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TO BE COMPLETED BY APPLICANT EVALUATION FOR <br /> AGENCY USE ONLY <br />A. BACKGROUND [help] <br /> <br />1. Name of proposed project, if applicable: [help] <br /> <br /> <br />2. Name of applicant: [help] <br /> <br /> <br />3. Address and phone number of applicant and contact person: [help] <br /> <br /> <br />4. Date checklist prepared: [help] <br /> <br /> <br />5. Agency requesting checklist: [help] <br /> <br /> <br />6. Proposed timing or schedule (including phasing, if applicable): [help] <br /> <br /> <br />7. Do you have any plans for future additions, expansion, or further activity related to or <br />connected with this proposal? If yes, explain. [help] <br /> <br /> <br />8. List any environmental information you know about that has been prepared, or will be <br />prepared, directly related to this proposal. [help] <br /> <br /> <br />9. Do you know whether applications are pending for governmental approvals of other <br />proposals directly affecting the property covered by your proposal? If yes, explain. [help] <br /> <br /> <br />10. List any government approvals or permits that will be needed for your proposal, if known. <br />[help] <br /> <br /> <br />11. Give brief, complete description of your proposal, including the proposed uses and the size <br />of the project and site. There are several questions later in this checklist that ask you to <br />describe certain aspects of your proposal. You do not need to repeat those answers on this <br />page. (Lead agencies may modify this form to include additional specific information on project <br />description.) [help] <br /> <br /> <br />12. Location of the proposal. Give sufficient information for a person to understand the precise <br />location of your proposed project, including a street address, if any, and section, township, and <br />SEPA Environmental checklist (WAC 197-11-960) <br />City of Anacortes Updated May 2014 Page 2 of 11