5631 HIGHWAY PL 2018-01-02 MF Import

FIV iiNV1RONMENfAL CHECKLTST Less than $1,000,000 value - $50 $1,000,000 valu= or more - $100 Introduction: The Stale Environmental Policy Act of 1971, Chapter 43.21C, RCW, requires all utatc and local governmental agencies to consider environmental values both for their own actions and when licensing private proposals. The Act also requires that an F.TS be prepared for all major actions significantly affecting the quality of the environment. The purpose of this checklist is to help the agencies involved determine whether or not a proposal is such a major action. Please answer the following questions as completely as you can with the information presently available to you. Where explanations of your answers are required, or where you believe an explanation would be helpful to government decision makers, include your explanation in the spac-2 provided, or use additional pages if necessary. You should include references to any reports or studies of which you are aware and which are relevant to the answers you provide. Complete answers to these questions now will help all agencies involved with your proposal to undertake the required environmental review without unnecessary delay. The following questions apply to your total proposal, not just to the license for which you are currently applying or the pruposal for which approval is sought. Your answers should include the impacts which vi.11 be caused by your proposal when it is completed, even though completion may not occur until sometime in the future. This will allow all of the agencies which will be involved to complete their environmental review now, without duplicating paper work in the future. NOTE: This is a standard form being used by all state and local agencies in the State of of proposals. Many of the questions may not apply to your proposal. Washington for various types j If a question does not apply, just answer it "no" and continue on to the next question. ENVIRONMENTAL CHECKLIST FOMA BACKGROUND 1. Name of Proponent R /� _ /-1 �� A-)_ I 2. Address and Phone Number of Proponent: 5 ! 3. Date Checklist Submitted 4. Agency requiring Checklist_L 5. Name of Proposal, if applicable: -- -7 y 3 - Gs 1.1r_'_Pi T. 6. Nature and Brief Description of the Proposal (including but not limited to its size, ' general design elements, and other factors that will give an accurate understanding of its scope and nature): C< Ki 7Roc]JoN Of LW000 1::MNV 7. Location of Proposal (describe the physical setting of the proposal, as well as the extent of the land area affected by any environmental impacts, including any other information needed to give an accurate understanding of the environmental setting of the proposal): l�c�ca ON Nl�lil 4� O�\cE z rt.0LK 500,-tf f�• � a ?110' ,s 1' ate- e� =,• �-_� ��q� 8. Estimated Date for Completion of the Proposed Action: Y �� 3J k