612 EDMONDS WAY.PDFIIIIIIIIIIIIII
11047
612 EDMONDS WAY
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ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE): �1'7
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:— q3.�q DETERMINATION: E] Conditional Waiver n Study Required XWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DAT
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA
LATEMKDSTs\Fomis\Street File Checklistdoc
Critical Areas Checklist
Site Information
project Name: Permit Number.
Site Location: (,)a Property Tax Account
Approximate Site Size (acres (A 4-
Have you filled outa Critical Areas Checklist for a project on this site before?
General Site Conditions
Date of most recent action:
1. Has the site been cleared or logged? C\
Soils / Topography
2. In theSn0h0mish . County Soil Survcy� what is the mapped soil type(s)? �iL� 'k
3- Describe the general site t0P09r2PhY Check all that apply'
—Flat less than 5 fbet'clevation change over entire site.
Rolling: slopes on site geneadly less than 15% (a Ycrtical rise of 10 feet ovcr a
horizontal distance of 66 feet.)
EU113r a ( a vcrtical rise
. slopes presmton site of more than 15.% and less than 30Y
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
domments
Hydrology[Vegetation
4. Site contains areas of year-round standing water. -bz�-
5. Site contains areas of seasonal standing water. 1) Depth:
6. Site is in the floodway A Z�, - floodplain±-0--of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? 0 flows
are year-round? Flows are seasonal?
8. Site is primarily: forested -meadow _;shrubs _;mixed
9. Obvious wetland Is present on site: _nJ
10. Wetland inventory or map indicates wetland present on site
i on site:
11. Critical Areas or map indicates any Critical Area
Foe,..�;ity Use Only
re
-requi d
sTUDY: REQUIRED: Ce
tudy not requir;6A if -sipecified Conditi o'ns.*sadsfied.
NDITIONAL WAIVE.R:,:CrjtJca areas s
WAIVER: tritical areas study is not required.
TJ Reviewer
Determination Number. CA Planner
Rev.3.T2171/9.2...
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City of Edmonds
Critical Areas Checklist
The Critical Awn Chw4dist 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 developmcatpermit
to the City.
The purpose of the Checklist is to enable
City staff to determine vhether any potential
Critical Areas am or may be present on the
subject propert�. The infbrmation needed.to
complete the Chedidist should be easily
available from observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
'PeAklp
An applicant� or his/her representative, must
fill out the chedidist, sign and date it, and , "
submit it to the City. The City will review-d"
the chwMist, make a precursory site visit.
and make a on of the subsequent
steps necessary to complete a development
permit Vplication.
Vilith a signed copy of this form, the
applicant should also submit a vicinity
of the pared with enough detail that City
staff can f ind and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
LIU\ k �&"� , .
_U� -
Name
I
�6
Title
Street Address
City, State, ZIP Phone
Signature Date
AppUcant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature
Date
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - - - - --------- ------------- - ------------
703-00400 NEW CONSTRUCTION F] REPAIRS F-1 LID NO . ................. . ASMT. NO - -------- --------
OWNER.... EARL--L.-...HERRE-N ............ ....................................... CONTRACTOR ..................................................... ------------ ----------------- PERMIT NO. � ...................
JOB ADDRESS ------ 6-1.2 --- EDMGNDS.--WAY ------ ------------------------------ LEGAL DESCRIPTION: LOT NO - --------------- .............. ....... BLOCK NO . .............. ....................
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11
NAME OF ADDITION ....................................................
DYE TESTED ON SEWER
Approved:
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PWW-0001-1 1/75 (REV.1 1/78) DATE ---------------------------- --------------- By ------------------------------------------------------------