543 HOLLY DRIIIIIIIIIIIIII
14100
543 HOLLY DR
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'690 - 199
City of Edmonds
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
Io 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).
STREET FILE
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
Of the parcel with enough detail that City
staff can find and identify the subject
parcel(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:
bc,v A T c�� 0,
Name
Title
5g----,> 00
Street Address
0
y, S to Zl�n Phone
s .� `7'1ti-ly`ly
Signature Date
Applicant Representative:
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Name
Title
3
Street Address
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Ci ,State, IP Phone
J
Signature v Date
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Critical Areas Checklist"
Site Informat' n
� 744
Project Name: 'hermit Number:
Site Location: S 3 W e l Property Tax Account Number. a S a 10 3 —d -1) b- o o 1
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before? h
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action: 9 3
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? ri \ l o r` o
3. 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 of horizontal distance.)
Steep: grades of greAter than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water: 1 -e-
5. Site contains areas of seasonal standing water: h cj h Approx. Depth:
6. Site is in the floodway k'10 floodplain '" G of a watercourse.
7. Site contains a creek or an area where water flows across the grounds surface? "D�flows
are year-round? Flows are seasonal?
8. Site is primarily: forested ; meadow `� ;shrubs _ ; mixed
9. Obvious wetland is present on site: tn.v
10. Wetland inventory or map indicates wetland present on site: n h
11. Critical Areas inventory or map indicates any Critical Area on site: h o
For City Use Only
C
r
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: 3 - C5
Issue Date:
A-, Address or Vicinity of Construction: 943 Hotly Drive
B.. Type of Work (be specificWns t. lly" PE IP. Main in Holly .Drk f rom 134' E to
9 0 1 9 5441E of c/1 of 5 Av. S 'to serve 510,535,543
Hollty Df Pettached Dr.9310721(2),
Contracto4lashington Nat' 1 Gas Co Contac . ran wan
Mailing Address: 815 Mercer St. Seattle, Wn Phone: 224-2278=
State License #: 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. ' ❑ Commercial ❑ Subdivision ❑ City Project JaxTitility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single. Family . ❑ Other '
INSPECTOR: INSPECTOR:� . Atyc
F. Pavement or Concrete Cut : ❑ Yes @No G. Size of Cut: x H. Charge $
APPLICANT TO READ ANDr IGN.
INDEMNITY: Applicant understands and by his signantre to this application, agrees to old e City of Edmonds harniless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen,' that may be made against the of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs; and attorney fees by reason of granting this permit.
r, _
THE CONTRACTOR IS RESPONSIBLE FOR. WORKMANSHIP AND MATERIALS FOR PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION
AND ACCEPTANCE OF THE WORK. ES77MATED RESTORATION FEES WILL BE HELD UN77L THE. FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR,CREDIT WILL BE PRO`CESSWO,R ISSUANCE TO THE AEPLICANT.
Construction drawing of proposed work requiredwith permirlfpplidtio(17.3
A 24 hour notice is required for inspection; Please call the Engineering Departrltiy
Work is to be inspected during progress and at completion. 777 `
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City .regulations as required by -the City Engineer:
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the wor`kingtday;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink eopy of the permit will be available
on site at all times for inspection purposes.
r
Signature: Date: March 30, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK ,
NO WORK SHALL'BEGIN PRIOR TO -PERMIT ISSUANCE
Engrg. Div. 1991
Eng. Div. July 1985
Critical Areas Checklist' STREET FILE,
Site Information
m Project Nae`c,,� �eit Number:
Site Location: _S4 3 W o l l�j A Property Tax Account Number:. s a 10 c) - o c o ,I
Approximate Site Size (acres or square feet): 1- q X `_, C
Have you filled out a Critical Areas Checklist for a project on this site before? h 0
General Site Conditions
1. Has the site been cleared or logged? e S Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? ' D ct. ri c ° '^ `'b
3. 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.)
5 Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
HydrologyNegetation
4. Site contains areas of year-round standing water: . v, -e—
5. Site contains areas of seasonal standing water. - `h Q r\ �� Approx. Depth:
6. Site is in the floodway kV floodplain o of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? Y1 bflows
are year-round? Flows are seasonal?
8. Site is primarily: forested : meadow `� ; shrubs ; mixed
9. Obvious wetland is present on site: Inti
10. Wetland inventory or map indicates wetland present on site: n b
11. Critical Areas inventory or map indicates any Critical Area on site: i� c
For City Use Only
a,9p 199—
City of Edmonds
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(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:
b" t C.1 � � ct
Name
C1 �1 L c.. �. k-
Title
Street Address
vim0
City, S te,�ZIF 1n 17 � `i _ � `i y y Phone
Signature Date
Applicant Representative:
Name
Title
l_)c-,Vt c� K. (' P_, a
S q _� ��z, (1;-� D" .
v_C'l ii C L -?
Street Address --
-- ---- '5�' cf 7 C) VI- C
Ci�State�IP ; Phone
Signature Date
I y `1 `�
The City of Edmunds EASEMENT
Sewer Drawing EASEMENT NO . ........................ --------------
104-06500 NEW CONSTRUCTION El REPAIRS D LID NO ................... ASMT. NO . ..................
OWNER -...-J.AGaUELlUE.--lET9EL ............................................. CONTRACTOR ------------------------------------------------------------ - ---------------------- PERMIT NO. ....................
JOB ADDRESS ------- 5,43 --- HOLLY --- DRIVE - ------------------------------------ LEGAL DESCRIPTION: LOT NO. -------------- ----------------------- BLOCK NO. -----------------------------------
-
----------------------------------------------------------------------------------------------------------------------------------------------------------------
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
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DYE TESTED ON SEWER
Approved:
PWW-0001-1 1175 (REV.1 1/78) DATE ............................................ By ---------------------------- -------------------------------
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