HomeMy WebLinkAboutLand Use Permit Master Application Form_PSE Gas Main Ext_149th Ave SEDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
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Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: City of Renton ROW PROJECT OR DEVELOPMENT NAME:
PSE Gas Main Extension for Verizon Wireless
ADDRESS:
N/A
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
15214 149th Ave SE
CITY: N/A ZIP: N/A
TELEPHONE NUMBER: N/A KING COUNTY ASSESSOR’S ACCOUNT NUMBER(S):
232305-9070
APPLICANT (if other than owner)
NAME: Julie Nelson EXISTING LAND USE(S): Single Family Residential
COMPANY (if applicable):
Puget Sound Energy, Inc.
PROPOSED LAND USE(S): N/A
ADDRESS:
PO Box 97034, PSE-09N
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
Residential Low Density
CITY:
Bellevue
ZIP:
98009-9734
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable) N/A
TELEPHONE NUMBER: 425-457-5216 EXISTING ZONING: RC-Resource Conservation
CONTACT PERSON PROPOSED ZONING (if applicable): N/A
NAME: Julie Nelson SITE AREA (in square feet): N/A
COMPANY (if applicable):
Puget Sound Energy, Inc.
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED: N/A
ADDRESS:
PO Box 97034, PSE-09N
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
N/A
CITY:
Bellevue
ZIP:
98009-9734
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable) N/A
TELEPHONE NUMBER AND EMAIL ADDRESS:
425-457-5216
julie.nelson@pse.com
NUMBER OF PROPOSED LOTS (if applicable)
N/A
NUMBER OF NEW DWELLING UNITS (if applicable):
N/A
PROJECT INFORMATION (continued)
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NUMBER OF EXISTING DWELLING UNITS (if applicable):
N/A
PROJECT VALUE:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): N/A
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): N/A
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.
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): N/A
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable): N/A
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PROJECT (if applicable): N/A
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE SW QUARTER OF SECTION 23, TOWNSHIP 23, RANGE 5, IN THE CITY OF RENTON,
KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Julie Nelson, declare 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 knowledge and belief.
Signature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
Dated Notary Public in and for the State of Washington
Notary (Print):
My appointment expires:
PROJECT INFORMATION (continued)
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Z:\MLP Municipal Land Planners\5 MLP Folders & Past Employees\Julie Nelson\Kerry projects\Renton_Verizon Gas Install\to submit\for CD
Rom\Land Use Permit Master Application Form.doc Rev: 08/2015