HomeMy WebLinkAboutA_Land Use Master App_250909_v1.pdfCITY OF RENTON I PERMIT SERVICES
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Washington State Department of Transportation
MAILING ADDRESS: 15700 Dayton Ave N, Shoreline, WA 99133
prefer to receive all correspondence via US mail.
APPLICANT (if other than owner)
NAME: Amy Oppfelt
PHONE: 206-440-4529
MAILING ADDRESS: 15700 Dayton Ave N, Shoreline, WA 98133
71 1 prefer to receive all correspondence via US mail.
CONTACT PERSON
NAME: Amy Oppfelt
PHONE: 206-440-4000
EMAIL: nwpublicaffairs@wsdot.wa.gov
COMPANY (if applicable): WSDOT
EMAIL: amy.oppfelt@wsdot.wa.gov
COMPANY (if applicable): WSDOT
PHONE: 206-440-4529 EMAIL: amy.oppfelt@wsdot.wa.gov
MAILING ADDRESS: 15700 Dayton Ave N, Shoreline, WA 98133 1
I prefer to receive all correspondence via US mail.
PROJECT INFORMATION
PROJECTOR DEVELOPMENT NAME: NWR South 23 - 25 Pavement Repair Project XL6747
PROJECT/ADDRESS(ES) AND PARCEL NUMBERS: WSDOT Right -of -Way SR 167 and SR 515
EXISTING LAND USE(S): Public Highway PROPOSED LAND USE(S): N/A I
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION: N/A
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable): N/A
EXISTING ZONING: WSDOT Right -of -Way
SITE AREA (in square feet): 548,100 square feet
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE DEDICATED: N/A
PROPOSEDZONING: N/A
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable): N/A
NUMBER OF PROPOSED LOTS (if applicable): N/A
NUMBER OF NEW DWELLING UNITS (if applicable): N/A
NUMBER OF EXISTING DWELLING UNITS (if applicable): N/A
PROJECT VALUE: $ 1
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable): N/A
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LAND USE PERMIT MASTER APPLICATION
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable): N/A
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if applicable): N/A
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW PROJECT (if applicable): N/A
IS THE SITE LOCATED IN ANY TYPE OF ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE SQUARE FOOTAGE (if applicable):
❑ AQUIFER PROTECTION AREA ONE ❑ AQUIFER PROTECTION AREA TWO
❑ FLOOD HAZARD AREA
❑ GEOLOGIC HAZARD
❑ HABITAT CONSERVATION
LEGAL DESCRIPTION OF PROPERTY
SQ. FT. ❑ SHORELINE STREAMS & LAKES
SQ. FT. ❑ WETLANDS
SQ. FT.
(Attach legal description on separate sheet with the following information included)
181)
SITUATE IN THE
QUARTER OF SECTION , TOWNSHIP
W.M IN THE CITY OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
SQ. FT.
SQ. FT.
N, RANGE 05 E
I, (Print Name/s) Amy Oppfelt , 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 rn l wledge nd elief., I
Signature of OwnerMepresentative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
h1411JU MSIZ41IM
I certify that I know or have satisfactory evidence that � WV Lll V O A'( 1 I— signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
ZrJ Z
Dated
Notary Public in and for tWState of Washington
-IU152-R)ttI oG,�
Notary (Print):
My appointment expires: r i u wck f 2o2-7
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