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RECEIVED
J U L - 1977
s
City of Edmonds
f;6ii MUMIty Devel, A
DATE: July 6. 1977
i-eceIpt tE-- I009
ccOv�
A $25 fee will be collected by the City of Edmonds for analysis
of'the Environmental Checklist and the preparation of a Threshold
Determination. No -fee will be charged for proposals which would
be categorically exempt if they were not located in an environ-
mentally sensitive area.
ENVIRONMENTAL CRECKLIST FORM
`
I. BACKGROUND
1. Name �f. Proponent Thomas D. Archer
r
2. Address and Phone Nino er of- Proponent:
.9311 S.E. 36 hstreet
Mercer-rs-lifid. WA 98040
'
3. Date C iec.list Su nntte - - _.__•
4. A enc Y Requiring Checklist_Edmondu
g
5. Name of Proposal, if applica Te:
6. Nature ant Briet Description or tie Proposa inc u3-
ing but not limited to its size, general design ele-
ments, and other factors that will F,ivc an accurate
und6tstanding of its scope and nature):
Planned res.•Ldenral omm +n j'tw containing e1 oven
large single family re Bj.dentAl I.Qfi6
7. ocation o I'roposa uescri e L c p �vsica� setting; of
the' proi�osiil., as well as the extent of the land area
affected by nny environmental impacts, including any
other information n.eeded to give an accura'ra understand-
ing of the environmental setting of the proposal):
Plan is to preserve natural enyirament and all
types of trees and foliage.
B. Estim tea Date for omp etion of tnc Pr.o—posec_Action
Spring
197mits,
9. Li t• alo Licenses or Government e+ppr.ova s
Required for the Proposal (federal, state and local--
including rezones):
Health Department approval and City of Edmonds
P
-31-
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