23809 104TH AVE W (2).PDF23809 104TH AVE W
CA FILE NO- 146—OLO
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
1. Site Address/Location: PAN 7
-7
2. Property Tax Account Number:
3'
3. Approximate Site Size (acres or square feet):
k-
;PW 6"
4. Is this site currently developed? ___��yes; - no.
If yes;'how is site
5. Describe the general site topography- Chedc all dig 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 diogance of 66-fect)-
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal dLstance 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 d= 33-feet)-
Other (please describe):
6. Site contains areas of year-round standing water- 0 _; Approx. Depth:
7. Site conWins areas of seasonal stabding water. Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N V floodplain of a water course.
9. Site contains a creek or an area where waw flows across the grounds surface? Flows are year-
round? , N 0 Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc) C- C S
11- Obvious wetland is present on site: i,( b .
For City Staff Use Dkdy
Site is'Zoned7
0 5 loe
2.* -SCS-ffiapped soil type(s)? A Uae"4- Urbc--,� 7
W-edand inventory or C_A_ inap indicates wetl2nd present on site? NO
0
4- :..:.,Critical Areas inventory or C-A. map indicates Critical Area on site?
5 -::.':site miithir designated earth subsidence- landslide hazard area?
I
6: Site dmig"nated on the Environmentally Sensitive Areas MaFi?
DETERN11NATION
A10
A,10
CONDMONAL WAIVER
Date
RcV0110094
4190-194-
City of Edmon&
Critical Areas Checklist
The Critical An= 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 propeny. The
mformation needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical An= inventories, maps,
or sWd surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
JAN 1996
and submit it to the City. 'Me City will
review the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary to complete a
devckqmmt permit application.
With a signed copyof this form, the
applicant should also submit a viculuty map
or plot plan for individuai lots of the parcel
with enough detail that. City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other Pertinent infonnation (eg. site
Plan, topography map, etc.) or studies in
conjunction with this checklist to assist
staff in completing their preliminary
assessment of thesite.
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 / Applicant: Applicant Representative:
A V i i:> SC t
Name Nam
2- 3' �� " -7 / C. -�, A vz.- Li,
Street Address
City, State, ZIP Phone
Signature Date
�_L/ 2 — 2- 51 2-
Street Address
City, State, ZIP rkone
Signature
Vate
It