City of Sumner
Short Plat
Application
(Please fill out ALL fields unless otherwise noted)
Supporting Materials Required:
Office Applicant - (please check off al applicable “applicant” boxes
This Application Form and Checklist
1 copy of the Title Report
LID Segregation Form and Fee (Please consult Public Works Staff for applicability)
Required permit fee (Please consult the Permit Specialist)
Short Plat Drawing (To scale including ALL items below) 4 - Copies 11” x 17”
(Prepared, stamped, and dated by a licensed surveyor) 2 - Full Sheet 18”x 24”
Legal Descriptions of existing and proposed lots
Vicinity map
Zoning of the site
Property line dimensions and square footage of new lots
Existing public and private roads, driveway access and all easements
Existing and proposed fire hydrant locations or distance to the nearest hydrants
All major man-made features; drainage ditches, railroad tracks, etc.
Existing building locations and setbacks from property lines (if any)
Proposed access width
Building envelopes and lot number assigned to each lot
Location of nearest existing utilities including sanitary sewer, storm drainage, and water services
Environmental constraints identified and delineated (if any) such as wetlands, rivers, streams, slopes
Critical Area Notices as applicable per SMC Chapter 16
Site/Project Address (if available): P
arcel #:
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
click to sign
signature
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