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NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
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City of Edmonds
Critical Areas Checklist
The C ritied Areas Chocldist contained on
this foma is to be filled out by any person
pmpazigg a Dcvdopmcnt renmit
AppUation fore City of Edmonds prior
to hidher submittal ofa, devdopmeat Permit
to the City_
The purpose of die Cheddist is to enable
City staff to determine whether any p
Officd Areas are ormay bopreseaton the
snbjoctpnoPtzty. The iafomiation nodded to
complete dw Checklist should be.c&sily
available from observations of die site or
data available at City Hall (Critical Areas .
inventories, maps, or soil surveys).
An applicant; or bislher repr+escatative. must
fill out the ehaddist. sign and data it. and
submit it to the City_ The City will review
and maim as deter„miaatrp oaf site �� subsequent
stcPs nay to complete a dcvdopmcnt
pctunit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of dto pared Mi& enon & deW diat try
staff can find and identify the subject
pazod(s). In addition, the applicant is
eneomr3god to inclu& any other pertinent
information or stud'es in conjunction with
this Chemist to assist staff in completing
their prcliminaw agent of the site -
I have completed the attached Critical Area Ch=Mist and attest that the answers provided arc
factUA to the best of my knowledge (fill out the appropriate column bdow)_ .
Ownerl Applicant:
Name
v Y�J
Title
IT rl �k��JA �fb �5
-Aty. State, ZIP Phone
Applicant Representative:
None
Title
Street Address
City. State. ZIP Phone
'ignature Date Signature
Date
Critical Areas Checklist'
0itc xuform, a ' 1 A
Project Name: A .(t Permit Number
Site Location: 3 76v Property Tax Account Number-
Approximate Site Size (acres or square feet): v�
Have you filled out a Critical Areas Cheddist for a project on this site before?
General Site Conditions
1. Sas the site boas cleared or logged?
0*7
Date of most recant adios
Soils I Topography Aj pt7_Wcov t~9-SAN
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? L-API D L - I /•
3. Describe tho gcncW site topography. Check all that apply.
Flat less than 5 fed dovation change over entire sits
lling: slopes on site generally less than 15% (a vortical rise of 10 feet over a
horizontal distance; of 66 fed.)
Hilly: slopes present on site of more than 15% and less than 30% ( a vortical rise
of 10 feet of horizontal distances)
Stoop: grades of gt+eata d= 30•/a present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water.
5. Site contains area of seasonal standing water: t4 Approx_ Depth:
6. Site is in the floodway ._ floodplain of a water course
7. Site contains a creek or an area what water flows across the grounds surface? N-2—f laws.
are year-round? Flows are seasonal?
8.
9.
10.
11.
Site is primarily. forested : meadow —;shrubs —;mixed
Obvious wetland is present on site:
Wetland inventory or map indicates wetland present on site
Critical Areas inventory or map indicates any Critical Area on site: b
3
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1
City of Edmonds
a�+ I V E D -
DEL - 6 RE CEI
PLANNING U&f. DEC - S
PLA4'NiNG DEK.
Critical Areas Checklist
The Critical Areas Checkist 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 development
permit 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 subjeex 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 repriesentative,
must fill out the checklist, sign and date it,
and submit it to the City. The City will
review the chec list, make a precursory site
visit, and make a determination of the
subsequent steps •necessary to complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map*
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject paroel(s). In
addition, the applicant shall include
other pertinent infor=nation (eg. site
Plan, topography ! mp,. etc.) 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:
45IZ1 ^-2 ���lE� O t�M T Co. -
Name
�2— ( I` 1 M LPa�� 7 Qom!y
Street Address
?ao - (050 -$z 17
City, State. ZIP Phone
Signature
l I I3o • tip{
Date
Applicant Representative:
s-reva
Name
Street Address
C3�---vv ti. S boo4
City. State, ZIP Phone
Signature Date
CA FILE NO_
Critical Areas Checklist
Site Informa>rion (soils/tgpography/hydrology/vegetation) _
1- Site Addrewl oration: 219 1-5 A.> c> 2 Iq b1 7G.4% Aq s W . -
2. Property Tax Account Numb- -cam
3. Approximate Site Size (acres or square feet): -2 -Wo Sr- 2(c, 7cC-;5,r em s•=
4_ Is this site currently developed? X yes; no. If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
T 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 oa site of more "-15% and less than 30% (a vertical rise
of 10feet over a horizontal distance of 33 to 66feet)-
Steep: grades of greater than 30% present on site (a vertical rise of 10 feet over a
horizontal distance of less than 33feet).
Other (please describe):
6. Site contains areas of year-round standing water_ VJO ; Approx- Depth:
7. Site contains areas of seasonal standing water_ o " Approx. Depth:
What season(s) of the year? t\I rn- IS,-? 1 e,L C-
a -gam
8. Site is in the floodwayyk floodplain NO of a water course.
9. Site contains a creels or an area where water flows across the grounds surface? Flows are year-
round? 00 Flows are seasonal? Oo (What time of year? k)c)T 4Pit • ).
10. Site is primarily: forested_ ; meadow ; shrubs ; mixed ;
urban landscaped (lawn,shrubs etc) .
11. Obvious wetland is present on site. -
For,
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l�r �kah � 1irC�1 }rCiiiIIVCatO[y.Or•i :'�:^.7nijl.indicates'Clltipl'i m on -site' ^a } ! Yf✓9 t s} y}. h t.
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Rnao2a93
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
Tu v CSC 1 0-1 _E PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REOUIRED DEDICATION_
IZ
PROPOSED
NAME
T R (GG7 �n) e-IL4 t'f I+JG , IH1_�
aooREss
Po a G 1C 40q
CITY ZIP TELEPHONE NUMBER
rcir-,Voi
STATE LICENSE NUMBER EXPIRATION DATE
Tie t c-o 1 21c� Mj
Legal Description of Property - include all easements .
L.-r 1 i3t aGSG -Z 1 1 N YC O i"o-Tl-3
3N01
Property
Tax Account Yr
a�
` L'� " G�i I
Parcel No. J•��Sti
NEW
RESIDENTIAL
PLUMBING
OADDITION
O
COMMERCIAL
MECHANICAL
APT. BLDG.
nO
REMODEL
LJ SIGN
GRADING
FENCE
REPAIR
O CYOS.
t—X_FT)
DEMOLISH
WOODSTOVE
❑
SWIM POOL
INSERT
HOT TUB/SPA
,
RETAINING WALL/
FGARAGE
CARPORT
II ROCKERY
❑ RENEWAL
NUMBER NUMBER OF CRITICAL
O OF DWELLING AREAS
m STORIES ( UNITS , NUMBER
O
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
K7r.. T18�-1 t✓S� Ttl 5 N --
ALLOWED
EA BEPA REVIEW
PROPOSED I COMPLETE IEXEI
EXP
ZONE PERMIT NUMBER +' T '940W4}
JOB Nor—
ADDRESS I-I�i O 1 1 to � Nol; J�+
TESCP Approved 0
RW Permit Required D
Street Use Permit Req'd 0
Inspegtion Required O
Sidewalk Required D
PRV REQUIRED
YES 0 NO ❑
ADO NO.
VARIANOE OR CU PLANNING REVIEW BY DATE
SETBACKS -FEET HEIGHT LOT COVERAGE
REQUIRED LOAD
❑ YES
MARKS O
PROGRESS INSPECTIONS PER UBC 305 x
FINAL INSPECTION REQUIRED
HEAT SOURCE:
GLAZING
q/D
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADUJGIFILL
Any construction on the public domain (curbs, sidewPiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application:180 Days
Permit Limit: / 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
H successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials
,.
f employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DevoslT
Q
modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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•
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa•
ONLY
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT( DATE SIGNED
DEPARTMENT
1A f
�1 lap
rjx'�eue-
CITY OF
OF
OFFICIA R DATE
Iv,P.{i.�.�rG+L-.
EC
-1
CALL FOR
RELEASE ATE
ATTENTION
INSPECTION
- D'�!
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� _O�w1�
ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK - Owner GOLD - Assessor