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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 I 425-430-7200
www.rentonwa.gov
e
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: PROJECT OR DEVELOPMENT NAME:
0 1N&iH-o.1-0. Vrnu( res '\c.lbi..Ce....
ADDRESS: PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE: 4'2-+ (A)1 l\..)D$ofl-_. c,..Ay ~.:. e_& .. fU,N wA, q'(pSb
PHONE NUMBER: KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S}:
. t/'c,c'.; c:x:;,16
EMAIL ADDRESS•:
0..1 refer to receive all corres ondence via US Mail.
APPLICANT (if other than owner) EXISTING LAND USE(S):
P .i:s ,o-c:11. ·, u= S 1NS.l~ '.FAM\ 1 V
PROPOSED LAND USE(S):
'Stl'fG,_1 C I=' A-MI l., I/ I?..£ .S, D'f £.
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
ZIP: %l Ii,
EXlf lNG ZONING: -~
PHONE NUMBER: PROPOSED ZONING (if applicable): n,
EMAIL ADDRESS•: \L. '.\ u._fQ,cnCi\,c.. «'j
D I refer to receive all cor ail.
SITE AREA (in square feet): G, 600
CONTACT PERSON SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED: tJ/ A,
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable) NIA
NUMBER (?_!;·PROPOSED LOTS (if applicable) N ,1 A-:
NUMBER OF NEW DWELLING UNITS (if applicable):
fJ /.A •
NUMB:r, 0~ EXISTING DWj:UING UNITS (if applicable):
EMAIL ADDRESS•: D I refer to receive all corre
PR~lCT VALUE: .
' -~Oo, o b .o ; oo
*By completing the email address field the owner/applicant/contact person 1s optmg to receive all formal 1.1. . . . . . . . no 1 1cat1ons and project documents m d1g1tal format via email unless otherwise requested.
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL IS THE SITE LOCATED IN ANY TYPE OF
BUILDINGS (if applicable): 'o6 \ 5 ,::,, ,t.+ ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): / Pr AQUIFER PROTECTION AREA ONE
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL AQUIFER PROTECTION AREA TWO
BUILDINGS (if applicable): /v/A FLOOD HAZARD AREA __ sq.ft.
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): ,J / A GEOLOGIC HAZARD __ sq.ft.
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if HABITAT CONSERVATION __ sq.ft.
applicable): 'tJ ,~ SHORELINE STREAMS & LAKES __ sq.ft.
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicable): N/Pr WETLANDS __ sq.ft.
LEGAL DESCRIPTION OF PROPERTY
Attach le al descri tion on se arate sheet with the followin information included
SITUATE IN THE ____ QUARTER OF SECTION , TOWNSHIP N, RANGE ,WM. IN THE CITY OF RENTON, KING COUNTY, WASHINGTON -------
AFFIDAVIT OF OWNERSHIP
I, (Print Namels)l/llf I ~>D8/'.O1f2. 8NGJ!l '.JJ~.~eclare under penalty of perjury under the laws of the State of Washington that I
am (please check one) 0,.the current owner oft~ property involved in this application or D 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.
Signa~re of~
STATE OF WASHINGTON ) ) ss
COUNTY OF KING )
Date
L
Date
I certify that I know or have satisfactory evidence that f{f!({l/,f D&t:/J/4(5(af, J:;t cl-I fl ,-ii ,11-{(g~t.\ Y~nstrument and
acknowledge 11 to be h1s/her/their free and voluntary act for the uses and purpo6l) J2ll!ll1oned in the instrument
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Dated / ••• •····{li-475,r•··~:,,~.,, --;-;N-J.6t:::a=-ry~P~'t:1ct,~n~a.,cnd7-;-fo--'r~th-e'S~ta--:te-of==W=as=h-In-g---,t€~n---------• .. ·····~~
{ ( NO!.~Rr \ \ Ht-LK cZINoEg <;' l<A Lc:Lf • ;g_ PLJ C ~! i Notary (Pnnt):
\~\~ BU ~'"/ § ':,., ·-:'J'.r. <${_?$ $ ':. ~···'!?3/ EXPl~\~ •• •6~ •• My appointment expires: ,,,,,,,~1: WAS\-\,'!,,,,,• ,,,,,,,11uu••"
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