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DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 980571425-430-7200 ;
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Robert Harrison (City of Renton)
ADDRESS: 1055 S Grady Way
CITY: Renton, WA ZIP: 98057
TELEPHONE NUMBER: (435) 430-6500
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER:
CONTACT PERSON
NAME: ROSS Widener
COMPANY (if applicable): Widener & Associates
ADDRESS: 1902 120th PI SE, Ste 202
CITY: Everett, WA ZIP: 98208
TELEPHONE NUMBER AND EMAIL ADDRESS:
(425) 332-3961
rwidener@prodigy.net
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
2018 Street Patch & Overlay with Curb Ramps
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
47.481241, -122.203044
98057
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
N/A
EXISTING LAND USE(S):
Legal right-of-way (ROW)
PROPOSED LAND USE(S):
Legal ROW
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
CMU - Commercial Mixed Use
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
N/A
EXISTING ZONING:
CD - Center Downtown
PROPOSED ZONING (if applicable):
N/A
SITE AREA (in square feet):
63,943.8 SF
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
0 SF
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
0 SF
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
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017
PROJECT INFORMA
NUMBER OF EXISTING DWELLING UNITS (if applicable):
N/A
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): N/A
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
TION continued
PROJECT VALUE -
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
L] AQUIFER PROTECTION AREA ONE
Ll AQUIFER PROTECTION AREA TWO
ZI FLOOD HAZARD AREA 987.6 sq. ft.
LJ GEOLOGIC HAZARD sq. ft.
U HABITAT CONSERVATION sq. ft.
J SHORELINE STREAMS & LAKES 21,778 sq. ft.
L3 WETLANDS sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
SITUATE IN THE NW QUARTER OF SECTION 17 , TOWNSHIP 23N , RANGE 5E , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Robert Harrison declare under penalty of perjury under the laws of the State of
ZeuWashington that I am (please check one) ✓ the ` involved in this application or U the authorized
representative to act for a corporation (please attach proof of authorization) and that the foregoing statements and answers herein
conta' d and the information herewith are in all respects true and correct to the best of my knowledge and belief.
Signature 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 e ii fwk H Qm�sj, } signed this instrument and
acknowledge it to be his/her/their free and voluntary act or the uses and purpose mentioned in the instrument.
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
SITUATE IN THE NW QUARTER OF SECTION 17 , TOWNSHIP 23N , RANGE 5E , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Robert Harrison declare under penalty of perjury under the laws of the State of
ZeuWashington that I am (please check one) ✓ the ` involved in this application or U the authorized
representative to act for a corporation (please attach proof of authorization) and that the foregoing statements and answers herein
conta' d and the information herewith are in all respects true and correct to the best of my knowledge and belief.
Signature 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 e ii fwk H Qm�sj, } signed this instrument and
acknowledge it to be his/her/their free and voluntary act or the uses and purpose mentioned in the instrument.
LA
Dated ��`.��w�Hia "It/
' f f/ Notary Pu lic in
ggtON Il
F11 //
for the State of Washington
r �
i,
Z7 Fo
Notary (Print):
/ N�A g AUB00'
'-Z.: My appointment expires:
/ 111111N\������
v
0 1WA;�\? � 2
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017