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HomeMy WebLinkAboutMASTER APP_SHAW MEDICAL HARDSHIPPrintFormResetFormS*veForm,ZDEPARTMENTOFCOMMUNITY&ECONOMICDEVELOPMENTPlanningDivision1055SouthGradyWay,6thFloorIRenton,WA980571425-430-7200www.rentonwa.govLANDUSEPERMITMASTERAPPLICATIONPROJECTINFORMATIONPROJECTORDEVELOPMENTNAME;________________________hctcoI71€CI)CCk\Hcrdsii,PROJECT/AODRESS(SWOCATIONANDZIPCODE:J(tQYCt1tftNCKINGCOUNTYASSESSORSACCOUNTNUMBER(S):EXISTINGLANDUSE(S):PROPOSEDLANDUSE(S):EXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:PROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable)EXISTINGZONING:PROPOSEDZONINGçifapplicable):SITEAREA(insquawfeet):SQUAREFOOTAGEOFPUBLICROADWAYSTOBEDEDICATED:SQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:PROPOSEDRESIDENTIALDENSITYINUNITSPERNETACRE(ifapplicable)NUMBEROFPROPOSEDLOTS(ifapplicable)NUMBEROFNEWDWELLINGUNITS(Ifapplicable):P1/-IPROPERTYOWNER(S)NAME:zZg7%)DS-cADDRESS,—CCflZIP:TELEPHONENUMBEf06-’2/7—APPLICANT(Ifotherthanowner)NAME:COMPANY(ifapplicable):ADDRESS:CITY;ZIP;TELEPHONENUMBER:CONTACTPERSONNAME:COMPANY(itapplicable):ADDRESS:CITY:ZIP:TELEPHONENUMBERANDEMAILADDRESS:(2/ar7--1H:\CED\Data\Forms-Templates\SeIf-HeIpHandouts\Planning\MasterApplicationdocRev:10/2017 PROJECTINFORMATION(continued)AFFIDAVITOFOWNERSHIPi,(PiintNamels)z/24?7//..4)declareunderpenallyofperjuryundlawsoftheStateofWashingtonthatIam(pleasecheckone)thecurrentownerofthepropertyinvolvedinthisappcationortheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheinformationherewithareinallrespectstueandcorrecttothebestofmyknowledgeandbelief.?__________________________DateSignatureofOwner/RepresentativeDateNUMBEROFEXISTINGDWELLINGUNITS(Ifapplicable):SQUAREFOOTAGEOFPROPOSEDRESIDENTIALBULDINGS(ifapplicable):SQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(Ifapplicable):zge,40SQUAREFOOTAGEOFPROPOSEDNON-RESIDENTlLBUILDINGS(itapplicable):SQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):NETFLOORAREAONNON-RESIDENTIALBUILDINGS(ifappUcable):NUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicable):PROJECTVALUE:ISThESITELOCATEDINANYTYPEOFENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDESQUAREFOOTAGE(ifapplicable):OAQUIFERPROTECTIONAREAONE0AQUIFERPROTECTIONAREATWOOFLOODHAZARDAREA_____sq.ft.OGEOLOGICHAZARD______sq.ft.0HABITATCONSERVATION______sq.ft.OSHORELINESTREAMS&LAKES______sq.ft.OWETLANDS______sq.ft.LEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINTHE5€ccCAeOUARTEROFSECTION15,TOWNSHIP.Z3RANGEQZTINTHECITYOFRENTON.KINGCd6NTY,WASHINGTONSigWatureofOwnerIepresenth6vSTATEOFWASHINGTON)55COUNTYOFKINGIcertifythatIknoworhavesatisfactoryevidencethat_______________acknowledgeittobehIsmerfthelrfreeandvoluntaryactfortheusesandsignedthisinstrumentandDated—JULIOP€REZNotaryPublicStateofWashingtonMyAppointmentExpiresDec19,2020—_Notary(Print):Myappointmentexpires:2H:\CED\Data\Fcrms.Templates\Self-HelpHandouts\Planning\MasterApplication.docRev:10/2017 February1st2018EdmundShaw160JerichoAvenueNERenton,WA98059Atm:AngeleaWeths(AssociatePlanner-CityofRenton)Re:DuplexviolationDearAngelea,TheidentificationmarksA&Bhavebeenremovedfrommailbox&buildings.Themobilehomeunithasneverbeenaduplexstylebuilding,onlyasinglelivingunit.Ioriginallyset-uptheseparateaddressformybusinessmailtokeepitseparatedfrommyhomemailof160JerichoAvenueNE,27yearsago.Mybusinessoperatesoutofmygarage,thatistosayanoffice&asmallamountofstorageofaround500squarefeet.Allworkperformedforthebusinessiscompletedoffsite,noworkisperformedonsite.Icurrentlyemploythreeemployeeswhowork@jobsoffsite.MyfutureplansistoretireinAugustofthisyear&givethebusinessovertomysuperintendentwhowillmovethebusinesstoTacoma.Yourstruly,EdmundShaw