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City of Edmonds
Critical Areas-- Checklist.!
TheCritical Areas Checklist contained'on, and,submitit.to the'City. IMeCity will
this form be.filled out by_any.pe=R-,,,,, make a pre�� site
si r0pWffiq:cheddis4
preparing a Development Permit
make.a. determination of the
Applicatio n e y ofEdmondsprior
..,�xi-I.,�visit,:and
subs mplete a_-tii
I � 11 , equent geps necessary,
Mh
to of a developMent.,,, 17*� .Yt
1;1�� _dev'elo6ment.p�qnita pplication.
I Oz. 1-3,-*
permit to the City.
z 1., � � , .
Midi a- f
signed copy o this fbrrn;,the;'.
The purpose of the Checklist is to enable'
��hcaht' should also submit a vicinity map
City staff to determine whether any
or plot plan for individual lots of the'parcel
potential Critical Areas are or may be
with enough detail that City staff can find
present on the subject property. The
and identify the subject parcel(s). In
information needed to complete the
addition, the applicant shall include
Checklist should be easily available from
other pertinent information (e.g. site
observations of the site or data available at
plan, topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps,
conjunction with this Checklist -to assist
or soil surveys).*
staff in completing their preliminary.
of the site.
Ana�plicant,or-histh6r*representativ'e,�7-�,--�—
must fill out the checklist,:sign and it%t hm
-date
IQ 7. iA
al ve Z;
I have. completed, the' -attached Critical Area.Checklist,and. attest.that.1he answers provided �are,'.�,—
tactual,.tothe best,of my.,knowledge (fill out.theappiopriate column below)z--
Owner Applicant:
Applicant Repres'
I—IVOO _q _S(A_
Namet
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Z��t /Y1 E�I A?
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Suva Addr= Stri&Wd&��
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C
CA.FILE NO-.
Critical Areas Checklist''
Sitelnfornia�ion .(soils/topography/hydrology/vegetation)
60
1. Site Address/Location:c-tR,1-1-'�7 17-6 '44 &-1-- j�W-
2. Property TaxAcrount Number: 0 C/
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? —__yes; --"no.
If yes; how is site developeo?:.:-.
.5. Describe the general site topography'. 'Check all that apply.
Flat: less than 5-feet el entire site.,,
evation diange over
Nirticil rise
op�' h6lj less than 15%'(a- 0 over a,
_hohzontal distanceof-66-feet).
Z�rlu anl,
P
le--ss--tfia,&3'0% a vertical rise
_of. so
-feet of 33. t666466t).
-grades of greater. than 30% present on site (a vertical rise of I 0-feet over a
horizonW distance,of less than 33-feet).:,
Otheir (please describe).- -
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal stabdingwater: all Approx. Depth:
What season(s) of the year?
8. Site is. in the floodway floodplam of a water course.
/to.
9. Site contains 'a creek , or an area wheii water flows across the grounds surface? Flows' are year-
round? F16W'S"' (What time of year?.
10. Site is primarily: forested meadow,, -;,shrubs mixed,.-� iF-
urban landscaped (lawn,sbrubs etc)
11. Obv�i6us wetland is present'on site-
V
AO
_ 61.n
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
L
APPLICAPON
roll -1
CARDNo - ------------------------------
The City of Edmonds SlIDE S PERMIT EASEMENT No . ..............................
OUTSIDE INSIDE�0---"' REPAIRS El
................ .......... PERMIT
13
CONTRACTOR ----
OVVV,rNER ...... Vl— J�/
STREET.......... BLOCK ............. ; ..................................
LOTNo . ..... ....................
HOUSE No - ---------- ........ ........ AVENUE ............. No.
.. ............... Z 6>. ---------------
............................................
. ....................... ..... ................
NAME ADD - ----------
Date
3SUED................................... DEPOSIT, $ .............................................
Approved:
DATE .... ....... By A/
PROVED-
1963