CRA19970236.PDFCA FILE NO.
Critical Areas Checklist CtZy+ j 99-1(02
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
2. Property Tax Account Number:�j^t
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; X no.
If yes; how is site developed?
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: A/0 ; Approx. Depth:
is
7. Site contains areas of seasonal standing water: NO ; Approx. Depth: _
What season(s) of the year?
8. Site is in the floodway 0 0 floodplain of a water course.
E
Site contains a creek or an area where water flows across the grounds surface?' Flows are year-
round? Nt7 Flows are seasonal? (What time of year?
10. Site is primarily: forested X ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc) 15C,
11. Obvious wetland is present on site: �)n
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 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: Applicant Representative:
V'-�- 01/1"�
ame
Street Address
C46
Name
'gay 00a '�" <5�- 6 c)
Street Address
Ciq, State, ZIP Phone City, State, ZIP Phone
Signature
Date
Signature
0
•
Date 0