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8546
24104 88TH PL W
C4 FILE NO.
Critical Areas Checklist
---------------- -------------------- ------------------------
Site Ird ormatio'n (soils/ topography/ hydr6logy/ vegetation)
1, Site Address/ Location: A. 6).
2. Property Tax Account Number- 12 6 -6 4:9 5
3. Approximate Site Size (acres or square feet); S'F o Y
4. Is tbis site curreptly developed? &-Y,*e-s, no.
If yes; how is site developed? Ad�Ott_y PUCLL�A�4___.
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'pver 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 l,ess than 33-feet).
Other (please describe);
6. Site contains areas of year-round standing water- Approx. Depth:
7. Site contains areas of seasonal standing water; -,Approx. Depth., ILrIx-
What season(s) of the year?
8. Site is in the floodway--A-1 floodplain--t1/0
— of a water course.
9. Site contains a cT ek or an area where water flows across the grounds surface? Flows are
year-round? Flows are seasonal? _ (What time of year'?
10. Site is primarily, forested NO meadow :shrubs ' A10 ;mixed. //19
urban landscaped (lawnshrubs; etc)
'A1110
11. Obvious wetland is present on site.
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City of Edmonds
Critical Areas
11C. 107
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 Edmond's
prior to his/her subtTdttal 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 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).
An applicant, or his/her representative,
r.71 -�4-1, A-,,nAe14r.+ cn' wnrl r4m+A
Checklig-t. _1?9
"I
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
permitapplication.
With a signed copy ofthis form, the
applicant should alsogu.bmit a vicinity
map or plot p Zan for individual lots of
the parcel with enough detail that City
staff can find and identify the soject
parcel(s). In addition, the applicant
shall include other pertinent , ;
information (e.g. site -plan,, topography
map,. etc.) or studies in conjunction
with this Checklist to assist staff in
completing their preliminary
assessment of the site.
"LUOL
I have completed the attached Critical Area Checklist and attest that the answer-P
provided are factual, to the beat of my knowledge (fill out the appropriate colurim
below).
Owner/ Applicant:
Name
;,Y1Cq
Street A ddres.8
C-01A &6 1. OJ4 �Am --, "4&0
City, state, ZIP Fhone
1,4k, dA
§1wwtuW / Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
. . I ; 1--- -1
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