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Critical Areas Checklist
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Site Information (soils/topography/hydrology/vegetation)
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1. Site Address/Location- ,
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed? S
S. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site. 9 119,9
Rolling: slopes on site generally less than IS% (a vertical rise of 10-feet over NO
horizontal distance of 66-feet). r
Hilly: scopes present hon site of more than orizontal distance 661 feet).a/� 30(a vertical rise of
10-feet over aorizontal distance of 33
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: tV 0 ; Approx. Depth:
What season(s) of the year?
"arc: flood lain ! of a water course.
8. Site is in the floodway _ � p
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? U A Flows are seasonal? �JA (What time of year? )
meadow ; shrubs mixed
10. Site is primarily: forested
urban landscaped (lawn,shrubs etc)
11. obvious wetland is present on site: ➢J 2 "J 2
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3;. :Sip hazard area?
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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
thb 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).
Owner/Applicant:
(2)' TAR[(:
Name
Street Address
City State Zip
4-L -'s- -- G--? 0 - / S 2-
Telephone
'.(0 !�
Signature
-7/) Y / ? 7
Date
c-n=pdonVanakad.doe
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
(over)
1nc.1S9v
March 26, 1999
Kurt Stark
4809 72"d Place S.W.
Mukilteo, WA 98275
CITY OF EDMONDS
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771.0221
DEVELOPMENT SERVICES DEPARTMENT
Planning • Building • Engineering
Subject: Determination regarding Critical Areas Checklist # 99-73
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
y You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Sharla Graham
Planning Secretary
Enc: Critical Areas Determination
* Architectural Design Board
C: ReceptionWna\CRLTR.doc
• Incorporated August 11, 1890 •
Sister City - Hekinan, Japan
APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No...........................................
117-04350
OWNER.--•--••. Hubbard- -...Ra..............................................•---.......---•--.. CONTRACTOR.................--------------------...........---.....------------.......----------------------- PERMIT No.......................
OADDRESS....... 1020... GrandVi.ew... S.t-.................................................... LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No. ............................................
obt
•
7
NAMEOF ADDITION-•.........................•--------........-----..........---•----.......---....--...................................-..................
DYE TESTED ON SEWER, 1972
Approved:
DATE................................................ By ....................••---
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number, t 6^ 7
Issue Date` 10 `02'T -77
A. Address or Vicinity of Construction: 1020 Grand*iAyr (9793400)
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B. Type of Work (be specific): Install 425' of 2"MPE IP Main @ '13'NdC/L
Grandview St from 511W to 4751W C/L Olympic. View Dr
C. Contractor: Puget Sound Energy Contact: Mariamne Kingsbury
Mailing Address:
1122 ,-o--S Eli Fderett Phone: -' 356-7500 X7596
State License #:
98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial
❑Subdivision
❑ City Project )] Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family
❑ Single Family
❑ Other
INSPECTOR:
INSPECTOR: 1nI
f
F. Pavement or Concrete Cut : 1] Yes ONO 4 G. Size of Cut: _4 x �H._ ChQ
APPLICANT TO READ-ANITSIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmless from injuries, damages, or claims 'of any
kind or description whatsoever, foreseen or- unforeseen, that may. 'be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the.defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BYCITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCF_SSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required.for inspection. Please call the Engineering Division; 771-0220.
Work and material is to be inspected during progress and at completion..
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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.'
I have read the above statements and understand the permit requirements and the pink copy Of the permit will be
available"'on site at all Imes for in purposes.
Signature_: Date. 10-10-97
(o ractor or ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: t� ) ►� RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER l26-f,,0 �� DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: F� RESTORATION FEE:
T OTAL FEE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE ' Eng. Div 1997
. A: ,
FIELD INSPECTION NOTES. (Fund 111 - Route copy to Street Dept.)
Comments•
I
CONTRACTOR CALLED FOR INSPECTION ❑ YES, ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
FIELD INSPECTION NOTES. (Fund 111 - Route copy to Street Dept.)
Comments•
I
CONTRACTOR CALLED FOR INSPECTION ❑ YES, ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
a
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Notes: The City of Edmonds
1)
Field locate all utilities.
Call 1-800-424-5555
24 hours before digging.
2)
Survey is not required
3)
Maintain a minimum of 5'
horizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4)
Cuts in paving are shown as q
5)
cuts in paving anticipated.
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SILL OF MATERIAL
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TAX CODE'
9EO. NO
Natural Gas
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