CRA20050023 (2)_111141ir
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Critical Areas Checklist CAFile No:
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 1`1 o O 3 117-Vv,.<�a�
2. Property Tax Account Number: 2G O GO t (- (� Q 0 06-7
3. Approximate Site Size (acres or square feet): ,(2.- o_r_v__
4. Is this'site currently developed? yes; no.
If yes; how is site developed? ot_ sC s Xqr�� VOIINv
5. Describe the general site topography- Check all that apply.
Flat' less than 5-feet elevation change over entire site.
Rolling: slopes om 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 wafter:- Approx., Depth:
�.
7. Site contains areas of seasonal standing water:.: ; Approx. Depth:
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:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? - 1 2-
3. SCS mapped soil type(s)? 1-) c7 Oct
►cps ,
4. Critical Areas inventory or C.A. map indicates Critical Area on site? o 4 .ram b; ,&
within designated earth subsidence landslide hazard area? o .
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by: � c, r __ -,1, , Date:-- �O �- OS
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City. of Edmonds
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
Date Received: v 4 7
City Receipt #: k—'59 3
Critical Areas File #: Dam
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant: -a/ CdT
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.
•
may be, present on the subject property. The information Please submit a vicinity map, along withthe signed copy
needed to complete the Checklist :should' be easily of this form to assist'City staff in finding and locating the.
available from observations of thesite'or data available at specific, :piece of :property described on Ibis, form. In
City Hall (Critical areas inventories, maps, or soil addition, the : applicant:_.:shall : include other pertinent
surveys). information (e.g. site plan, topography. map, etc.) or
studies in conjunct on -with this Checklist -to assistant -staff
in completing their preliminary assessment of the site.
The undersigned a hcan _ and his/her/its heirs and assigns, ` r
gn pp ' t, gns, 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
attorneys fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/hedits agents or employees. •
F 'C
By my signature, Ica* that the information and exhibits herewitli }xsubmitted are true and correct to the best Aof my
knowledge and that I am authorized=to file this-application..on.the behalf df the'owner as`listed below.
SIGNATURE OF APPLICANT/AGENT
`DATE
Property Owner's Authorization
Bymy.signature, I certify, that I have, authorized the above Applicant/Agent to .apply for the subject land use application,
and grant my permission f
br4w,public,qffidials and the,staffof the City.of Edmonds to -enter the. subjectproperty_for the
purposes of inspection d pos#nJ attendant tq this application.
SIGNATURE OF OWNER _
Owner/Applicant 11- _
rrw\�— C�.t'
Name.
n- 00 3 ..7CA)6 Q�1.
Street Address
City State Zip
Telephone:
DATE 3 f .o.
Applicant Representative:. .
Name
Street Address
City State. Zip
Telephone: •
Email address (optional): Email Address (optional):