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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor 1 Renton, WA 98057 1 425-430-7200
www.rentonwa.eov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME:
-J . Lot e. G-nS C-F6
ADDRESS:
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CITY:
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STATE:
ZIP:
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PHNUM
EMAIL ADDRESS*: "�cJ6A�.�i?C�rh Aga`
❑ I prefer to receive `all corres o dence via US M . Cqr-
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER:
EMAIL ADDRESS*:
❑ I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: .
COMPANY (if applicable):
ADDRESS:
I b SV b Vt aL�n.. �cV
CITY:
STATE:
ZIP:
PHONE NUMBER
EMAIL ADDRESS*: , j(s-a�
❑ I prefer to receive all correspondence via US Ma . Ct�
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PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
13 zZ o (.� 1-: �7,--, ? (' , , S af 0-( �\'A41+ &
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
1050 Hoquiam Ave NE, Renton WA 98059
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
'A
PROPOSED LA k(SE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
PROPOSED ZONING (if applicable):
SITE ARcEA (in�square feet):
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
NUMBER OF EXISTING DWELLING UNITS (if applicable):
PR9JECT VALUE:
* lI? Sbc�
*By completing the email address field the owner/applicant/contact person is opting to receive all formal notifications
and project documents in digital format via email unless otherwise requested.
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable):
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicable):
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY
CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
❑
AQUIFER PROTECTION AREA ONE
❑
A41JIFER PROTECTION AREA TWO
❑
FLOOD HAZARD AREA
sq. ft.
❑
GEOLOGIC HAZARD
sq. ft.
❑
HABITAT CONSERVATION
sq. ft.
❑
SHORELINE STREAMS & LAKES
sq. ft.
❑
WETLANDS
sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
SITUATE IN THE ___________ QUARTER OF SECTION ------- TOWNSHIP ______ N, RANGE ______ ---- W.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) N i (.s �P_ j �� , declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) [the current owner of the property involved in this application or ❑ the authorized representative to act for a
corporation (please attach proof of authorization) and that the foregoing statements and answers h rein contained and the information
herewith are in all respects true and correct to the best of my knowledge and bed ef!! /// 7
Signature Owner/Representative Date Si ', 6' of Ow'rYerTRKpAsentative Date ,
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that Niccd Scp6i2 t 3 n':FfY SOPEAt signed this instrument and
acknowledge it to be his/herAheir free and voluntary act for the uses and purpose mentioned in the instrument.
pI /2r- /2 o"Z3
Dated �EN S y'/,o
i
06,Y
NOTARY
PuBuc : z
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i� '��(�•.� �M fro
.�••••N..•s•
1/ O I IWAS\ % 0``
Notary Public in and%rthe State of Washington
Notary (Print):
My appointment expires: Q �/26/ 20 Z Zf