801 228
th
Ave NE
Sammamish, WA 98019
425-295-0500 | www.sammamish.us
2020-01-SCUP Page 1 of 5
SHORELINE CONDITIONAL USE
PERMIT APPLICATION
ABOUT THE SHORELINE CONDITIONAL USE PERMIT
Code Reference
Shoreline Management
Title 25 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
A Shoreline Conditional Use Permit should be used to request one of the
conditional uses outlined in the Sammamish Shoreline Master Program.
Sammamish’s Shoreline Master Program helps protect the community’s
health and the natural environment by regulating developments and uses
of water bodies and the associated upland areas.
The Sammamish Shoreline Master Program contains development
regulations including conditional uses that may be allowed when specified
conditions are met.
APPLICATION REVIEW PROCESS
A Shoreline Conditional Use Permit is a Type 4 decision subject to a
hearing and decision by the Hearing Examiner based on the
recommendation of the Director. The Hearing Examiner then forwards the
application to the Department of Ecology and the state Attorney General
for further review and approval or disapproval.
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 4
Preliminary Review Deposit
Legal Notice Publication & Mailing Deposit
Environmental Consultant Services (if applicable)
Environmental Checklist Review (if applicable)
Fire Review
See current fee schedule
2020-01-SCUP Page 2 of 5
SHORELINE CONDITIONAL USE PERMIT 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
Do you control the property where the work is being proposed (lease, easement, or fee-ownership)?
Yes
No
Property Information continued on next page
2020-01-SCUP Page 3 of 5
SHORELINE CONDITIONAL USE PERMIT APPLICATION
PROPERTY INFORMATION CONTINUED
Is the proposed project located on a parcel that abuts the King County Trail Corridor?
Yes
No
Does the proposal require the use of or crossing the King County East Lake Sammamish Regional Trail for
access to the project site?
Yes
No
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
04. Acceptance of Financial Responsibility - Affidavit of Applicant Status
05. Historic Resources Affidavit
06. Water Availability Certificate
07. Sewer Availability Certificate
08. Preliminary Septic Approval (if required)
09. Eastside Fire & Rescue Plan Review Sheet
10. Title Report (<30 days old)
Must be less than 30 days old
Must be for the parcel(s) related to this application
11. Legal Description
Must be for parcel(s) related to this application
Must be a title verified description by a Washington State licensed surveyor
12. 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 Labelsin MyBuildingPermit.com
After submittal, the City will request the Excel version of the template via email
13. SEPA Checklist
Submittal Checklist continued next page
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SHORELINE CONDITIONAL USE PERMIT APPLICATION
SUBMITTAL CHECKLIST CONTINUED
14. JARPA Form
15. FEMA BiOp Habitat Assessment
16. No Net Loss of Ecologic Function Analysis
17. Floodplain Compliance Narrative
18. Critical Area Affidavit
19. Critical Area Study (if applicable)
20. Geotechnical Report
21. Criteria Compliance Narrative (if required)
Detail how the application meets the criteria listed in WAC 173-27-160 including:
Consistency with RCW 90.58.020 policies and the Shoreline Master Program
How the proposed use will not interfere with the normal public use of public shorelines
How the proposed site use and project design are compatible with other authorized uses in the
area & with the Comprehensive Plan’s and Shoreline Master Program’s planned uses for the area
How the proposed use won’t cause significant adverse effects to the shoreline environment
where the project is located
How public interest won’t suffer a substantial detrimental effect
22. Traffic Concurrency Certificate
23. Traffic Impact Analysis Report
For proposals generating 10 or more new vehicle trips during AM or PM peak hour
May also be required for projects not generating 10 AM or PM peak hour vehicle trips (see the
Public Works Standards for requirements)
24. Storm Drainage Analysis (Technical Information Report)
25. Stormwater Facility Information Form
26. Storm Water Pollution Prevention Plan (SWPPP)
27. PW Standards Deviation (if proposed)
28. Plan Set
2020-01-SCUP Page 5 of 5
SHORELINE CONDITIONAL USE PERMIT APPLICATION
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4
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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:
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
Shoreline Development
Scope of Work
Conditional Use
Complete & save this form before uploading it in the “File Upload” section along with the required
submittal documents.
click to sign
signature
click to edit
click to sign
signature
click to edit