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� <br />ruv:�or^�exr,�t, CHLCi:LIST <br />Less than $1,000,000 value - $50 <br />$1,000,000 value or more - $!00 <br />I•itroduction: The Stace Environmental Policy Act oE 1971, Chapter 43.21C, B�[d, requires all <br />sta[e and local governmencal agencies to consider environmen[al values both for their own <br />actions and when licensing private proposals. The Act also requires that an EIS he prepared <br />for all major actions significantly aEfecting the quality of the environmenc. The purpose <br />of this checiclis� is te help the agencies involved determine whether or not a proposal is such <br />a major action. <br />Please answer the following questions as completely as you can with the information presently <br />available to you. [dhere explanations of your answers are required, or where you believe an <br />explanation would be helpful to government decision makers, include your explanation in the <br />spac� provided, or use additional pages if necessary. You should include references to any <br />reports or studies of which you are aware and which are relevant to the answers you provide. <br />Complete answers co these questions now will help all agencies involved with your proposal <br />to undertake the required environmental review without unnecessary delay. <br />The following auestions apply to your total proposal, not just to the license :or which you <br />are currently applying or the proposal for wnich ap�roval is sought. Your answers should <br />include the impacts which will be caused by your prcposal when it is completed, even though <br />completion may not occur until sometime in the future. This caill allow all of the agencies <br />which will be involved to complete their environmental review now, without duplicating <br />paper work in the future. <br />`10TE: This is a standard form being used by all �tate and 1oca.1 agencies in the State oc <br />Sdashington for various types of proposals. :Sanv or the questions nay not anply to your prop��sa. <br />If a question dues not apply, just answer it "no" and continue on to the nest question. <br />ENVIROD?MENT9I, CHECKI.IST FORt�1 <br />1. BACKGROWi D <br />1. Name of Proponent C I' �'' �F c�/=C �'. �[ <br />2. Address and Phone Number of Proponent: 3C0" '; .�_ ! " "' " '- �, . - <br />'rO{=�^ �'::7 -^^il <br />3. Date Checklist Submitted 8-� -�� <br />4. Agency Bequiring Checklist C�-"� ¢��.�4�--E I� <br />S. Name of Proposal, if applicable: FItZ� S"G"j�pf.1 ��(? <br />6. Nature and Brief Description oi the Proposal (including but not limited to its size, <br />general design elements, and other factors that will give an accurate understanding <br />of its scoge and nature): F�QE STG71OfJ ��1 E(S��IIPM �T 2a�.`t'5 (c c� L�MiT Q�- <br />�LIGE (LE�TINFr OFFIC . --� <br />7. Location oF Proposal (describe the physical setting of the proposal, as well as che <br />�2 extent of the land area affezted by any environmental impacts, including ,ny other <br />=P''��� information needed to give an accurate understanding of the environmental setting of <br />the proposal): 1�TS l,Z��,4, �GI'¢a��d i7 Gf 5!�'Gi� 1,ip 3 O� R�P ar cF N�<c"� -a:�:�: <br />?2Gc.i� DIV NO.� �2�cm SQ F%��'P'cfl� '�l5?� cAP. LGT �t�A c=�citp�.17 �- =cLL•_ s�'� <br />_'* � — ' '� -. <br />H f �+l T = <br />GE8 E'-GES <br />�..� � . �. 3FG �- � . <br />timaced Dace for �omple[ion of the Proposed �lction: �__.�•��,. � <br />9 <br />