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CRA20000102IIII�lIII Cat FILE NO. f Areas Checklist___ __________________Crit-cal ,�e4dzm 016Z Site Information (soils/top/o'graphy/hydrology/vegetation) 1. Site Address/Location: D G 2. Property Tax Account Number: 3. Approximate Site Size (acres or square feet): - _7Z41 4. Is this site currently developed? no. -}-yes; If yes; how is site developed? � i' 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: f • What season(s) of the year? 8. Site is in the floodway 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,shrubs etc) 11. Obvious wetland is present on site: - - - -Fvr City Staff Use .1. Situ is Zoned? SCS mapped soil types /PGi" 3 Weiland':inverito y or C A Tnap;indicates wetlaad present on stt0 #. Critical' Areas tndentory'wr C A lap indicates CriticalArea on stte Site within designated earth suMdencc:Iandslide, hazard area? YIQ Site designated on the Fnvironttieafal'Iy Sensitive Areas Map? < . Aa_ehkdm Aw 10/03/97 CkA 0oo o ED Of •y0 City of Edmonds Development Services Department "":. .>" Planning Division Phone: 425.771.0220 ��c. 1890 Fax: 425.771.0221 C Critical Areas Checklist Fee: $45.00 Date Received by Dev. Serv. Dept: L 'W ©o City Receipt No: Date Mailed to Applicant: WQ 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. 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). PLEASE PRINT CLEARLY Owner/Applicant: c p � � 4-'1 �1-yt Dr t✓ �7`�G-�� rJ Name q •D'? P*L'y � i Street Address E9Mo-ems. O-A City State Zip Telephone Signature Date d:reception/jana/CAC LHandout.doc Applicant Representative: :GLc koso�J Name Street Address City State Zip Date Revised 4/10/2000