HomeMy WebLinkAboutA_Master AppCITY OF RENTON I PERMIT SERVICES
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: \ PHONE:
MAILING ADDRESS: EMAIL: . , m
prefer to receive all correspondence via US mail.
APPLICANT (if other than owner)
NAME: -r--.,,._, 1 .,._ \ n "' <...J v_t:t..,,__r .....,__ _\....,; v \ \( O --r H-" _____ COMPANY (if applicable): QA\J:E:Y T:-?E _
PHONE: EMAIL: ~
1;;;;;M=A=-1L_1N_G_A_D_D_RE_ss_=~~(o=dt~~c__.,.J__.G,C.L.cv:.:.~~J---Un 1 t (,,
I prefer to receive all correspondence via US mail.
'6Vf1 t I W'J?i
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: j '-'{)e,..r ~--_ -('j""--t--'--'""-<--=--~e::.L.....:e....:::.....::..._--'-'5"~ _________ ----1
PROJECT/ADDRESS(ES) AND PARCEL NUMBERS: ~?Jj_O
EXISTING LAND USE(S): PROPOSED LAND USE(S): /JI
___________ ---<....;::........:...,c....:..._ ____ -i
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable):
EXISTING ZONING: B--=-=-IO __ PROPOSED ZONING:
SITE AREA (in square feet): Q 3a_)°"
~---------~'=:....i..DJ-/i-=-------------
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: .t ,,, ~ao -t_ -'f Ax_l
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable):
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LAND USE PERMIT MASTER APPLICATION
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):
D AQUIFER PROTECTION AREA ONE D AQUIFER PROTECTION AREA TWO
D FLOOD HAZARD AREA SQ. FT. D SHORELINE STREAMS & LAKES SQ. FT.
D GEOLOGIC HAZARD SQ. FT. D WETLANDS SQ. FT.
D HABITAT CONSERVATION SQ. FT.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE /J IA,) QUARTER OF SECTION L/ , TOWNSHIP ~ N, RANGE _Jf_ ~
W.M IN THE CITY OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) :::ra'h),, C...,, 1£. "'T fl , 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 information herewith are in all respects true and correct to the best
of~ belief. / ~ 0-/.-,
Signature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) 55
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ____________ signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
Dated Notary Public in and for the State of Washington
Notary (Print):
My appointment expires: _________________ _
rentonwa.gov/permitservices I planningcustomerservice@rentonwa.gov I 425-430-7294 10/24/2023 I Page 2 of 2