1123 5TH AVE Siiiiiiiiii lill14707
1123 5TH AVE S
ADDRESS: 112 -3
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR: -
CRITICAL AREAS: 0 / 7-6 DETERMINATION: ❑ Conditional Waiver Study Required Xwaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: YU41
SEWER LID FEE $:
SHORT PLAT
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:_
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
cw�a/ 3iz��
WATER METER TAP CARD DATED: 1011416
OTHER:
LOT:
LID #:
BLOCK:
L:\TEMP\DSTs\Forms\Street File Checklist.doc
RECEIVE ® RAM04 P+ti4f. GFAaR I:�„
MAR 2 7 2001
DEVELOPMENT SERVICES CTR.—x
CITY OF EDMONDS
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{' roved plani and specifikaborm and Building DcNmncat A=tions xhm=_
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proved platy and specifications, and Buifdfng, Dcpa vstcnt stua-stiow tf erain- '
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p:vved pLw vW spedficatimr, and D"ag Dqnrtc=t -ma6c%-- thwcuL
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Wwaton ...... P=IPA Revi by--e
Building Dcl%utmait,
ThIx Vzrrsit dOfS?)r,.' COkIr. imTALI=icw�
T FILE APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT EASEMENT No ......................
NEW CONSTRUCTION ❑ REPAIRS ❑
104-03400
Paul Richter
OWNER..............•---------------•-•--.................--•-•-----•--•---...---•-.............-•-•--------........ CONTRACTOR..-----•----••---•-•---•-------------.................------•--•---•----•......................... PERMIT No. ......................
ADDRESS 1123 - 5th Avenue S............... LEGAL DESCRIPTION: LOT No.........-----.......--••--............------.. BLOCK No. ....................... .........
•. .. ............... .• ......................................
NAME OF ADDITION .
E
0
�Or
•
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE................................................ By----......-----......................................................
of ED City of Edmonds
Development Services Department
4
Planning Division
Phone: 425.771.0220
ADZ 1 aq0
Fax: 425.771.0221
Critical Areas File #:,�ff, (00-- 0 t—1 6
Critical Areas Checklist Free: $45.00
Date Received by Dev. Serv. Dept:
City Receipt No: /1v61�
Date Mailed to Applicant: I — 14-- 2-cz!30
CRITICAL AREAS CHECKLIST
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 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 subject 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 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 assist staff in completing; their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
�o,yw/�.T�ir4�✓,tl ZZddfJFi J2
Name
Street Address
City State Zip
Telephone
Signature
Applicant Representative:
A-1 en
Name
'A/.
Street Address
&--P r, o Al.D S ; 4J.�. o,2a
City State Zip
Telephone
Signature '000000;k� or
Date Date
d:recept"ane/CACLHandout.doc
Revised 4110/2000
Atical Areas C hecklist
-----------------
Site Information (soils/too h h drology/vegetation P�'a/
PY Y )
1. Site Address/Location: //� -� S /Q 0 g . 1?
2. Property Tax Account Number: Z5 27 O32 jq* Ob
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? ✓yes; no.
If yes; how is site developed? 7' A (f,4X T/V) G'NT
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 1S% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 1 S% and less than 30%0 ( 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: ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain 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: ,
6;�,---1. �tr4-+—r-.p.�--;•:-•.+Ya -r+tf •�,.. y�'**�����} " r' i3'e'.•.�.. ••...<a•.�:.•y :x.>s: .;, ...
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AP
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r. '' v: i , `;' ;f • .•�''•,��Ji`�'���'.a:':'..•Y•� � wy�Y��`•h rdiY,;+
.a�: RAY} \}trcf�`• •`�':fi 3i✓tit? �:�s�<'•�i
Aakdkdaq R@Y (WOM
0
City ®f Edmonds
Development Services Department
Planning Division
PhonB: 4".771.0220
Fax: 425.771A221
Critical Areas File #•
Critical Areas Checkli7-�-'ee: ; I;y 4
Date Received by Dev. Checklist_
IDS ;; ; :
City Receiptrio; `. E.
Date Mailed to Applicant: 1 I._ . „ :-;NZ00c
CRITICAL ICAL AS CH CK; I..,q�T°
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Pemuit 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 whather any potential Critical Areas are, or
my * Present on the subject 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,
naps, or roil surveys).
An applicant, or his/her re :i ; 4 ntative, trust fill out
the checklist, sign and daet : i 1, =d submit it to the
City. The City wiU revic, a t,ie checklist, make a
precursory site visit, and. m:� I ; rl4 determination of the
subsequent steps necessary + ; ;;iraplete a development
permit application.
Piece submit a vicinity mii i;,l.ong with the signed
copy of Buis form to assist , v staff in finding and
locating the specific piece , i ,-1:,roperty described on
this form. In addition, d it : qiulplicant shall include
other pertinent information , e ; site plan, topography
map, etc.) or studies in conj .i ,, : glint with.this Checklist
to assist staff in coral 1:: 1 r 1j. their preliminary
assessment of the site.
I have cm pleW the stud Critirai Areas Checklst and attest that the answers 11. r, -I died are fiwW4 to the
best of my knowledge (fill out the appropriate column below►),
Owner/Applicant:
- 11
F�EC
MA ' - )nni
City State ���� Zi
DEVE CITY PMENT
EERVIC S ES CTR.
Telephone
s4natlure
Date
Applicant Representath i
����.. ! Id
,..,»�'/�✓ to
Name ��}}
S&w Addriess
wwo
city State Zip
Telephone
Signe= - ... , ..,.
Date .
Rev W 4f1 WM
Atical Areas Checklist _
Site in#ormataon 5011S/to o ^h r "'-'-`__�___:� ...,,..________ .
t P �F Y./h dy ology/vegetation) R E CE: j VE:.
1. Site Address/Location: " g . 4 MAR
2. Property Tax Account Number: 2� 27 OZE 14* pd E �' U
r 'ELOPUE T SEFi JCCES C i R.
3. Approximate Site Size (acres or square feet): CITY of EarvroAalls
4, Is this site currently developed? ✓yes; no.
If yes; how is site developed? f f Leer/; j i eAX T/v) G M T_
5. Descn'be the general site topography, Check all that apply.
Flat: less than 5-feet elevation change over entiresite.
Rolling: slopes on site generally less than I5% (a vertical rise of 10- ver a
horizontal distance of 66-feet). ••
Hilly: slopes present on site of more than 15% and less than 30% I. -dcal 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 I • `;set over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: ; Approx. Del !
7. Site contains areas of seasonal standing water: ; Approx. Depth
What season(s) of the year?
8. Site is in the floodway fToodplain� of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? F 1 ; ; ;Ire year-
round? Flows are seasonal? (What time of year? _ ),
10. Site is primarily: forested : meadow : shrubs
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
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