20160504145303.pdfCity of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
ARE
t RAS C'nT'rJ'"V_'JCKL1ST
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 I 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).
PLEASE PRINT CLEARLY
Owner/Applicant:
i
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Name
Street Address
City State Zip
J A
Tel phone
Signature
7 -//-Do
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
d:reception/jana/CACLHandout.doc Revised 4/10/2000
CA FILE NO.
Critical Areas Checklist
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Site Information (soils/to ogra rhy/hydrology/vegetation)
1. Site ddress/Locat,ion:�
2. Property Tai. Account lumber: 4*5 3 ,. D07— 0 KtL
( q ) S 7 itcre�
3. Approximate Site Size acres or square feet
4. is This site currently developed? X_ yes; no,
hbw js site.developed?
Describe the general site topography, Check all that apply.
N,�V90
Flat: 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 10 -feet over a
horizontal distance of less than 33 -feet).
Other (please describe):
6. Site contains areas of year-round standing water: -72&1y)e, ; Approx. Depth:
7. Site contains areas of seasonal standing water: aQ-., ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway '720 floodplain of a water course.
9, Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? -720 Flows are seasonal? .720 (What time of year? )
10. Site is primarily: forested : meadow : shrubs :mixed _
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: /7/)
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