Fillable DEMOLITION PERMIT APPLICATION CHAPTER 16.20 SMC (City of Sammamish)

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DEMOLITION PERMIT APPLICATION CHAPTER 16.20 SMC (City of Sammamish)

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DEMOLITION PERMIT APPLICATION CHAPTER 16.20 SMC
Demolition Permit Application
Page 1 of 2
Updated 09/05/2019
Department of Community Development
801 228th Avenue SE
Sammamish, WA 98075-9509
Phone: 425-295-0500
Fax: 425-295-0600
Web: www.sammamish.us
www.mybuildingpermit.com
A Demolition Permit is required to ensure that the structure(s) are removed from King County Assessor’s
records and the site is left in a safe and sanitary condition.
Tree removal requires a separate permit.
Property Information
Permit Information
Property Address:
Tenant (if Commercial):
Property Owner:
Owner Address:
Parcel Number(s):
Project Name:
Owner Phone:
Permit Number:
YES NO Is a well onsite? If yes, please show on site plan and indicate if it will be capped.
YES NO Is the site located on or adjacent to a City of Sammamish historic resource?
YES NO Will any underground flammable liquid storage tanks be removed? If yes, applicant is required
t
o report to Department of Ecology.
YES NO Is a septic system present? If yes, applicant is required to report removal to King County
P
ublic Health.
YES NO Per testing report is asbestos present in the structure? (if built 1977 or earlier)
YES NO Per testing report is lead present in the structure? (if built 1977 or earlier)
This permit is for:
Demolition of ___ residential dwelling(s) Year built ________
Demolition of ___ manufactured home(s) Year built ________
Demolition of ___ commercial structure(s) Year built ________
Demolition of ___ accessory structure(s)
Primary Contact Information
Contact Name:
Company Name:
Contact Address:
Phone:
E-mail:
Contractor Information
Contractor Name:
Contractor’s L&I License #:
Contractor Phone:
Contractor E-mail:
Address:
Demolition Permit Application
Page 2 of 2
Updated 09/05/2019
Submittal Items
Site Plan including structures to be demolished, clearing limits, tree protection, septic systems,
underground storage tanks, wells, sinkholes and TESC measures
Asbestos Testing Report – Required for structures built 1977 and earlier
Lead Testing Report – Required for structures built 1977 and earlier
Historic Resources Affidavit - Required for structures >40 years old
Arborist Report – If demolition activity is within a significant tree dripline
Geotechnical Report – If sinkhole onsite
By signing this application, I authorize employees/agents of the City of Sammamish to enter onto the property, which is the subject of this application
during regular business hours. The sole purpose of entry is to make any examination of the property necessary to process this application.
I certify that I am the owner of this property or the owner’s authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such
application. I have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If
the scope of work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Application or construction documents will be reviewed within a reasonable time period based on the current workload. Construction documents
which do not conform to the requirements of Chapters 16.05, 16.10 and 16.20 SMC will be rejected in writing, stating the reason (s) therefore.
Applications for which no permit is issued within one year following the date of application shall expire by limitation. Applications may also be
canceled for inactivity. If an applicant fails to respond to the department’s written request for revisions, corrections, actions or additional information
within 90 days of the date of request. The Building Official may extend the life of an application for any of the conditions listed under SMC 16.20.225
(3) exist.
The Permit Center may authorize refunding of not more than 80 percent of the building permit fee paid when no work has been done under a permit
issued and not more than 80 percent of the plan review fee paid when an application for a permit for which a plan review fee has been paid is
withdrawn or canceled before any plan review is done. No refund shall be made for application or plan review fees where a plan review has been
performed and the application is rejected in accordance with SMC 16.20.220. Impact fees paid at time of issuance are not subject to refund/or
deferred payment within permit cancellation. Impact fees are not vested to submitted date on the application. The Permit Center shall not authorize
refunding of any fee paid except on written application filed by the original permitee not later than 180 days after the date of application.
All provision of laws and ordinances governing this type of work shall be complied with. The granting of a permit does not presume to give authority
to violate the provisions of any local, state or federal law regulation construction of the performance.
I hereby certify that I have read and examined this application and know the same to be true and correct.
Signature of Owner or Authorized Agent Date
Acknowledgements
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DEMOLITION PERMIT APPLICATION CHAPTER 16.20 SMC (City of Sammamish)

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Completed 24 January 2021

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