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EXHIBIT 2 CITY OF EDMONDS File No 00— jqq-V
EDMONDS, WASHINGTON Date 60 716-7
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APPLICATION TO HEARING EXAMINER APO'S_
FOR CONDITIONAL USE PERMIT Rect. No.
if j( HEARING DATE
APPLICANT: -7 -7 /a
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LOCATION OF PROPERTY(ADDRESS) �:-- - w t1w Au iz S
LEGAL DESCRIPTION OF PROPERTY 0=09�� (,q,,3 6 r4 PnIl a F tj.s 4.
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To be completid by the Planning Division: Use Zone B�J
Legal description checked and approved by: Date:
VICINITY SKETCH: PLEASE SH014 BELOW A VICINITY SKETCH AS PER EXA]-TPLE,
INDICATING NORTH.
Example:
SUe�-YEX-�T-J,107 I
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CONDITIONAL USE REQtESTED: Cof
DETAILS OF PROPOSED USAGE: U -14
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RELEASE/HOLD HARM�LESS AGREEMENT U
The undersigned applicant, his heirs and assigns, in consideration for the
City processing.the application agrees to release, indemnify, defend and,
hola the City of Edmonds harmless from anv and all damazes and/or claims for
damages, including reasonable attorneys' fees, arising from anv action or
inaction of the City whenever such action or inaction is based in whole or
in part upon false, misleading or incomolete information furnished by the
applicant, his agents or employees.
PERMISSION TO ENTER SUBJECT PROPERTY
The undersigned applicant grants his, her or its Dermission for public
officials and the staff of the City of Edmondspo en ter the subject
property for the purpose of'insoection and pos ng a ttend nt to this
application. J / It I
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ENVIRONMENTAL CHECKLIST_
Purpose or Checklist: . Act (SEPA), chapter 43.21C RON, requires all governmental agencies to consider
The State Environmental PolicN
the crivironmental impacts or a proposal before making decisions. An environmental impact statement (EIS) must be
prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of
agency identify impacts from your proposal (and to reduce
this checklist is to provide information to help you and the g
or avoid impacts from thc'proposal. if it can be done) and to help the aQcnc)- decide whethcr an EIS is required.
Instructions for Applicants:
This environmental checklist asks you to describe some basic information about your proposal. Governmental agen-
cies use this checklist to determine whether the environmental impacts of your proposal are significant, requiring
most precise information known, or nive the best de -
preparation or a . n EIS. Answer the questions briefly, wit . h the
scription you can.
)1ou must answer each question accuratel\ and carefull), to the best or your knowledge. In most cases, you should
your ' n observations or project plans without the need to hire experts. If you
be able to answer the questions from . ow or "does not ap-
reafl\ do not know the answer, or if a question does not apply to yo I ur pro I posal, write "do not know"
ply,,. Complete answers to the questions now may avoid unnecessar\ delays later.
Some qUeSLions ask about governmental reaulations, such as zonina, shoreline, and landmark desionations. Answer
these questions if you can. If you have problems, the governmental agencies can assist You.
do them over a ocriod of time or on
The checklist questions ap�ly to all parts of your proposal, even if you plan to -or its environmental
different parcels of land. Attach an\ additional information that will help describe your proposal vide additional in -
effects. The agency to which you submit this checklist may ask you to explain your answers or pro
mav be sianificant. adverse impact.
formation reasona;l\ related to determining ir Lher,
Use or checklist for nonproject proposals:
CoMpICLC this checklist for nonproject proposals, -even though questions may be answered "does not apply." IN AD-
DITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D).
For nonproject actions, the references in Lhe checklist to the words "project," "applicant.," and "property or site"
should be read as "proposal," "proposer." and "affected eeoeraphic area." respectively.
A. BACKGROUND
1. Name of proposTkproject. if applic#e:
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2. Name of applicant: A (L 4
3. Address and phone numbe� of applicant d ontact. person -
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4. Date checklist prepared: � — ?- Sr-7
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5. Agency requestina checklist:
6. Proposed timing or schedule (in phasing, if applicable):
7. Do you have an ans for future additions, expansion, or further activity related to or connected with this proposal?
If yes, explain. 0, -1) d A -
-I-
-now about that has been prepared, or will be prepared, directly related to
S., List anv environmental information you k
this proposal.
als of other proposals directly affecting the
9. Do vou know whether applications are pending for governnicRtal appro\
property covered by your proposal? If yes, explain.
10. List any government lapprovals or permits that will bc needed for your proposal, if known.
project and site.
11. Give brief, comr)lete description of your proposal, including the proposed uses and the size of the
There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not
need to repeat those answers on this page. (Lead agencies may modifv this form to include additional specific infor-
mation on project description.)
12. Location of the proposal'. Give sufficient information for a person to understand the precise location of your pro-
posed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur
over a range of area. provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map,
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and topographic map. if reasonablN available. While you should submit any plans required by the agency, you are no
required to duplicate maps or detailed plans submitted with any permit applications related to this checklist.
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description or the site (circle one - nFlat, oiling, hilly, steep slopes, mountainous,
other _.
b. What is the steepest slope on the site (approximate percent slope)?
TO BE COMPLETED BY APPLICANT
c. What general types of soils arc found on the site (for example, cla sand, gravel. cat,
Y<Ei, yV prime
muck)? If you know the classification of agricultural soils, specify them .
farmland.
d. Are there st.V�cc indications or history of unstable soils in the immediate vicinity? If so,
describe. M 0
e. Describe the purpose. type, and approxi ate quantities of any filling or gradino pro-
posed. Indicate source of Fill.
r. Could -erosion occur as a result of C r construction. or use'? If so. generally describe.
%D - 491
a ious surfaces after project
.. About what percent of the site will be covered with
construction (for -example. asphalt or buildintls)? d PAV A.
h. Proposed measures to reduce or control erosion, or other im I pacts o4h . e earth, if any:
2. Air
a. What types Of emissions to Lhe air would result from the proposal (i.e., dust, automobile,
odors. industrial wood smoke) durina construction and when the projeo completed'? If
any. generally describe and give approximate quantities if known.
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b. Are there any off -site sources of emissions or odor that may_'�ffcct your proposal'? If so,
aeneralIv descr&.
c. Proposed measures to reduce or control emissions or other impacts to if
I any:
EVALUATION FOR
AGENCY USE ONLY