511 5TH AVE S.PDFiiiiiiiiiiiiii
14698
511 5TH AVE S
lB99-199
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City of Edmonds
Critical Areas Che"k1l.st
rho Critical Areas Checklist contained on
Ids form is to be filled out.by any person
=paring a Development Permit
%pplication for die CSty of Edmonds prior
0 his/her submittal of a development permit
0 the City_ . ,�
he purpose of flit Checklist is to enable
:iV staff to determine whether any potential
Wtical Areas are or,may be present on the
Alect property. The information needed to
mmplctc the Qroddist should be easily,
rai'lable from obse=vations'of the site or
dta available at (Sty Hall (Critical Areas
Iventories, maps, or -soil surveys).
•
RECEIVED
APR 15 2003
PERMIT COUNTER
i
An applicant,.or his/her rcprescntative must
fill out the checklist, sign and date it, and
submit it to the City. The City wilt review
the chcddist, make a precursory site visit,
and make a determination of the subsequent
stepsnoccssary to oomplete a development
petmrt application_
With a signed 'co of this form, the.
applicant'should also subuut i vicinity map
of the parcel with enough detA that City
.staff can find. and identify the subject
parcel(s)_ In addition, the applicant is
encouraged to include any other pertineat .
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site_
have completed the attached Critical Area Checklist and attest that the answers provided -are
c tual, to the best of my knowledge (fill. out the appropriate column below).
caner / Applicant:
me
Address
State, ZIP Phone
I:
lature Date
Applicant Representative:
Name
Title
—C—L _N
Street Addr
_ -03 3/
City, te, ZIP Phone
Signature Date
� � 4
-� FILE
RECEIVE.0 n
BEET F
Critical Areas Checklist' MAY 1 7 1993
Site Information PERMIT COUNTER
Project Name: jq Y P&A Permit Number.
Site Location:. 50 Property Tax Account Number. 1'J--4 y Z- Z N -
2
Approximate Site Size (acres or square. feet): &0 v
Have you filled out a (critical Areas Checklist for a project on this site before? 00
General Site Conditions
1. Has the site been cleared or logged? A%l-l- Date of most recruit action: lUlf
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil typc(sp X1,A
3. Descxz'be 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 foet_)
Silly: slopes present on site of more than 15% and less than 301/e ( a vortical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on' site.
Comments _L�s d7/1 �. el�e� 613
Hydrology/Vegetation. t '
4_ Site contains areas of year-round standingfwater: N
5. Site contains areas of seasonal standing water_ / Approx. Depth:
6- Site is in the floodway A L floodplain4/A-of a water course-
7- Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? _&g- Flows are seasonal?
8. Site is primarily: forested ; meadow -shrubs mixed
9. Obvious wetland is present on site:. �FJ0
10. Wetland inventory or map indicates wetland present on site: Al _
11. Critical Areas inventory or map indicates any Critical Area on site:/
'Deteeminauon Number.
Rev'RZM2
•
City of Edmonds
Development Services Department
Planning Division .
Phone: 425.771.0220
'Fax: 425:771.0221
DATED RECEIVED: Z1 0'
CITY RECEIPT #:
Critical Areas File M. .
Critical Areas Checklist Fee: 45.00
DATE MAILED TO APPLICANT:
CRITICAL AREAS -CHECKLIST
The Critical Areas Checklist contained on this, form is The City will, review the checklist,
to be filled out by any person preparing a Development site visit, and make a determina make a precursory
Permit Application for the City of Edmonds prior`to steps necessary k complete a'on of the subsequent
his/her submittal of a development permit'to the City,a lication P development permit
!!� PP
f The purpose of the Checklist is to enable City staff to Please submit a vicinity ma
determine whether any potential, Critical" Areas are, or copy of this form tY P, along with the signed
may be rm to � assist City staff in finding and
y present on the subject property. The locating the"specific piece of property described on this
!� information needed to •complete ,the Checklist should form. In addition, the applicant shall in
be easily available from observations of the site or data pertinent. information (e. .site l elude .other
available at City Hall (Critical areas inventories ma g Pan, topography ma
. or soil surveys).
. ps, etc.) or studies in conjunction with this Checklist o
assistant staff in completing their` preliminary
" - assessment of the site.
An
aPPlit, or his/or representative, must fill out the
checklist, sign and date it, and submit it to the City.
I. have completed the attached CRTTTCAL AREAS..CHE
Ifactual to the best of my knowjed e f 11 out the a ro riate coniCEIn below T andattest that the answers, are
g ( PP . P ;
WMT
Owner/Applicant:
Applicant Representative:
Name . ��` Q r a
Name G"
t Address
Street Address
(ot,1f)5 WA C(go2o dW�O S -
State Zip city A� �50Z0
�' ate
h n d Zip
Telep ne: 4�Z5 %
r
Pate:_5 /Zi /a 7 Sign e
1Date: 1 D
'pellm�dl°rm'�CACL Fom�dx RECEIVED 0rJ-"-=CAM F"ft&c
APR 15 ZC
PERMIT COUNTER ' -
COE NO. ea-1o5
Critical Areas
Checklist
--------- {-------------------—---------
Site Information soils/topography/hy y/ve-etatio
I. Site Address/Location: 515 — 544' 4,,10 .1 11 n r a -,
2. Property Tax Account Number.,_ Sa7a3-2—
- 3. Approximate Site Size (acres or square feet): 1 17
4. Is this site currently developed? ✓ yes; no.
If yes; how is site developed? a hor1 a,YJ
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 risg 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): 5�n�22rI Si-�,�r,2S%,Gj ►�-j �St
6. Site contains areas of year-round standing water. JV0 Approx. Depth:
7. Site -contains areas ofseasonal,standing water:'- ; Approx.:Depth
What season(s) of the Yam? h G
8. Site is in the floodway floodplain..: of water. course: ,
9. Site contains "a creek or an area where water flows across the groiinds surface? Flows are year-
round? XjD Flows are seasonalT No, ! (What time of year?: n a'
10. Site is primarily: forested ; mead w ).
shrubs. ` :mixed
urban landscaped (lawn,shrubs etc)
IL . Obvious wetland is present on site: • �p
for•CityStaff se Only....:.
I. Site. as Zoned? .:.
2:. SCS mapped soil type(s) T.
etlaniinventor5!oC?1:rriapandcateswetlarid.preseritbnsite�
.
4: Critical Area inVentory�oi. C:A: mtip`indicatesCitipl Ai..
Site within designated earttauisidenceaandsiidehazaid
6. Site:designated on the£nviroriii3erifal1y Sensitive Aieas Map?
DETE MINATION
ST[aDY iZE(UIRED CONDITIONAL WAIv£R
WAIVER::': : `:.::.............:. .
Reviewed.by _ :.:.. i ( 0 ('IIK--01
i
Planner:..: :............ .IV
Date.
cMA,,- Rev
•
City of Edmonds
Development Services'Department
Planning Division
Phone: 425.771.0220
Fax: 425.771,0221
DATED RECEIVE5: .0 Ze
CITY RECEIPT #:
Critical Areas File M
Critical Areas Checklist Fee: $45.00
DATE MAILED:TO APPLICANT:
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 hislor representative, must fill out the
hecklist, 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.
,.l
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
assistant staff in completing tlieir 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:
Street Address
City _ State Zip
' I 1 Date: 5 / 2,1 /6 '2
:mY&cumenWWHmadf0c =1CACL Form-doc
aherchcm�ana/ "WCACL Forcndoc
.Applicant Representative:
1% A(1A; S�rP�I-
Street Address
_Fd W ups In1 q Bozo
City ate Zip
�i =
APR 1 5 2003
PERMIT COUNTER
CA S NO.
Critical Areas Checklist
------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
2.
-3
4.
Property Tax Account Number:
Approximate Site Size (acres or
Is this site currently developed? v/ yes; no.
If yes; how is site developed? _ ' h011So and
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
•s•
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): 51npprj % j Cost
6. Site contains areas of year-round standing water. O ;Approx. Depth:
7. Site contains areas of seasonal standing water: ; Approx. Depth:
What season(s) of the year? h
8. Site is in the floodway ___A6— floodplain MD of a water course.
9. Site contains a creek or an area where water flows cross the grounds surface? Flows are year-
round? D Flows are seasonal? NO (What time of year? n u
_ ).
10. Site is primarily: forested .,mead w _' shrubs _ : mixed
urban landscaped (lawn,shrubs etc) l.
11. Obvious wetland is present on site:. �p
--� .for•CityStaff se -Only
1. Site .is Zoned? .:.:.:..:
)?
2. :SCS mapped -soil types_
3: Wetland inventory;C A :map:indicates..ivedand.prese ' on site? LEo
4. Critical Areas-inventory•or.C:A :m2p:ii dicates: Critical Area on site?
.5. Site withindesignaied earth ubsid.enceaandshde. hazaid areal:_ ' "( .
6. Site:designated on the £nvironiiieritally Sensitive Areas Map?
DETERMINATION
9
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b ChkA c Rev IWOM
'; ; "7ti . ;,.. �.� .; yt :, �,� 3 � � ' '�: 9�I�s . �.. - ;V. r 'r,�. , L 4 .. ,;QtiY,?-� a , r-rh . "''Ziy'� :,� tq� �,A { . � ��.. k. � , +� .A.:!;: � s.�r✓,�h.. ; x
CITY,,OF EDMONDS .' Permit No. a
`COVMUNITY SERVICES DEPARTMENT RECEIVED
'RIGHT-OF-WAY CONSTRUCTION` PERMIT JUL
'Issue Date
a
Z
0
W
F-
U
W
O
w
PATES A�Tc� R.�PA 12 ENGIgEEI IN 1 Pub
A. • Owner: • ont actor:
Name !FT" Ay 5 Name 21019 RUIN !j q
Mailing Address Mailing Address
City State Zip City State' Zip
Y-\Jg:r Wra-i-I N &_10 —3z0-7
7 'EET FILL'
�;� State License Number Telephone Number
C. • Address or Vicinity of Construction: `J i t S7"T4i A\1 S
Type of Work to be Done: pll L� TL7 12#i 1ST IST11J [� p�u�E2 P�lESTA
fN.- W t N L ES C.
CONCIP-e-Te: G- DCc
D. • Work in Connection With: ❑ Sub or Plat ❑ Single Family City Projects
❑ Commercial ❑ Multifamily ❑ Utility
E. • Pavement Cut: ❑ Y 121V F. • Size of Cut: X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be made% ainst the City of Edmonds, or any of its departments or employees, including or not limited to the defense
19
of any legal proceedings including defense costs, court 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 INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for ;issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations. `
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
"h
I understand the above and that this permit must be available ate the job site for inspection purposes at all times.
Signature: r Date. —
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: RAC Vv M:? C,yT
Time Authorized: Void after S eP T' j S T- days.
Special Conditions: N h
RELEASED BY:
D a t e 7 - / k _c1__1
PERMIT FEE: _F
Restoration Fe
Receipt No.:
Fund III Fee:
Street Cut Dimension's:
INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE .
x =$
Date
Eng. Div: March 1989
FIELD INSPECTION NOTES ,, ,, (Fund III - Route copy to Street Pe t.)
Comments:
Y
1. Diagram:
P
,A
r
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
5140H06115H"COUHTV_
PUBLICI'.TILITI dSTEICT 140.1'
ERRS
CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST
TO
bode
FROM
e-
DATE
6 --1-'1
ADDRESS/LOCATION/POLE NUMQtR
f4 Ave
Soofk E J pn 0h is
.Room � y le
WORKORDER NO:
ACTIONtREO e
J ts�a a 40
DRAWING NO.
a Is e
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4rAc lae Cet h
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t vl t 0 r c r�
C-e Im Pk S
a e C i o
4-127-
..................
1
.-. •
REQUESTED BY
APPROVEDBY
COMPLETEDBY
DATE
DISTRIBUTION: WHITE -,ORIGINATOR
CANARY -TO REOUESTOR=RETU RN TO ORIGINATOR WHEN COMPLETED
D� y9
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