22205 93RD PL W.PDFIII . iiiiiiiii
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22205 93RD PL W
Crititail -Afe' ai�--.Ch6dk ist,
n"'(SOUS/to 19raphy/h NO
d I rl
Ski lnfoei4i �ff etatio
Y roo
L' Site Address/Location rl�26
2. Property Tax Acmunt Number.
3- Approximate Site Siz,. (acres or square feet): 0&_ 600
U
is, q��"y developpd?. es; no.
r - v,,
4!f, y
If yes; how is site developed?
4j.;
5. Describe the general site Check all that appl:
`op0FW tla� iz
S Wa�'; less han 546�t over endre'sit&.-�'
Rolling: sl0peson site generally I= than 15% (a vertical rise of 10-feet -over
a
horizontal distance of 6�-feet).
oi
Hilly: 'Aopes present on'skiof more than 15%*��d less''ilmh 30% (?�verti rise.-,,,.*
cal.
of 10-feet over.a horizontal distance of. 33 1 to 6&feeet)....
Steep: grades of greater than 30% present on site (a vertical rise of 10-feef over a
horizontal distance of less than 33-feet).
.,Other (please describe):.
6. Siteco.ntiiiis' ir eas of. '-'round standing water No" Approx.'Depth:
year
7. Site contains areas of seasonal standmg'vr'Aer. ;Approx. Depth:,.
What sea"son(s5'o!`f'the'yea0.
8. Site is.inffie floodway floodplaih Of a water course..
9. Site contains'a- creek or an am where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily-. forested meadow shrubs mixed
urban landscaped Oawn,shrubs etc)
11. Obvious wetland is present on site: /\0
—Fo City Staff Use Only
1. Site is Zoned? S
2. - �CS mapped. soil type(s)? Adev._� . -21, slIc c
3. Wedand inventory or CA. map indicates wetland present on site?
4;,,. :-,Critical Aims inventory or CIA. map indicates C ritical Area on site?
5.. designated earth subsidence hridsl
ide hazard area?
6. * --:�itd . des'i;gnated on the Environmentally Sensitive Areas Mapl
.DETERMINATION
DY REQUIRED
WAIVER
Revie . wed bj� 4A
pig 4z.I=z
RcwOIM4#V4 t
CONDMONAL WAIVER
7 - ( -7- 7
Date
0
7.1 M.
-41 _4
ZI,
14
A
0 - 7L 9 Ci 14,
'RECEIVED:
CIRV of E
dmofids,
DEC V. 6 1
% -bWtR�
AMIT
-me Critical.,A� 6 heckIL-st contained on (AW.,stibnfivit to the City. 'The City will
this form is to be filled out by any pmwn review the. 0 ist�.-make a prequrs9FY. site' J
p rcpa Peimit
nng a DeVeloomint and maim a deterzninatio� of the
Application for the City of Edr�onds pnor subsequent iteps necessary to cqmplete a
to his/her submittal of a development devekqnnent pm . mit application. *%�-
permit to the City.
With a signed copy of this forifi, t1w
The urposeof"theii
p Checklist is to enable..--- applicant should also submit a vicinity map
City staff to dit n' ei *w- -he t he r- a n Y or..plot,plan forindividual lots of the parcel"
potential Critical Areas are or mayb6` with a�ough detW that.Cit
!pan find
presenton the subject property."I'lie' aMid6Wlyihi subject parcel(s)- in
"de"
information needed to complete the addition, the.applicaiit shall indu
Checklist should be easily available from other.per.tibust informatioi -(igrsiteI-& Wii,
n
observations of the site or data avail;able at. -plaup topogi��i��nt�p, qc-) pr studies iw-,.
City Hall (Critical Areas i6�wries, maps. conjunction with this Checklist to assist
or sdid surveys). staff in completing their prelirniinary.
assessmentof t he site.
An applicant, or his/her representative,
must fill out the checldist� 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) -
Owner I Applicant; Applicant Repres eintative.-
Nade Na . nie
St&e(Aadress Street Address
UA M r>
CitVy State ZIP city, S
Phone ZIP
12
Signature
10kib rre Date Date �PAVL
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