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611 SATER LN
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRIT ICAL AREAS DETERMINATION: 0 Conditional Waiver [] Study Required aiver
W
DI SCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID#:
SHORT PLAT FILE: LOT: BLOCK. -
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) M
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERNUT #:
WATER WTER TAP CARD DATED:
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MAR 19
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DEVELOPMENT SERVIUES C"i
7j CITY OF EDMONDS
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City Aftmonds
Development Services Depar,4nent r
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Planning Division _0
Phone: 425.771.0220
loc. %9r) 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' f6r 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, I 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 ReceWfi&.��'
City Receipt #:
Critical Areas File #:
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 infraction based in whole or pa�rt 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 applica io on the behalf of the owner as listed below.
t
SIGNATURE OF APPLICANVAGENT DATE W-' 7,n��3
Property Owner's Authoriz tion 14�-XJZJ4-T-t5
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By my signature, I ce f:,,t I ave authorized the above Applicant/Agent to apply for the subject land use application,
fo )
and grant my permission or e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspectipu ost
-an osting attendantto this-66-D-1-0ation.
SIGNATURE OF
Owner/Applicant:
Name
Street Address
IrD WO W 0 5
City State Zip
Telephone: 7 71 6
Email address (optional):
Critical Areas Check] ist.doc/4.22.2003
DATE -Z —
Applicant Representative:
Naiiie
/501 4!�,Ox // &,5�
Street Address
City State Zip
Telephone: 3Ze,() &S-9 '-/M f tl
Email Address (optional):
I'le e- " :5 T-1 Z q �Ieaw
CA File No: D6
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: !� /� _: 5 W —/ & P, , �,, e KI QIE- T�- ^eolu 6 -5 4-Alf-
2. Property Tax Account Number: Pi 20,'-*> -3 212,2
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? X yes; — no.
If yes; how is site developed? '511'fjL1F_ IcWlffle-�l 6
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 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 contains a creek or an area where water flows across the grounds surface? Flows are year-round?
-Flows are seasonal? (What time of year? Y
10. qite meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff
1. Plan Check
2. Site is Zoned?
G3
4.
SCS mapped soil typLi(s
Critical Areas inventory or C.A. map indicates Critical Area on site? A/0
5. Site within designated earth -subsidence landslide hazard area? 6_10
STUDY
DETERMINATION
WAIVER
Reviewed bv.
Critical Areas Checklist.doc/4.22.2003
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\/ UORUTHY DROBNER
Utility Di| | ing
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SUBWEC-F: Change of street addresses
/
Building Department
,
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old
'
new
-
'604-3rd
Ave.
No.
604 Safer
Lane
.�'
606-3rd
Ave.
No,
John Stenger
606 Safer
Lane
'
608-3rd
Ave.
No.
Walter Sh on
608 3afar
Lane \
^'
610-3rd
Ave.
No.
R. Suran
610 Safer
Lane >
/
6/4-3rd
Ave.
No.
R. M. Murphy
611 Safer
Lane '
610-3rd
Ave.
No.
Bruce Fyf`
615 �ufor
Lane
'`
`
618-3rd
Ave.
No.
Roy E. Jones
617 Safer
Lane
Today |
am mailing
letters to the
above 'n regard
to the change of oddress,
�^
A copy
of one
is attached for your
information.
Thanks
Ann
'