An integrated clock and power distribution network in a semiconductor device includes assigning a first tile to a location on a placement grid corresponding to a top metal layer. An orientation is assigned to the first tile relative to the top metal layer placement grid. The first tile is placed on a representation corresponding to the top metal layer in accordance with the assignments. A second tile is assigned to a location on a placement grid corresponding to a top-1 metal layer. The orientation is assigned to the second tile relative to the top-1 metal layer placement grid. The second tile is placed on a representation corresponding to the top-1 metal layer in accordance with the assignments. The first and second tile are arranged as a full-dense-mesh distribution structure. The first tile includes an integrated clock and power distribution structure. The second tile includes a low impedance underpass structure.