Fillable ABOUT SEPA REVIEW Code Reference Chapter 20.15 SMC (City of Sammamish)

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ABOUT SEPA REVIEW Code Reference Chapter 20.15 SMC (City of Sammamish)

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801 228
th
Ave NE
Sammamish, WA 98019
425-295-0500 | www.sammamish.us
2020-01-SDT Page 1 of 4
STATE ENVIRONMENTAL POLICY
ACT (SEPA) REVIEW APPLICATION
ABOUT SEPA REVIEW
Code Reference
SEPA Procedures
Chapter 20.15 SMC
Resources
King County iMap
Sammamish Property Tool
Questions?
Submit Project Guidance
Visit the Permit Center
City of Sammamish
801 228th Ave SE
Sammamish, WA 98075
www.sammamish.us
The Department of Community Development rarely performs a SEPA
review separately from an accompanying land use application.
Procedures and standards regarding the timing and content of the
environmental review are outlined in Chapter 20.15 SMC.
SEPA REVIEW SUBMITTAL TIMING
SEPA REVIEW RELATED
TO A LAND USE PROJECT
Include a SEPA environmental checklist and
supporting material as part of the land use
application
SEPA REVIEW RELATED
TO A CONSTRUCTION
PROJECT ACTION
Submit this SEPA Review Application at the
same time as a Construction Permit
Application.
APPLICATION REVIEW PROCESS
A SEPA threshold determination is a Type 2 decision made by the City’s
SEPA Responsible Official.
FEES
Applicants are responsible for providing an initial deposit (as well as
additional deposits as needed) to cover all application review costs.
FEES APPLICABLE TO THIS PROJECT
Counter Service Intake, Type 2
Legal Notice – Publication & Mailing Deposit
Environmental Consultant Services (if applicable)
Environmental Checklist Review (if applicable)
See current fee schedule
2020-01-SDT Page 2 of 4
STATE ENVIRONMENTAL POLICY ACT
(SEPA) REVIEW APPLICATION
OWNER INFORMATION ☐
Owner is organized as an LLC*
Name:
Company:
(if applicable)
Address:
Phone:
APPLICANT/REPRESENTATIVE INFORMATION
☐
Applicant is organized as an LLC*
Name:
Company:
(if applicable)
Address:
Phone:
E-Mail:
*O2020-513 requires owners/applicants organized as a single-member or multiple-member LLC to provide the
names and addresses of all members, including all individuals who hold transferable interests in the applicant
or its members. Please provide this information using the supplemental form on www.MyBuildingPermit.com.
PROPERTY INFORMATION
Property Address:
Parcel Number(s):
Total Lot Area(s):
Total Critical Areas on Property:
(Square Feet)
(Square Feet)
Please complete the below for any critical areas on property:
Type
Total Area
Type
Total Area
(Square Feet)
(Square Feet)
☐
Frequently flooded area
☐
Lake
☐
Landslide area
☐
Critical aquifer recharge area
☐
Seismic hazard area
☐
Wetland
☐
Erosion hazard area
☐
Stream
☐
Erosion hazard near sensitive
water bodies overlay
☐
Fish & wildlife habitat
conservation area
2020-01-SDT Page 3 of 4
STATE ENVIRONMENTAL POLICY ACT
(SEPA) REVIEW APPLICATION
SUBMITTAL CHECKLIST
A PDF of each document is required at time of submittal. Please label files as numbered and listed below:
(For example: 02 Project Narrative)
☐
01. Signed Application Form
☐
02. Project Narrative
☐
03. Preapplication Conference Letter (if applicable)
☐
04. Acceptance of Financial Responsibility - Affidavit of Applicant Status
☐
05. Title Report (<30 days old)
− Must be less than 30 days old
− Must be for the parcel(s) related to this application
☐
06. Legal Description
− Must be for parcel(s) related to this application
− Must be a title verified description by a Washington State licensed surveyor
☐
07. Mailing List, Map, and Labels
− Include all property owners within 1,000 feet of the site (2,000 feet for properties within the
Erosion Hazard Near Sensitive Water Bodies overlay)
− Utilize the Excel template provided and upload a PDF version, with the map, under “Mailing List,
Map, and Labels” in MyBuildingPermit.com
− Af
ter submittal, the City will request the Excel version of the template via email
☐
08. SEPA Checklist
☐
09. Critical Area Affidavit
☐
10. Critical Area Study (if applicable)
☐
11. Geotechnical Report (if applicable)
☐
12. Storm Drainage Analysis (Technical Information Report)
☐
13. PW Standards Deviation (if proposed)
☐
14. Plan Set
CERTIFICATIONS & SIGNATURES
I have read this application in its entirety and certify that all information submitted, including any
supplemental information, is true and complete to the best of my knowledge. I acknowledge that willful
misrepresentation of information will terminate this permit application. I understand that my submittal will be
reviewed for completeness and, if found to be complete, will be processed pursuant to Chapter 20.05 SMC.
Owner Signature:
Date:
Applicant/Representative Signature (if applicable)
Date:
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2020-01-SDT Page 4 of 4
STATE ENVIRONMENTAL POLICY ACT
(SEPA) REVIEW APPLICATION
1
4
3
2
ONLINE SUBMITTAL INSTRUCTIONS
Create an account on MyBuildingPermit.com.
Select “Apply For Permit” and then select “Sammamish” as the jurisdiction.
Select the following:
Application Type
Land Use
Project Type
Any Project Type
Activity Type
Use Approval
Scope of Work
SEPA only
C
omplete & save this form before uploading it in the “File Upload” section along with the required
submittal documents.
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ABOUT SEPA REVIEW Code Reference Chapter 20.15 SMC (City of Sammamish)

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Completed 24 January 2021

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