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

4 t Less than $1,000,000 value - $50 $1,000,000 value or more - $100 Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, RCW, requires all state and local governmental 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. 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 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 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 Washington for various types of proposals. Many of the questions may notapply to your proposal If a question does not apply, just answer it "no" and continue on to the -next question. ENVIRONMENTAL CHECKLIST'FORM 1. BACKGROUND 1. Name o 2. Addres 3. Date Checklist Submitted of Proponent: 4. .Agency Requiring Checklist S. Name of Proposal, if applicable: 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): _ .42 a L 000 S frm�c 1Pf 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) : 4'5 % 11-✓c? 8.. Estimated Date for Completion of the -Proposed Action: