1062 C AVE.PDF1062 C AVE
ADDRESS: OAfl,L
TAX ACCOUNT/PARCEL NUMBER: 0C)(D191-I.00Z� �I 1
BUILDING PERMIT (NEW STRUCTURE): 19 U z: b -5 jq (S�
COVENANTS (RECORDED)
CRITICAL AREASRA—39 DETERMINATION: ❑ Conditional Waiver ❑ Study Required r h Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: �— BLOCK: 2-
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DSTs\Forms\Street File Checklist.doc
IE
CARD No. - ............... ......... ..
EASEMENT No. ................. ........ ... ............
OWNER ............ ................................................. CONTRACTOR ... W& ...Ir .............. ........ . ............ PERMIT No.=.�
... . ;
STREET
HOUSE No. ....... ..0.4......................
AVENUE LOT No . ............ ........... ...................... .......... .. ......... .. BLOCK No . ... ........... - ... .............. ....... ..... .. .
010
....... 1491
NAME ADD —50 . .... ......
7*-
V4
Approved:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, ............................. ........................
SEWER WORK ORDER ISSUED ................................................
DATE BY
APPROVED
1piV5.. a&
The Critical Areas Checldist ooutainW on
this fora is to be filled out by any person
prcpa nng. a Devdopment permit
Application for the City of Edmonds prior
to his/her submittal of a dewd wnent
permit to the City. i
The purpose of the Checklist is to enable
City staff to determine whedw=y
potential Critical Areas are or may be
Present on the subject Property. The
information uoodod to complete tine
Chocks sho dd be ea Oy amenable fray
oluecvations of the site or data available at
(Sty EW (Critical Areas hwaftria. MaM
or soil surveys).
An applicant, or his/her, r xem, 1,
ut
must fill othe choddist, sign and date it. .
RECEIVEE).
MAR 15 =1995 =`
COMMUNITY SEFIVIC i
and submit it to the City. The City will
review the dhecldist, maim a precursory site
visit, and make a determ matron of the
subsequent steps ueoessary to complete a
dmdopmcat, pit application.
With a signori copy of this form. the
should also submit a vicirnity map
or plot plan for rndnacdual loft--
the pared
with enough detail City staff can fund
mad identify the sWjca pared(s). Ta
ad&G0s6 the aPPGmnt don indude
Office Pantineut W'onn2fion (eg. site
PbWv UpoSmPhY' . eto orsW&M in
004MCCM vAM this CbedcGt to aC - -st
SW.in oompletug their pr+erU0ht ry
of the site.
I have eoaqdctcd
qd bext amwbed Critical Ana istmd attst brat the.aasv xs p�� are
• e.my (fill ont the rig �� .
App Repro
�U,V
EN Sw�� u.1'i I
i
0
city' �' zip Phone .
Date
CA FILE 140-
s-3q
Critical Areas Checklist
Sue Information (sodshopogcaphy/hydrbl lveg iou)
1. : Sire Addf ess�ow G C
2- Property Tax Account Number. 9 4-ON-- 0 0 S- 0
3- Approx7imate Site Size (acres or Square feet).
4. Is this site currently developed?
If yes; how is site aeveloped?-- - f e v� �► �P T a Gyt 1 yyp Si �/ �r Cv
5. Descnibe the general site topography. Qieck an that apply.
_:4- Flat: less than 54at devation change ewer eatire site,
Rolling: slopes oa site generAy less than 15% (a vertical The of 10-feet over a
horrxoatal d-rst mwe of 66-feet).
HiUy. slopes present on site of more ciao 15% and 1= thaw 30% ( a vertical rise
of 10-foet over a borboatal distance of 33 to 66-fat)-
steep: grades of gMzW don 30% present on site (a vertical rise of 10-feet over a
hodzoatd distance of less than 33-fat).
Other (please desrn'1,ex
6. Site contains areas of year-c ound sbmdigg water: ,n,\\ ; Appwx. ;
7. Site Contains areas OfSCsna ft wa a V • AppwrDepft
-
What season(s) of die year?
& SaC is in the 800dww--4, L) floodpwa _ of a water Course.
9. Sae Contains or as as'ea wbae waDx >Aowt aa+oss the gnonads:ntfaoe? Flows one year-
tound? ; Rows are seas=W (What time ofym?�
10. Srtc is priraan7y. forested ;.meadow ; shmbs _A
utbaa landscaped (lawnAmbs etc) .rP •
11. Obvious wetland is poeseat oa srtc � •
'1_,.'. • _ •�S m�iplsed so�zrne(sr •, .; _ .. . � ,.
3or: t etliad 4gt/eotory C.A. MV.i dtcaft Wdbnd present anSW. - Z -'iw
-0% � 41e-'WCU&fty-*eCdWsow 'ra kdaCiwxw Arew4piiLo_••�'-`��;�w��jij
w4hurtiaatedtacth
:dwoelaerdsld0 �mrdalC� -,�di/ :,y , _ r • ..�''
['i1:..�C,�II�Ai lVl\., _ i,•�_ . - �Z't"� � � • •�yky
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Akt
is
ION & AING PERMIT C �ppl,.N
APPUCAT
limit,- one year.
Permit
CITY OF EDMONDS Building Department
e following work, in accordance, with the acoom,
ppLjCATION is hereby made for a permit to construct th
one
6e
A are submitted herewith for approval.
Two sets
ying plans and specifications.
Off -St
pan
Parking ....... .....
new alter ............................. .. ................... .....
re air ... ........
Work addn r .....X
. . . .... . ........
........ Fire zone ... �-w;
Use zone .. .................
Const. type
Occupancy .......................
Blk ....... .... Xddn ......... .. ...........
.. .. ..........
Address Lot...
.................................. . . .........
......
Area........................................... S,:ptic tank........................:.
Lot frontage .................. .. .
..............................
front .............. ...... .. r. side ......................
1. 1. side......................... ..... rear....
Bldg. set -bay
Tel No .... .....
Owner. ,,,,7Q- Z-LS-
Tel. No .............
Address........ .. .. ............................
Builder... .. . . . ......
......... .. ,..-7cl.,No
............
. ....... .......... Address..._..........._
Fla" by DE-T-RIPTION
..........
IF The' Remarks.:..
yosts First.Additfon'tto
South 101 fee" of -Lot 5, Block 2,
recorded in Vol.
on
to the plat thereof ............. According
records of Snohomish County, was1h ingt
. ......... ........
of Plats, page 6,
�:ura�c p6rml616'ffapplicable Codes and State laws * :regulating -this
ect statement, and I agree to comply Vltl-
Theabove is a corr
work.
......�
........
Addrs-.A:-'Date�
Signed �wner/Ag, ..
_0 -b
to the above oonditior6, and to compiianc.e.:wit.h'#�e;ap,,,
PEkMIT for the above work is bereby approved, subject
and specifications, and Building Department notations thereo-
proved plans
......... Permit fee ....... . . ...........
Reed
Valuation
Date.... ... ...
..........................
Building Department, By... ................
A
Electrical , g, Sewer orEleLL lationj..
This Permit does not cover Plumbing, er 0
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