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1 of 2 GENERAL INFORMATION Registered REPs Portal Account Contact Name: I hereby certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am to file this application and act on the behalf of the signatories of the above authorization. Print Name: _ Date: Signature: _ FOLLOWING INFORMATION REQUIRED (IF APPLICABLE) Name: Signature: Tax Lot and STR/Lot Subdivision: City: State: Owner Contract Purchaser Consultant Option Purchaser* Option Expiration Date *Owners Signature also required Name: Signature: Tax Lot and STR/Lot Subdivision: City: Owner Contract Purchaser Consultant Option Purchaser* Option Expiration Date *Owners Signature also required CERTIFICATION Name of Development: Name of Applicant: Phone: Email: Address: City: State: Zip Code: Description of Proposed Action: Proposal includes the removal of trees? Y/N AUTHORIZATION TO FILE SIGNATURE OF ALL PERSONS WITH AN INTEREST IN THE PROPERTY Location of Subject Property: Legal Description (attach additional pages if required): Property Contiguous to Hazardous Liquid Pipelines Must Provide Ticket Number From “One Call Center”. Office Use Only: Application Plan: CGP# CLEAR & GRADE PERMIT (CGP) APPLICATION DEVELOPMENT ENGINEERING EFFECTIVE DATE: 04/22/2025 SIGN SIGN SIGN ---PAGE BREAK--- 2 of 2 The following information should be submitted prior to submittal so that staff can establish plan review fees: Land Area Cleared/Disturbed (sq. ft.) Amount of Material Moved (cubic yds.) Amount of New Impervious Surface (sq. ft.) Amount of Replaced Impervious Surface (sq. ft.) Amount of New Pollution Generating Surface (sq. ft.) Amount of Significant Trees Removed Amount of Landmark Trees Removed Development Engineering Division, 15670 NE 85th St, Redmond, WA 98052 (425)556.2876