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HomeMy WebLinkAboutThai Food Truck submittal 20170920PrintFormResetFormSaveForm—Renton0PlanningDivisionLANDUSEPERMITMASTERAPPLICATIONPROJECTINFORMATIONPROJECTORDEVELOPMENTNAME:_______________________PROJECT/ADDRESS(S)/LOCATIONANDZIPCODE:)(4.Jjf5i’Jcrncc?,II£OAKINGCOUNTYASSESSOR’SACCOUNTNUMBER(S):PROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable)PROPOSEDRESIDENTIALDENSITYINUNITSPERNETACRE(ifapplicable)DEPARTMENTOFCOMMUNITYANDECONOMICDEVELOPMENT/PROPERTYOWNER(S)NAME:c;5p%o3ofc{r,LLCADDRESS:4—i1isNE-ce(B’vd.CITY:y-4n’3!SZlP:O57TELEPHONENUMBER:rjqi5•3APPLICANT(ifotherthanowner)EXISTINGLANDUSE(S):PROPOSEDLANDUSE(S):EXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:EXISTINGZONING:ADDRESS:1%o111ANCITY:ZIP:ooi1TELEPHONENUMBER:?Jt,-2CONTACTPERSONNAME:DfCiiiCOMPANY(ifapplicable):7lLLCADDRESS:AeCITY:ZIP:TELEPHONENUMBERANDEMAILADDRESS:ZO6z9=g±JJDyOPROPOSEDZONING(ifapplicable):)SITEAREA(insquarefeet):SQUAREFOOTAGEOFPUBLICROADWAYSTOBEDEDICATED:SQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:NUMBEROFPROPOSEDLOTS(ifapplicable)1H:\CED\Data\Forms-Templates\Self-HeIpHandouts\Planning\MasterApplication.docNUMBEROFNEWDWELLINGUNITS(ifapplicable):Rev:08/20150.L PROJECTINFORMATION(continued)I,(PrintName/s)It)hiIr%\..1A_L...declareunderpenaltyofperjuryunderthelawsoftheStateofWashingtonthatIam(pleasecheckone)thecurrentownerofthepropertyinvolvedinthisapplicationortheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheintormationherewithareinallrespectstrueandcorrecttothebestofmyknowledgeandbelief.cSignatureofOwner/RepresentativeDateSTATEOFWASHINGTON)SSCOUNTYOFKINGIcertithatIknoworhavesatisfactoryevidencethatsignedthisinstrumentandacknowledgeittobehis/her/theirfreeandvoluntaryactfortheusesandpurposementionedintheinstrument.°(7_______________________________—I(‘1l)gtonlf%t(hoMYooi\lN,iX.-NotaryPublicinandfortheStateofWashingtonMci(oNotary(Print):KJUMBEROFEXISTINGDWELLINGUNITS(ifapplicable):SQUAREFOOTAGEOFPROPOSEDRESIDENTIALBUILDINGS(ifapplicable):SQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):SQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIALBUILDINGS(ifapplicable):SQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):NETFLOORAREAONNON-RESIDENTIALBUILDINGS(ifapplicable):NUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicable):PROJECTVALUE:ISTHESITELOCATEDINANYTYPEOFENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDESQUAREFOOTAGE(ifapplicable):AQUIFIERPROTECTIONAREAONEJAQUIFIERPROTECTIONAREATWOFLOODHAZARDAREA______sq.ft.UGEOLOGICHAZARD_____sq.ft.UHABITATCONSERVATION______sq.ft.USHORELINESTREAMS&LAKES______sq.ft.UWETLANDS______sq.ft.LEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINTHE_________QUARTEROFSECTION____,TOWNSHIP____,RANGE____,INTHECITYOFRENTON,KINGCOUNTY,WASHINGTONAFFIDAVITOFOWNERSHIPSignatureofOwner/RepresentativeDateDatedMyappointmentexpires:2t4cty))2-o-i-OH:\CED\Data\Forms-Templates\SeIf-HeIpHandouts\Planning\MasterApplication.docRev:08/2015 DEPARTMENTOFCOMMUNITY()oI7-\ANDECONOMICDEVELOPMENTCn(JABATEMENTAGREEMENTTEMPORARYUSEPlanningDivision1055SouthGradyWayIRenton,WA98057Phone:425-430-7200IFax:425-430-7231I,jviQ\CoObeingtheApplicantfortheTemporaryUsePermitattheLocationof:-1flcNEHerebyauthorizetheCityofRentontosummarilyeliminatetheTemporaryUseandallevidenceoftheuseifithasnotbeenremovedasrequiredbythetermsofthepermit.IalsoagreetoreimbursetheCityforanyexpenseincurredinabatingthisTemporaryUse.Signature:___________________________________STATEOFWASHINGTON55COUNTYOFKINGIcertifythatIknoworhavesatisfactoryevidencethat11peCithisinstrumentandacknowledgeittobehis/her/theirfreeandvoluntaryactfortheusesandpurposementionedintheinstrument.DatedNotaryPublicinandfortheStateofWashingtonNotary(Print):Myappointmentexpires:-2Su1i%vd-eI%UViL’\j’tO5’PrintName:Date:oçewc41tko/fi/iJOHNRLEATYNotaryPublicStateofWashingtonemmissionExPisO3/26/2Oi$H:\CED\Data\Forms-Templates\SeIf-HelpHandouts\Planning\TemporaryUseTier1.docRev:05/2015 NotesMaroomThaim4715NESunsetBlvd0NI1608l6FeetWGS_1984_Web_Mercator_Auxiliary_Sphere-RëiTtOflFinance&ITDivisionInformationTechnology-GISRentonMapSupport@Rentonwa.gov8/19/2017ThismapisausergeneratedstaticoutputfromanInternalmappingsiteandisforreferenceonlyDatalayersthatappearonthismapmayormaynotbeaccuratecurrent,orotherwisereliableTHISMAPISNOTTOBEUSEDFORNAVIGATIONCityofRentonPrintmapTemplateLegendCityandCountyBoundaryOther“!CityofRentonI.AddressesParcelsBuildingFootprints F’PublicHealthSeattle&KingCountyir:I.—PermanentFood-RiskBasedPR0086$536783PERMIT___——--——MofrikFooUiflt-RiskCategoryifiI3/31/2018PERMITNO.PIEGRANTEDTOLOCATIONMAROOMTHAIM(KC546)@17620108THAVESERENTON9805579127THAVESSEATfLE,WA98108FORAPERIODBEGINNING7/19/2017MAILINGADDRESSMAROOMTHMM(KC546)doDUANGKAEWPHUNGPERMTRAKOOL.15320111THAVENEBOTHELL,WA98011IDATED7/24/2017SUBJECTTOALLSTATELAWS.COUNTYBOARDOFHEALTHRULESANDREGULATIONS,AND/ORCITYORCOUNTYORDINANCESPERTAININGTHERETO.THISPERMITMAYBESUSPENDEDORREVOKEDUPONVIOLATIONBYTHEHOLDEROfANYOFTHETERMSOFTHESEREGULATIONS.ThISPERMITISNOTTRANSFERABLEANDMUSTBEPOSTED[NACONSPICUOUSPLACE.ThISPERMITISNOTVALIDUNLESSSIGNEDBYOPERATOR.NEWOWNERSMUSTAPPLYANDPAYFORANEWPERMITBEFOREBEGINNINGOPERATION.X_zsEOPERATORSIGNATURE