Skagit County Planning & Development Services
1800 Continental Place Mount Vernon, WA 98273
Inspections (360) 336-9306 Office (360) 336-9410 Fax (360) 336-9416
PL#:____________
Rev. 2/8/06 Page 1 of 4
Date Routed
Concurrency Determination Form
Binding Site Plan
Commercial Building Permit
Contract Rezone/Amendment
Final Plat (if not done with Pre)
Long CaRD
Plat or SPU Modification
Preliminary Plat
Short CaRD
Short Plat
Special Use Permit Level 2
Other___________________
Route to: Public Works PUD Fire District#______ Health Dept. Sheriff
UGA _____________________ Other Purveyor: _________________________________________
Return by: ___________________________ Return to: ___________________________________
Tentative Reservation of Capacity issued on: _______________________________________________
Parcel ID#: __________ Assessor Tax #:_______________ - __________ -__________ -____________
Parcel ID#: ____________ Assessor Tax #:_______________ - __________ -__________ -__________
Section____ Township____ Range____ Comprehensive Plan/Zoning Designation:__________________
Site Address:_________________________________________________________________________
Urban Growth Area: Yes No If yes, City: __________________________________________
Comp Plan/Zoning within 200 feet: ________________________________________________________
Acreage / Lot Dimensions: ______________________________________________________________
Number of lots: ________ Number of Dwelling Units: _______ Phased Project?
Yes No
Road access:
Private County – Permit #:__________________ State – Permit #:__________________
Road to be accessed: ___________________________________________________________________________
Road Segment: _______________________________________________________________________________
New peak hour trips generated: ___________________
Traffic analysis submitted for project: Yes No If yes, attached? Yes No
If Comprehensive Plan rezone/amendment, see attached narrative describing the density and intensity of use.
Water Source: Ind. well Permit #:__________ Community Well Public Provider: _____________________
Sewage Disposal: Septic – Permit #:__________________ Public Sewer:_____________________
Project Description: __________________________________(Attach additional sheet if necessary.)
Transportation Concurrency
Part One - County Road System Concurrency:
Yes No The County Road System is in concurrence; or
Yes No The County Road System is not in concurrence but the development will
not add more than 4 peak-hour trips to any County road segment that the Birdsall
Method has identified as having an unmet improvement need; or
Yes No The County Road System is not in concurrence but the applicant agrees
to provide transportation improvements or Transportation Systems Management
strategies and/or other binding financial commitments to increase the planned capacity
on the County road system within 6 years resulting in a new determination that the
County Road System is in concurrence.
Part Two - Individual Road Segment and Intersection Concurrency:
Yes No The level of service on each Affected County Road Segment and each
Affected County Intersection will meet or exceed the standards adopted in the
Comprehensive Plan; or
Yes No The applicant agrees to modify the project or provide transportation
improvements or Transportation Systems Management strategies and/or other binding
financial commitments that will result in the level of service on each Affected County
Road Segment and each Affected County Intersection meeting or exceeding the
standards adopted in the Comprehensive Plan.
Water Concurrency
Yes No - Project is located within the service area for a public water system as
identified in the Coordinated Water Services Plan (CWSP) and the applicant has
provided a letter of water availability from the applicable water system purveyor.
Yes No -The project shall be conditioned as follows to provide water system
improvements necessary to meet the applicable urban or rural standards as set forth in
Appendix A of SCC 14.28: _________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Rev. 2/8/06 Page 2 of 4
Sewer Concurrency
Yes No - Project is located within an area approved for public sanitary sewer
pursuant to the applicable sewer purveyor’s Comprehensive Plan and complies with all
requirements of that purveyor for obtaining sewer service, including any conditions as
appropriate for improvements necessary to meet the applicable standards set forth in
sewer requirements adopted by the purveyor.
Police Concurrency
Yes No In Urban Growth Areas – Project impact will not increase the LOS need of
1 officer per 1,000 population served or per 100 acres of developed commercial or
industrial property, whichever is higher.
Yes No In Rural Areas - Project impact will not increase the LOS need 1 officer
per 2,000 population served.
Fire In Urban Growth Areas -
Yes No The proponent has provided proof from the applicable water purveyor that
the project provides fire flow in accordance with the Coordinated Water System Plan
(Section 4 Minimum Design Standards) and the Uniform Fire Code. Actual Fire Flow
requirement shall be set by the jurisdiction(s) having planning authority over the
particular UGA and Coordinated through the Skagit County Fire Marshal.
Yes No NA The authority having jurisdiction (Skagit County Fire Marshall’s
Office) has the capability of providing annual inspections of the proposed commercial or
industrial development.
Yes No The fire suppression provider has the ability to comply with the following
90 percent of the time:
a) Within 5 minutes response time, delivering up to 200 gallons per minute
(gpm) fire flow in an offensive (interior) attack, with a minimum of 4
firefighters for responses to structural fires, vehicle fires, other outside
fires, motor vehicle accidents, activated fire alarm systems or other
hazardous conditions; capable of delivering a minimum of Basic Life
Support including defibrillation with a minimum of 1 First Responder or
Emergency Medical Technician for medical responses.
b) Within 10 minutes response time, supporting the interior structural fire
attack with teams which may include a ventilation team, a search &
rescue team, a team for a backup line and standby firefighters totaling
between 8 and 12 firefighters on-scene; providing Heavy Rescue
capability, including heavy hydraulics, at motor vehicle accidents.
c) Within 20 minutes response time, delivering 1500 gpm fire flow in a
sustained defensive attack mode for structural fire responses. For
buildings larger than 10,000 sq. ft., delivering 2000 gpm and have an
elevated master stream capability.
Rev. 2/8/06 Page 3 of 4
Fire: In Non-Urban Growth Areas
Yes No The proponent has provided proof from the applicable water purveyor that
the project provides fire flow in accordance with the Coordinated Water System Plan
(Section 4 Minimum Design Standards) and the Uniform Fire Code. Actual Fire Flow
requirements will be set by the Skagit County Fire Marshal’s Office.
Yes No The provider has a Washington Surveying and Rating Bureau (WSRB)
public protection classification #8 or better.
Yes No Within an IF-NRL designation, the project must also be within 5 road
miles from a recognized Community A fire station, or within 10 road miles to a
recognized Community A fire station and within 5 road miles of a fire station having an
Initial Attack Fire Apparatus.
Project was reviewed on _______________ ____, 20__ . It was determined that the
project:
1. Transportation Meets concurrency requirements: Yes No
Does not meet concurrency requirements Yes No
_________________________________________
Signature
2. Fire Meets concurrency requirements: Yes No
Does not meet concurrency requirements Yes No
_________________________________________
Signature
3. Water Meets concurrency requirements: Yes No
Does not meet concurrency requirements Yes No
_________________________________________
Signature
4. Sewer Meets concurrency requirements: Yes No
Does not meet concurrency requirements Yes No
_________________________________________
Signature
5. Police Meets concurrency requirements: Yes No
Does not meet concurrency requirements Yes No
_________________________________________
Signature
Rev. 2/8/06 Page 4 of 4
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