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Home My WebLink AboutA_Land Use Master Application_2019_190306.pdfPrint Form I Reset Form ] Save Form x „ • DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT 3. Planning Division 1055 South Grady Way, 6th Floor I Renton, WA 98057 425-430-7200 ` www.rentonwa.eov LAND USE PERMIT MASTER APPLICATION PROPERTY OWNER(S) NAME: Nelson Gould ADDRESS: 10620 NE 174th Place CITY' Bothell, WA STAATE: ZIP: W 198011 PHONE NUMBER: EMAIL ADDRESS': ❑ Irefer to receive all correspondence via US Mail. APPLICANT (if other than owner) NAME Don Ikeler COMPANY (if applicable):ChICk-fll-A, Inc ADDRESS: 15635 Alton Parkway Suite 350 CITY: STATE: STATE: ZIP: CA 192619 PHONE NUMBER: (949) 923-8243 EMAIL ADDRESS': ❑ I prefer to receive all correspondence via US Mail. CONTACT PERSON NAME' Carlos Arias COMPANY (if applicable), 4G Development & Consultir ADDRESS P.O. Box 270571 CITY' San Diego ST TE' 19ZI2198 PHONE NUMBER (951) 970-9138 EMAIL ADDRESS':carias@4gdev.com ❑ I prefer to receive all correspondence via US Mail PROJECT INFORMATION PROJECT OR DEVELOPMENT NAME- Chick-fil-A, Inc PROJECT/ADDRESS(S)!LOCATION AND ZIP CODE: 361 Rainier Ave S Renton, WA 98055 KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S): 007200149;007200215;0007200151 EXISTING LAND USE(S): Restaurant building and parking lot. PROPOSED LAND USE(S): New commercial restaurant with drive-thru EXISTING COMPREHENSIVE PLAN MAP DESIGNATION: n/a PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable) EXISTING ZONING: CA commercial arterial PROPOSED ZONING (if applicable): n/a SITE AREA (in square feet): 41,308 square feet SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS: n/a SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE DEDICATED: n/a PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable) NUMBER OF PROPOSED LOTS (if applicable) 3 NUMBER OF NEW DWELLING UNITS (if applicable): NUMBER OF EXISTING DWELLING UNITS (if applicable): PROJECT VALUE: $1.1 million *By completing the email address field the owner/applicant/contact person is opting to receive all formal notifications and project documents in digital format via email unless otherwise requested. PROJECT INFORMATION (CONTINUED) SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable): SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable). SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL BUILDINGS (if applicable): 4,195 square feet SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable). a NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if applicable): NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW PROJECT (if applicable) tbd 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 5q. 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) SITUATE IN THE QUARTER OF SECTION TOWNSHIP N, RANGE _,W.M. IN THE CITY OF RENTON, KING COUNTY, WASHINGTON AFFIDAVIT OF OWNERSHIP I. (Print Namels) . 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 orthe 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 respects truand correct to the best of my knowledge and belief. — � '1A Si of wn rlRe STATE SHING' COUNTY OF KING ve IDate SS Signature of Owner/Representative Date I certify that I know or have satisfactoryrice that signed this instrument and acknowledge it to be hislherltheir free and vola qd for the uses and purpose mentioned in the instrument Dated Notary Pum and fo�4he State of Washington Notary (Print),. My appointment expires: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of �I'2.�'-�IJG� r)�, On A C)%41 ZO l °I before me, r.� t C� C 1 � Date Here Insert Name and Title of the Officer personally appeared �/�-�' 11FM Eg== Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/site/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is true and -cored. BETH E WIiT(WITNESS my hand d official seal. Commission # 2138085 z Notary Public - California Orange County Signature M Cnmm ExPIMODC22.2019t Signature of Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — Limited ❑ General ❑ Individual ❑ Attomey in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner -- ❑ Limited General ❑ Individual ❑ Attomey in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907