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Critical Areas Checklist
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Site Information (soils/ topography/ hydrology/ vegetation)
• 1. Site Address/Location: C�--
2. Property Tax Account Number: S/3/0SqD ti DOn
3. Approximate Site Size (acres or square feet): 19 20 `4 S.
4. Is this site currently developed? _ yes; -4/no.
If yes; how is site developed? f1Z?g Xjpiw_ 9&4_4 4ILL/
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
�olling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
1/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: _. A( ; Approx. Depth:
iWhat season(s) of the year?
8. Site is in the floodway-4zo-- 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? AhQ (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 Site: is zoned?::K�5V
NO
DFZERMINATION
STUDYRI
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Reviewed by: A
ca chk doc Rev 02/17 7,::�
City of Edmonds
04W 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).
E:Cg1VED
O C T 0 8 1998
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
Dave 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:
4f-' 4f %V D/iV /f
Name
/Y-3/l %I st Aox.- z�vT
Street Address
ZVAZLAgW vIk '? 3 7
D
Ci y State Zip
Telephone
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Signature
D 1fa
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ote
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Applicant Representative:
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Street Address
F11�1'1 I. . ► i .
Cit;- State zip
0to
Date
(over)