407 3RD AVE N.PDFIIIIIIIIIIII
4880
407 3RD AVE N
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ yegetation�
1. Site Address/ Location: L[0_7 ry-4 Av P
2. Property Tax Account Number: TM QV, 9i
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed?**-/ yes; — no
If yes; how is site developed? —A '�4 9__
"2,'-2- CY) (*-) 0
U
CA File No: C7) -L— I 4q
I Ai tf er,
5. jZcribe the general site topography. Check all that apply. 9
Flat: less than 5-feet elevation, change over entire site.
Rolling: slopes on site generally less than. 1.5% (a vertical rise of 10-feet over a Vorazontal
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)
11. Obvious wetland is present on site:
L
2.
3.
'4.
5
For City Staff Use Only-- ---------------
Plan Check Number, if applicable?
Site is Zoned?
SCS mapped soil type(s)?
Critical Areas inventory or C.A. map indicates Critical Area on site?
Site within designated eartlisubsidence landslide haaird area?
WAIVER
ate:
Critical Areas ChecklisU3.19.2001
11 C. 1 L" -
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 st#ff 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 Received:
City Receipt
Critical Areas File
Critical Areas Checklist Fee: $45.00'
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 detennination. 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 pioperty 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 applic�tion 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 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 this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT 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 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 this application.
SIGNATURE OF OWNER DATE UJ
PLEASE PRINT CLEARLY
Owne-/A pplicant: Applicant Representative:
Name
W)r7
Strect �ddress
acl �Y�
City State Z,
Telephone:
Email address (optional):
Critical Areas ChecklisU3.19.2001
Name ,
Street Address
City I State Zip
Telephone:
Email Address (optional):
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App !cant shall repair/replace a 1 damat
Utilzq� L-s or frontage improvemer ts in City
righl -of-way per Q standards that is caused
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or oqcui,,-; during the permitted project.
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0WNER/CONTT-*,AQTOR. IS RESPONSIBLE
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BUILDING DEPARTMENT
6TREET FILE CITY OF EDMONDS
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APPLICATION
for
The City of Edmonds SEDE SEWER PERN[IT EASEMENT No . ..........................................
NEW CONSTRUCTION D REPAIRS D
113-04700
OWNER... ....... Relen --- B.ack ......................................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ...... �9.7 ... 3.rd.-.Av-e ...... N ............................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
.. .. .... . ..... .. . .. -
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ...................... ...............................................
PA-h6ck �ontractors Inc
Job# 106136553
August 18, 2004
Sheet 1 of 1 Rob Inglis
WORK AREA 3'x 5'
IN GRASS PLANTER
9'PKG SHOULDER
TYR BOTH SIDES -
CHANNELIZATION DEIACE SPACING
MPH
TAPER
TANGENT
50/70
40
so
35/45
30
60
25130
20
40
Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds
Traffic Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" B/O unless
otherwise specified.
4. Alert affected residents.
5. Work area will be 21'W of C/L
of 3 Ave N & 170'N of CA of
Daley St.
APPROVED AS NOTED
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City of Edmonds Permit No: a aall—
H T-OF-WAY CONSTRUCTION PERMIT
Issue Date:
B. Type of Work (be specific
n I , _. _(- I
a
C�,
0� 10 to 13 4P S
Q
C. Contractor: Pi � QM L-L 6-1-) Contact: 3U-Q- (t)(0-,
Wailing Address: i_3�t)30 3�av 00J Phone: c420 4-
A
4 - Q'I Bond: $
state License#: A Lo- 4(5"jnaA Liability Insurance:,,
D. duilding Permit # (if applicatble)) Side Sewer Per,mit # (if applicable)�
ornmercia 'F��Ji--S6divis_i6n --�'E]"Cit�,P EU'C (PUD'VERIZONJ§E, AT&T, OVWD):-.,
E. '-'F� -C_ �OJ.9c
Multi -Family, Single Family r-1 Other
1N9PF.CT0R- A40 C n 1*vpix i 1 114 A vJK � 1-4, (z-
F. PAVEMENT CUT. WYES El NO
CONCRETE CUT: LJ YES El NO
G.� SIZE OF CUT X
INDEMNITY.-: Applicant underhands by,.hislher-si ature,to thi§ licati6n. helshe, holds- the City of Edmonds harmless ftom
injuries, damages or claims ofany'kind
or aescription whatsoever, foreseen or un/bra that may be made a'gainst the City of
Edmonds, bi- any of its departments or employees, including -but- noiqimitedto,.therdgfe��se-o'j any legal pr�cqedings including defqnse
costs and attorneyfees', by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR AIPERIOD, OF ONE. YEAR FOLLOWING THE FINAL
INSPECTIOJV�4ND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL,�#E HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT KILL BEPROCESSED FORJSSUANCE TO THEAPPLICINT.
Traffic con'trol and public safety shall be in accordance with City regulations as' required by the City Engineer. Every
flagger, must'be trained. as required by (WAC) 296-155m305 and must have certification verifying completion of the
required trahAft in their possession.
Restoration, is to.. be.in accordance with'City codes.. All street-c.ut. trench wokk shall be patched with asphalt or City -
approved material prior t0,the end' of the Workday EXCEPTIONS.
0
f 'v� ire
Three sets:6f:cofisttiiction` rawin$s 6 *dposed or �i u d W.itkAIfiFpi6rmWapp ication.,:
-d q J re
ACALL DIAL -A DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
e�
I HA VE REAJ THE,ABOVE STA TEMENTS AND"UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TI MUST MAKE THE PINK COPY OF THE PERMIT, AVAILABLE ON'ISITIEl'-4TALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
FOR CITY USE'ONLY
Right-of-way Fee:,J�/K;, 0. 01�- /5.10
A p'proyed by: �0.41 M1 z6z 11 A. 1(1-"-., 1
[I , ,� 4 JL . I —
riz , oidAfter Al� k,' ./ 1-9 ;��/ Zat7, Disruption.Fee/Fund 111:
Time Autho. "',ed:N
Special Conditions:&-l-,,=II e_0%Ai rQ 0 tgg�* AN 20
AI
1> I r In t4 - At ',,r -A IF r-Ir C-7-S 13. P11-S 1 091 -t cTotal Fee: -A* 2 7-T.
.7-cP AAi Cxoil ReceiptNo:
-rr)-SrA1e-t- ()'I= -ugorei Issued by:
f
5"MIN. Pr%2/-JU 4�1, r-#"r*y e!s ?/�r_
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eIr C)1144 -7 1- CiZ
_�f��A� .7i 7'
111 r — - F%73
UPON COMPLETION OF PERMITTED WORK9 ANENGINEERING FINAL,,,.,,
INSPECTION IS, REQUIRED PER CHAPTER 18.00. OF. THE EDMONDS
COMMUNITY DEVELOPMENTCODR, 425-771-0220, Ext. 1326)
DATE:,,7 14, 0
FINAL APPROVAL OF PERMITTED WORK. Vll� //5
ln�sctor.s Signature
Fo r inspection requirements'see Engini. J! iln
g Inspection Info rm , a , t i " 6.n..''handout.
NO W01ZK SHALL 131JAN 11RIOIZ TO m,,izmrr ISSUANCE
DAMy Documents\Fq'rms�i�gmng\ROWpermit_.doc