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23827 104TH AVE W
#P20
CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrol P_V/Ve etation)
1. Site Address/ Location: ONIP V , ��J,-A),IV4
2. Property TaxAccount Number: 10 0 0 0 U
3. Approxhinat6 Site Size (acres or square feet)*- III
14
4. Is this site currently developed? yes; — no.
If yes; how is. site developed? S-G-f le-,
64
5. DeVo the general site topography. Check all that apply. NTER
PERM0 COU
Flat less than 5-feet elevationchange 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'ri,se 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 (pleasedescribe): --------- --
6.- Site contains areas of year-round standing Water: Approx. Depth:
7. Site contains areas of seasonal. s, g water: A111 Approx. Depth-.
What season(s) of the year?
8. Site is in the floodway floodplain Of a water course.
9. Site c k or an area where water flows across the grounds surface?. Flows are year-round?
Flows ar seasonal? (What time of year?
10. Site is prim arily:- forested meadow shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: U0
For City St aff Use 0'nily 003 . I
1. Plan Check Number, if applicable? WOO& !�W?_Vl-
2. Site is Zoned? G
3. SCS mapped soil type(s)? &v &r Q�ravt[W 6aAnbLu Wam 0—s". C-)topct2.
Li i j
4. Critical Areas inventory or C.A. map indicates Critical Area on site? 0 V1 e-, 6�1)0 W VN
5. Site within designated earth subsidence landslide hazard area? N 0 12 txf-, DLA i I cl � V1
0 Ri (A'a I -t-D M 61 Y-,c, fi V\ 0j I CAc,+fv m in a -h on
DETERMINATION
STUDY REQUIRED
Reviewed bV. zvwr--
X WAIVER
Date: I U
#P20
'41c, 1%9�-,
City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
befilled 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 site or data available at
City �Hall (Critical areas inventories, maps, 'or soil.
surveys) -
Date Received:- 9141r
City Receipt#: -71 reo
Critical Areas File #: 'Pop 5 - of a 7-
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant: 9- -,'S-
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 thisfoiffi 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
studiesin conjunction with this Checklist to assistant staff
in completing -their. preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs,. and assigns, in cons . ideration on the processing of the application agrees
to release, inderrinify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, Arising from any. action or -infraction based in whole or part upon, false, misleadingi, inaccurate or
incomplete information furnished by the applicant, his/her/it agents or emplo*y-ees.
By'my signature, I cer* that the inf�rmation and exhibits herewith
submitted 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 aflisted. below'.
SIGNATURE oF APPLicANT/AGENT
DATE
Property Owner9s Authorization
By m y signature, I cer* that I have authorized the above Applicant/Ag ent to apply for the subject land use applic* ation,
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 po i g attendant to thi pplication.
SIGNATURE OF OWNER
DATE
I PLEASE PRINT CLEARLY
Own r/Appticant: ,Applicant Representative:
C)fvwj
Name Name
(A4
-Street Addrqss;
city State zip
Telephone: qD�7-57
Street Address
City State Zip
Telephone:
Email address (optional): - Email Address (optional):