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22910 102ND PL W
Critical Areas Checklist - . CA. File No: (-h - 0 (- 17-1
Site Information (soils/ topography/ hydrology/vegetatioil)
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1. Site Address/ Location: We3f
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2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): 35' acr-c 1_57.2.zla F91_1 2-
_21
4. Is this site currently developed? ��Yes; — no.
If yes; how is site develo,
.ped? &'he LWle- 5'J17gJe_ ',,Carn�14 rC51'61cAce_
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 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 cofit-tim areas of year-round standing water I . 0 App : rox. Depth:
7. Site contains areas of seasonal standing water' 190 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 17,� floodplain of a water course.
9. Site tamis a creek or an area where water flows across the grounds surface? Flows are year-round?
I - Flows. are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site: 40
Critical Areas Checklist.doc/3.19.2001
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City of Edmonds
Development Services Department
Planning Division
Phone: 425' * 771.0220
1%91�
Fax: 425.771.0221
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 the application 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 information
needed to complete the Checklist should be easily
available from observations of the sitebr data available'at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received:
City Receipt #:—.,.
Critical Areas File #: CA-01 - tZ4
Critical Areas Checklist Fee:, $45.00
Date Mailed to ADDlicant: (2- -,C)
A property owner, or his/her authorized representative,
must fill out -the checklist, sign and date it, and submit it
to the City. The City will 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 applica�t 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.
P
The undersigned applicant, and his/hff/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless 6orn any and all damages, including reasonable
attomey'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 submi ' tted 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 APPLICANVAGENT DATE
Property Owner's Authorization
By my signature, I cer* 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 IAi DATE
PLEASE PRINT CLEARLY
Owner/Applicant:
5Aep�e,i /' ant .. C.
Name
Street Address
City State
zip
Telephone: ��2s- —ZZ,,�
Email address (optional):
Applicant Representative:
(5-- -� a A e,
Name
Street Address
City State zip
Telephone:
Email Address (optional):
Critical Arcas Checklist.doc/3.19.2001