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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division C;R
7.055 South Grady Way, 6th Floor I Renton, WA 98057 J 425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME:
t inJ
ADDRESS:
-StI-P ri. Z
CITY: STATE: ZIP:
PHONE NUMBER:
EMAILADDRESS' ► F. C h�'ri� ►c. , l . t._tr E
❑ I Prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable);
ADDRESS:
CITY: I STATE: I ZIP:
PHONE NUMBER:
EMAIL ADDRESS":
❑ f prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME:
L. A,,l 0 A �1 PtG til l
COMPANY (if applicable):
l� 1 A
ADDRESS:
.L3z> S�
CITY: STATE=Izllgp�
U
PHONE NUMBER
Q 6 - e 5f) -- -7 c �I
EMAIL ADDRESS':C�o��n ;e r• JP VJDt� - { .tom
El refer to receive al bo es ndence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
4 (& rr(Z f? -b" -Pk) 4 L_.
PROJECT[ADDRESS(S)!LOCATION AND ZIP CODE:
5110 `L$r'04 8T
i?et1+0- 61Aa59
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
c--�--
PROPOSED LAND USE(S):
t.5 1'7 Lwt� (—
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAF
DESIGNATION (if applicable)
EXISTING ZONING:
rQ-�v
PROPOSED ZONING (if applicable):
SITE AREA (in square feet):
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS: .
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
NUMBER OF EXISTING DWELLING UNITS (if applicable):
PROJECT VALUE:
*By completing the email address field the owner/applicanticontact 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}:
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN {if applicable}:
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable):
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicable):
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
vrEacn ie at aescri tion 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)_ Pne_w n..,) �f�° &,n;4Lsdeclare under penalty of perjury under the laws of the State of Washington that I
am (please check one) [�ie owner
current of the property involved in this application or ❑ the 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 true and correct to the best of my knowledge and belief.
031 0� po ao, �
Sign r f Owner/Representative Date Signature entative Daof Own Re este
STATE OF WASHINGTON )
} SS
COUNTY OF KING } J
I certify that I know or have satisfactory evidence that
acknowledge if to be hisAw/their free and voluntary act for the u and pu
k�
V(G�/1 ;W 2 ol r
1111
Dated ►� CLEO, fit N tary Publ'
V.s ., 0 ; Not ry {Print);
pti8�'tCl ti 0 �_
appointment expires:
1111J, OF
�� iY�i signed this instrument and
ase me an in �� i �t ment.
for the StaTe of Wing n
' , aVe t,