STORM & SITE PLAN APPROVAL FOR RESIDENTIAL CONSTRUCTION

SITE AND PROJECT DATA

Description of Work:

Parcel Number

Lot Number:

Plat/Development:

Property Size

No. of Bldgs. on Site:

Property Owner's Phone Number

Property Owner's Email Address

Is the Applicant someone other than the property owner?

Yes

Applicant Phone Number

Applicant Email

Is there a seperate contact for this project?

Yes

Project Contact Phone Number

Project Contact Email

ALL INSPECTION RESULTS SHALL BE EMAILED TO:

Engineer:

Engineer Phone Number

Engineer Email

SITE INFORMATION

Lot Size:

Total Area of Disturbance:

Site Impervious Area:

Existing:

Proposed:

Site Impervious Coverage:

Existing %:

Proposed %:

Will there be work performed in the right of way?

Yes

If yes, a seperate right of way permit shall be required for any encroachment into the right of way.

Is this permit application submitted as a result of a code violation?

Yes

If yes, provide violation #:

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Lender/Issuer of Payment Bond:

Lender/Issuer Phone Number

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Any changes will be reported to the jurisdiction in which the permit is valid immediately. By leaving the contractor information section blank, I hereby certify further that contractors (general or subcontractors) will not be hired to perform any work in association with this permit. I also certify that if I do choose to hire a contractor (general or subcontractor) I will only hire those contractors that are licensed by the State of Washington.

Signer:

Owner

Agent

Contractor