DSW04
DevelopmentServicesDivision
2163011thAvenueSouth,SuiteD
DesMoines,WA98198
Phone:(206)8707576
www.desmoineswa.gov
USEPERMI
T
S
UBMITTALWORKSHEE
T
WHATISTHEPURPOSEOFAUSEPERMITANDTHISWORKSHEET?
Allusesidentifiedaseitherconditionalorunclassifiedpossessuniquecharacteristicswhichmakeit
impracticaltoautomaticallyincludeitinanyclassesofuseassetforthinthevarious zonesdefined
inCity’szoni ngco de.Therefore,thepurposeofthereviewistodetermineifthecharacteristicsofany
suchuseisr easonablycompatiblewiththetypeofusespermittedinsurrounding areasandto
stipulateconditionsofapprovalasmayreasonablyassurethatthebasicpurposesofthezoning
regulationsareserved.

Thisworksheethasbeendevelopedtohelpprospectiveapplicantspreparetherequireddocumentationthat
willfacilitatethesubmittalofacompleteapplication.Pleasenotethatthisisnottheofficialapplication,but
atooltoassistinthecompilationofthematerialsrequiredforthereviewbytheCity.Itisimportantthat
prospectiveapplicantscontacttheDevelopmentServicesDivisionpriortosubmittingofanapplicationas
someproject’smaynotrequirethesubmittalofallthematerialslistedormayrequireadditionalmaterials
notlisted.TheCityofDesMoinesofferspreapplicationmeetingsforallprojectsatnocost
totheapplicant.
Application:Provideone(1)copyofacompletedMasterDevelopmentApplication.AnonlinePDF
fillableformversionoftheMasterDevelopmentApplicationisavailableatthefollowingwebaddress:
http://www.desmoineswa.gov/DocumentCenter/View/119
ProjectNarrative: Providefive(5)copies.Thenarrativeshouldprovideabriefandthorough
descriptionoftheproject.
TitleCertificate:Provideone(1)copy.Thecertificatemustbenotmorethan30daysoldatthe
timeofsubmittal,andmustincludecopiesofalleasements,deedrestrictionsandotherencumbrances
restrictinguseofthesite.
SitePlans:Pleaseprovidefive(5)copies.Theapplicantshallsubmitadimensionedplandrawnata
scaleof1”=20’.Thesiteplanshallcontainthefollowing:
Date,ScaleandNorthArrow(orientedtothetopofthepaper/plansheet).
Subjectpropertywithallpropertylinesdimensioned.
Existingstructuresanddistancestopropertylines.
Squarefootageoflot(s)andofexistingstructures.
Locationoftheneareststreet(s),includingalleysandotherrightsofway.
Offstreetparkingareas.
Groundcontourstoadequatelydescribesiteconditions.
Legaldescriptionoftheproperty.
NoticeMap:Provideone(1)copyoftheplatlayouton8.5”x11”paper.
Page1of2
Page2of2
VicinityMap:Provideone(1)copyofavicinitymapon8.5”x11”paper.
CertificateofWaterAvailability:Pleaseprovideone(1)copy.
CertificateofSewerAvailability:Provideone(1)copy.
NoticeMap:Provideone(1)copyoftheplatlayouton8.5”x11”paper.
VicinityMap:Provideone(1)copyofavicinitymapon8.5”x11”paper.
Radiusmap:Pleaseprovide(1)copy.Theradiusmapshallidentifyallpropertieswithin300feetof
theproposedproperty.Theradiusmaybeenlargeddependingonthenatureoftheproject.
MailingLabels:Pleasesubmitone(1)copy.Provideacompletelistofthenames,parcelnumbers,
andtaxpayer’sofficialmailingaddressesasshownintherecordsoftheKingCountyAssessor’s
Websiteforallpropertieswithin300feetoftheboundariesofthesubjectsite.Iftheofficialmailing
addressisdifferentthanthesiteaddress,provideamailinglabelwiththesiteaddressaddressedto
“Occupant/Tenant”.Itwillbetheapplicant’sresponsibilitytocompletethemailing.
StateEnvironmentalPolicyAct(SEPA)Documentation:AllusepermitsrequireaSEPAreviewin
conjunctionwiththereviewoftheusepermit;therefore,theapplicantshallprovidetwo(2)copiesofa
completeSEPAChecklist.AwordversionoftheSEPAchecklistisavailableatthefollowingweb
address:http://www.desmoineswa.gov/DocumentCenter/View/1647
EnvironmentalDocumentation:Thesiteplanshouldshowthedistancefromanyenvironmental
featuresdefinedinChapters18.86and14.40DMMC.Inthecaseofasteepslopeshowthetoeand/or
topoftheslope.Showtheboundaryforallfloodplainsandwetlandsandforwaterbodiespleaseshow
theordinaryhighwatermarkorthetopofthebankofastream.Provideawrittenexplanationofthe
proposal’scompliancewiththecriteriaspecifiedinChapters18.86and/or14.40DMMC.Otherplans,
specialstudies,mitigationplans,orotherinformationshallbeprovidedasrequiredfordevelopment
withinsensitiveareasandtheirbufferspertheCity’sEnvironmentallyCriticalAreasandFloodHazard
Codes.Providethree(3)copies.
GeotechnicalReport:Providetwo(2)copiesifrequired.
PreliminaryTechnicalInformationReport(TIR):Providethree(3)copies.TheCity’sSurfaceWater
ManagementEngineerwilldetermineifaTIRiswarrantedatthepreapplicationfortheproject.
TrafficImpactAnalysis(TIA):Providethree(3)copies.TheCity’sTransportationEngineerwill
determineifaTIAiswarrantedatthepreapplicationfortheproject.
CD:ProvideaCDthatcontainsallthePDFversionofthestudiesandcompletesiteplans.
AdditionalInformationRequirements:SpecialstudiesormaterialrequestedbytheCitynecessary
forthereviewoftheapplication.
ApplicationFees:AsrequiredbythecurrentDevelopmentServicesFeeSchedule.
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