HomeMy WebLinkAboutA_Land_Use_Permit_Master_Application_190724_v1.pdfDEPARTMENT OF COMMUNITY
Renton ciTv of
AND ECONOMIC DEVELOPMENT 11 l
1� eY1®1�11 %ij+
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME:
,
ADDRESS: 3 4 zo NC-- -4 T V`C'S f
CITY: I Wy, \ U V \ ZIP:
TELEPHONE NUMBER:
APPLICANT (if other than owner)
NAME: av) O
COMPANY (if applicable): L
ADDRESS: Fj (-I Iry )(OD 1 CJ IN Gam/
CITY: ZIP:
TELEPHONE NUMBER: a C— 3-72 -TJ;'
CONTACT PERSON
NAME: v,J
COMPANY (if applicable):
ADDRESS: t 9 l 1 n I p' , 1 DkL !� qT h I �F
CITY: p �'j I�S� 1ZIP: q 91(71 5-6
TELEPHONE NUMBER AND EMAIL AD7RESS:
V13 115 2 @ ko-tmcLj .CrM
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
PROPOSED LAND USE(S):
F
TING COMPREHENSIVE PLAN MAP DESIGNATION:POSED COMPREHENSIVE PLAN MAP DESIGNATIONplicable)TING ZONING:
PROPOSED ZONING (if applicable):
SITE AREA (in square feet):
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 08/2015
PROJECTINFOR
NUMBER OF EXISTING DWELLING UNITS (if applicable):
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):
MAT
ION continued
PROJECT VALUE:
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
❑ AQUIFIER PROTECTION AREA ONE
❑ AQUIFIER 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
Attach legal description on separate sheet with the following information included
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
1T�,,�,q V i¢A 1U).
I, (Print Name/s;) \,Ueclare 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 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 f nowledge and belief.
ZQJ
Signature wner/ presentative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
SS
COUNTY OF KING
I certify that I know or have satisfactory evidence that _
acknowledge it to be his/her/their free and voluntary act
signed this instrument and
purpose
Notary Public in alTd for the State of Washington
Notary
My appointment expires:
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 08/2015