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#x'20 <br />Critical Areas File : U` ` o 9 l <br />Initial Determination - $155 <br />❑ Subsequent Drmination - $90 <br />Date Received: - 12 —`" i <br />Date Mailed to Applicant: A7 <br />The purpose of this checklist is to enable City staff to <br />determine whether any critical areas and/or buffers are <br />located on or adjacent to the subject property. Critical <br />areas, such as wetlands, streams and steep slopes, are <br />ecologically sensitive or hazardous areas that are <br />regulated to protect their functions and values. The City's <br />critical area regulations are contained within Edmonds <br />Community Development Code (ECDC) Chapters 23.40 <br />through 23.90. <br />Property Owner's Authorization <br />Cit of Edmonds <br />Development Services Department <br />Planning Division <br />Phone: 425.771.0220 <br />www.edmondswa.gov <br />A property owner, or an authorized representative, must <br />fill out the checklist, sign and date it, and submit it to the <br />City. Staff will review the checklist, conduct a site visit, <br />and make a determination of whether there are critical <br />areas and/or critical area buffers on or near the site. If a <br />"Critical Area Present" determination is issued, a report <br />addressing the applicable critical area requirements of <br />ECDC Chapters 23.40 through 23.90 may be required <br />depending on the scope of the proposed activity. <br />By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my <br />knowledge and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject <br />property for the purposes of inspection attendant to this application. The undersigned owner, and his/her/its heirs, and <br />assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of <br />Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction <br />based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its <br />agents or employees. <br />SIGNATURE OF OWNER---,��......... DATE <br />Owner: <br />Applicant/Agent: <br />IA') W Tt,� <br />W Name Name - <br />Street Address <br />City State Zip <br />96� -2--� Pa \4 ,-e AP IJ ;> 1 o <br />Street Address <br />City State Zip <br />Telephone: q7 -S-970 `29Telephone: l f <br />Email address: f) ,�� 1 Email Address:—Pl,' �/60 ° ����� . cow <br />Revised on 619116 P20 - Critical Areas Checklist - 2016 Update.docx Page 1 of 2 <br />