Fillable AccAddApp Access & Address Application

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AccAddApp Access & Address Application

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BROWSE SKAGIT COUNTY GOVERNMENT (WA) FORMS

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Access Application revised 3 1 2017.doc - Updated: 3/7/2017 Page 1 of 5
Access checklist (see attached forms):
□ 1. Application form with the access portion completed
□ 2. Flagged driveway (yellow/black flagging is provided)
□ 3. Assessor’s map no larger than 11 x 17 (highlight the subject property)
□ 4. Site plan no larger than 11 x 17
□ 5. Access Fee $ __________
□ 6. Certificate of Insurance
Application form line by line instructions:
o Parcel ID #: Assessor’s parcel number is REQUIRED; enter the lot number if
applicable.
o Assessor Tax #: as shown on the tax statement or the Assessor’s webpage
o Address if assigned
o City: location of the property.
o Plat #: enter the plat number if applicable.
o Section, Township, Range: for property in Skagit County.
o Applicant: Name, address, city and zip, daytime phone REQUIRED, and email of the
agent, contractor, or owner who is submitting the application. This will be the contact
person for any questions concerning the application.
o Owner: Name and address of the person(s) who is the current owner of record.
o Access From: indicate the county road #.
o Requesting Access For: check the appropriate access need.
o Requesting an Access From: name of the road the proposed or existing driveway
accesses.
o County road is accessed from: indicate the side of the road that the access is on.
o Flagged: yellow/black flagging will be provided and must be used to flag the
proposed or existing driveway NO EXCEPTIONS. The flagging should be tied on
stakes at least two feet above ground on either side of the driveway/access road, and
should be visible to the access inspector from his vehicle.
o If access is in conjunction with building/grading permit: indicate # and type.
County Road Access Application Instructions
Skagit County Public Works
1800 Continental Place Mount Vernon, WA 98273
Phone: (360) 416-1400
Access Application revised 3 1 2017.doc - Updated: 3/7/2017 Page 2 of 5
Site plan guidelines:
◊ Property lines and corners
◊ North Arrow
◊ Plat name and number, or lot number, if applicable
◊ Title block information
◊ Name and location of all roads that border the property (state, county, or private)
◊ Approved access location
◊ Distance from the property line to existing and proposed structures
◊ Distance from the property line to the driveway access
◊ Multiple or abandoned driveways: indicate locations on the site plan
◊ Number of existing structures: briefly describe structures and include their
locations and dimensions on the site plan
• Site plans reduced from a larger size must be LEGIBLE at the submitted size
• Insufficient or inaccurate information may delay the access request
How to print an online Assessor’s Map:
Go to www.skagitcounty.net. Select ‘Records Search’ on the homepage. Use the links to
the Assessor’s Office to search for your parcel by site address, parcel number, or owner.
Select ‘Zoom to this parcel on iMap’ Click the print button
For application assistance please contact Skagit County Planning and Development Services.
For technical assistance or Skagit County Road Standards please contact Skagit
County Public Works.
Access Application revised 3 1 2017.doc - Updated: 3/7/2017 Page 3 of 5
AC#____________ Access Fee $_________ Rcvd By________ Paid __________
RETURN
FORMS TO:
Parcel ID #: _________ Lot #: _____ Assessor Tax #: _________ - _________- ________ - _________
Address: _________________ City:_________________________ Plat #: _______________________
Section______ Township_______ Range_______
Applicant
This is the person
who is submitting
application.
Owner
This is the person
who is the current
owner of record.
____________
____________
_____________________________________________________________________
Name
____________________________________________________________________
Address City State Zip Code
__________________ __________________ ______________________________
Phone (Required) Fax e-mail address
Name_______________________________________________________________
____________________________________________________________________
Address City State Zip Code
__________________ __________________ ______________________________
Phone (Required) Fax e-mail address
Access from: * County Road. - #___________
If your access has already been approved, please attach a copy
Requesting access for: Single Family Residence Multi-Family Commercial Commercial Ag Temporary
Short Plat Plat Common Approach Recreational Lot Access Change Other: __________________
Requesting an access from (County Road Name):________________________________________________
County road is accessed from the (Circle one): (N) (S) (E) (W) side of the road. Flagged access: Yes No
If this access is in conjunction with a building or grading permit: Permit #:___________ Permit Type: __________
*Access approval required from WSDOT for access from state routes * Permit not required on private roads
The Applicant shall defend, indemnify and hold the County, its officers, officials, employees and volunteers
harmless from any and all claims, injuries, damages, losses or suits including attorney fees, arising out of
or in connection with activities or operations performed by the Applicant or on the Applicant’s behalf out of
issuance of this Permit, except for injuries and damages caused by the sole negligence of the County.
Signature of applicant: _________________________________________________________________________
Print name:
Title of Applicant:
It is the responsibility of the owner to notify all utilities and private property owners when such property is
subject to injury or damage through the performance of the proposed construction and the applicant shall
make all necessary arrangements relative to the protection of such property and/or utilities.
Date:
Skagit County Planning & Development Services
1800 Continental Place Mount Vernon, WA 98273
Phone: (360) 416-1320 Fax: (360) 416-1340
COUNTY ROAD ACCESS
Access Application revised 3 1 2017.doc - Updated: 3/7/2017 Page 4 of 5
Insurance requirements for all work performed within County Right-of-Way
The Applicant shall furnish and maintain all insurance as required herein and comply with all limits, terms
and conditions stipulated therein, at their expense, for the duration of the contract. Following is a list of
requirements for this contract. Any exclusion that may restrict required coverage must be pre-approved by
the County. The Permit shall not be effective until evidence of all required insurance and bonding is
provided to the County. The Applicant’s insurer shall have a minimum A.M. Best’s rating of A-VII and shall
be licensed to do business in the State of Washington. Evidence of such insurance shall consist of a
completed copy of the Certificate of Insurance, signed by the insurance agent for the Applicant and returned
to the County Department with whom the Permit in executed. The insurance policy or policies will not be
cancelled, materially changed or altered without forty-five (45) day prior notice submitted to the department
with whom the Permit is executed. The policy shall be endorsed and the certificate shall reflect that the
County is an additional named insured on the Applicant’s general liability policy with respect to activities
under the Permit. The policy shall provide and the certificate shall reflect that the insurance afforded applies
separately to each insured against whom claim is made or suit is brought except with respect to the limits of
the company’s liability.
The policy shall be endorsed and the certificate shall reflect that the insurance afforded therein shall be
primary insurance and any insurance or self-insurance carried by the County shall be in excess and not
contributory insurance to that provided by the Applicant.
The Applicant shall not commence work, nor shall the Applicant allow any subcontractor to commence work
on any subcontract until a Certificate of Insurance, meeting the requirements set forth herein, has been
approved by the County and filed with the department with whom the Permit is executed. Upon request, the
Applicant shall forward to the County the original policy, or endorsement obtained, to the Applicant’s policy
currently in force.
Failure of the Applicant to fully comply with the insurance requirements set forth herein, during the term of
the Permit, shall be considered a material breach of contract and cause for immediate termination of the
Permit at the County’s discretion.
REQUIRED COVERAGE: Providing coverage in the amounts listed shall not be construed to relieve the
Applicant from liability in excess of such amounts. The insurance shall provide the minimum coverage as
set forth below:
1. GENERAL LIABILITY INSURANCE: The Applicant shall have Commercial General Liability with limits of
$1,000,000.00 per occurrence, which includes general aggregate, products, completed operation,
personal injury, fire damage and medical expense.
2. ADDITIONAL INSURED ENDORSEMENT: General Liability Insurance must state that Skagit County, its
officers, agents and employees, and any other entity specifically required by the provisions of this
Agreement will be specifically named additional insured(s) for all coverage provided by this policy or
insurance and shall be fully and completely protected by this policy from all claims. Language such as
the following should be used, “Skagit County, its Officers, Agents and Employees are named
Additional Insured.”
The construction of all public and private roads in Skagit County shall comply with the most recent version
of the Skagit County Public Works Standards adopted by the Board of Skagit County Commissioners. See,
SCC 14.36.010
No person shall be permitted to build or construct any approach to any county road without first obtaining
permission therefor from the Board (of Skagit County Commissioners). The boards of the several counties
of the state may adopt reasonable rules for the construction of approaches which, when complied with, shall
entitle a person to build or construct an approach from any abutting property to any county road. The rules
may include provisions for the construction of culverts under the approaches, the depth of fills over the
culverts and for such other drainage facilities as the board deems necessary. The construction of
approaches, culverts, fills, or such other drainage facilities as may be required shall be under the
supervision of the county road engineer, and all such construction shall be at the expense of the person
benefited by the construction. See, RCW 36.75.130
UTILITY DAMAGE IS COSTLY, CALL BEFORE YOU DIG 1-800-424-5555.
Access Application revised 3 1 2017.doc - Updated: 3/7/2017 Page 5 of 5
Name Address
Site Address Parcel Number Date
Scale
340'
120'
PROPERTY LINE
350
'
20'
EXISTING
DECK
DECK
205'
30'
ROSS ROAD
N
JOHN AND JANE DOE
1203 ROSS ROAD
P123456
4/16/07
1142 CROFT ROAD
SEDRO-WOOLLEY, WA
25'
65'
160'
SITE PLAN EXAMPLE
(if existing)
Lot 3
Jones Addition
Notes:
1. The site plan must include:
A. Property lines and corners
B. North Arrow
D. Title block information
E. Name of all roads that border
C. Plat name and number, or
2. A site plan that is reduced from a
3. Insufficient or inaccurate information
G. Distance from the property line
to existing and proposed structures
H
G
E
B
D
A
C
RESIDENCE
GAR.
lot number
, if applicable
the property (state, county, private)
F. Approved access location
to the driveway access
H. Distance from the property line
larger size must be LEGIBLE at the
submitted size
may delay the address request
F
NOT TO SCALE
20
'
L
C
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AccAddApp Access & Address Application

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Completed 6 November 2019

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