HomeMy WebLinkAboutEx03_Modification_Application 566 Bronson.pdfOcl; � Co. +rdh
Asp 1i c-c--k—oP%
CITY OF RENTON I PERMIT SERVICES
' LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: A PHONE: 3 3 3
MAILING ADDR EMAIL: *VtA
prefer to receive all correspondence via aUUS-�mail.
APPLICANT (if other than owner)
NAME: COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
1 prefer to receive all correspondence via US mail.
CONTACT PERSON
NAME:Qd± eve_ . COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
rTl prefer to receive all correspondence via US mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME: flt' fADM
PROJECT/ADORESS(ES) AND PARCEL NUMBERS: 6 v
EXISTING LAND USE(S): PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable):
EXISTING ZONING,% PROPOSED ZONING:
SITE AREA (in square feet):
SQUARE FOOTAGE Of PUBLIC ROADWAYSTOBE DEDICATED:
i
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable):
NUMBER OF PROPOSED LOTS (if applicable):
NUMBER OF NEW DWELLING UNITS (if applicable): r
NUMBER OF EXISTING DWELLING UNITS (if applicable): PROJECT VALUE:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable):
rentonwa.gov/permitservices I pllanninitcustomerservice0grentonwa.gov 1 425-430-7294 10/24/2023 1 Page 1 of 2
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):
O AQUIFER PROTECTION AREA ONE ❑ AQUIFER PROTECTION AREA TWO
❑ FLOOD HAZARD AREA SQ. FT. ❑ SHORELINE STREAMS & LAKES
❑ GEOLOGIC HAZARD SQ. FT. ❑ WETLANDS
❑ HABITAT CONSERVATION SQ. FT.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information Included)
SITUATE IN THE
QUARTER OF SECTION_________, TOWNSHIP N, RANGE
W.M IN THE CITY OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
SQ. FT. I
SQ. FT.
I, (Print Name/s) 1n ^ declare under penalty of perjury under the laws of the State of
Washington that I am (peas eck one) tV 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 my knowledge and belief. , I
c I /Wh�Z
Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING
Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that ► L112 P. So signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the nd purpo mentioned in the instrument.
Dated �R At to' Notary Pu lic in and
G� 0tARy�i: i
u 579� % oz Notary (Print):
J' err ?• 1�.
appointment expires:
State of Washington
rentonwa,goV/o rmitservices I alanninitcystomerservice@rentonwa.ltov 1 425-430-7294 10/24/2023 1 Page 2 of 2