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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT L;R
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 1 425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Glacial Ventures II LLC
ADDRESS:18300 Redmond Way, Suite 140
CITY: Redmond
STATE:
WA
ZIP:
98052
PHONE NUMBER:
EMAIL ADDRESS*:admin@bluefern.com
❑ I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable) -
'Glacial Ventures 11 LLC
ADDRESS:18300 Redmond Way, Suite 140
CITY: Redmond
STATE:
WA
ZIP:
98052
PHONE NUMBER:
EMAIL ADDRESS*:
❑ I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: Holli Heavrin
COMPANY (if applicable):
Core Design, Inc.
ADDRESS:12100 NE 195th Street, Suite 300
CITY. Bothell
STATE:
WA
ZIP:
98011
PHONE NUMBER (425) 885-7877
EMAIL ADDRESs*:HHH@coredesigninc.com
❑ I prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
Canopy Boundary Line Adjustment
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
2020 NE 40th Street and 4006 Lincoln Avenue NE, Renton,
WA 98056
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
334570-0017 and 334570-0019
EXISTING LAND USE(S):
PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
R-8
PROPOSED ZONING (if applicable):
N/A
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/applicant/contact 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
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE NE QUARTER OF SECTION 32 TOWNSHIP 24 N, RANGE 5 _,W.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) I " 1Q0 , declare under penalty of perjury unde 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 knowledge and belief.
}
Signature of Owner/Repres tative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING 1
I certify that I know or have satisfactory evidence that koc * QAM&g� signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and pdrl5ose mentioned in the instrument.
Dated
C2 • a 3 -a0a a
MICHELLE K BRANLCY
Notary Public
State of Washington
Commission # 176727
My Comm. Expires Feb 10, 2023
Notary Public in and for the 'State of Washington U
R'c,�J/e, Kl
Notary (Print):
My appointment expires: TCJ010 1�0a.J