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1135 VIEWLAND
WAY
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°• .. � °ti City Of Edmond
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Date Received: /of
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.City Receipt #: ( / . - ,,
Critical Areas File #: wool— co t 3 t
Critical, Areas Checklist Fee: $45.00
Date,Moiled to ADDlicant: . 1p_i o �o
The Critical Areas Checklist contained on this form is to AYproperty owner, or his/.her - authorized representative,
be filled out by any person preparing �a De`velopment'`��'�must fill out the checklist, sign and date. it, and submit it
Permit Application for the City of Edmonds prior 'to to the City. The City will' review the checklist, make a
his/her submittal of the application to the City. precursory site visit, and make a determination of the
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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).
su sequent steps necessary to complete a development
permit application.
Please submit a vicinitymap, along with the signed copy
of ,this form to assist.City staff -in .finding and locating the
.specific piece of property described --on thus -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 their preliminary assessment. of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based' in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE CI 1 S 1 T
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and'the staff of the City of Edmonds to enter the subject property for the,
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER `� DATE
Owner/Applicant:
L$V%V, sue -IN .
Name
Street Address
City State Zip
Telephone:. L-la, �- 7 -76--qq;k -
Email address (optional):
Applicant Representative:
Co J_"C_
Name
?03)as -r
Street Address
L
City State Zip
Telephone: —k26 .5 �'! 7- 3b -7
Email Address (optional):
Critical Areas Check] ist.doc/3.19.2001
CA File No:
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: _. 1 3 S. ` 1/►� „� I CIJ w aN
2. Property Tax Account Number: a0(-06 (Q(QW 6017n A�_A
3. Approximate Site Size (acres or square feet);
4. Is this site currently developed? �;
If yes; how is site developed? S I t,
P 3I ACZE b
5. Describe the general site topography. Check all that apply.
'.'be
Flat: less than 5-feet elevation change over entire site.
Mh
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: no ; Approx. Depth:
7. Site contains areas of seasonal standing water: no ; Approx. Depth: _
What season(s) of the year? h l ti
8. Site is in the floodway 0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
r, I ti . Flows are seasonal? k I ol• (What time of year? t4 l a . ).
10. Site is primarily: forested ; meadow ;shrubs ; mixed
urban landscaped (lawn,shrubs etc) is
11. Obvious wetland is present on site: vt0
1j
Critical Areas Checklist.doc/3.19.2001