194 SUNSET AVE SIIIIIIIIIIIIII
14491
194 SUNSET AVE S
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
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 ma s -or soil
M
BUDS
Dq -oA
Date Received: ZIZ-�LOL--I
City Receipt #; —3Gn
5 7—
Critical Areas 'File #: M.
Critical Areas Checklist Fee: $135.00
,Date Mailed to Applicant:
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.
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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, andMTHUMITs heirs,—an-J—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: = '
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the -owner- as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to.apply for the subject land use application,
and grant my. permission for the public officials and the staff. of the City of Edmonds to enter the subject property for the
purposes of inspection and.posting attendant to this pplication.. -
IGNATURE OF OWNER C . DATE 2 lilt
PRINTPLEASE CLEARLY
Owner/Applicant: Applicant Representative:
v-
Name Name
d Si S u� *rr M 2,. 7to/z> —,,PAR P.) S
Street Address Street Address
City State Zip iciLlaij
State Zip
Telephone6et,A 1/ 3 ` 006
Email address (optional):
Telephone:
Email Address (optional):
Critical Areas Checklist.doe/4.22.2003
Critical Areas Checklist
Site Information. (soils/ topography/hydrology /vegetation)
1.
2.
3.
4.•
5.
C�
7.
CA File No: OL� -,Z;5
Site Address/Location: / ��% .u,� c ��' �. V e f�� ti S L, , '%80:2- 4
Property Tax Account Number: gZEdo/
Approximate Site Size (acres or square feet): CZ
Is this site currently.developed?,4, yes; no.
If yes;'how is site developed? S ► 1t j P 2,4-4 1
Descriibbee 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).
Hihy: 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
Steep: ,grades of greater than 30°�6 presentl a Mfe=R=3
distance. of less than 33-feet). A/�
Other (please describe): -o0 # T 1ULjjj
Site contains areas of year-round standing water: 4 ; Approx. Depth:
Site contains areas of seasonal standing water: jf� o ; Approx. Depth:
What season(s), of the year?
8. Site is in the floociway_ floodplain yip of a water course.
9. Site contains a creek or, an area where water flows across the grounds surface? Flows are year-round?
Yl a 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
For City Staff Use Only. .
1. Plan Check Number, if applicable?
2. Site is Zoned?
3.' SCS mapped soil type(s)?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?..ten
5. Site within designated earth subsidence landslide hazarti'area? }=
DETERMINATION
STUDY REQUIRED X - WAIVER
-Reviewed by.�c= Date:
Critical Areas Checklist.doe/4.22.2003