CRA19950243.PDFCritical 111111111
II lIII- �� A.-����,hecklist CO 44 199�a�
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 9,2D H O} I v
' 2. Property Tax Account Number: S b S " -�0 1 - O l 5 U �7 �b `GO °� I fp- Oa
3. Approximate Site Size (acres or square feet): { S E o a o s 4 * 1(,, ooc, SV, - od 1 -013 �G j
4. Is this site currently developed? K yes; no.
If yes; how is site developed?- S % c1 G (e �4 �.,, i ti (R�s r tr e
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rev 01/04N4
ar90.19y_
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. •_Al
-.
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). L
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
RECizivE13
DEC 0 7 1995
PERMIT COUNTER
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 parcel
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:
..ERk CONNi"GOitm
Name
C(z l d oil;-,
t c V ef�i
Street Address
,L,.,&, Wk, 99Qa!o
City, State, ZIP 77i-377? ` Phone
vi ' F. 2b9S
Signature Date
•
11
Applicant Representative:
Ma.�k QU tA G-1 (A LA�
Name-
Street Address
UDC. i 7 8 -7 8 2?
City, State, ZIP Phone
Mril S i s �►
Signature I JDate