City of Sumner
Boundary Line Adjustment
Application
(Please fill out ALL fields unless otherwise noted)
Supporting Materials Required:
Office Applicant - (please check off all applicable “applicant” boxes)
This Application Form and Checklist
Boundary Line Survey (Refer to SMC17.08.030) 4 - Black Line- Full Sheet 18” x 24”
(Drawing shall include the following items)
Site plan drawn to scale and provide dimensions for all required items including property lines
Vicinity map & Project zoning, date, scale, and north arrow
All public and private roads, driveway access, utilities, building envelopes and all easements (specify type, width
and include legal description)
Existing and proposed fire hydrant locations and water main sizes; or distance to the nearest hydrants
Name, address and telephone number of the applicant
Proposed lines for all affected lots indicated by heavy solid lines
Existing lot lines proposed to be changed indicated by heavy broken lines
Parcel numbers of all affected lots
Square footage for each lot to satisfy the minimum zoning requirements (Note: land contained in access easements
and pipestems shall not be included in lot size computations)
All major man-made features; drainage ditches, railroad tracks, etc.
Existing building locations; setbacks from property lines and distance between structures
Proposed on-site utilities including sanitary sewer, storm drainage, water services
Environmental constraints identified and delineated
Legal descriptions of existing lots and proposed legal descriptions of new lots
Legal Description 2 - Copies
LID Segregation Form and Fee (Please consult Public Works Staff for applicability)
Title Report 2 - Copies
Permit Fee (Please consult Permit Center for fee)
Site/Project Address (if available): Parcel #:
Owner: Phone: Email:
Owner Address: City: State: Zip:
Surveyor/Engineer/Contractor: Phone: Contractor License Number:
Address: Email: City: State: Zip:
Contact Person: Phone: Fax:
Contact Address: Email: City: State: Zip:
Description of Project:
Community Development
1104 Maple Street, Suite 250
Sumner, WA 98390
Tel. (253)299-5530 Fax: (253)299-5539
www.ci.sumner.wa.us
File Number: __________________________
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.
**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. (building permits only)
_____________________________________________________
_______________________________________________ DATE: ______/_____/_____
SIGNATURE OF OWNER / AUTHORIZED AGENT PRINTED NAME
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signature
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