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Critical Areas Checklist
Site`Inforrmation. soiWt0 ram, l(0 h,� -�" t,
r P°g phy/hydrology/vegetat<on) art
1 ite Address11 ocation_ '1 Z13
PropeityATax=Accouut-Number..6,6G OOo`-`ot�i- v '
3-' Approximate Site Size (acres or square feet): • 1 sow F�
f} a, •.., _ 0
4 Is this site currently developed? L x yes; no.
rIf yes; how is site developed?_ s�..r tc t=•., �, a2es �r�ev,ce, Lx a�s� 11
5. Describe the general site topography- Check all that apply`
, �i i% "�, `i L.cy .! e� `$.si it•.LP Cc. t�' .:w. �� 7'. `^ -
_ X Fiat: less than 5-feet elevatio:n`chai�ge'oiier "entire site. .
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet-over a
horizontal distance of rr.n
r n IC, a
' Hilly: slopes^present on site of more than15% and less than 30% (4�v`eiticaifriseV`
y.. ,. of 10-fee 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- Ny ; Approx. Depth:
?. Sitecontainsareas,ofseasonal standing water_ No - Approx. Depth: :: ''Y�•.:,. i4.
What season(s) of the year?
8. Site is in the floodway No fioodplain AJa of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ' NO . Flows are seasonal? _ AJ0 (What time of year? ).
10. Site is primarily: forested ; meadow ;shrubs ; mixed ;
urban landscaped (iawn,shrubs etc) .
11. Obvious wetland is present on site:
For City Staff Use Only
1. Site is Zoned? S — (Z
2- SCS mapped soil type(s)? .� �Irbu�✓ G• Csti..ro 101C Z--a 20 511poc
3. Wetland inventory or C-A. map indicates wefland present on site?
4.1- ••,Critical Areas inventory or C.A. map indicates Critical Area on site? t ae.s hi. -.- r, , s `.._ _ C
5.. Site within designated earth subsidence landslide hazard area?
6. Site designated on the Environmentally Sensitive Areas Map? /[�6
.DETERMINATION.:. _....... .._. _ ... .
"STUDY REQUIRED CONDITIONAL WAIVER _
_ WAIVER
Reviewed by:'
Plafiner Daie
�Q. � ' e��..:+,u•,. pay:✓ Gr"�'y," r`' doe 4
r,i. 1 FY,t rx tk`f. `'a'�`s �R1 t•�^IF• N F ti .' ' .'. .. , ,
ri , o- 4 $S•' 1 J i �t � ; i �ft R t. 4.1 '
4 ce rr ,a'� Z �• ` : - s -! i v r 1 �' Z ; r �° �-
.rrnx.r i.i,a� Ct`•91i c�'(".+ riiii'"a• �lr{c�.0 r::ti,.'�ie i.t fS::9°rt .z
�,d ty�Ci� , .. • lr{ .i,t it -. y3 ,t �S.P _ , -. � •.' ,:, t - •.
•f A r � rl' � t' 1 , � � r i , - r ( ; ♦ • r q i � 'y, �V .1
.xb" �t :�'i` St,��,` a"]�''',r.. �., r :"bt'•.v 7•,;,�- e42.e (,•� wK rf a .(� 1 �'4 .+{) 1 r G t....'.-., i{a.l}>�.���.Ii.V✓J, �1.A '' �.Tl C.�r r .I-
N.EC�i.���
r � .q Jf .64�I � < 'S s / "-.y 7 ,:1 C' t,,f�y+.-J.� J) ;a�i� •i C� .:.i t-t :+siC �/EP�O xV �^,pt`,r'�•• t � .
s:.a i9q° ` 19�96.. 9t
.p �'y6,. .. •: ,-�°fat• - lt't;{V 1� R.Fr;Ji.A�:ft®.. sq;.r�ti�}:-d{i,i:i3+13 G'..i:• y. {s ..
C ty;; of Edmonds _ i� r�.::''t .. � w x ►:,�:,:.pERMIT�Cpe1WTER
k1l
st
The Critical Areas CheWist'cont n6d on ` :'` ''d„' ` r . ?
this form is to be filled out by and,J' .liiint into the.City- The City will
�Y Pin tie
preparing:a Development Permit
Application for the City F.ci
review ch' make a r+ecurso
"_ P ry site
,... nake'a determination of the
of mon prior°
to his/her submittal of a devel oP�t:
s6bsegtieat st* 'necessary to complete a
.
,..._... .
permit to'tlie City.
_
. developmen bon °�..
permit applica - ._..._, _ ....
_
The purpose of the Checklist is to enable
City
With a signed copy of this form; the
applicant should also submit a vicinity map
staff to determine whether an Y
potential Critical Areas are or may be
_
or pint plan for individual lots of the parcel
present on the subject
.1 property: The :. ..
with enough detail that City staff can find
_' .. and "ideati . th,e sib' :. .. .
]5
information needed to complete the
J� parcel(s)- in
addition, the applicant shall include
Checklist should be easily available from -
observations of the site or data available
oiher.pertineat information ,(e.g. site.,
at
City Mall (Critical Areas inventories, maps,
plan; topography Map, etc.) or studies in
-cot�junctiion with this Checklist to
or soil surveys).
assist
staff in completing their preliminary
An applicant, or his/her representative,
assessment of the site.
must fill out the checklist, sign and date it,
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate. column below)'..'
Own•,... _..._._. -._.._ ... . .
Owner I Applicant:
Applicant.Representative:
Name
(� _._-._...... _....._ _ .... _....,. , -'-- •- Name �...
7gfh
Street Address
Street Address
�"� 3 W✓-i CI kO L6
City, State, ZIP Phone
f
Signature Date
City. State, ZIP Phone
Signature . Date
Side Sewer Drawing
0
The City of Edmonds
NEW CONSTRUCTION ❑ REPAIRS 1$ WJ C IT-1
EASEMENT NO- --------------------------------------------
LID NO. -.....-....--- ASMT. NO-------------------
ESTZ I'AG
OWNERC,l` l!��--h -------------------------------*--11--------------- CONTRACTOR-----Q-, \-�------....----------...------------------------..------------- PERMIT NO. .---- ............ /
JOB ADDRESS .1A-3---------- � �Tl'i... \/E .-.,YQ :.------ LEGAL DESCRIPTION: LOT NO - -------------------------------- ----- BLOCK NO. -----------------------------------
-3>/w
PWW-0001-11/75 (REV.11/78)
►.
---------------------------------------------------------------------------- ----- ---------------------------------------------------------------------------------
NAMEOF ADDITIO.1 ------------------------------------------------..-...------------.-.-...----------------------..-------�
35,
s.s. EFtSEME�,tT /
o /
n
II �P�.c.
a
o �
I� =�VOOTS
tA
I 3 1 Z-r 4 N o. /
cl
Approved: n pp
DATE-------------------------------------------- BY `.2 ��7�-----...------------..---
APPLICATION
The City for
SIDE SEWER PERNaT
EASEMENT No ...........................................
NEW CONSTRUCTION E] REPAIRS ❑
OWNER....... ......... CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
It"E7—, t-4.
ADDRESS. .......................................................................................................... LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No . ............................................
V
9
a
0
NAMEOF ADDITION .........................................................................................................................................
Approved:
DATE................................................ By ......................................................................