HomeMy WebLinkAboutA_Land_Use_Master_Application_201005_v1DEPARTMENT 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)
I SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
IS THE SITE LOCATED IN ANY TYPE OF I
ENVIRONMENTALLy GRIT I CAL AREA .. PLEI\SE INCLUDE I
SQUARE FOOTAGE (if applicable):
0 AQUIFER PROTECTION AREA ONE I
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable):
0 AQUIFER PROTECTION AREA TVoJO
0 FLOOD HAZARD AREA l __ sq. ft .,
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
I
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable):
0 GEOLOGIC HAZARD
0 HABITAT CONSERVATION
__ sq. ft. I.
__ sq. ft.
I
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE '
NEW ~ROJECT (if applicable): . __ __j
EJ SHORELINE STREAMS & LAKES
0 WETLANDS
LEGAL DESCRIPTION OF PROPERTY
~~799 sq. ft.
__ sq ft.
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE NW QUARTER OF SECTION 32 , TOWNSHIP 24 N, RANGE 5 E ,VV.M. IN THE CITY
OF RENTON, KING COUNTY. WASHINGTON -------
I AFFIDAVIT OF OWNERSHIP
-g,r ;s+ow
I, (Print Name/s) Gregory Perotto & Kristopher -Sftnjeclare under penalty of perjury under the laws of the State of Washington that I
am (please check one} 0 the current owner of the property involved in this application or 0 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.
I
(~P.A~. I 0~ _______._]/ 1:.)'207-0 ~~ner/~ve Oat Signature of Owner/Representative
. _,/lsj'].o-zD ~
T t.to ~~A .crs -----------------------------------Notary (Print):
My appointment expires: 04/4?~7-J ; ~ ----1-. -~----------