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Innovative - Responsive - Professional
Complete this form to submit at City Hall. Or, use to submit your application entirely online.
Land Surface Modification
Permit Checklist
Building Services
Use this checklist to help gather all the required information and documents in order to submit a complete Land Surface
Modification Permit Application.
Land Surface Modification Permit Application (completely filled out)
Soils Report prepared by a professional engineer (for paper submittal, 2 copies required) in any of the following
Development is identified to be in a high or moderate landslide hazard, seismic hazard area or flood plain.
Grading is to be in excess of 500 cubic yards.
The Building Official determines that special conditions or unusual hazards exist.
Street Lighting Analysis prepared by the INTO Light Division of Puget Sound Energy (When required as a condition
of a related subdivision approval.)
If located in an RH zone within the Rose Hill Business District (RHBD), and exterior lighting is proposed on
buildings, or in parking or storage areas, show compliance with the RHBD Exterior Lighting Requirements. An
exterior light photometric site plan may be required.
Environmental Checklist (Consult with the Planning Department at 425-587-3600 to learn if one is required. One is
always required if the scope of project exceeds 500 cubic yards or if you are proposing to develop a commercial or
multiple-family site.)
A completed Rodent Abatement Declaration and letter from the rodent abatement company must be provided
prior to issuance of the Land Surface Modification permit, even if there is no demolition work.
Public Works Improvement Evaluation Packet (Not required if there are no utilities or street improvements.)
Drainage Technical Information Report (TIR). See Storm Drainage Policies D-2 and D-3. Projects that trigger
Simplified Drainage Review must submit a Simplified Drainage Plan Submittal Template to meet the TIR
requirement. (For paper submittal, 2 copies shall be provided.)
Construction Plan Set shall contain the following. (For paper submittal, 3 complete copies of the construction plan
set are required.)
A copy of the proposed plat, if there is one, indicating lot numbers, dimensions and access easements. (For
reference only.)
Tree retention plan (See KZC 95.30 or call the Planning Department at 425-587-3600 for details on which plan
is required for your project.) The plan must include proposed locations of all roads, driveways and utilities, and
must be consistent with civil plans.
Drainage Plan (if applicable). See Storm Drainage Policies D-2 and D-3.
Topographic survey of the land showing existing and proposed contours at 2-foot intervals, certified and
signed by a registered land surveyor licensed in the State of Washington. The survey must be related to a
known elevation (King County NAVD 88) datum point in the public right-of-way (note datum point on plans).
Boundary survey of the subject property, as approved by the City, certified and signed by a registered land
surveyor licensed in the State of Washington, showing the layout and dimensions of the lot(s), drawn to scale
(indicate scale used), and provide a north arrow.
Land Surface Modification Permit Checklist - continued
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In addition to the submittal documents required above, if you are proposing to develop a commercial or multi-family
site, the following items are also required to be submitted with the Land Surface Modification Permit Application.
Development plan, drawn to scale, including:
Lot size and property dimensions
Proposed use/number of units
Density calculation
Required setbacks and existing easements
Dimensions of existing and proposed structures
Existing significant trees
Recreational open space location and dimensions (required for 4 or more units only)
Horizontal façade requirements
Pedestrian, bicycle, and transit facilities (See KZC Chapter 105)
Lot coverage calculations (based on full development buildout)
Sidewalks, drop-off areas, and accessible routes
If you are proposing to develop a commercial or multi-family site:
Site Plan (If the proposed project may impact significant trees or you propose to remove significant trees, an extra
copy of the site plan must be provided for paper submittal.)
Existing and proposed fire hydrant assemblies, with distance (by way of vehicular traffic) to subject parcel(s)
of property.
Construction Stormwater Pollution Prevention (CSWPP) Plan (Required for projects creating 500 square feet or
more of new or replaced impervious surface.) Projects that trigger this requirement are required to submit a
Construction Storm Water Pollution Prevention (CSWPP) Plan Template.
Proposed limits of grading. In the case of plats and planned unit developments, the scope of grading is limited
to rights-of-way, utility easements or access easements. Erect a temporary 6-foot-high chain-link construction
fence along the limit of grading line. In addition, erect a siltation fence to control erosion along required
setbacks of streams, wetlands, and/or steep sloped areas. NOTE: NO GRADING BEYOND THIS LIMIT OF
Location of each significant tree. Clearly mark on the site plan all the trees and their drip lines, whether they
are to be retained or proposed to be removed, as identified in the Tree Retention Plan. Show tree fencing and
protection notes for trees to be retained. (See KZC 95.34.)
Street names, locations and dimensions of existing improvements and specific proposed improvements in
right-of-ways and easements serving the development.
All access easements, including their length, width, grade, pavement width, and any turnarounds that have
been required.
Landscape/utility strip with street trees planted 30 feet on center
Existing watercourses, streams, or wetland areas.
Road concurrency (if more than 9 dwelling units or 20 parking stalls are proposed)
Wetland or stream report (if applicable)
SEPA checklist (if more than 9 dwelling units or 20 parking stalls are proposed or if work is occurring on lands
covered by water)
Development layout shown on the Site Plan (Road network, building locations, etc.)
Traffic report
Land Surface Modification Permit Checklist - continued
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A performance bond for on-site erosion control and right-of-way repair must be submitted to the Public Works
Rodent abatement must be started at least 2 weeks prior to any clearing or land surface modification, and
depending on bait acceptance, may need to continue through the project work. You must submit a letter from the
Rodent Abatement Company stating when the abatement was started and what level of bait is being accepted.
The developer or contractor must schedule a pre-construction meeting with the Public Works Department prior to
any on-site work. Please call 425-587-3800 to schedule the meeting.
Notify the Planning Department to arrange for an inspection of wetland or stream buffer fencing and for tree
The following actions shall be taken prior to issuance of the Land Surface Modification Permit.
The Land Surface Modification proposal complies with the conditions of any associated zoning or subdivision
Landscape plan, including:
Significant trees to be retained per Tree Retention Plan
Identify required landscape buffers
Supplemental planting calculations (See KZC 95.40)
Show plant location, species and size
Parking plan, including:
Required parking, including multi-family guest parking and accessible stalls
Parking layout/plan drawn to scale (indicate scale)