10716 235TH PL SW.PDF10716 235TH PL SW
6-4/A� 3��t�sw �
TAX ACCOUNT/PARCEL NUMBER: Z'�--O 5:��Lu6,2) -D / -On
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: ! l D I DETERMINATION: ❑ Conditional Waiver ❑ Study Required �khaiver
DISCRETIONARY PERMIT #'S
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #: "
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSTslForms\.St=t File Checklist.doc
• OFILENO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: /0 Yl(p — ;-3S5b-) P1
2. Property Tax Account Number: 3(P .2L r% D of i 000
3. Approximate Site Size (acres or square feet): «t C
4. Is this site currently developed? ✓ yes; no.
If yes; how is site developed? Vious�r—
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 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 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: iJb ; Approx. Depth:
7. Site contains areas of seasonal standing water: 0 ; Approx. Depth: _
What season(s) of the'year? Nv
8. Site is in the floodway g p floodplain_ _ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? go 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: � p
-ca chk.doc; Rev 10/03i97
APR09199
City of Edmonds (CA GL / 0) 16,(- Pk#CQPM�410ES
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).
Owner/Applicant:
Name
Street Address
City State
Telephone
Signature
Date
Zip
Applicant Representative:
Name
Street Address
City State Zip
Telephone
K>� .5V-\,
Signature
`4— �-11
Date
(over)
�' )^ �:% i-�-f' G'' r � C9_ c�..�- ,�IL� 1W ^- `'% � �.... ...� � /n / 1 �_.1�G ✓�G /�.-l-r� ,,,.., v 1:�_2 C,� � �`'1
lhc. 189v
April 16, 1999
Steve & Kristi Suver
23120 53`a Ave. S.E.
Bothell, WA 98021
0 0
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 # 99-91
Dear Applicant:
BARBARA FAHEY
MAYOR
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 ENVIRONMENTar r_NUCKLIST OR CRITICAL AR a
S 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 copyof the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
-.410111111111
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB- Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
*Architectural Design Board
C: R eceptionUana 1C R LTR. doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan