540 12TH AVE N.PDF1111111111
635
540 12TH AVE N
CA FILE NO.
Critical Areas Checklist
----------------- --------------------------------------------
Site Information (soil s/topography/hydrology/vegetation)
1. Site Address/Location: t::'� (::) 1 2-1 �'j
2. Property Tax Account Number: — !E� !?7:6(10 co 03 S 00
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _LZyes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply. '11N _V
010 .9
Flat: less than 5-feet elevation change over entire site. 4949S
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a 7,
horizontal di stance of 66-feet). 11,40
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 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: A_)�q Approx. Depth:
7. Site contains areas of seasonal standing water: 4A) Approx. Depth:
What season(s) of the year?
8. Site is in the floodway�4/_f_j flo.odplain of a water course.
9. Site contains p creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10 S1 oresled ea o shrubs
mixed
eurib�2afll=n�dsca�pe�dl shrubs etc)� '44,-
11. Obvious wetland is present on site:
DETERMINATION
Aca-chk.doc; Rev 10/03197
City of Edmonds.
CRITICAL AREAS CHECKLIST
The Critical. Areas C hecklist 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 Checklik 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 infor m-ation (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).
Owne pplican
Name
A
Street Address
07-
city State Zip
f 4"14 9
DaV
creception\janakad.doc
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
(over)
s
) 11 :� 7,
RECEivED
71
NOV 0 3 1999
DEVELOPMEN! SERVICES CTR.
CITY OF EDMONDS
CA FILE NO,
Critical Areas Checklist
---- ------------- - ------------------------
Site Information (soils/topography/hydrology/yegetation)
I . Site Address/Location: tf:�' c_-) I 2—ti— u��
2. Property Tax Ac count Number: — E5 ';�(o CC 0 CK-)
3. Approximate Site Size (acres or square feet): 5-7z _'e'y A-�r-
4. Is this site currently developed? __LZ`yes; no.
�#c
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.
7'
Rolling: -slopes on site generally less than 15% (a vertical rise of 10-feet over a ASN",'
horizontal distance of 66-feet). 41*0.
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 3 3 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: /L)�q 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 p �reek or an area where water flows across the grounds surface? Flows are year-
round? PX Flows are seasonal? (What time of year? _J
10 Si �®resled do
meado shrubs mixed
���u7riban �=ands�=aped I shrubs etcjJ_
11. Obvious wetland is present on site:
Aca-chkAoc; Rev 10/03/97
City of Edmonds
CRITICAL AREAS CHECKLIST
The Critical. Areas Checklist contained on this form is
to be fill ed 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 infor m-ation (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).
Owne pplican
Name
. 19 A
1-32'ev
Street Address
city State Zip
f 4,-4
DaV ;/
cxeception\janakaddoc
.. Applicant Representative:
Name
Street Address .
city State
Telephone
Signature
Date
Zip
(over)
BARBARA FAHEY
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
C. 1 S 9 "1
October 15, 1999
Keith Wickard
23280 29th Avenue West
Brier, WA 98036
Subject: Determination regarding Critical Areas Checklist # 99-274
Dear Applicant:
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.
........ .... . ........ ......... ......
............................................ ... ... .
................... ................................... ........................
IMPORTANTINFORMATION TO*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,
Will You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL AM
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Eric: Determination
* Architectural Design Board
C:Reception\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
0
0
APPLICATION
for
The City of'Edmonds STREET FILE SIDE SEWER PERMT
OUTSIDE E] INSIDE X REPAIRS E]
OWNER ------------ 4"e-
............. 7 ... .. . efx�� .................................
HOUSENo. .. . ............. ---------- '41 -----------------------
CARD No . .................................
No . .................................
EASEMENT i
CONTRACTOR ...... q ... ................ c� --- ----- PERMIT No.
STREET �5'—
AVENUE LOT No . ...................................................................... BLOCK No . ....................
lbl-
NAME ADD . ..... ............
..... .....
--- - ----- .... .............................................
I
J
APPROVED -
EC 9 1964
4%
Date Approved:
BACKFILL WORK ORDER ISSUED ----------------------------------- DEPOSIT, $ .............................................. 0-P
SEWER WORK ORDER ISSUED .......................................... DATE L12z1zle: ................ * --------- By ........... ..............
N
"!�Jnt: 71
Z
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Can PROsPeet, 6-1107 when work
Is ready for Inspection. (No inspec-
SIDE SEWER PERMIT tions Saturday, Sunday or holidays.) N2 1196
ADDRESS ---------_-------- _5A0_._T.We_Lfth..Av.enUe ... No.r.th
OWNER ............. LY.19� ... ZiAp4r�cj ...... ............................................ CONTRACTOR ....... �rrow Construction
......................................................... ..........
Perniission is granted .... ...... 1�"gljbgX! ... 9 ......... jq..�!�.' for ---------------------- daYsv to REPAIR or CONNECT a side sewer
with City Sewers in accordance with aPplication on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —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—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3--Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; min mum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—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. 5—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 se . wer or Its ap-
purtenances except to Insert the pipe into the wye.
.. .. ..........