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632 2ND AVE N
City of Edmonds
CRITICAL AREAS CHECKLIST
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 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, 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 this form 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 studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant*
Kame
Street Address
;, Z-4::;-7Z
city State Zip
Date
c:reception\jana\cac1.doc
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
(over)
CA FILE NO. T�
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology etation)
1. Site Address/Location: :!57 eC)
2. Property Tax Account Number: 4F_,�ro cv a - o o R
3. Approximate Site Size (acres or square feet): /27, 0 (cc 0�,, ?:F,
4. Is this site currently developed? no.
If yes; how is site developed? a-rri- I- (Dee X-5
5. Describe the general site topography. Check all that apply.
1 A�at. 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 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 1 0-feet over
a horizontal distance of less an 33-feet).
S
�:P ;�i
Other (please describe): 1��
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: L� 7;AApprox. 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 s hrubs
mixed
urban landscaped (lawn.shrubs etc)
11. Obvious wetland is present on site:
— - ------- - ---- --------- For City -staff. Use Only----- — — ------- — --------------
:1. Site is Zoned?
2..� SC.S..mappe,d,s.o.il,.typp(p).?.—
:-3. Wetland inventory or C.A. map indicates wetland present on site?
y
4. Critical Areas inventor or: A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area? A/1�1
Site designated on the Environmentally Sensitive Areas Map?, 4/6
CONDiTibNAL wANER
'77
Date
^ca_chkdoc; Rev 02/11/97
4%C_()Q�
.19
9-9-97
Les Stewart
632 2nd Avenue North
Edmonds, WA 98020
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning /Building e Parks and Recreation - Engineering * Wastewater Treatment Plant
Subject: Determination regarding Critical Areas Checklist * 97-177
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO -EiEWOTEb:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENIALChtgqt(LIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a couy of the CRITICAL AREAS CHECKLIST and DETERMINA TION WITH ALL _41111110
PERMITAPPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB� Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
Note Attachments:
* Architectural Design Board
C:Reception\Jana\CRLTR.doc 0 Incorporated Au - gust 11,. 1890 0
Sister*Cities International — Hekinan, Japan
/00v- -7 3'
PLANNING DATA
NAME:
SITE ADDRESS: 02 2--c-41le 1�16AT- E:.
ZONING: PLAN CHK#:
PROJECT DESCRIPTION:
CORNER LO (Yes/No) FLAG LOT---/(I-(Yes/No)
SETBACKS:
Required Setbacks:
Front: '-d Left Side: Right Side: Rear: /5
Actual Setbacks:,
Front: 1Y Left Side:
L- Right Side: �57/ Rear: 30
Street map checked for additional setback required,7 (Yes/No)
. X.0
LEGA!- NONCONFORMING LAND USE DETERMINA-�
A *ISOUED (Y/N)
LOT COVERAGE: -27 "J
Maximum Allowed: 35 Actual:
BUILDING HEIGHT: 5-
Maximum Allowed:- _Actual Height:
Datum Point: Datum Elevation: �
A.D.U. CREATED?: 41d 1,
SUBDIVISION:
CRITICAL AREAS #: *.c� 7—/77 �jAIIV
SEPA DETERMINATION:
LOT AREA:
OTHER:
Plan Review By:_ZJ�Sow---T-:�-��
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