Fillable Short Plat or Preliminary Plat Application (City of Kirkland)

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Short Plat or Preliminary Plat Application (City of Kirkland)

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The Short Plat or Preliminary Plat Application (City of Kirkland) form is 4 pages long and contains:

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BROWSE CITY OF KIRKLAND (WA) FORMS

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Page 1 of 4
DevSvcs-PMC-1.0-20150810
Innovative - Responsive - Professional
Short Plat or Preliminary
Plat Application
Planning Department
This permit application packet is designed to obtain all the information necessary to allow the City to make a well-
informed decision on your application. Please refer to the attached application checklist to determine the materials
which must be submitted to complete your application. All application materials are public information.
Your application will be evaluated on the basis of the information you provide, the criteria listed in the pertinent
sections of the Subdivision Ordinance, the Kirkland Comprehensive Plan, other City regulatory ordinances, inspection of
the property, as well as public comments.
YOU ARE ENCOURAGED TO MEET WITH A PLANNER FROM THE PLANNING AND BUILDING DEPARTMENT PRIOR TO AND
DURING PROJECT DESIGN TO DISCUSS PROJECT COMPLIANCE WITH CITY REGULATIONS. YOU MUST MEET WITH A
PLANNER TO OBTAIN GUIDANCE ON THE APPLICATION MATERIALS YOU MUST SUBMIT.
Copies of City ordinances such as the Comprehensive Plan, Zoning Ordinance, Subdivision Ordinance, and Shoreline
Master Program are available at the Planning and Building Department in City Hall, 123 Fifth Avenue; and the Kirkland
Public Library, 308 Kirkland Avenue. To purchase the Comprehensive Plan or Zoning Ordinance, call Code Publishing
Company at (800) 551-2633. The City ordinances can also be found online.
As a result of your application, you may be required to make improvements such as sidewalks, curbs, street trees, or
utilities undergrounding within the rights-of-way abutting your property. Please refer to Chapter 110 of the Zoning
Ordinance and/or consult with a planner to determine if this is the case.
NOTE: Information provided by the Department of Planning and Community Development represents a preliminary,
qualified assessment which is based on the information provided by the applicant/contact person. More
detailed technical review of a specific development permit application may disclose additional substantive or
procedural requirements. Furthermore, in the case of a short plat, the role and the authority of the
Department of Planning and Community Development staff is advisory only. A final decision only is made, after
public comment, by the Planning Director.
Primary Contact Person
Name
Address
City State Zip Code
Daytime #
Alternate #
Email:
Note: If applicant is not property owner, he/she must be authorized as agent (see page 2).
Prefer written correspondence by email provided. Prefer written correspondence by address provided.
Complete this form to submit at City Hall. Or, use mybuildingpermit.com to submit your application entirely online.
Page 2 of 4
DevSvcs-PMC-1.0-20150406
Short Plat and Preliminary Plat Application - continued
Secondary Contact Person
Name
Address
City
State
Zip Code
Daytime #
Alternate #
Email
Prefer written correspondence by email provided. Prefer written correspondence by address provided.
Site Information
Site Address Parcel #
The site is zoned and is presently used as
Size of property
Number of lots proposed
Proposed name of subdivision
Intended use of the proposed subdivision
If one large lot suitable for subdivision remains, explain reason:
Has the property been subdivided before?
Yes No
If so, what is the Planning Department permit number?
Have you met with a planner prior to submitting your application?
Yes No
Name of Planner Date of pre-submittal meeting
Pre-submittal case Number
YOUR APPLICATION WILL NOT BE COMPLETE UNTIL ALL DOCUMENTS LISTED ON THE APPLICATION CHECKLIST ARE
SUBMITTED.
YOU MAY NOT BEGIN ANY ACTIVITY BASED ON THIS APPLICATION UNTIL A DECISION INCLUDING THE RESOLUTION
OF ANY APPEAL, HAS BEEN MADE. CONDITIONS OR RESTRICTIONS MAY BE PLACED ON YOUR REQUEST IF IT IS
APPROVED. AFTER THE CITY HAS ACTED ON YOUR APPLICATION, YOU WILL RECEIVE FORMAL NOTICE OF THE
OUTCOME. IF AN APPEAL IS FILED, YOU MAY NOT BEGIN ANY WORK UNTIL THE APPEAL IS SETTLED. YOU MAY ALSO
NEED APPROVALS FROM OTHER CITY DEPARTMENTS. PLEASE CHECK THIS BEFORE BEGINNING ANY ACTIVITY. If you
suspect that your site contains a stream or wetland or is adjacent to a lake; you may need a permit from the state or
federal government.
STATEMENT OF OWNERSHIP/DESIGNATION OF AGENT
The undersigned property owners, under penalty of perjury, each state that we are all of the legal owners of the
property described on the short plat map.
With respects to this application, we designate to act as our agent:
Page 3 of 4
DevSvcs-PMC-1.0-20150406
Short Plat and Preliminary Plat Application - continued
AUTHORITY TO ENTER PROPERTY
I/we acknowledge that by signing this application I/we are authorizing employees or agents of the City of Kirkland to
enter onto the property which is the subject of this application during the hours of 7:00 a.m. to 5:00 p.m., Monday
through Friday, for the sole purpose of making any inspection of the limited area of the property which is necessary to
process this application. In the event the City determines that such an inspection is necessary during a different time or
day, the applicant(s) further agrees that City employees or agents may enter the property during such other times and
days as necessary for such inspection upon 24 hours notice to applicant(s), which notice will be deemed received when
given either verbally or in writing.
HOLD HARMLESS AGREEMENT READ CAREFULLY BEFORE SIGNING
The undersigned in making this application 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 Kirkland, 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 Kirkland, 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.
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further
certify that I have full power and authority to file this application and to perform, on behalf of the owner, all acts
required to enable the jurisdiction to process and review such application. I have furnished true and correct
information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of
work requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Applicant
Name
Address
City State Zip Code
Daytime #
Alternate#
Email
Signature:
Owner 1
Name
Address
City State Zip Code
Daytime #
Alternate #
Email
Signature:
Page 4 of 4
DevSvcs-PMC-1.0-20150406
Short Plat and Preliminary Plat Application - continued
Owner 2
Name
Address
City State Zip Code
Phone
Email
Signature:
Agent (other than applicant)
Name
Address
City State Zip Code
Phone
Email
Signature:
Alternate Formats: Persons with disabilities may request materials in alternative formats. Persons with hearing
impairments may access the Washington State Telecommunications Relay Service at 711.
Title VI: Kirkland's policy is to fully comply with Title VI of the Civil Rights Act by prohibiting discrimination against any
person on the basis of race, color, national origin or sex in the provision of benefits and services resulting from its
programs and activities. Any person who believes his/her Title VI protection has been violated, may file a complaint
with the City.
To request an alternate format, file a complaint or for questions about Kirkland's Title VI Program, contact the Title VI
Coordinator at 425-587-3011 or titlevicoordinator@kirklandwa.gov.
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Short Plat or Preliminary Plat Application (City of Kirkland)

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Completed 3 August 2020

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