HomeMy WebLinkAboutGrading and Drainage Permit Request FormOwner Name:
❑ Check if other PERMIT NO.
Property Address:
permits arerequired
Civil Engineer/ Designer Contact lnformat� �Wll
Name:
Phone No.
Mailing Address:
Email:
City, State:
Zip:
State License Number:
❑ Yes ❑ No
1.
ff •. R. .
Is the work within 200 feet of the high water mark of Lake Washington?
❑ Yes ❑ No
2.
If Yes to # 1: Are you placing or removing or in combination 25 cubic yards or more of material?
❑ Yes ❑ No
3.
Is there fill work included for the purpose of improving fish and wildlife habitat?
❑ Yes ❑ No
4.
Is the work within a geologically hazard area See Chapter 20.50 or 20.67 MMC ?
❑ Yes ❑ No
5.
Is the work near or adjacent to a stream or wetland?
❑ Yes ❑ No
6.
Are there significant trees being retained within the clearing area, or being impacted by gradingactivity?
❑ Yes ❑ No
7.
1 Does the proiect include new construction of a basement?
Proposed
Total Surface Area Disturbed:
Total Area of New/ Replaced Impervious Surface:
Grading Information:
Import
Onsite
Total
Quantity of Excavation/ Cut (cubic yards)
Quantity of Fill (cubic yards)
Total
Quantity to be exported offsite:
Please provide a brief description of the grading and drainage work:
Permit Fee:
Engineer
Approval:
Tech Fee:
Tree
Approval
L!2e:
Building
Permit Issued:
Approval.
1 of 1 Rev. 01/10/2018