505 5TH AVE S (3)iiiiiiiiiiiiii
14698
511 5TH AVE S
0
lB99-199
City of Edmonds
Critical Areas Checklist
the Critical Areas Checklist contained on
Ids form is to be filled out.by any person
=paring a Development Permit
application for die City of Edmonds prior
0 his/her submittal of a development permit
o the City_ .
he purpose of flit Gieddist is to enable
:ity staff to determine'"edier my potential
k tical Areas are or,may be present on the
thject property. The information needed to
omplctc the Choddist should be easily.
railable from observations'of the siteor
rta available at (Sty Hall (Critical Areas
Ivaitorics, maps, or -soil surveys).
RECEIVED
APR 15 2003
PERMIT COUNTER
An applicant,.or lzisIer represcntative, must
fill out the cheddist, sign and date it, and
submit it to the City. The City will review
the chcddist, make a procausory site visit,
and make a determination of the subsequent
stepsneccssary to complete a development
permit application_
With a signed copy of this forme, the.
applicant' should also submit a: vicinity map
of the parc d with enough detail that City
staffcan 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
theirpmiry assessmentof thesite.
lave completed the attached Qitical Area Checklist and attest that the answers provided -are
atrial, to the best of my knowledge (fill. out the appropriate column below).
caner / Applicant:
. I��
IIIC
L\
Address
State, zip Phone
I:
lature Date
Applicant Representative:
Name
Title
Street Addr
kh 7�O -03 3/
City, te, ZIP Phone
Signature Date
� � 4
BEET
FILE • RECEIVE. n
Critical Areas Checklist' MAY 1 7 1993
Site Information PERMIT COUNTER
Project Name: rJW-',,GtqY4&A permit Number:
Site Location:. 5D Property Tax Account Number.
Approximate Site Size (acres or square. feet): v
_4L�
Have you filled out a (critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? A%/-17 Date of most recent action: lUlf
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil typc(sp
3. Descxz'be the general site topography. Check Al 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_)
Silly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present.on• site.
Comments /i_59 2749d2 She Q e�3 61) �d1�n .,,"AST &424 25;��
Hydrology/Vegetation t '
4. Site contains areas of year-round standingfwater: N
5. Site contains areas of seasonal standing water. AID Approx. Depth:
6. Site is in the floodway —ALfloodplain4t/� of a water course-
7- Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? —&±- Flows are seasonal?
8. Site is primarily: forested ;meadow ;shrubs mixed
9. Obvious wetland is present on site-
10. Wetland inventory or map indicates wetland present on site: A—
11. Critical Areas inventory or map indicates any Critical Area on site:/
Ddteeminauon .Numbe'.
Rev'3R7192 .
•
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
to be filled out by any person preparing a Development site visit, and make a dete checklist, make a precursory
Permit Application for the City of Edmonds prior `to steps necessary to complete
of the subsequent
his/her submittal of a development permit'to the City,a lication.: P a development permit
PP /
v,
C! The purpose of the Checklist is to enable, Cit sta
determine whether an Y ff to Please submit a vicinity map, along with the signed
y potential Critical' Areas are, or copy W this form to assist City staff in finding and
may be, present on the subject property. The locating the"specific piece ofProperty
information need ed to 'complete the Checklist should form. rn addition, the app ant shall described
inciude n this
be easily available from observations of the site or data pertinent information(e.g.site other
available at City Hall (Critical areas inventories, ma s . etc. Plan, topography map,
or soil surveys):
- P , ) or studies in, conjunction with this Checklist to
CV assistant staff in completing their` prelimin
assessment of the site. �'
' An applicant, or hislor representative, must fill out the
Checklist, sign and date it, and submit it to the City.
I. have completed, the attached
.., CRITICAL AREAS .CHECKLIST and attest that the answers .provided are
factual to the best of my knowjedge (fill out the ap...
ropriate column below).. � � °
(Owner/Applicant:
Name
Address
State
Zip
Applicant Representative:
—LLD M��hn SErPQ�-
Street Address
d woo ,(s Inj A- 9 solo
City ate Zip
Telep ne: -7-7 G _c
Date:_5 / 2I & Signattitr
7�
&'CAM Foma« RECEIVED
FOM d�
Date: 162
'
APR 15 ZC_�J
PERMIT COUNTER '
.0
COE NO. (D;k D
Critical Areas Checklist
----------------------------------- -------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
id 110,
2. Property Tax Account Number
765
3. Approximate Site Size (acres or square feet): -7
4., Is this site currently developed.? yes; no.
If yes; how is site developed? A
5. Describe the general site topography. Check all that apply.
flat: less than 5-feit elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical+ ris;9'0'f I 0-fect over a
horizonW distance of 66-feet).
Hilly: slopes present on site of more than 15% andiess than 30% a vertical rise of
10-feet over a horizontal. distance.,of 33 to 66-feet).
Steep: grades of greater than 30% present-oll site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe): -kj lost
6. 6. Site contains areas of year-round standing water.
]VO Approx. Depth:
onal, standing w
7. Sitecontainsarea's of seas ater:'Approx. 'Depth:'
What season(s) of the yW.
bO
8. Site is in the floo4way floodla�,p __ of a water
-&
course:
9. Site contains reek or an area wherewater flows across the gro6nds surfacel I Flows are year-
round? )YD Flows are seasonalT (What time of
year?
10. Site is primarily: forested mead w shrubs.
:mixed
urban landscaped (lawn,shrubs etc) 7P
IL Obvious wetland is present on site:
-or-Ci
-ty.
I. Site as Zoned?
_r2Lf .14. V '..:
mapped. 0Sol. -typ" e( .1 Wetland- inNiefitoix.., C
i?1riiap:indicates
4: Ciftkai Areas inventory ..... tdo Aida dj Site
.5. Site within -&signi ' d earth ul ...t (;g,'andslj 0ha*daii6i7<
6. S1te:de's'ign*aied*-on the `tn .,y. ,.ensitiveAYeasMap?
DETEAMINAVON
11
S TMU D Y - R E W,. .1 RJE D
CONDITIONAL WAIVER.
WAIVER"'
Reviewed by�
Pl
anner:..:antler.
D aie,
'a-CMAm Rev 100M
_a C. 1 S9"
•
City of Edmonds
Development Services'Department
Planning Division
Phone: 425.771.0220
Fax: 425.771,0221
DATED RECEIV
0 Z/
CITY RECEIPT #:_ /
Critical Areas File #:
.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 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.
The purpose of the Checklist is to enable City staff to Please submit a. vicinity map, along with the signed
determine whether any, potential .Critical Areas are, 'or, copy. of this form. to assist City staff, in finding and
may be, 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, include other
be easily available from observations of the site or data. pertinent .information (e.g. site plan, topography
available at City Hall (Critical areas inventories,. maps, etmap,
c.) or studies in conjunction with this Checklist to
or soil surveys)'. assistant staff in com letin their
P g preliminary
assessment of the site.
An applicant, or hislor representative, must fill out the
hecklist, sign and date it, and submit it to the City.
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: ' -
�d �R��� �T�T �c ��-fl✓ �
Street Address
�DMoti19�c, Y�� Clgo2m
City _ State Zip
'1. V Date:_5 IZ1 J6 7_
:mYdoeumenta WHmadfocma/CACL Form.doc
ahercltem Jana/fWWCACL Form doc
.Applicant Representative:
Street Address
_Fj mnvyls itJ f - q bozo
City ate Zip
, Teleploe: ( *Z S ) 77 � - S
APR 1 5 2003
PERMIT COUNTER
CA A NO. Op, —10LI
-----------------------
Critical Areas Checklist
----------------------------------------
ite Information (soils/topography/hydrology/vegetation)
l . Site Address/Location: S 1 4,.. �._ _ _ _ �� .. N n n .,
2.
- 3.
4
Property Tax Account Number:
Approximate Site Size (acres or
Is this site currently developed? ✓ yes; no.
If yes; how is site developed? ho���o aryl npD-yf0�inn 5�in�
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%o 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. O ;Approx. Depth:
7. Site contains areas of seasonal standing water: ; Approx. Depth:
What season(s) of the year? h ot
8. Site is in the floodway ___A6— floodplain [D of a watercourse.
9. Site contains a creek or an area where water flows cross the grounds surface? Flows are year-
round? D Flows are seasonal? rho (What time of year? n a
10. Site is primarily: forested :,mead w _' shrubs _ : mixed
urban landscaped (lawn,shrubs etc) .
11. Obvious wetland is present on site:. �f p
-- £orCiry sta#i::
I. Site .is Zoned?- _.
2: SCS mapped -soil
3: Wetland inventory.. or CA.'. map::.1n hcatds- v dand_pr6se 't-on
4. Critical Areas'inventory•or.QA <: ftp:iiidicates: Critical Area.ori site?,., .
S. Site w.ithindesignated eartb-. u1#sid.ence landslide. hazaid
6. Site:designated on the £nviroiimentally Sensitive Areas Map?
DETERMINATION
STUDY.it1CU7RED CONDITIONAL WAIVER:
WAIVER :.
Reviewed,
by; (/OCA
Planner:..::.... .
Date .
b akA=_ Rev IaoM
6
� 'C ., .'vsti'.�,'-a ,r-ny. '"dirt '�,'�e, �Y•a�•Ak•,,W.,b}: ,ryr�v. .i4:' +�q.:. ��.t ',�r✓„ ;x
r f-.
CITYOF EDMONDS . ' Permit No.
`e'
A&' UNITY SERVICES DEPARTMENT RECEIV :1
'RIGHT-OF-WAY CONSTRUCTION PERMIT JUL
Issue Date
Z
0
W
E—
U
a
0
w
A. *owner:
PETES A VT O R.=PA Ie_ENG1yEE �1Nt�actor:
Name11 STH A14 5
Mailing Address
1DMbhJ1D5 Iu6 41$OZ0
City State Zip
E&,'E FILE
Y—\)A:r
Pub
Name
2 101 % RLAN cj q
Mailing,Address
52MMENDS tuft 94?Q
City State' Zips
Mp-a-TIN (o-70 -3zo-7
State License Number Telephone Number
C. • Address or Vicinity of Construction:
Type of Work to be Done: Pu D TL7 P_#i1S,(_- Pf_--iNes !
fN.- W t N C. FS C.
Go W C-V_E,f4: G- D k
D. • Work in Connection With: ❑ Sub or Plat ❑ Single Family City Projects
❑ Commercial ❑ Multifamily ❑ Utility
E. • Pavement Cut: ❑ Y 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.
I understand the above and that this permit must be available ate the job site for inspection purposes at all times.
VSignature: 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: ROB W HIT C.QT.T
Time Authorized: Void after SEFT I1�7 days.
Special Conditions: N h
RELEASED BY:
PERMIT FEE: _P
Restoration Fe
Receipt No.:
Fund III Fee:
Street Cut Dimension's:
Date 7 i - 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:
a
Y
Diagram:
F
,A
r
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Ju
45140HUPIIS WE0UNTV_,
r— Lo—w10
PUBLIC-L'.TILITS dSTEICT`N0.1
.. /:
CONSTRUCTION OPERATIONS AND ENGINEERING REQUEST
TO
Dale yvh 4 A rkh
FROM
0e-
DATE
6-'1 -('21
ADDRESS/LOCATION/POLE NUWtR
S'
ino,�,Js
R oom J � y le 0
WORKORDER NO: DRAWING NO.
ACTIONtREQUESTEP,"
e J tstL as 40 a ls-el ce 4v
(� es
E s t �e a k so com4rAclae Ceti,,
t i r t N
c -e vn C k A S14 0ci e c i a
4-127-
.................
1
e .-.THER AC:TION REQUIRED.
REQUESTED BY
APPROVED BY
COMPLETEDBY
DATE
DISTRIBUTION: WHITE -,ORIGINATOR _
CANARY -TO REOUESTOR 'RETURN TO O RIGINATOR WHEN COMP L ETED