Rees_Permit_Critical Areas Checklist_Signedr Critical Areas File #:
0 Initial Determination - $110
0 Subsequent Determination - $5
Date Received:
Date Mailed to Applicant:
City o ]Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
www.edmondswa.gov
The purpose of this checklist is to enable City staff` to A property owner, or an authorized representative, roust
determine whether any critical areas and/or buffers are fill out the checklist, sign and date it, said submit it to the
located on or adjacent to the subject property. Critical City. Staff will review the checklist, conduct a site visit,
areas, such as wetlands, 'streams and steep slopes, are and make a determination of whether there are critical
ecologically sensitive or hazardous areas that are areas andior critical area buffers on or near the site. if a
regulated to protect their functions and values. The City's "Critical .Area Present" determination is issued, a report
critical area regulations are contained within Edmonds addressing the applicable critical area requirements of
Community Development Code (ECDC) Chapters 23.40 ECDC Chapters 23,40 through 23.90 may be required
through 23.90. depending on the scope of the proposed activity.
Property Owner's Authorization
By my signature. I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and grant my pern fission for the public officials and the staff of the City of Edmonds to enter the subject
property for the purposes of inspection attendant to this application. The undersigned owner, and his/her is 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:
SiCyNATURE OF OWNER DATE
Owner:
Name
f' Q- -r-r
Street Address
City Stag Zip
Telephone: ct i 9 - ct 44-
E ail address: Vieck+k e 1. tv",
Applicant/Agent:
Nam '
O 801K i i
Street Address
City Slate Zip
Telephone:. - Q 6-74-'7`
Email. Address:
Revfsed on 14,q7 P20 - Critical Areas Checklist Page I of 2
CA File No:
Critical Areas Checklist
Site Information
1. Site .address/Location: � tt c�t� l�� l
2. Property Tic Account Nrrrnber: 00t 4 0 t000 t 01
Approximate Site Size (acres or square feet): C SE
4. is this site currently developed? 9 'des 0 No
if yes, how is the site developed` W L t i =
. Describe the general site topography. Check all that apply.
Flat to Rolling- No slope on/ to the site or slopes generally less than 15% (a vertical
rise of 10-feet over a horizontal distance of 66-feet).
Moderate: Slopes present on/ to site of more than 15% and less than 40% (a vertical
rise of 10-feet over a horizontal distance of 25 to i-feet).
0 Steep. Slopes of greater than 40% present on/ adjacent to site (a vertical rise of 10-feet over a
horizontal distance of less than 25-feet).
6. Have there been landslides on or near the site in the past? n Yes X No
If yes, please describe.
7. Site contains areas of fear -round standing water? 0 Yes (approx. depth; }tK No
g. Site contains areas of seasonal standing water? 0 Yes (approx. depth: } X No
If yes, what season(s) of the year?
9. Site is in the floodway or floodplain of a water course? 0 Floodway 0 Floodplain
10. Site contains a creek or an area where water flows across the grounds surface? D'Ces f & No
If yes, are flaws year-round or seasonal? O Year -round Ci Seasonal (time of yyear: )
11 f)hvious wetland is present on site? C]Yes % No
For City Staff Use Only ---,�...�.�..... -.�
L Zoning:
. SCS mapped soil tvpe(s); '
13. Critical Areas inventory or C.A. map indicates Critical Area on site:
1. Site within designated North, Edmonds Earth Subsidence and Landslide Hazard Area (ESHLA)?
DETERMINATION
CRITICAL AREAS PRESENT
Reviewed by:
Date:
Revised on 1,1417 p2o Ct iticalAreas C'.ht ckiist Page 2 of 2