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A_Land_Use_Permit_Master_Application_Shoreline_Master_Program_Update
PROJECTINFORMATIONPROJECTORDEVELOPMENTNAME:2018SMPPeriodicReviewPROJECT/ADDRESS(S)/LOCATIONANDZIPCODE:ShorelinesoftheStateKINGCOUNTYASSESSOR’SACCOUNTNUMBER(S):N/AEXISTINGLANDUSE(S):N/APROPOSEDLANDUSE(S):N/AEXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:N/APROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable)EXISTINGZONING:N/APROPOSEDZONING(ifapplicable):SITEAREA(insquarefeet):N/ASQUAREFOOTAGEOFPUBLICROADWAYSTOBEDEDICATED:NIASQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:N/APROPOSEDRESIDENTIALDENSITYINUNITSPERNETACRE(ifapplicable)NUMBEROFPROPOSEDLOTS(ifapplicable)N/ANUMBEROFNEWDWELLINGUNITS(ifapplicable):N/APrintForm4hResetFormSaveFormiDEPARTMENTOFCOMMUNITY&ECONOMICDEVELOPMENTPlanningDivision1055SouthGradyWay,6thFloorIRenton,WA980571425-430-7200www.rentonwa.govLANDUSEPERMITMASTERAPPLICATIONL4A1too2,t,PROPERTYOWNER(S)NAME:N/AADDRESS:CITY:ZIP:TELEPHONENUMBER:APPLICANT(ifotherthanowner)NAME:CityofRentonCOMPANY(ifapplicable):CEDDept.ADDRESS:1055SouthGradyWayCITY:RentonZIP:98057TELEPHONENUMBER:(425)430-7436CONTACTPERSONNAME:PaulHintzCOMPANY(ifapplicable):CEDDept.ADDRESS:1055southGradyWayCITY:ZIP:TELEPHONENUMBERANDEMAILADDRESS:1H:\CED\Data\Form5-Templates\Self-HeIpHandouts\Planning\MasterApplication.docRev:10/2017 PROJECTINFORMATION(continued)NUMBEROFEXISTINGDWELLINGUNITS(ifapplicable):PROJECTVALUE:N/AN/ASQUAREFOOTAGEOFPROPOSEDRESIDENTIALISTHESITELOCATEDINANYTYPEOFBUILDINGS(ifapplicable):ENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDE___________________________________________________SQUAREFOOTAGE(ifapplicable):SQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):ciAQUIFERPROTECTIONAREAONESQUAREFOOTAGEOFPROPOSEDNON-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/s)________________________________________________,declareunderpenaltyofpeijuryundrhlawsoftheStateofWashingtonthatIam(pleasecheckone)thecurrentownerofthepropertyinvolvedinthisapplicationortheauthorizedrepresentativetoactfracorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheinrmationherewithareinallrspectstrueandcorrecttothebestofmyknowledgeandbelief.SignatureofOwner/RepresentativeDateSignatureofOwner/RepresentativeDateSTATEOFWASHINGTON)SSCOUNTYOFKINGIcertifythatIknoworhavesatisfactoryevidencethat________________________________________signedthisinstrumentandacknowledgeittobehis/her/theirfreeandvoluntaryactfortheusesandpurposementionedintheinstrument.DatedNotaryPublicinandfortheStateofWashingtonNotary(Print):Myappointmentexpires:________________________________________________2H:\CED\Data\Forms-Iemplates\SeIf-HelpHandouts\Planning\MasterApplication.docRev:10/2017