CRA20020011.PDFIIII�lIII
`� Of EDIV City of Edmonas
Development Services Department
Planning Division
Phone: 425.771.0220
ta��"90 Fax: 425.771.0221
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 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 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).
0
Date Received:
City Receipt #:
Critical Areas File #: O
Critical Areas Checklist Fee: $45.00
Date Mailed to ADDlicant:
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 in 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 con ect to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
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 public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER
Owner/Applicant:
G e,ora►e_,,, Vou re-,z.
Name
Ql(1 CrJ 6
Street Address
LQf-
City State Zip
Telephone:
Email address (optional):
DATE
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
Critical Areas Checklist CA File No: OE-11
Site Information (soils/topogra by/hydrology/vegetation)
1. Site Address/ Location: 1 t 1 (D t. rK pl U V 1 e Lo r .
2. Property Tax Account Number: -1 Z11O 430 ODE 002
3. Approximate Site Size (acres or square feet): ��' Q Gr e-,
4. Is this site currently developed? _yes; 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: iJ n ; Approx. Depth:
7. Site contains areas of seasonal standing water: N D ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site conta creek or an area where water flows across the grounds surface? Flows are year-round?
A Flows are seasonal? /JjA (What time of year? fJ4 ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site: 00
itory ar'C.A aiap indieat& Ciatieal Area on site? `.
toed earth subs deuce iandsli :hazakd areas `fit. `.
{DFI MINATION
g
::._' ... Date:
Critical Areas Checklist.docJ3.19.2001 '3 , -U 1
n ti z tit - a v.
vrx?
y-5 ,
t
k
.k
05
07
r
r .t
9217
r 9219221
z
1 9223
r:Y
s
x _ �
9225
9227
9229
18230
�\�
0117
17530
17624 17600
F
17626
17628
17627
T
17702
17720
17707
17748
7 42
�•
17709
�4
17802
17715
•x
` \\\
17808
17819
1771
17839
8941
17905
17927
\ \ 17922
17924 17926 17928
17951
\�
1,8005
18010
9001
18004
8727
1
n
18020
18015
18017 47
c
�
18030
c
N
'$r'1
p
o
°'
m
1
9108 9100
0
`9
18109
1811
w
9110
18121
9102
18107
18108 g
18128
CO
N
N
9112 9106
18206
9122
18130
18121
8717
9118
18214
18129
18218
18210
8721
18230
18215
18300
N
18220
O
18229
8720
18302
18230
18310
8714
18311
9131
18312
Zoning and Vicinity Map
1