Laserfiche WebLink
ENVIItONn7L:NTAL Cf[GCiCLIST <br />(�25.00 P'ee Required) <br />� i- <br />, <br />�C�C������ i <br />SCP 71978 � <br />Introduction: The Stnte Snvironmental Policy Act of 1971, C11-Y OF EV�RETT <br />ChapYer 43.21C , RCN , requires all stute and local governmentnl <br />agencies to consider environmentnl values both for their otivn �'"'�"��'�` U��t. <br />nctions and w;ien licensing private proposals. The Act also <br />requires that an �IS be prepared for all major ac�ons significantly <br />affecting the quality of the environment. The purpose of this ' <br />checklist is to help the agencies involved determine whether or not <br />n proposal is such u major action. <br />Please answer the follo�ving questions as completely as you can <br />with the information presently availaUle to you . Nhere explanations <br />of your answers are required, or vrhere you believe an explanation <br />would be helpful to government decision makers, inchide your <br />explanation in the space provided, or use additional pages if <br />necessary. You should include references to any reports or studies <br />of which you are awnre and which are relevant to the anstivers you <br />provide. Compiete answers to these questions no�v �vill help all <br />agencies involved with your proposal to undertake the required <br />environmenfal review without unnecessar,y delay. <br />The follotivirig questions apply to your total proposal, not just to the <br />license for tvhich you are currently applying or the proposal for <br />which approval is sought. Your answers should include the impacts <br />whicli tvill be caused by your proposal �vhen it is completed, even <br />though cor.ipietion may not occur until sometime in the future. This <br />will nllotiv all of the agencies which tvill be involved to complete <br />their environmental review now, �vithout duplicating paperwork in <br />the future. <br />NOTE: This is a standard form being used by all state and local <br />agencies in the State of {Nashington for various types of proposals. <br />Nlany of the questioiis may not apply to your proposal. [f a question <br />does not apply, just answer it "no" and continue on to the next <br />question. <br />ENVIRONMENTAL CHECKLIST FORM <br />I. BACKGROUND <br />..� <br />1. Name of Proponent /;:�.•� �-�;'. � / <br />2. Address and Phone Number of Pr� <br />., /J_. . –, . � ..— / ,- ._ <br />3. <br />e <br />