415 3RD AVE N.PDF111111111111
4883
415 3RD AVE N
CA FILE NO.
Critical Areas Checklist
----------------------- ----------------------------------------
Site Information (soil s/topo graphy/hydrology/ve getation)
1. Site Address/Location:
2. Property Tax Account Number: o oO
3. Approximate Site Size (acres or square feet): (fZ S7
4. Is this site currently developed? yes; _no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15 % (a vertical rise of 1 0-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
1 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% 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: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodwayG=::3,,,r, 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:
ftl�.chk.doc; Rey 10/03/97
City of Edmonds
Vz
SIEP 1999
,PERW WU111111",
NAW CRITICAL AREAS CHECKLIST
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.
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).
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.
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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
Street Address
City State Zip
2— 3--' — ;2,2 (9' — 3 3 5-1
Telephone
,;z7—A"J -, a , 0"',
Signature
I �? Z , ,
Applicant Representative:
Name
Street Address
City State
Telephone
Signature
Zip
Date
c:rccepflon\jana\cac1.doc
Date
(over)
It) C . 1 B () ")
Harold R. Jensen
415 3'.d Avenue North
Edmonds, WA 98020
Subject:
Dear Applicant:
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
September 13, 1999
Determination regarding Critical Areas Checklist # 99-251
BARBARA FAHEY
MAYOR
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
........... ........
.................... - .......... I .................. ........
.............. .............. ............ .........
.......... ....... ...............................
IMPOR TA N T. INFO RMATI.Off: T.0'::BE:.-NOTED .............. .. . ..........................
. .. ..... . . ...
.......... ...........
................. ................ ...... : _.:.., ................... - ...
.............. ..
........................ ...... ......................... .. ...................................... ........... ...... ............ - ...... - ..........
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
moo. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 411111111
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:Recepfion\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
City of Edmonds
z er C;F
IVFD
SF P It 1999
9ERMIT COU1110
CRITICAL AREAS CHECKLIST
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.
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).
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.
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 Checklis't
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
N�me
3
Street Address
City State Zip
2- -5--
Telephone
Svignature
Date
c:rccepflon\jana\cac1.doc
Applicant Representative:
Name
Street Address
City S tate
Zip
Telephone
Signature
Date
(over)
0 A
CA FILE NO. CA
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1 Q; A .4 A N 1<14-11 j — I J/111, I
ress ocation: ::�7__ — 4-:2— j ek_
2. Property Tax Account Number: :2— o
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; _ no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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
I 0-feet over a 'horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% 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: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodwayG,,zW_,rr 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? ty�—� (What time of year?
10. Site is primarily: forested meadow :shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: C_��
AN-ChILdOc; Rev 10/03/97
APPLICATION
for
The City of Edmonds SIDE SEWER PERYaT EASEMENT No . ..........................................
NEW CONSTRUCTION [] REPAIRS 0
11 -04800
OWNER.......... flarold ... Jensen ................................................................. CONTRACTOR .................................................................................................. PERMIT No . .......... ...........
ADDRESS ...... �1.5 ... 3.rd .... Avg ...... N ............................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By � .....................................................................
MEMORANDUM
Date: September 27, 1999
To: Alecia Cox
From: Susie Read
Subject: REFUND
Please prepare a refund check in the name of Harold E. Jensen for $40.00. The plan check #99-
325 was submitted for on 9-10-99 but the applicant -has since changed the design of the job.
Please mail the check to 415 3rd Ave. N, Edmonds, WA 98020. 1 have enclosed a copy of our
receipt #13993 for your records.
Thanks,
Susie Read
City of Edmonds cze Community Services
RFEC IVED
SEP 21 10
Olf
7 7'
::tc
74Z�1�,O-v -,�
VA
I I
Received of:
Address: 34-0 A
Project Location: 3 Ave
Check No. Cash
Total Received
-w
Water'Meter Size:
Ar�owit
Water Connection Fq4p:
Sewer Permit/Repair
TnmkChar,qe---,
Sewer Connection/LID Fee
R/W Construction Penonlit Fee
Street Cut/Restoration Fee (620. Fund)
Street Disruplion Fee (111-1 Fund)
Engineering 2.2% Inspection Fee.
-Engineering Specs & Plans Fee
Storm Drainage Fee
Street Use Permit
Building Permit Fee - Type
Plan Check Fee
State Surcharge (022 Fund)
Zoning Application Fee - Type
Shoreline Permit Fee
SEPA Review Fee
Recording Fee
Maps/Books
Photocopies
Traffic Mitigation Fee
Sidewalk Contribution
09/17/1999 �H:01 360653122618 PREMIER FENCE
PAGE 02
I PROPOSAL
JENSON
��EMIER
CUSTOMER
RESPONSIBLE
FENCE
FOR PERMIT
le 70
P. 0. Box 66 Marysville, WA. 98270
WHERE
4508 - 136 ST. N.E., Marysville
State Lic. PREMIF*095J4
REQUIRED
CUSTOMER Harold Jenson_
ADDRESS 415 3rd gve-N
Edmonds WA. 98020
CITY
RES. 425 778 3351 BUS.
FAX.
CHAINLINK
POWER
CEDAR
CONCRETE
2'
TO GRADE
YES
STAIRSTEP
OUT
FACING
POST
10'max
SPACING
5ET
ONLY
METAL
BASE
COMPLETE I YES
'11 GAW
WIRE CAGE
BARB WIRE
TEN, WIRE GA
TERIMAINAL 23/8
P Po
OSTS
S 17/8
�UNE POSTS
OP 16/8
RAIL
YES
SEATTLE I LYNNWOOD
(425) 742-8277
MARYSVILLE I EVER t:1 I
(360) 653.6225 (425) 25"264
Fax (360), 653-1226
vx-/
q0 I gtAt�
R, E C E I V, vow , ED
SEP 17 699
EENGNM ING
f
32'x6'
I'Taller Post
32'x4' CONCRETE
FRONT PAD
PAYMENT IN FULL DUE ON COMPLETION
Cgidfomar advises end wwrants that 1141A110 Is otmer trio owrior -or ugent of the owner -of the Prop day described haneon.
CUSTOMER ASSUM93 FULL RESPONSIBILRY FOR LOCATION OFFENCE and &gross to, of customer**010 axponfk
defend and hold Premier Fence Company harmless mapecting claims of encroachment claims of damage to underground
faciliffles, andtir any other cialms brought an account of the work hereinabove dascrtbod, CUSTOAfER AGREES TO PAYFOR
SAID LAqOjq AND MATEj;UALS IN FULL UpON COMPLE770N. Further. customer ocknowtodges end agrees tha4 In the event
of colloction of customwole payment obilonuon horoundarls pl000din the hands of an attorney, customersholl PSY OffornbYs
to" and court costs tharabynecosaftated. Rabilling fees and f.6% parmonth will *lso bo occuded.
APPR&IED AND ACCEPTED
PRICE 788.00 DATE _ 9 -. 19 T9
SALES TAX 67.60 CUSTOMER'S SIGNATURE _ n X, PIC t�(s
TOTAL $ 853.60 SALES REPRESENTATIVE — Jim iLgrtz
t
HOUSE 32'x6'
1' Taller Post
FRONT
e-
32'x4' CONCRETE
PAD
DEVELOP, 01999
cj;�%Afr S