652 3RD AVE N.PDF4911
652 3RD AVE N
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Ej Conditional Waiver Study Required aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: �2 /22 41
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): CN 06/7 —
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
S1 DE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LID #:
BLOCK:
LATEMP\DSrs\Fonns\Street File Checklist.doc
-C. Jb7_
City "6Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax:. 425.771.02.21
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 the application 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. 'Me 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 Received: W N D
City Receipt#: -1-7 -7
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 reviewthe -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 part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature,'I certify thaZtILrIL=ibII and correct to the best of my
knowledge and that I am autho n eI==ed below.
SiGNATuRE OF Appul
Property Owner's Authorl'zAtidw 7=*=MMftM_ - - - -
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this plication.
SIGNATURE OF OWNER P� DATE.
Owner/Applicant:
aujx�
Name,
Stre.rA Address
llcr��6 IkWI
City State Zip
Applicant Representative:
Name
Street Address
city State Zip
Telephone: Telephone -
Email address (optional):
Email Address (optional):
Critical Areas Check] ist.doc/4.22.2003
CA File No:Agq -(I I
Critical Areas Check.list
Site Inforra'ation (soils/ topography/ hydrology/vegetation)
1. Site Address/ Locatiom -3 A) o i /h ).,lot
-7
2. Property Tax Account Number: () �) 2— 4 0 0 00 #'�-q40-7 '0 3Q Do (.0 D-0 og
3. Approximate Site Size (acres or square feet):
4.1 Is this site currentlydeveloped? _Z yes; no.
If yes; how is. site developed? e� Jl:j
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 v tical rise of 10-feet over a horizontal
er
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: .-A prox Depth:
p
7. Site contains areas of seasonal standin Approx. Depth:
9 water:
What season(s) of the year.?.,
8. Site is in the floodway floo��plain o a water c . ourse.
.4�
. 5k
re wateeflo,
91. Site c6ntains a creek or an ar a-,w; Wi�dcrdss the, groun s s�riace? Flow�s are year-round?.
YV/ A % . *- 1 11 *1 1 -
--R ws 6sdasonal?. (What time of year7
10. Site primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs.etc)
11. Obvious wetland is present on site:
- --- ---- For City Staff Use Only
1. Plan Check Number, if a]
2. Site is Zoned?
3. SCS mapped soil type(s)?
e 15 - Cv�-re/- 4� A e �ql
4. . Critical Areas or C.A. map indicates Critical Area on site? /\Jo.A e
5. Site within designated earth subsidence, landslide hazard area? No.
Reviewed
DETERMINATION
REQUIRED X WAIVER
Date: 9/1 Mo I/
Critical Arcas Checklist.doc/4.22.2003