HomeMy WebLinkAboutA_Master_Application_180919_v1DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
NAME : "tl,. 4 W!Ki 'o. ~C<JS _-lt: Q
ADDRESS :
5
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE :
7ACP Qw-nt4 4. n Qaos1
TELEPHONE NUMBER :
KING COUNTY ASSESSOR 'S ACCOUNT NUMBER(S):
o o
APPLICANT (if other than owner)
NAME :
EXISTING LAND USE(S):
0
PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
ADDRESS :
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
ZIP : (if applicable)
TELEPHONE NUMBER:
EXISTING ZONING:
CONTACT PERSON PROPOSED ZONING (if applicable);,
I' •
SITE AREA (in square feet):
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
COMPANY (if applicable): "\~<tV.. DEDICATED :
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
ADDRESS :
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
-
TELEPHONE NUMBER AND EMAIL ADDRESS : NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
1
H :\CED\Data\Forms-Templates\Self-Help Handouts\Pianning\Master Application .doc Rev : 08/2015
RECEIVED
09/20/2018 jtaylor
PLANNING DIVISION
PROJECT INFORMATION (continued) .----------------------------------------, .---~----------~-----------------------,
NUMBER OF EXISTING DWELLING UN ITS (if applicable):
SQUARE FOOTAGE OF PROPOSED R ESIDENTIAL
BUILDINGS (if appli cable):
SQUARE FOOTAGE OF EXISTING RES IDENTIAL
BU ILDINGS TO REMAIN (if applicable ):
SQUARE FOOTAGE OF PROPOSED NON -RESIDENTIAL
BUILDINGS (if applicab le ):
SQUARE FOOTAGE OF EXISTING NON -RESIDENTIAL
BUILDINGS TO REMAIN (if appl icable):
NET FLOOR AREA ON NON -RESIDENTIAL BUILDINGS (if
applicabl e):
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PROJECT (if appl icable):
-----------------------------------------'
PROJECT VALUE :
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA , PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
0 AQUIFIER PROTECTION AREA ONE
0 AQUIFIER PROTECTION AREA TWO
0 FLOOD HAZARD AREA __ sq . ft .
0 GEOLOGIC HAZARD __ sq . ft .
0 HABITAT CONSERVATION __ sq . ft.
0 SHORELINE STREAMS & LAKES __ sq . ft.
0 WETLANDS __ sq . ft .
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the followin information included
SITUATE IN THE __ QUARTER OF SECTION __ , TOWNSHIP_·_, RANGE __ , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I , (Print N~fsf.':~' ;f1ff'/crare unde r penalty of perjury under the laws of the State of Wash ington that I am (please check one) 0 the
current pwner of the 'property involved in this application or 0 the authorized representative to act for a corporation (please attach proof
of authorization) and that th e foregoing state ments and answers he rein contained and the information herewith are in all respects true
and correct to the best of my knowledge and bel ief.
Signature of Owner/Representative S ignature of Owner/Representative Date
STATE OF WASHINGTON)
) ss
COUNTY OF KING )
I certify that I know or have satisfactory evidence that CJ5c.tl/V ~ ~ . signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purp~ned m the instrument.
:o-.'''''""'''''' ~ ........... ~QRA J ,,,, a,{Cf-Z.Ol ~ .:::-C.,~''''"'"11 1t,,· Jr.,~ Ill
___ _._1---'-----'--------------~:r--.:::-""'' ~sSION '''' '~ 'l --~-..c::.----=--....::....:.--,c-\-=~.::....:.==---------------------
Dated E /'o~~~OT-4~ ~+.;:"--,., ~ Notary Public in and fort -; ::(.) .,.,.(. .,~ ~
~ ~ "'-e.._ ~~ ~ ~ I J t ~ ~H .o,_ r ff ~ U q_r.J.nt-::T -t-UfL.1 r '/. ...., ~ "8 L\V --='--=..:......:..._ __________________________________ _
~ "/. ,,,,8.1 " ;=0~ E Notary (Print): 'l ~ ,,,, 9-1--:> , ...... " -II 0 11 1111\\\\\'''' 0 ..:::-
111 'f::' w sr\''~ $" 1ftt 111 A ,&appointment expires : 1\\ ,,,,
2
H:\CED\Data\Forms -Templates\Self-Help Handouts\Piann i ng\Master Appl ication .doc Rev : 08/2015