715 3RD AVE S.PDFiiiiiiiiiiii
4995
715 3RD AVE S
ADDRESS:
TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
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) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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#P20
Critical Areas Checklist
Site Information (soils/topography/hydrology/
1. Site Address/Location: %/,!5--
2. Property Tax Account Number: cn (�6 n n
3. Approximate Site Size (acres or square feet): _ _ l� C� l' 2
4. Is this site currently developed?, yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
- Flat: less than 5-feet elevation change over entire site.
CA File No: �_A o6- i l (P
IF
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: pp p
A rox. Depth.
What season(s) of -the year?
8. Site is in the floodivay floodplain 4 0 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)
11: Obvious wetland is present on site: X/b
For City Staff Use Only
1. Plan Check Number, if applicable? 6 L-P 20010 09 2.9
2. Site is Zoned? F-5 Cv
3. SCS mapped soil type(s)? 9 y-A yr it ty y AVI d y l On w► 0- 0, -1 610 pt5) .
4. Critical Areas inventory or C.A. map indicates Critical Area on site? N Q he-* fa V10 WVv
5. Site withindesignated earth subsidence landslide hazard area? N O .
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by: C11 Yl a/ Ld GL 1 0-- Date: 0 5 / t 2 d O f0
,4C. 189,J
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City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
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 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. The information
heeded, 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:
City Receipt #: V=6 .
Critical Areas File #: ' l I fo
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, orr 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 .forma 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 fumished by the applicant, his/tier/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and convect to the best of my
knowledge and that I am authorized to file s application on the behalf -of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE
Property Owner's Authorization
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 application. A
SIGNATURE OF OWNER ,
Owne /Applicant:
A r- L, n/� M �e r r l �-7L
Name ff
S t Addr s
City State Zip:
Telephone: 4c� S
Email address (optional):
DATE (�
Applicant Representative: .
Name,
Street Address
City State Zip
Telephone:
Email Address (optional):
APPLICATION
for
The City of Edmonds T R E-JEH I,' F L SIDE SEWER PERMIT
NEW CONSTRUCTION (-] REPAIRS EASEMENT No . ..........................................
ton - e)-7 7 n
OWNER .... Hopf nax ...... Ed wa rd ------------------ ............. CONTRACTOR ......................... * ...... ----------------------------------------------------- PERMIT No. ......................
- _...3_rci
ADDRESS .... 71.5. ............ Ava 5 ............................................ LEGAL DESCRIPTION: LOT No.... ........................... ............... BLOCK No . ............................................
NAME OF ADDITION .....
June, Iq 701
Dya, Tas+q-d Oti Sewer
Approved:
DATE........................................ ....... By ......................................... ............................
9'�;r' elLc'�'
CITY CLERKTPG
OF EDMONDS FORME"CITY CON� ���1215TH AVENUE NO.
EDMONDS, WA 98020 2006m9140134 32.00
SNO14
O12ISH C4llNl�lm �ASHINGTON
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address:
Edmonds, Washington
Legal Des
Assessor's Parcel Number: 42<2 7 D06576 0220
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
Edmonds Community Development Code (ECDC) and understand that an accessory dwelling
unit as defined in ECDC Section 21.05.015 is prohibited until an Accessory Dwelling Unit
Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the
criteria in Chapter 20.21 are met,. and all the necessary items are submitted, including an
affidavit of occupancy and a covenant to be filed with the Snohomish County regarding the
regulations imposed on Accessory Dwelling Units. �
C
Property Owner Signature:
Property Owner Name (printed). _
Date:
/o
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH )
(94V'V A&-Ve . �7/-5 o-r- &bxoNda
I certify that I know or have satisfactory evidence that lfs�-T,cc,eyc� ,q , yy�C ern-,�G
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
No.tary's.pessure seals must be smudged. D d: - jr O 6
t�,.,� •., Signature of
Notary Public:
�• ' "'; ,+ 3' Residing at:
My Appointment -
Expires:
9- 19 o20O`7
° ....
Wasri�N
THOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
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