Development Services
21630 11th Avenue South
Suite D
Des Moines, WA 98198-6398
(206) 870-7576
www.desmoineswa.gov
Grading Permit Application
Site Address:
Property Information
Tax Parcel Number:
Site Area:
Current Zoning
Project Name:
Project Description: (Provide a complete description of the project)
Total Import of Fill
Total Export of Fill
Total Area Cleared
List All Environmentally Critical Areas located on the site
(See DMMC 18.86 for a complete list)
Other Materials: (Describe and identify all other materials than earthen
materials imported and exported from the site)
Location of export site: (Describe the location)
Owner
Same As Applicant
Name:
Mailing Address:
City, State, Zip:
Phone Number:
Name:
Des Moines Business
License Number:
WA Contractor's
License Number:
Phone Number:
City, State, Zip:
Mailing Address:
Company:
Contractor
Phone Number:
City, State, Zip:
Mailing Address:
Name:
Applicant/Contact
DSA-02
Page 1/5
Select One
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Surface Water Management Information
Total Affect/Altered Area:
Existing Impervious Surface Area:
New Impervious Surface Area:
New Pollution Generating Surface Area:
Total Amount of Fill: Total Amount of Excavation:
Describe how the project will change absorption rates, drainage patterns, the amount and/or rate of groundwater
recharge and surface water runoff over and off the site.
Describe how downstream properties will be affected by any changes to the above parameters.
Describe how the project will affect water quality of off-site water bodies (i.e. the ultimate destination of
stormwater runoff of the site).
Is the property currently served by storm drainage facilities? If yes, please describe the facilities.
To which water body is the stormwater routed? Is this water body in the same subwatershed as the proposed
project?
Will surface water runoff be outletted through neighboring properties? If yes, please describe how adjacent
properties will be affected. Have easements been secured?
Are there springs on the site? If yes please explain.
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Land Alteration Information
Identify all Critical Areas located on or adjacent the project site.
Wetlands Hillsides Geologically hazardous areas
Erosion and landslide hazard areas
StreamsFlood hazard areas
Ravine Sidewall or Bluff Seismic hazard areas
Fish and wildlife habitat conservation areas
Critical aquifer recharge areas
Identify the area for each existing slope category as a percentage of the total site area located on the proposed project site
0 - 15% Slope: 15 - 25% Slope:
40+% Slope:25 - 40% Slope:
Amount of Disturbance Allowed. The following chart sets forth the maximum slope disturbance allowed on a
development site:
The overall amount of disturbance allowed on development sites which have any combination of the above slope categories
shall be determined by the following formula:
(Square Footage of Site having 0 – 15% slopes) X 1.00 + (Square Footage of Site having 15 – 25% slopes) X 0.60 +
(Square Footage of Site having 25 – 40% slopes) X 0.45 + (Square Footage of Site having 40%+ slopes) X 0.30 =
Total Amount of Allowable Site Disturbance.
If the proposal will exceed the maximum disturbance limits the applicant must submit a Environmentally Critical Area
Development Exception Application in order for the City to determine if the City will authorize a deviation from this
standard.
SLOPE
AMOUNT OF SLOPE
WHICH CAN BE DISTURBED
FACTOR
0 - 15% 100% 1.00
15 - 25% 60% 0.60
25 - 40% 45% .45
40%+ 30% .30
Will rockeries or retaining walls be required? If yes, identify location and height on plan.
Yes No
Will rockeries or retaining walls be over four feet as measured from the bottom of the footing or retaining a surcharge?
Yes No
If the answer is yes to the above question, please contact the Building Division of the Planning, Building and Public Works
Department as a Building Permit maybe required for the construction of the identified rockery or retaining wall. If a
Building Permit is required, the Grading Permit will not be issued until approval of the required Building Permit.
Specify the proposed changes in elevation, how much land will be affected, method of compaction of fill, and where the
fill is to be placed on the site. Also, list the composition of the fill material.
Will grading activity occur within twenty (20) feet of an adjacent property?
NoYes
Site Plans: Please provide four (4) copies. An accurate plan for the entire site illustrating the existing conditions shall be
submitted to the city containing the following information:
(a) Plans shall show the existing grade for the entire site and the adjoining properties within 100 feet.
(b) All property lines with bearings and distances shown.
(c) Existing vegetation on the site designated by its common names, location, type, size and condition of trees and
ground cover on site.
(d) The location of all existing drainage facilities, natural and manmade, which transport surface water onto, across, or
from the site including: streams and surface waters, artificial channels, drainpipe, or culverts.
(e) The location and estimated capacity of any areas which impound surface water.
(f) Location and estimated discharge of all visible springs in excess of one gallon per minute.
(g) The location of all structures, utilities, and their appurtenances, including structures and utilities on adjacent
properties within 20 feet when such information is reasonably available. Said improvement locations shall also be
staked on site to enable the city to review improvement locations and their relationship to the site and existing
vegetation;
(h) Identification of all critical areas governed by chapter 18.86 DMMC;
(i) Identification of all areas regulated by the provisions of the DMMC flood hazard code;
(j) Location and capacity of all drainage facilities and related construction;
Grading/Clearing Plan: Please provide four (4) copies. An accurate plan for the entire site illustrating the proposed
conditions shall be submitted to the City containing the following information:
(a) Plans shall show the finish grade in relation to the existing grade for the entire site and the adjoining properties
within 100 feet in sufficient detail to identify how grade changes will conform to the requirements of this code.
(b) Location and capacity of all drainage facilities and related construction.
(c) Boundaries of all areas to remain in the existing or natural condition.
(d) Location of all vegetation shown on the plan which will remain after completion of the work and the minimum
distance to the nearest excavation and/or filling.
(e) Landscape plan.
(f) The placement of excavated material, fill, and other graded material.
(g) Location of building setback lines, and approximate demarcation of land cuts including but not limited to
foundations, retaining walls, and driveways.
Plan Sheet Specifications: The plan sheets shall conform to the following standards:
(a) The date, basis, and datum of the contours.
(b) Date, north arrow, and adequate scale (1:10, 1:20, or 1:40) on all maps and plans.
(c) Contours will be at two-foot contour intervals.
(d) Contact information for the applicant,the property owner, and legal description shall be provided on the coversheet.
GRADING PERMIT SUBMITTAL REQUIREMENTS
Slope Disturbance Plan: Please provide four (4) copies. An accurate site plan identifying area(s) contained within each
of the four different slope categories. If the site contains slopes greater than 15%, the plan must calculate the total
authorized disturbance based on the formula on page 3 of this application form.
Civil Engineering Plans: If infrastructure improvements are required as part of the project (i.e. road construction,
frontage improvements, drainage facilitates, etc.), provide five (5) complete sets of engineering plans. These plans must
meet the submittal requirements established the Transportation Engineering and Surface Water Management Divisions of
the Planning, Building, and Public Works Department.
Geotechnical Report: Provide two (2) copies, if required
Technical Information Report (TIR): Provide three (3) copies if required
Application Fee: As required by the current Development Services Fee Schedule.
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Temporary Erosion and Sedimentation Control Plan: Please provide four (4) copies. The plan shall be consistent with the
design requirements of the 2005 King County Surface Water Design Manual and shall be prepared by a licensed civil
engineer. The plan must also contain the following information:
(a) Sequence for clearing, grading, filling, drainage alteration, and other land-disturbing activities.
(b) On-site soil or earth material storage locations and source of import materials, and location of the site where soils will be disposed.
(c) Schedule for installation and removal of all temporary erosion and sediment control measures, including vegetative measures.
(d) An outline of the methods to be used in clearing vegetation and in storing and disposing of the cleared vegetative matter.
Vicinity Map: Provide one (1) copy of a vicinity map on 8.5”x11” paper.
Statement of understanding:
I hereby apply for this permit to do the work indicated, and acknowledge that I have read this checklist and the completed
application. I also hereby certify that the information furnished by me is true and correct and the I agree to comply with all
City of Des Moines ordinances and Washington State laws regarding land clearing, grading and/or filling.
Statement of ownership:
The undersigned property owner(s), under penalty of perjury, each state that they are all the legal owners of the property
described herein and authorize individuals or entities identified herein as applicants to file this application allowing for said
property's development.
Authority to enter property:
The undersigned property owner(s), do hereby authorize employees of the City of Des Moines to enter onto property
described in this application to examine and inspect as necessary to process this development application.
Hold Harmless Agreement:
The undersigned, certifies under penalty of perjury, the truth and/or accuracy of all statements, designs, plans and/or
specifications submitted with said application and hereby agrees to defend, pay and save harmless the City of Des Moines, its
officers, employees, and agents from any and all claims, including costs, expenses and attorney's fees incurred in investigation
and defense of said claims whether real or imaginary which may be hereafter made by any person including the undersigned,
his successors, assigns, employees and agents, and arising out of reliance by the City of Des Moines, its officers, employees and
agents upon any maps, designs, drawings, plans or specifications, or any factual statements, including the reasonable
inferences to be drawn therefrom contained in said application or submitted along with said application.
Statement of Ownership and Hold Harmless Agreement
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Complete Application Date:Land Use Type:
Submittal Date:Application Number:
TO BE COMPLETED BY DEVELOPMENT SERVICES STAFF
STATE OF WASHINGTON )
)
County of ____________ )
I, the undersigned, a notary public in and for the State of Washington, hereby certify
that on this __ day of _______ , 20____, _________________________
personally appeared before me, to me known as the individual(s) empowered to execute
the foregoing instrument, and acknowledged that they signed and sealed the same as
their free and voluntary act and deed for the uses and purposes therein mentioned.
_______________________________________________
NOTARY PUBLIC in and for the State of Washington, residing at ________________ County.
My Commission expires: ___________________________
Name Name
Signature Signature
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