CRA19950070.PDFIIIIIIIII -
08 CA FILE NO.5
Critical Areas Checklist -&ee /9cl5_00%v
Site Information (soils/topography/hydrology/vegetation) _
1. Site Address/Location: 1 7 6 2-6 Oy,02) l C CJ r'.edo- Ed.
2. Property Tax Account Number: S7 S1 000 !S'z1DFO 7
3. Approximate Site Size (acres or square feet): 3,2,, ocy
4. Is this site currently developed? Ryes; no.
If yes; how is site developed? Tw o R2S'
5. Describe the general site topography. Check all that apply.
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: &0; Approx. Depth:
7. Site contains areas of seasonal standing water: _; Approx. Depth:
• What season(s) of the year?
8. Site is in the floodway_ floodplain of a water course.
9. Site contains a reek or an area where water flows across the grounds surface? Flows are year-
round? 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: .
3 Site within des�gnatil `earth subsidence landslide: hazard :area?
4 Stte esignate<1 on tfie £nyiroumentally. `Sensitive;Areas':Ivlap? ...:
:DETERMINATION. .
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed .by
Plan Date
Rev 09R9/93
690 199-
City of Edmonds
Critical Areas Checklist
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 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parse
with enough detail that City staff can find
and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Street Address
City, State, ZIP Phone
Signature
Date
Applicant Representative:
Name
O Dd
Street Address
ZZ&e l Lea Z?-ol 2-
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Aw.
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Date