HomeMy WebLinkAboutA_Land_Use_Permit_Master_Application_171113_v1DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
1
J:\2017 Project Files\174041 - Gene Coulon Park Struct Repairs\F.
Permits\01_Applications\GeneCoulon_RentonMasterApplication_10.18.17.docx Rev: 08/2015
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: Todd Black, City of Renton
PROJECT OR DEVELOPMENT NAME:
Gene Coulon Park Maintenance
ADDRESS:
1055 South Grady Way
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
1201 Lake Washington Blvd N
Renton, WA 98056
CITY: Renton
ZIP: 98057
TELEPHONE NUMBER: 425.430.6571
KING COUNTY ASSESSOR’S ACCOUNT NUMBER(S):
3344500775, 0523059010
APPLICANT (if other than owner)
NAME: Same as owner
EXISTING LAND USE(S): Public Park
COMPANY (if applicable): PROPOSED LAND USE(S): No Change
ADDRESS:
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
Residential
Low Density
CITY: ZIP:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable) N/A
TELEPHONE NUMBER: EXISTING ZONING: R1-Residential 1 du/ac
CONTACT PERSON PROPOSED ZONING (if applicable): N/A
NAME: Nicole White
SITE AREA (in square feet): 57 acres
COMPANY (if applicable):
PND Engineers, Inc.
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED: N/A
ADDRESS:
1736 Fourth Avenue S
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
N/A
CITY:
Seattle
ZIP:
98134
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable) N/A
TELEPHONE NUMBER AND EMAIL ADDRESS: NUMBER OF PROPOSED LOTS (if applicable)
N/A
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
2
J:\2017 Project Files\174041 - Gene Coulon Park Struct Repairs\F.
Permits\01_Applications\GeneCoulon_RentonMasterApplication_10.18.17.docx Rev: 08/2015
206.624.1387
nwhite@pndengineers.com
NUMBER OF NEW DWELLING UNITS (if applicable):
N/A
PROJECTINFORMATION_(continued)I,(PrintName/s)ToddBlack,declareunderpenaltyofperjuryunderthelawsoftheStateofWashingtonthatIam(pleasecheckone)thecurrentownerofthepropertyinvolvedinthisapplicationorEltheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheinformationherewithareinallrespectstrueandcorrecttothebestofmyknowledgeandbelief._p/4E—iSigrtureofOvnØ/RepfetiveSTATEOFWASHINGTONCOUNTYOFKING)55DateIcertifythatIknoworhavesatisfactoryevidencethat_jacknowledgeittobehis/her/theirfreeandvoluntaryactforSignatureofOwner/RepresentativeDateNUMBEROFEXISTINGDWELLINGUNITS(ifapplicable):N/ASQUAREFOOTAGEOFPROPOSEDRESIDENTIALBUILDINGS(ifapplicable):N/ASQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):N/ASQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIALBUILDINGS(ifapplicable):N/ASQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):N/ANETFLOORAREAONNON-RESIDENTIALBUILDINGS(ifapplicable):N/ANUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicable):N/APROJECTVALUE:$1,265,000.00ISTHESITELOCATEDINANYTYPEOFENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDESQUAREFOOTAGE(ifapplicable):ElAQUIFIERPROTECTIONAREAONEQAQUIFIERPROTECTIONAREAThVOElFLOODHAZARDAREA____sq.ft.ElGEOLOGICHAZARD____sq.ft.ElHABITATCONSERVATION____sq.ft.SHORELINESTREAMS&LAKES____sq.ft.ElWETLANDS_____sq.ft.LEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINTHESWQUARTEROFSECTION5,TOWNSHIP23,RANGE5,INTHECITYOFRENTON,KINGCOUNTY,WASHINGTONAFFIDAVITOFOWNERSHIPDdtedsignedthisinstrumentandpurpoementtdnedininsrument.expires:I3J:\2017ProjectFiles\174041-GeneCoulonParkStructRepairs\F.Permits\O1_Applications\GeneCoulon_RentonMasterApplication_1O.18.17docxRev:08/2015