23350 HIGHWAY 99.PDF23350 HWY 99
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Critical Areas Checklist CA File No:- y
Site Information (soils/to��g�aphy/hydrology/vegetation)
1. Site Address/Location:" 5
2. Property"Tax Account Number:-0043Z - 00�yi OV stKO _ b`3;fUo57 003
_28ti
3. Approximate Site Size (acres or square feet): ! 0 J� Ob 0 -5; Ay eXF . 4W_ ' zliF-s CAA
4. Is -this site currently developed? — yes; no. ` A ( V` �4 eve viole6L
If yes; how is site developed?. PA ) V, V, ti 1 __"S C r
r MAR 3 1 2006
5. Describe the general site, topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site. REVELOPMENT SERVICES CTR.
CITY
OF EDMONDS i
.Rolling:. slopes on site _generally ,less than _15°� . (a vertical rise of 10=feet over a horizontal
distance -of 664eet):.r
Hilly: slopes present on site of more than 15°�6 and
less than 30°�6 (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 overa horizontal
distance of less than 33-feet).
Other (please describe): . .
6. Site contains areas of year-round standing water: 0 N C ;' Approx. Depth:
7. Site contains areas of seasonal standing water: ,uhJ C . ; Approx.. Depth � --
What season(s) of the year?
8. Site is in the floodway floodplain /(10,4F of a water course.
9. Site contains a creek or an area where water flows across the grounds: surface? Flows are year-round?
A/ 41A.�F Flows are. seasonal?. (What time of year? - ).
10. Site is primarily: forested meadow ; shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: 1,10 Al F
1.
2.
3.
For City Staff Use Only /YQe_
Plan Check Number, if applicable?A.
Site is Zoned?. Cre CG
SCS/mapped se(s)? 'oiltypt5- ��t-U �rW,r, a �0 4� gloneg
4. Critical Areas inventory or C.A. map indicates Critical Area on site? e('o��
5. Site within designated earth subsidence landslide hazard area? Alm ,
DETERMINATION
l� WAIVER
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City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Applicatf6lW for �46e' City of Edmonds prior to
his/her submittal of the application 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 `thee 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).
Date Received: 3131 /o
City Receipt #: 2 $ 41,17
Critical Areas File #:—
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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 'mi ' conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its.heirs, and. assigns,. in consideration on'the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any : action or infraction based in whole. or part upon false, misleading, . inaccurate or
incomplete information furnished' by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this applic on on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AAllZ
GENT (XN DATE'
Property Owner's Authoriza on
By my signature, I certify that I have authorized the above Applicant/ Agent to apply for -the subject land use application,
and grant my permission for, the ublic officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection an s ' a this application.
SIGNAT[J OF OWNER DATE
Owner/Applicants Applicant.Representative: .
G11AXGFs 64aff - 01.0.
Name6aUlPi 4)1-011r4ap- Chi Pj' AND- GTE, Name
P0- 64A /3 - 6 ' / / g /1!
Street Address Street Address
rVFr1_F'T_r 044 W o p
City State Zip
Telephone: Gl • �.5 d' ?"
Email address (optional):
City State Zip
Telephone: 1,,'96
Email Address (optional):��/'«�i;�,a��►�!„ /