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A_Master Application_180601_v1
PrintFormResetFormSaveFormDEPARTMENTOFCOMMUNITY&ECONOMICDEVELOPMENTPlanningDivision1055SouthGradyWay,6thFloorIRenton,WA980571425-430-7200www.rentonwa.govLANDUSEPERMITMASTERAPPLICATIONPROPERTYOWNER(S)_________________________NAMiE\I6TThIeTre4ZeMrniADDRESS:1(3G(z9TJ\VeSECflV:ZIP:TELEPHONENUMBEI(OLJ3’3_9APPLICANT(ifotherthanowner)______________________________NAME:COMPANY(11applicable):ADDRESS:CITY:ZIP:TELEPHONENUMBER:CONTACTPERSONNAMEThm½N+4-j%.,4L______ _ _ _ _ _ _ _ ____________COMPANY(ifapplicable):ADDRESS:)GIZ9TlvC-SECITY:ZIP:TLEPHONENUMBERANDEMAILADDRESS:(zoo3a’y-ZciLI________________________±MP2ept,a1L‘eMSW._____________________1‘1PROJECTINFORMATIONPROJECTORDEVELOPMENTNAME:e±jCIVALCcE‘&iWE1PROJECT/ADDRESS(S)/LOCATIONANDZIPCODE:IGG3G(aim%t-S’C.‘,WAi9gosg_sSeSKINGCOUNTYASSESSORSACCOUNTNUMBER(S):EXISTINGLANDUSE(S):PROPOSEDLANDUSE(S):EXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:PROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable)EXISTINGZONING:PROPOSEDZONING(ifapplicable):srwAREA(insquareffiet):SQUAREFOOTAGEOFPUBLICROADWAYSTOBEDEDICATED:SQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:PROPOSEDRESIDENTIALDENSITYINUNITSPERNETACRE(ifapplicable)NUMBEROFPROPOSEDLOTS(ifapplicable)NUMBEROFNEWDWELLINGUNITS(ifapplicable):H:\CED\Data\Forms-Templates\SeIf-HeIpHandoub\Planning\MasterApplication.docRev:10/2017 PROJECTINFORMATION(continued)NUMBEROFEXISTINGDWEWNGUNITS(ifapplicable):PROJECTVALUE:SQUAREFOOTAGEOFPROPOSEDRESIDEN11ALISTHESITELOCATEDINANYTYPEOFBUIWINGS(ifapplicable):ENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDE__________________________________________SQUAREFOOTAGE(ifapplicable):SQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):UAQUIFERPROTECTIONAREAONESQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIALUAQUIFERPROTECTIONAREATWOBUILDINGS(ifapplicable):_____________________________________UFLOODHAZARDAREA_ _ _ _ _sq.ft.SQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):UGEOLOGICHAZARD_ _____sq.ft.NETFLOORAREAONNON-RESIDENTIALBUILDINGS(ifUHABITATCONSERVATION_ _____sq.ft.applicable):USHORELINESTREAMS&LAKES_ _ _ ___sq.ft.NUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicable):UWETLANDS_ _____sq.ft.LEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINThE___ ___ __QUARTEROFSECTION___,TOWNSHIP___ ,RANGE___INThECITYOFRENTON,KINGCOUNTY,WASHINGTONAFFIDAVITOFOWNERSHIPI(PrintName.€,declareunderpenallyofperjuryundlawsoftheSlateofWashingtonthatIam(pleasecheckone).jt1ecurrentownerofthepropertyinvolvedinthisapplicationorttheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheinfonnationherewithareinallrespectstrueandcorrecttothebestofmyknowledgeandbelief.JJzx“.a-s/ia/iIreofOw43Repts9itativedate/SignatureofOwneriRepresentativeDateSTATEOFWASHINGTON))SSCOUNTYOFKINGmnoMqThWteHcvr&lIcertifythatIknoworhavesatisfactoryevidencethatTctrtWA?Y)TtHCtWit)signedthisinstrumentandacknowledgeittobehisTheritheirfreeandvoluntaryadforTheusesandpurposementionedintheinstrument.Hazjto,Wb4ua-UilqIDDatedNotaryPublicinandfortheStateofWashington__ __7.ownMJIaKt,)roAwNULLAKKO________________________________________NOTARYPUBLICNotary(Print):STATEOFWASHINGTONcoMMISSIONEMyappointmentexpires:______________________________________________2H:\CED\Data\Forms-Templates\Self-HelpHandouts\Planning\MasterApplication.docRev:10/2017