Planning, Building, and Public Works Department
Critical Areas Review Application
21630 11th Avenue South, Suite D
Des Moines, WA 98198
Application Date: ________________________________ Permit No.: ____________________________________________________
Site Address:
Parcel Number:
Project Name:
Site Area:
Current Building Square Footage: ________________________________
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
Frequently Flooded Areas
Fish and Wildlife Habitat Conservation Areas
Critical Aquifer Recharge Areas
Environmental Studies (provide a complete description of all studies that have been completed):
Has a Boundary Survey been completed? ______ Has a Topograph Survey been completed? ______ Is the property near the shoreline? ______
Project Description:
Same as applicant
Mailing Address:
Mailing Address:
City, State, Zip:
City, State, Zip:
Phone Number:
Phone Number:
Relationship to Property:
Project Narrative: Provide three (3) copies. The narrative should provide a brief and thorough description of the project. If the
applicant is requesting any deviations or modifications, as part of the narrative the applicant must itemize the requested
deviations and provide justification for each of the requested deviations.
Site Plans: Please provide three (3) copies. The applicant shall submit a dimensioned plan drawn at a scale of 1” = 20' (or other
scale approved by the Development Services Division). The site plan shall include a scale, date, north arrow, source of information
and contain the following items:
Location of existing and/or proposed building(s).
Property Lines.
Abutting street or access.
Identify the toe and/or top of ravines, sidewalls, or bluffs.
Identify steep slopes by the categories established in the City's Critical Area Regulations.
Identify all wetlands; show the wetland boundary and corresponding buffer.
Identify all streams; illustrate the ordinary high water mark and corresponding buffer.
Identify all other water bodies and illustrate the ordinary high water mark.
Identify all other areas regulated as Critical Areas, by the City's Critical Area Regulations.
Identify all significant vegetation and distinguish native from altered conditions.
Written Justification: Please provide three (3) copies. A written explanation demonstrating the proposal's compliance with each
of the decisional criteria established for each specific requested development exception(s) and/or reasonable use exception(s)
contained in the City's Municipal Code.
Special Studies: Please provide three (3) copies. For all wetlands and streams, a delineation report prepared by a qualified
scientist shall be submitted to the City. Other studies maybe required for other identified Critical Areas; please check with the
Development Services Division to determine if a study is required as part of the initial submittal. During the review of a proposal
additional environmental information may be requested by Development Services.
Mitigation Plans: Please provide three (3) copies if mitigation is required. The applicant shall submit a dimensioned plan drawn at
a scale of 1” = 20' (or other scale approved by the Development Services Division). The mitigation plan shall be prepared by a
qualified scientist(s) following procedures set forth in the state Department of Ecology Guidelines for Developing Freshwater
Wetlands Mitigation Plans and Proposals, 2004, or as revised.
SEPA Checklist: Provide two (2) complete copies.
Mailing Labels: Please submit one (1) copy of the mailing labels, obtained from the King County Assessor website for all properties
within 300 feet of the boundaries of the subject site. It will be the applicant's responsibility to complete the mailing.
Radius map: Please provide (1) copy. The radius map shows parcels within 300 feet of the proposed property. The radius may be
reduced depending on the nature of the project.
Vicinity Map: Provide one (1) copy of a vicinity map on 8.5”x11” paper.
CD: Provide a CD that contains the PDF versions of all studies and complete site plans.
Application Fees: As required by the current City Development Services Fee Schedule.
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.
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: ___________________________
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