Medina, WA · King County
Environmental Checklist
This checklist helps project applicants describe a proposal and its potential environmental effects for the city’s environmental review.
What this form is
Complete this checklist for a project that is not exempt from the checklist requirement; if you are unsure whether the project is exempt, complete it for the Responsible Official to make a determination. The checklist asks about the applicant and proposal, its location and timing, and potential effects on environmental elements such as water, plants, transportation, and utilities. You can attach information that helps describe the proposal or its effects.
Who needs it
Applicants proposing a project that is not exempt complete the checklist; those unsure whether it is exempt can submit it for a determination.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document has no notary block; the signer signs and dates the checklist and declares under penalty of perjury that the answers are true and complete.
How to submit this form
- 1
Download the Checklist
Download the Environmental Checklist PDF.
- 2
Complete the Questions
Describe the proposal and answer each question accurately using the best information available to you.
- 3
Gather Supporting Information
Attach available information that helps describe the proposal or its environmental effects.
- 4
Sign and Submit
Sign and date the checklist, then submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Environmental Checklist?
- No. The checklist has no notary block. The signer signs and dates it and declares under penalty of perjury that the answers are true and complete.
- Who needs to complete the Environmental Checklist?
- Applicants with projects that are not exempt from the checklist requirement need to complete it. If you are unsure whether your project is exempt, complete the checklist for a determination.
- What information does the checklist ask for?
- It asks for information about the applicant, proposal, location, and schedule, as well as potential environmental effects and proposed measures to reduce or control them.
- How do I submit the Environmental Checklist?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Environmental Checklist doesn’t need a notary — but if you have another Medina form that does, a commissioned online notary can help.