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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor Renton, WA 98057 1425-430-7200
www rentonwa.�ov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Lin Shufen
nDDREss:16623 116th PI SE
CITY- Renton � STATE:
NVA
i —
PHONE NUMBER'. 77--
ZIP:
98058
EMAIL ADDRESS`: I 0j^J110 CI' Ia/ftcfu� , C.� "� ►
❑ I prefer to receive all correspondence via US Mail._
APPLICANT (if other than owner)
NAME: Cody Herron
COMPANY fir applicable) -
ABC Herron Tree
ADDRESS-
'P.O. BOX 64
CITY: STATE:
Gold Bar Wq_
PHONE NUMBER-. (425) 293-2443
zi P
98251
EMAiL ADDRtSS*�nauntainredd comcast-net
❑ I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: Cody Herron
ANY ter aPPiicabie)gBC Herron Tree
COMP
ADDRESS:P.C). BOX 64
CITY-
4Gold Bar
nur�.i no�o
STATE:
WA
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PROJECT INFORMATION
PROJECTOR DEVELOPMENT NAME:
Tree Removal - No development- activity
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:-
16623 116th PI SE, Renton, WA 98058
KING COUNTY ASSESSOR'S ACCOUNT NU
1423700910
EXISTING LAND USE(S),IL
i
Residential
PROPOSED LAND USE(S)-
o changes to land use
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
RMD
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
no change
R-6
PROPOSED.27-ONING (if applicable)
no change
SITE AREA (in square feet):
91750
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
unknown
SQUARE FOOTAGE OF PUB
DEDICATED'. none
PROPOSED RESIDENTIAL
I.IC ROADW"AYS TO BE
DENSITY IN UNITS PER NET
ACRE ('!f applicable) N/A
NUMBER OF PROPOSED LOTS (if applicable) i
NIA
NUMBER OF NEW [?WELLING UNITS (if applicable):
N/A__
(it'applicable):
E MAI L ADDRESS*mou nta i n redd @comcast. net PROJECT VALUE-.
L11 I prefer to receive all correspondence via US Mail. L---.
*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.
NUMBER OF EXISTING DWELLING UNITS
PROJECT INFORMATION (CONTINUED)
�i SQUARE FOOTAGE OF PROPOSED RESIDENTI)
BUILDINGS (if applicable):N/A
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):1 ,740
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable):N/A
SnHaRF FnnTAGE OF EXISTING NON-RESIDEN-"I]AL
BUILDINGS TO REMAIN (if applicable): N/A
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS i
applicable): NSA
J NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicfo)N:
! IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
[I AQUIFER PROTECTION AREA ONE
El AQUIFER PROTECTION AREA TWO
[:1 FLOOD HAZARD AREA
❑ GEOLOGIC HAZARD
❑ HABITAT CONSERVATION
❑ SHORELINE STREAMS & LAKES
El WETLANDS
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
sq. ft.
. ft.
s. f.
sq . ft.
SITUATE IN THE NW QUARTER OF SECTION 28 , TOWNSHIP 23 N, RANGE 5 ;VV.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
. "Faint Name/s)`» 1 � �', declare under penalty of perjury under the laws cif the Mate of Washington that I
i(
am (please check one) E] 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 foreqoing statements and answers herein contained and the information
herewith are in alL,respects true and correct to the best of racy knowledge and belief.
Signature of Owner/Representative. Date
STATE OF VVASHlNGTON
Signature of Owner/Representative
Date
} SS
COUNTY CIF KING
certify that I know or have satisfactory evidence that J � U_ �� Lsigned this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
174 'k, I �11 �6 It I# IL
� Washington
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Notary (Print):
My appointment expires' _/ �C � �� _ 2 026