9907 7TH AVE SE 2018-01-02 MF Import

ENVIltON&MENTAL CHECKLIST ($25.00 Fee Required) � SEP 7 1978 IJ Introduction: The State Environmental Policy Act of 1971, CITY OF EVERETT Chap— t— er 43.21C , RCl? , requires all state and local governmental P1a,;..,;.t5 0 pt- agencies to consider environmental values both for their own actions and when licensing private proposals. The Act also requires that an EIS 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 . II -here explanations of your answers are required, or where you believe an explanation would be helpful to government decision makers, include your explanation in the space 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 proposal for which approval is sought. Your answers should include the impacts which will be caused by your proposal when it is compl^ted, 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 paperwork in the future. NOTE: This is a standard form being used by all state and local agencies in the State of Washington for various types of proposals. Many of the questions may not apply to your proposal. If a question does not apply, just answer it "no" and continue on to the next question. ENVIRONMENTAL CHECKLIST FORM I. BACKGROUND 1. Name of Proponent 2. Address and Phone Number <�7i" G g. Date Checklist Submitted _ of Proponent:.