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< ; CA FILE NO. Z J1
Critical Areas Checklist
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Site Information (soils/topography/hydrology/vegetation) pVIP
1. Site Address/Location:
2. Property Tax Account Number: C71) (NE t�b Z:-N H ED
3
4. Is this site currently developed?
If yes; how is site developed?
Approximate Site Size (acres or square feet):
yes; Y no.
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 water: (� ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Y�V floodplain of a water course.
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,shr bs etc)
11. Obvious wetland is present on site: _V
3 Wetland inventory or C A map uidicates wetland present on iteT_
4 CnncalAreas invento or C A, map iridieatesCntical'Area on site?'�'i
r'v
5; : : Stte within designated earth subsidence Ia: &IMe hazard area?
SAte designated on the Env1roprnentally Sensitive Areas Map?_�
DM AMINATION
"ca ehk.doc; Rev 10/03/97
i
- 1
City of Edmonds
CC T 2 6 19g
rt
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
precursorysite 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 assist -staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:.
Name
Street Address
City State Zip
Telephone
�,Q
Sign e
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
c:reception\j ana\cacl. doc
(over)
C
Inc.1SO)
Kelly W. Leonard
126 North 40th Street
Seattle, WA 98103
Subject:
Dear Applicant:
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/Building - Parks and Recreation - Engineering - Wastewater Treatment Plant
November 10, 1998
Determination regarding Critical Areas Checklist # 98-259
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
y You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
*Architectural Design Board
C:ReceptionUana\CR LTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
® Incorporated August 11, 1890 •
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