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24216 107TH PL W
!i. Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
1. Site Address/-Ucation: el Ll J',/ Z ^ X
2. Property Tax Account Number: 9. 1 2-
3. Approximate Site Size (acres or square feet): ( '0 0
4. Is this site currently developed? Kves, no
AY
If yes; how is site developed? /f::p <X1.
5. , Describe the general site topography- Check all that apply. 0;
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generail y 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 305o present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal sta:nding water: X-le Approx. Depth:
What season(s) of the year?,
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek 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 ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc) r 1./ _r
11. Obvious wetland is present on site: C) R, 1]5N RE Koo 'A
For City Staff Use. Only-
1. Site is Zoned?
2. kS map ed snil typefq)?
p
-A wnd Q, b L ,j C_-�(kw 7 - RA .5140e-
3. Wetland inventory or C.A. rnap indicates wetland present on site? A/V
4;.---. :-.Critical Areas inventory or C.A. imp indicates Critical Area on site? If" 0
5. Site within' designated earth subsidence landslide hazard area? ItID
6. designated on the Environmentally Sensitive Areas Map? 1VQ
.DETERMWATION
-!'�tUDY REOUIRED
CONDITIONAL WAIVER
WAIVER
Reviewed by:
Date
Pla r
RAY01/04194
go -I o VJ
City of E&mon&
a
Critical Areas Checklis
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 a development
permit to the City.
The purpose of the Checklist is to en I able
City staff todeter-mine 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 availableat
City Hall (Critical Areas inventories, maps,
or soil surveys). -
An applicant, or his/her representative,
must fill out the checklist, sion'and date it,
Z;I
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 -
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for in�vidual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the a ' pplicant shall include
other.pertment information (e.g. site
Plan, topography map, etc-) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessmentof the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (r]II out the appropnate column below).
Owner / Applicant:
7'^
Name
- I - R
Street Address
00/0
'City, State, Zip Phone
Applicant Representative:
Narne
street Address
-� �- C?
-�21: V, 9-?
City, State, ZIP Phone
Signature
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ate
Date
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