Fillable Form 111 USEPERMI UBMITTALWORKSHEE DSW04 WHATISTHEPURPOSEOFAUSEPERMITANDTHISWORKSHEET? (City of Des Moines)

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Form 111 USEPERMI UBMITTALWORKSHEE DSW04 WHATISTHEPURPOSEOFAUSEPERMITANDTHISWORKSHEET? (City of Des Moines)

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DSW‐04

DevelopmentServicesDivision

2163011thAvenueSouth,SuiteD

DesMoines,WA98198

Phone:(206)870‐7576

www.desmoineswa.gov



USEPERMI

UBMITTALWORKSHEE



WHATISTHEPURPOSEOFAUSEPERMITANDTHISWORKSHEET?

Allusesidentifiedaseitherconditionalorunclassifiedpossessuniquecharacteristicswhichmakeit

impracticaltoautomaticallyincludeitinanyclassesofuseassetforthinthevarious zonesdefined 

inCity’szoni ngco de.Therefore,thepurposeofthereviewistodetermineifthecharacteristicsofany

suchuseisr easonablycompatiblewiththetypeofusespermittedinsurrounding areasandto

stipulateconditionsofapprovalasmayreasonablyassurethatthebasicpurposesofthezoning

regulationsareserved.



Thisworksheethasbeendevelopedtohelpprospectiveapplicantspreparetherequireddocumentationthat

willfacilitatethesubmittalofacompleteapplication.Pleasenotethatthisisnottheofficialapplication,but

atooltoassistinthecompilationofthematerialsrequiredforthereviewbytheCity.Itisimportantthat

prospectiveapplicantscontacttheDevelopmentServicesDivisionpriortosubmittingofanapplicationas

someproject’smaynotrequirethesubmittalofallthematerialslistedormayrequireadditionalmaterials

notlisted.TheCityofDesMoinesofferspre‐applicationmeetingsforallprojectsatnocost

totheapplicant.

Application:Provideone(1)copyofacompletedMasterDevelopmentApplication.Anon‐linePDF

fillableformversionoftheMasterDevelopmentApplicationisavailableatthefollowingwebaddress:

http://www.desmoineswa.gov/DocumentCenter/View/119



ProjectNarrative: Providefive(5)copies.Thenarrativeshouldprovideabriefandthorough

descriptionoftheproject.



TitleCertificate:Provideone(1)copy.Thecertificatemustbenotmorethan30daysoldatthe

timeofsubmittal,andmustincludecopiesofalleasements,deedrestrictionsandotherencumbrances

restrictinguseofthesite.



SitePlans:Pleaseprovidefive(5)copies.Theapplicantshallsubmitadimensionedplandrawnata

scaleof1”=20’.Thesiteplanshallcontainthefollowing:



 Date,ScaleandNorthArrow(orientedtothetopofthepaper/plansheet).

 Subjectpropertywithallpropertylinesdimensioned.

 Existingstructuresanddistancestopropertylines.

 Squarefootageoflot(s)andofexistingstructures.

 Locationoftheneareststreet(s),includingalleysandotherrightsofway.

 Offstreetparkingareas.

 Groundcontourstoadequatelydescribesiteconditions.

 Legaldescriptionoftheproperty.



NoticeMap:Provideone(1)copyoftheplatlayouton8.5”x11”paper.



Page1of2



Page2of2



VicinityMap:Provideone(1)copyofavicinitymapon8.5”x11”paper.



CertificateofWaterAvailability:Pleaseprovideone(1)copy.



CertificateofSewerAvailability:Provideone(1)copy.



NoticeMap:Provideone(1)copyoftheplatlayouton8.5”x11”paper.



VicinityMap:Provideone(1)copyofavicinitymapon8.5”x11”paper.



Radiusmap:Pleaseprovide(1)copy.Theradiusmapshallidentifyallpropertieswithin300feetof

theproposedproperty.Theradiusmaybeenlargeddependingonthenatureoftheproject.



MailingLabels:Pleasesubmitone(1)copy.Provideacompletelistofthenames,parcelnumbers,

andtaxpayer’sofficialmailingaddressesasshownintherecordsoftheKingCountyAssessor’s

Websiteforallpropertieswithin300feetoftheboundariesofthesubjectsite.Iftheofficialmailing

addressisdifferentthanthesiteaddress,provideamailinglabelwiththesiteaddressaddressedto

“Occupant/Tenant”.Itwillbetheapplicant’sresponsibilitytocompletethemailing.



StateEnvironmentalPolicyAct(SEPA)Documentation:AllusepermitsrequireaSEPAreviewin

conjunctionwiththereviewoftheusepermit;therefore,theapplicantshallprovidetwo(2)copiesofa

completeSEPAChecklist.AwordversionoftheSEPAchecklistisavailableatthefollowingweb

address:http://www.desmoineswa.gov/DocumentCenter/View/1647 



EnvironmentalDocumentation:Thesiteplanshouldshowthedistancefromanyenvironmental

featuresdefinedinChapters18.86and14.40DMMC.Inthecaseofasteepslopeshowthetoeand/or

topoftheslope.Showtheboundaryforallfloodplainsandwetlandsandforwaterbodiespleaseshow

theordinaryhighwatermarkorthetopofthebankofastream.Provideawrittenexplanationofthe

proposal’scompliancewiththecriteriaspecifiedinChapters18.86and/or14.40DMMC.Otherplans,

specialstudies,mitigationplans,orotherinformationshallbeprovidedasrequiredfordevelopment

withinsensitiveareasandtheirbufferspertheCity’sEnvironmentallyCriticalAreasandFloodHazard

Codes.Providethree(3)copies.



GeotechnicalReport:Providetwo(2)copiesifrequired.



PreliminaryTechnicalInformationReport(TIR):Providethree(3)copies.TheCity’sSurfaceWater

ManagementEngineerwilldetermineifaTIRiswarrantedatthepre‐applicationfortheproject.



TrafficImpactAnalysis(TIA):Providethree(3)copies.TheCity’sTransportationEngineerwill

determineifaTIAiswarrantedatthepre‐applicationfortheproject.



CD:ProvideaCDthatcontainsallthePDFversionofthestudiesandcompletesiteplans.



AdditionalInformationRequirements:SpecialstudiesormaterialrequestedbytheCitynecessary

forthereviewoftheapplication.



ApplicationFees:AsrequiredbythecurrentDevelopmentServicesFeeSchedule.

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Form 111 USEPERMI UBMITTALWORKSHEE DSW04 WHATISTHEPURPOSEOFAUSEPERMITANDTHISWORKSHEET (City of Des Moines)

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Completed 10 August 2020

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