Application For Preliminary Long Plat Form - City Of Westport

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OFFICIAL USE ONLY
CITY OF WESTPORT
Fee _______________________
PO BOX 505
Date Received
______________
WESTPORT, WA 98595
By _______________________
360-268-0835
File No. ___________________
APPLICATION FOR
PRELIMINARY LONG PLAT
Fee: $802.00 plus $31.00 per lot + Hearings Examiner Fees
(In addition, any professional service charges per Ordinance #1285)
A preliminary plat is a request to subdivide property into five or more lots for the purpose of residential,
commercial, or industrial development. A preliminary plat is reviewed by the City’s staff, Hearings Examiner
and City Council for conformance with the City’s subdivision standards and other regulations. The Hearings
Examiner will hold a public hearing after notifying neighbors and other agencies. The plat cannot be approved
unless appropriate provisions have been made for public facilities, such as roads, sewer and water. Preliminary
review will usually take about 90 days. If preliminary approval is granted, a final surveyed plat must be
presented within five (5) years with appropriate arrangements for all improvements.
NAME OF PROJECT __________________________________________________________________________
APPLICANT __________________________________________________________________________________
Mailing Address _______________________________________________________________________________
City, State and Zip _____________________________________________________________________________
Telephone ____________________________________________________________________________________
OWNER _____________________________________________________________________________________
Mailing Address _______________________________________________________________________________
City, State and Zip _____________________________________________________________________________
Telephone ____________________________________________________________________________________
ENGINEER/ARCHITECT/OTHER _______________________________________________________________
Mailing Address _______________________________________________________________________________
City, State and Zip _____________________________________________________________________________
Telephone ____________________________________________________________________________________
SUMMARY OF REQUEST _____________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
PROPERTY DESCRIPTION
General Location ______________________________________________________________________________
_____________________________________________________________________________________________
Site Address ____________________________________________ Land Area (acres) ______________________
Section _______________________________ Township _________________________ Range _______________
Assessor’s Tax Parcel Number ___________________________________________________________________
Full legal description of subject property (attach separate sheet if necessary) ____________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
I affirm that all answers, statements and information contained in and submitted with this application are
complete and accurate to the best of my knowledge. I also affirm that I am the owner of the subject site or am
duly authorized by the owner to act with respect to this application. Further, I grant permission from the owner
to any and all employees and representatives of the City of Westport and other governmental agencies to enter
upon and inspect said property as reasonable necessary to process this application. I agree to pay all fees of the
city which apply to this application.
Signed _______________________________________________ Date ___________________________________
Effective Date: January 2009
1
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