00841,' •1
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2q
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r 39.
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fn. 55
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A $25 fee will be collected by the City of Edmonds for analysis
of the Environmental Checklist and the preparation of a Threshold E`
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 CHECKLIST FORM
I. BACKGROUND
1. Name of ProponentlaRA WasT G_ o�-►�'R�tT10�1
Sii:
2. Address and Phone Number of Proponent:
Kp I�RpK.t L�-h 1�6gD �1 O
�OI
3. Date Checklist Su l:littec _
4. Agency Requiring Checklist e-Me O1: -ED ROMP
5. Name of -Proposal, if �applicable:
S ES
6,' Nature and Brir�iei Description ne 1'ropo!;al Inc u -
ing, but not limited to its size, general design el(! -
menus, and other factors that will fiive an accurate
understanding, of its scope and nature):
1.11.1 fLtLS I l ►`!"f i Al. C.OM'M IA IJ I G D NTA I I►► I N l.1
t'TAGL1 IV M I NI e— t-E FA. I^ IL M SIPI-NC-C.S
Les .
• 7. Location o t Propo::a uescri c t e p lysic.•1T setting; of
the proposal, as well as the etiCcnt of the land area
affected by ally environmental impacts, including any
other information needed to give an accurrlt-, understand-
ing of the environmental setting of the proposal):
lO 1 a4 4� pm-r o ILt>Momb s ®M WoOPE.D 1�01
t 1tMC&CA L bM tO PQJ" P4*4
8. Estim tc Date for Completion.f tEZ Pro{ -lose A tion:
9. List 01. all 1'ei.cuits, Licecl::es er Governa:enC hppr.ova s
Required for the Proposal (federal, state and local--
includinz rezones):
-31-