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NEW CONSTRUCTION p�-" REPAIRS [3
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OWNER ............................. ..... fs --5 ......... j
ADDRESS ........ LEGAL DESCRIPTION: L6 T No . ......................
NFE OF ADDITION ......................... ...............
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DATE
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TREATMENT PIAW
EASFJAENT No.
'!�L/ --------------------- PERIM
............ BLA)CK No . .............
4016&
RECEIVED
JAN 17 72
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Date: January 12, 1972
Memo to Director of Maintenance & Operation - Public Works
rrom: City Enginebr
Subject: Sewer Connection Charges
Legal Description:
The S 95 ft of the following tract: Bea. at a point
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462.50 ft, E and 60 ft S of the S1W Corner of the M/W
quarter of Sec 25, T 27 N$ Range 3 E; th S 275 ft; th
E 71 ft. th N 275 ft; th W 71 ft to the point of beg.
Commonly known as: 545
Forsyth Lane
Owner: Gogert & Sons
Z.F.F. Calculation:
(65.)(
x (5.50) ) = minimum
300.00
Connection Fee
Lateral
x ($100 ) =
-------
Lateral Charge
Uni.t
x ($ 25 ) =
25.00
Trunk Charge
10 00
Permit
$
335.00
Total
CC. :
Date: August 19, 1971
Memo to: Ron Whaley
Assistant Public Works Director
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: Lot "B" on attached drawing.
(Individual legals description not available at this time: --and
would not be until building permits are applied for.)
11
(vacant property on Forsyth Lane,
Commonly known as: between 5th and 6th Aves. ) Owner: Mrs. Mace A. Gay
Z.F.F. Calculation:
65.09 Z.F.F. x ( $7.50 $ 488.18 Connection Fee
1 unit x ($ 25.00) $ 25.00 Trunk Charge
$ 10.00 Permit
$ 523.18 TOTAL
cc - Mrs. Mace A. Gay
STREET FILE Date: January 129 1972
Memo to : Director of Maintenance & Operation - Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description:
Tho S 95 ft of the following tract*- Beg. at a point
462.50 ft E and 60 ft 3 of the 3/14 Corner of the N/W
quarter of See 259 T 27 N# Range 3 E; th 8 275 ft; th
E 71 ft. th Iq 275 ft; th W 71 ft to the point of beg.
Commonly known as: 545
Forsyth Lane
Owner: Gogert, & Sons
Z.F.1'. Calculation:
,65�091
x (5,05-0) ) � minimum
!'5
300.00
Connection Fee
Lateral
x ($100 ) =
Lateral Charge
Uni.t
x ($ 25 ) =
25.00
Trunk Charge
P
Permit
$
335.00
Total
cC:
CA FILE NO.
Critical Areas Checklist
------- -------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Address/Location: 5146 F07125,,L)_-h
2. Property Tax Account Number: __)70
IDS= , B - 12 - J -CA a)-/
3. Approximate Site Size (acres or square feet): ja X tQQ
4. Is this site currently developed? L// yes;_no.
If yes; how is site developed? in kwds!�a4Q/,17
5. Describe the general site topography. Check all that apply.
v' 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: f7 0 _,_; Approx. Depth:
7. Site contains areas of seasonal standing water: j2 0 Approx. Depth:
What season(s) of the year? /j ZO-
8. Site is in the floodway 4() 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) V,
11. Obvious wetland is present on site: /V
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City of Edmonds
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N,LW CRITICAL AREAS CRECKLI974r!!,,,
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
th� 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 devel'opment
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
sl�s Vnc:!sSi�h
Street Address
city State Zip
- 17 19 - Q S '7 '-1
Tel9"ne
Signature
- q-a,3-q9 —
Date
cxecepdon�anakacl.doc
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
(over)
It '17,C. 1891,
October 18, 1999
Pamela Black Heck
545 Forsyth Lane
Edmonds, WA 98020
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist # 99-268
Dear Applicant:
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.
................ .......
................. ....... ............ ........ ................
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS"DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR MT1CAL_AR.EAS STUDY.
The 'DETERMINATION' ' for the Critical Areas.Checkli st you submitted is a' site-ipecific determination not a
project -specific determination.
mo, You must submit a co-py of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL -111101111111
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Pennit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
*Architectural Design Board
C:ReceptionUana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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SUBDIVISXON (4 late or 10009 2bo 10 010,M)---,--
PLAT (5 loto or mora; foo io 05-.00 gaT lot, W 1/2@ 02
Ono coat per squara foot of lot. moc Im Q6 golat,,.
whichGvor is grzator. Thlo foo ic qro,?jLccbto -to
both pmliminery and finel plat oubuioolcoo.)
APPLICANT: Waco A. ADDAESS: St�2 Pino Sto
Y,
Indicato type or dapoo of intorast in tho pxWorty: Omol?.
OWER: SCM ADDRESS:
REQUEST THAT THE FOLLOVING DMCRIBED PROPERTY BE DXVIDED INTO '3 LOT& (Wicato atC:��WD
mo-10 M—MM-1
LIJW &I — oat-juaUki %V I&aw a %Q L1.1UAJW%&.-j 4�1 J6.&.Ro,0 af6o NaW X6,o )6WUW%;LJ L-�Ut� &.&OOQR Xl�o i&
All )LOCutoa In Foc
�!j
Uso ZONE: - !�
Kroll Map No.: Z o g rol
,a 0044111
10 1
CERTIFICATION: I do horaby aonLfy that I a -in tho abovo logally doocribod p003�orty v CM:9
furthor, thet all ccntiguoue proparty t2hich 1 own, tohich hao nat mcoi.703-
a provious ambdivi3icn opproval, ic included hQroin.
Preporty
SKETCH: Sho�i bolou or att8ch a ohotch of thG prop000d subdivioien droun -to a ocalo
similar to the excaplQ ohoz:7n ca thG mvarQo oido. On Gubdiviaicao, wbom pcomiblQ,
indicate location of exieting Goptic tanks and drcin field@. Includo vicinity @hatch
of the area per example shoun am tho mvor@o cido. If akQtchoa am ottachad, plowo
submit six copies. On subdiviaLaaa, attach a otctomnt of magono Ay. prcg*rty Lo
divided in the manner shotm, ow::% co aT.my other partinont- imfomztica
not woarant on the skotch.
NOTE: This oubdivioiam tchc3 into ac@am . t tho 251 edditicmal r/u Lzd1en'tcd
I I on tho Official ftz-�, Mop 2w Faooytho Lam.
t
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City of Edmonds Permit NO:
RIGHT-OF-WAYCONSTRUCTION PERMIT IssueDate:
A. Address or Vicinity of Construct ion: 545 Forsyth Ln
B. Type of Work (be specific): Verizon to �Iace. operat, P and maintAin a biiripej service T-Tire from
existing pedestal# 7509,located at,.'520 Forsyth Ln then East to a residence at 949 Forsyl-h—Ln.
'�h to Rlow 1 40 feet,nugh 2 drlyewayF; 2R fppt- an ej e
Verizo push roads 0 fe t
R.O.W. footaift Is 140 f P�-r
W.0- #2100-9POOlDB 2423. 10 ENGR:Max Davis
C. Contractor: Verizon Contact: PermIt roordinal-or—gherr-ky Jones
MailingAddress: 2312—C W. Casino RD Phone: 429—M-411i
Everett, WA 98204
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdivision F1 City Project E] EUC (PUD, M, PSE,* CHAMBERS, OVWD)
Multi -Family E] Single Family F� Other Verizon
INSPECTOR-
F. PAVEMENT: E] YES.-. E] NO' G. SIZE OF CUT x H. barge: $
CONCRETE CUT: E]YES ONO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicdrit.understands by hislher signature to this applicat'ion helshe"'holds the City of Edmonds harmlessfrom injuries,
damages or claims of an.� kind or description whatsoever, foreseen or unforeseen, that. may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgrahti_ng this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION ANRACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH,ITIME A DEBIT OR CREDIT WILL BE PR OCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control 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) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application. v
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Date: .2 7--0
Pw7v�tractov or igeTo
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK.
FOR CITY USE ONLY,
Right-of-way Fee':
'proved by:,/-"?n-M11
p
f7ime Authoriiedr., Void After Disruption Fee/Fund 111:
cums J, LMQ?k Restoration- Fee:
pecial Conditions: N
�gm PMIT, M03UMN S0rB*Ck_S Total Fee:, `7 S-
A�gftA (,.vtu wnwries - 1&0669,e tyk-y.9— Receipt No:
mr,- uNDSCHP& :42 Issuid by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
I FINAL APPROVAL OF PERMITTED WORK. _14�
INSPECTOR'S SIGNATURE 16,�TE:
For inspection requirements see Engineering Information Handout. *Z 1-7
I NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE