HomeMy WebLinkAboutA_Master Application - Olympic Renton Ave S. Project signed & notarizedDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor | Renton, WA 98057 | 425-430-7200
www.rentonwa.gov
*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.
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: PROJECT OR DEVELOPMENT NAME:
ADDRESS: PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
CITY: STATE: ZIP:
PHONE NUMBER: KING COUNTY ASSESSOR’S ACCOUNT NUMBER(S):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)EXISTING LAND USE(S):
NAME: PROPOSED LAND USE(S):
COMPANY (if applicable): EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
ADDRESS: PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
CITY: STATE: ZIP: EXISTING ZONING:
PHONE NUMBER: PROPOSED ZONING (if applicable):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
SITE AREA (in square feet):
CONTACT PERSON SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
NAME: SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
COMPANY (if applicable): PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
ADDRESS: NUMBER OF PROPOSED LOTS (if applicable)
CITY: STATE: ZIP: NUMBER OF NEW DWELLING UNITS (if applicable):
PHONE NUMBER NUMBER OF EXISTING DWELLING UNITS (if applicable):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
PROJECT VALUE:
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): applicable
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): applicable
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable): Not applicable
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): applicable
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable): applicable
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicable): applicable
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable): Not applicable
• AQUIFER PROTECTION AREA ONE
• AQUIFER PROTECTION AREA TWO i
• FLOOD HAZARD AREA sq. ft.
• GEOLOGIC HAZARD ' sq. ft.
• HABITAT CONSERVATION sq. ft.
• SHORELINE STREAMS & LAKES sq. ft.
• WETLANDS sa. ft.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE NE . QUARTER OF SECTION 13 , TOWNSHIP 23 N, RANGE _4E_
OF RENTON, KING COUNTY, WASHINGTON and NW 1/4 Sec 18, T23N, R4E
AFFIDAVIT OF OWNERSHIP
,W.M. IN THE CITY
I, (Print Name/s) Tim Dunn , declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) O the cunrent owner of the property involved in this application or Q 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 con-ect to the best of my knowledge and belief
July 23, 2020
Signature of Owner/Representative 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 for the uses and purpose mentioned in the instrument
Date
. signed this instalment and
Datec
JOSEPH A STONE
NOTARY PUBLIC
STATE OF WASHINGTON I
COMMISSION EXPIRES
AUGUST 22,2021
and for the State of Washington
Notary (Print):
My appointment expires: A