Master Development Application
Application Date: _____________________________________ Permit No.: ____________________________________________________
PROPERTY INFORMATION
Site Address: _____________________________________ Parcel Number: ________________________________________________
Project Name: ____________________________________________________________________________________________________________
Site Area: __________________________________________
Current Building Square Footage: ________________________________
Zoning:
Proposed Building Square Footage: ______________________________
Comprehensive Plan Designation:
Proposed Number of Units or Lots: ______________________________
Check all Environmentally Critical Areas located on the site
(see Chapter 16.10 DMMC for definitions)
:
Geologically Hazardous Areas
Erosion and Landslide Hazard Areas
Seismic Hazard Areas
Ravine Sidewalls and Bluffs
Hillsides
Wetlands
Frequently Flooded Areas
Fish and Wildlife Habitat Conservation Areas
Critical Aquifer Recharge Areas
Streams
List any special studies that have been completed:
Project Description:
APPLICANT/PRIMARY PROJECT CONTACT PROPERTY OWNER
Same as applicant
Name:
_______________________________________
Name:
_______________________________________
Mailing Address:
_______________________________________
Mailing Address:
_______________________________________
City, State, Zip:
_______________________________________
City, State, Zip:
_______________________________________
Phone Number:
_______________________________________
Phone Number:
_______________________________________
Email:
_______________________________________
Email:
_______________________________________
Relationship to Property:
Check all review types that apply. Fees are based on the current Development Services Fee Schedule.
Planning and Land Use Services
Conditional Use Permit Variance Zoning Code Deviations
Comprehensive Plan Amendment Zone Reclassification Administrative
Design Review Unclassified Use Permit Hearing Examiner
Code Interpretation Domestic Animal Review
Legal Lot of Record Research Appeal
Subdivision and Land Alteration Services
Lot Line Adjustments Land Clearing, Grading or Filling
Lot Consolidations Minor Deviations
Encroachment Resolution/Minor Planned Unit Developments (PUD)
Reorientations Preliminary
Subdivisions Final
Preliminary Modified Subdivisions
Final Preliminary
Short Subdivisions Final
Preliminary Binding Site Plans
Final Preliminary
Modified Short Subdivisions Final
Preliminary Master Plan Review
Final Projects less than 5 acres
Projects greater than 5 acres
Environmental Services
Shorelines Critical Areas Review
Shoreline Exemption Minor Activities
Shoreline Substantial Development Permit Single-Family Residential Development
Shoreline Conditional Use Permit Other
Shoreline Variance Tree and Vegetation Removal/Pruning
State Environmental Policy Act (SEPA)
Minor Activities
Single-Family Residential Development
Other
STATEMENT OF OWNERSHIP AND HOLD HARMLESS AGREEMENT
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.
Signature
Signature
Name
Name
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: ___________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome