7017 165TH PL SW.PDF7017 165TH PL SW
'1-400005— C) lz�
90 - 19.
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 775-2525
LETTER OF TRANSA41TIrAL
Date: June 22, 1992
To: Terrance Bagley
Carolyn Bagley
7017 165th PL SW
Edmonds WA 98026
Subject: Critical Areas Checklist
Transmitting:
For your information:
As you requested,:
For your file:
Comment and return:
Note attachments:
Comments:
Planning Division
Cindi Cruz
LAURA M. HALL
MAYOR
9 Incorporoted August 11, 1890 0
Sister Cities International — Hekinan, Japan
ft - - - (0
�'/� - �� -/o �-
890.1911-
City of Edmonds
Critical Areas Checklist
The Critical Arm Checiklist 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 developmentpermit
to the City. I
*Me purpose of the Checklist is to enable
City staff to determine whether any potential
Critical. Areas am or may be present on the
sabject 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 cheddist, make a precursory site visit,
and make a determination of the subsequent
steps necessary to complete a development
permit abplication.
With a signed copy of this form, the
applicant should also sabmit a vicinity map
of the parcel with enough detail that City
staff can find and identify the -subject
parc61(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:
Nain
-
e trdl'
Title
701-7 / It'o 5'0�' PL— :5--. W.
S MM �- Z
tree(
0 op
City, State, ZIP Phone
C/- 2�1
-JaZAiL,a 1-', 2nq
Signature Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP
Signature
Phone
Date
Critical Areas Checklist
Site Information
2
Project Name: Number:
'.5; 4,,7 k"110, _ik Account Number.
Site Location: ZO/'7 rope;Wf-
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
J"&_56 -0,00 -00 q- 6 o 1 7-
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action: _1�
Soils / Tono2raphy
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general, site topography. Check all that apply.
c,- Flat less than 5 feet elevation change over entire site.
_Polling- slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
A Hilly- slopes present on site of more than 15% and less than 30% a vertical rise
Wof 10 fc6t of horizontal distance.)
r) __$teep: grades of greater than 30% present on site.
Comments A 6- 7—,/ tk- L
HydrologyNegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of season� standing water: X (19 --Approx.. Depth:
6. Site is in the floodway &0 floodplain of a water course.
7. Site contains a cr:Z , an, area where water flows across the grounds surface? 4��_flows
are year-round? F ows �tfe seasonal?
8. Site is'primarily: fi6rested � " '' m9dow —;shrubs ;mixed
9. Obvious wetland is present on site:
41
10. Wetland inventory or map indicates wetland present on Site:
11. Critical Areas inventory or map indicates any Critical Area on site: A
—For City U�e Only
Rev 3n7/92
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION
OWY,f."AME /NAME OF BUSINESS PADO ESS
L L
1�5-exAme_,5- P EGAL DE
MAILING ADDRE55
—
PERMIT
NUMBER
7 149Z.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP APPrO"d D
RW P it A i,@d
er� equ
tily IP EXISTING REQUIRED DEDICATION S,.r I,.1 1 0
TELEPHONE NUMBER Un P*mil Req'd 0
2-toion Required 0
Side.alk ReQuired 0
E NUMBER
MEMO DATED
METER SIZE
JOUILOING SUPPLY SIZE
r
CITY
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
ALLOWED AOPOSED
SEPA REVIEW
COMPLETE EXEIV
EXP
Legal Description of Property - include all easements
I
VARIANCE OR CU
_R
PLA�71EVIEW BY
SETBACKS — FEET
FRONT '?45" SIDE /0 REAR 75_�
EIGH1
?_5
3 Property
Tax Account
ParZ No.
NEW
RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
ElREMODEL
APT. BLDG.
SIGN
El REP IR
DEMOLISH
EGARAGE
]CARPORT
GRADING
CYOS.
OODSTOVE
INSERT
C1 W
r7 RETAINING WALL/
" ROCKERY
FENCE
I x _FT)
SWIMPOOL
El HOT TUEI/SPA
11 RENEWAL
OF STORIES NUMBER OF
DWELL NO
7wo UNITS I
E WORK TO BE DONE JATTAf� PLGT PLANY
REVIEW BY
NO.
I =% 1 08 1 Z571
'rPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED 13 YES I GROUP 931 LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION
REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
H7ACE:
GLAZING 0/0
0 40
PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees. etc.) will require separate permission.
STATE SURCHARGE
,PermJl Application: 180 Days
Permit Llnrdt: 1 Year - Provided Work Is Started Within 180 Days �
STORM DRAINAGE FEE
ENO. INSPECTION FEE
- "Applicant, on behalf of his or her spouse, heirs, assigns and
successors- in interest, agrees to Indemnify. defend and hold
harmless the City of Edmonds, Washington. its officials,
employees, and agents from any and all claims for damages of
M
, hatever nature. arising directly or Indirectly from the Issuance
W
x of this permit. Issuance of this permit shall not be deemed to
0
9 modify, waive or reduce any requirement of any city ordinanc
PLAN CHECK DEPOSIT
-_63 1/529�
_j_
ox nor limit In any way the City's ability to enforce any Ord inanc:
TOTAL AMOUNT DUE
7Z
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz.
ed hereby, no person will be employed In violation of the Labor
I
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid. and receipt is
acknowledged in space provided.
tioMnsurance.
INSPECTION
S PGNPTURE (OWNER DATE SIGNED
DEPARTMENT
OFFICIAL'S SIGNATURE DATE
CITY OF
EDMONDS
V 6/
ATTENTION
CALL FOR
INSPECTION
DATE
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING -OR STRUCTURE
771-0220
UJIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBG
CHAPTER 3.
107-A7
PINK — Owner GOLD — Assessor
FILL