0 Side.- (a� Rear -
-
Actual Setbacks
Street:
Sile:(,\,)
Side CC-> q0,
El Detached Structures:
El Rockeries:
El Fences/Trellises:
El Bay Windows/Projecting Modulation:
D4 Stairs/Deck: okck, ceA-..�eA. orl
N %
Hulldw . t
Datum Point: N
Datum Elevation: N/A
F/A
Maximum Height Allowed:
Actual Height: 10 / 77 It A,0 6,�� e�oQ ckr-k
Other vko )np 6P
Parking Required:
Parking Provided:
Nc. CA07���
Lot Area: coq-
Maximum Lot Coverage: 35% �,4roposed:
Lot Coverage Calculations:
C%a
ADU Created: (YES Aa U
Subdivision:
Legal Nonconforming Land Use Determination Issued.- (YES
cofnfwnts
Plan Review
Pl"irq Data form G4-11-06,doc