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Phone: 425.77t.0220 °Fox: 425.771.0221 ° We6:p/v/w.EdmoudmW/\.gpv
DEVELOPMENT SERVICES DEPARTMENT ° PLANNING DIVISION
Fill 1121111111111111r,11
Date: March 7,2O14
To: Kelly Mackay — 515 S. Southern Street, Seattle WA 98108
jZbject: Critical Areas Checklist Determination
Comment: Enclosed, please find 8copy ofthe Critical Areas Checklist that you
submitted. You will find staff's determination atthe bottom ofthe
second page ofthe checklist. |fyou have any qUeStiOnS,please contact G
Planner for more information.
Sincerely,
Gina JaMicelk::Associate Planner
City of Edmonds Development Services Department
121 5'hAvenue North, Edmonds VVA98O20
425.771.0220x1778 1
"C. 1'6 -J -
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 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 inventorio5, rnapg, or, soil
surveys).
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 correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
71
SIGNATURE OF APPLICANT/AGENTDATE
Property Owner's Anthorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the s land use application,
and grant my permission for the,-ppblic officials and the staff of the City of Edmonds to enter=bject property for the
purposes of inspection and pq�tiqg,attendanfto this/apwiicat�on.
SIGNATURE OF OWNER
Owner/Applicant:
c
Name
--ILL(11 —Zcl:
t
Street Address
city
State Zip
Telephone:
.... .......
Email address:
DATE ��11
Applicant Representative:
Name
Street Address
City State Zip
Telephone: 0
Email Address:
Revised on 12118112 P20 - Critical Areas Checklist Page I qf2
CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
-,....�
1. Site Address/ Location: _ (���; c' eiJ
2. Property Tax Account Number:L
3. Approximate Site Size (acres or square feet):'"
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: Approx. Depth:
7. Site contains areas of seasonal standing waterApprox. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain— of a watercourse.
9. Site contains a creek 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) rr
11. Obvious wetland is present on site: l'
____n.,wn_____________________..______________a.®__®__d._®_-w_ For City Staff Use Only----- w_ -a___-_----_-----_®..-.---- .-------------- --_----_.,__ao.
1. Plan Check Number, if applicable? i. m,
Y t' ? it E2 A) t,,.,
2. Site is Zoned?'�:
3. SCS mapped soil type(s)? __A-J�, A ke�t '' „ wa d i'tli 1 2 i1,, ,(!�°I . ' g '
4. Critical Areas inventory or C A neap indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard
SI I']E DR7l FRMINAnON
IM
SQUIRED _._. __.. —_ _.__... ..__._.._._._WAIVER
. mm.mm m reviewed. x.° m `� r C'm Wr` .. mm.. mm .....mm.........................._..Date.mm........_ ........m% ........ ..... _...... ............._......._............_.....
Revised on 12118112 P20 - Critical Areas Checklist Page 2 of'2