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CITY OF RENTON Ι PERMIT CENTER
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: PHONE:
MAILING ADDRESS: EMAIL:
I prefer to receive all correspondence via US mail.
APPLICANT (if other than owner)
NAME: COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
I prefer to receive all correspondence via US mail.
CONTACT PERSON
NAME: COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
I prefer to receive all correspondence via US mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(ES) AND PARCEL NUMBERS:
EXISTING LAND USE(S): PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable):
EXISTING ZONING: PROPOSED ZONING:
SITE AREA (in square feet):
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): PROJECT VALUE:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable):
LAND USE PERMIT MASTER APPLICATION
sQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL BUILDINGS (if applicable):Not applicable
sQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable): Not applicable
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if applicable): Not applicable
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW PROJECT (if applicable): Not applicable
IS THE SITE LOCATED IN ANY TYPE OF ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE SQUARE FOOTAGE (if applicable):
AQUIFER PROTECTION AREA ONE AQUIFER PROTECTION AREA TWO
FLOOD HAZARD AREA SQ. FT. SHORELINE STREAMS & LAKES 0.7 Sa. FT.
GEOLOGIC HAZARD SQ. FT. WETLANDSs SQ. FT.
HABITAT CONSERVATION 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 Parcel is located in the middle of Lake Washington and
consequently does not have an associated legal description.
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s)DxanMaras, 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 herein contained
and the infermmation herewith arin all respects true and correct to the best of my knowledge and belief.
Signature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON)
SS
COUNTY OF KING
Icertify that I know or have satisfactory evidence that ylun_arws
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
signed this instrument and
As/223
Dated Notary Public in and fof the State of Washington
t
Twr R Lesad
Notary (Print):NOTARY
PUBLIC
S TATE My appointment expires:09eL/ a03y be WA VAS
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