DNS-Doc #1 - ESLHA Completeness Review Pre-Application FormOV EDA,
City of Edmonds �p
Completeness Review Pre -Application Form for
Earth Subsidence Landslide Hazard Area projects
Notice: This is not a Building Permit Application Form. This is Step One of a two-step process (see
Earth Subsidence Landslide Hazard Area Permit Submittal Checklist for description of the complete
application process) The Completeness Review is a preliminary process to determine that minimum
submittal requirements have been provided for the geotechnical and critical areas elements of the
Earth Subsidence Landslide Hazard Area Permit Submittal Checklist. If it is determined that
additional information is required to be complete, the applicant will be notified in writing of the
deficiencies and must resubmit for another completeness review (including fee of $500). This
process continues until the applicant is notified in writing that the Completeness Review is accepted
by the City consultant and may proceed to Step Two, Building Permit Application Submittal.
Completeness Review Application for: El New Single Family E] Addition
F-1 Interior Remodel E] Garage/Carport E] Repair E] Deck
F-1 Fence E Grading cyds F-1 Storage/Shed
F Fire System (Specify) E] Rockery/Retaining Wall
F-1 Other (Specify)
Description of Work: New Single Family Residence with Attached Garage
Site Address: 15722 72nd Ave W
Sno County Tax Account Parcel #: 00513100002501
PROPERTY OWNER: Kevin Keck & Heather Hathaway
Mailing Address: 538 Battery St. Apt# 508N
city: Seattle State: WA Zip: 98121
Phone: (775 ) 772-2630
FAX: (-)
APPLICANTICONTACT: E]Same as Property Owner E10ther
Fill out the following information if "Other".
Name & Mailing Address: Kyle Zerbey
city: Seattle
Phone: (206 ) 930-5147
6522 9th Ave NW
State: WA
FAX: (-)
E-Mail: kevkeck@me.com
hhathaway73@gmail.com
Zip: 98117
E-Mail: kyle@studiozerbey.com
8/25/2020 Packet Item # 3