21615 86TH PL W.PDF11111111 lill
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21615 86TH PL W
M
CA FILE NO. CY r/
Critical Areas Checklist
----------------- --------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I . Site Address/Location:
2. Property Tax Account Number:
L_�L I �Z_
3. Approximate Site Size (acres or square feet): /Ox
4. Is this site currently developed? yes; —no.
If yes; how is site developed?
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 I 0-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 I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: A10 Approx. Depth:
7. Site contains areas of seasonal standing water: A�O Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across tile grounds Surface? Flows are year- X/0
round? Flows are seasonal? _ (What time of year?
10. Site is primarily: forested : meadow ;shrubs mixed
urban landscapeerra—w7ANshrubs etc) tj
11. Obvious wetland is present on site: AJ 0
- -------------- --- -- ---- ------- '5
For C itv Staff Use Only --- -------- --------
L Site is 2oined?. 9,
Z SCS mapped soil type(s)?,
�1. W6il'ah d 'inventor v*'or C.A'.'map indicates wetland p
resent on site"
4. 'Cri.Eical Areas inventory or C.A. map indicates Critical Area on site'? No
:5 :Site: within, designat..
ed earth s-u6s.1denCe:i:an'd�iid.e..h;�zd.r.d.d.�.e.�?.
�6.: Site designated ori i.he'tnviro*nmentally'S*ensitive Areas Map? No
OETERMINATION
^ca_rhk,doc; Rey 10/03/97
City of Edmonds .
CRITICAL ARIEAS 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
infon-nation 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 his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City, The City will I review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
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 assist staff in completing their 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:
)c
Name
Street Address
city State
Telephone
Date
Applicant Representative:
Name
Street Address
51F026
Zip city . State
Telephone
Signature
Zip
Date
(over)
c:recepdon\jana\cac1.doc
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 10, 1999
George Smith
21615 86th Place West
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist # 99-43
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
. ...... ......
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
moo. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL AIIIIIIIII
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
* Architectural Design Board
C:ReceptionUana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11,. 1890
Sister City - Hekinan, Japan