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Development Engineering CCR-General Application-revised April 2025 1 of 2 I hereby certify that I have read and examined this application and know the same to be true and correct, and I am authorized to apply for this permit. Print Name: _ Date: Signature: _ Owner or Authorized Agent Site Information: Parcel ID Address/Location: Project Name: LAND Notice of Decision Letter with the CCR application) Future Land Use: Total Acreage: Description of Project: Civil Engineer Information: _ Billing Contact Applicant: Contact: Address: City: Zip: Phone: E-Mail: Applicant/Owner Information: _ Billing Contact Owner: Address: City: Zip: Phone: E-Mail: Architect Information: Billing Contact Applicant: Address: City: Zip: Phone: E-Mail: EFFECTIVE DATE: 04/23/2025 CCR GENERAL APPLICATION DEVELOPMENT ENGINEERING Email application: Development Engineering SIGN ---PAGE BREAK--- Development Engineering CCR-General Application 2 of 2 Project Details: Number of Lots (needed for plats, short plats, & BSP) lots Land Area Cleared/Disturbed (sq. ft.) (sq. ft.) Total Impervious Surface (sq. ft.) (sq. ft.) Amount of Material Moved (cubic yards) (c.y) Amount of New Impervious Surface (sq. ft.) (sq. ft.) Amount of Replaced Impervious Surface (sq. ft.) (sq. ft.) Amount of New Pollution Generating Surface (sq. ft.) (sq. ft.) Water Main Length (lineal feet) Sewer Main Length (lineal feet.) Estimate of Utility Special Appurtenances Amount of Significant Trees Removed Amount of Landmark Trees Removed Additional Contacts: Contact Type: Company: Contact: Address: City: State: Phone: Email: Contact Type: Company: Contact: Address: City: State: Phone: Email: Plans Include : (Check all that Apply) Water Sewer Stormwater Street (Frontage Imp) Side Sewer in ROW Street Lights Grading Traffic Control Tree Removal/ Retention Plan Project Type: (check one only) Large Commercial ( more than 1 acre) Mixed Use Small Commercial (less than 1 acre) Multi-Family # of Units Short Plat (9 Lots or Less) Single Family (residential only) Plat (10-25 Lots) Tree Removal/Retention Plan Plat (26 or More Lots) Plans Submitted Are For: (check one only) On-Site Improvements Tree Removals as Part of Grading Activity Off-Site Improvements Both on-site and off-site improvements Development Engineering Division. 15670 NE 85th St, Redmond, WA 98052 (425)556.2876