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Home My WebLink AboutA_Master_Application_Land_Use_Form_Sams_Club_UST_Removal_Project_180713_v1.pdfDEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT Planning Division ' 1055 South Grady Way, 6th Floor I Renton, WA 98057 425-430-7200 www.rentonwa.gov LAND USE PERMIT MASTER APPLICATION PROPERTY OWNER(S) NAME: Sams West, Inc ADDRESS: 2101 Simple Saving Drive CITY: ZIP: Bentonville 72716 TELEPHONE NUMBER: 479-277-9639 APPLICANT (if other than owner) NAME: Russell Morgan COMPANY (if applicable): NRC Environmental Services ADDRESS: 9520 10th Ave S Ste 150 CITY: ZIP: Seattle 98108 TELEPHONE NUMBER: 206-607-3000 CONTACT PERSON NAME: Russell Morgan COMPANY (if applicable): NRC Environmenal Services ADDRESS: 9520 10'h Ave S Ste 150 CITY: ZIP: Seattle 98108 TELEPHONE NUMBER AND EMAIL ADDRESS: 503-849-0753 rmorgan@nrcc.com PROJECT INFORMATION PROJECT OR DEVELOPMENT NAME: Sam's Club UST Removal Project PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE: 901 South Grady Way Renton, WA 98057 KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S): Parcel #2023059007 EXISTING LAND USE(S): Commercial Fuel Center PROPOSED LAND USE(S): Commercial Parking lot EXISTING COMPREHENSIVE PLAN MAP DESIGNATION: PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable) NA EXISTING ZONING: C PROPOSED ZONING (if applicable): NA SITE AREA (in square feet): 8,000 SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE DEDICATED: NA SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS: NA PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable) NA NUMBER OF PROPOSED LOTS (if applicable) NA NUMBER OF NEW DWELLING UNITS (if applicable): NA NUMBER OF EXISTING DWELLING UNITS (if applicable): NA SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable): NA SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable): NA SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL BUILDINGS (if applicable): NA SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable): 136918 NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if applicable): NA NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW PROJECT (if applicable): NA PROJECT VALUE: 10, 849 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 _ sq. ft. ❑ GEOLOGIC HAZARD _ sq. ft. ❑ HABITAT CONSERVATION _ sq. ft. ❑ SHORELINE STREAMS &LAKES sq. ft. ❑ WETLANDS _ sq. ft. LEGAL DESCRIPTION OF PROPERTY Attach legal description on separate sheet with the following information Included) 1111101111114 SITUATED IN THE NW QUARTER OF SECTION 20, TOWNSHIP 23, RANGE 5, IN THE CITY OF RENTON, KING COUNTY, WASHINGTON AFFIDAVIT OF OWNERSHIP I, (Print Name/s)\ 1M S WOitNc , 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 orKtthe 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 r cis true and correct to the best of myykknowledge and belief. / 45 Si n ture of Owner/Representative Date Signature of Owner/Representative Date STATE OF WASHINGTON SS COUNTY OF KING I certify that I know or have satisfactory evidence that � �'nM R SI N'Im 0413 signed this instrument and acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument. �p Dated - Q`!',••H E%pr rh H OtPRY z V PU6" i�////tIgTE OF� �r/�lotary Public in angor the State of Washington J l¢Je;r I'tary (Print): Fitment expires: