HomeMy WebLinkAboutA_Land_Use_Permit_Master_Application_220615_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)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL IS THE SITE LOCATED IN ANY TYPE OF
BUILDINGS (if applicable) NA ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
sQUARE FOOTAGE OF EXISTING RESIDENTIAL
MAIN (if applicable) NNA AQUIFER PROTECTION AREA ONE BUILDINGS TO
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL AQUIFER PROTECTION AREA TWNo
BUILDINGS (if applicable) NA FLOOD HAZARD AREA Sq. ft.
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable)" NA GEOLOGIC HAZARD Sq. ft.
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable) NA HABITAT CONSERVATION sq. t
SHORELINE STREAMS & LAKES 1200 sq. ft.
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicable) NA WETLANDS sq.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE SW
OF RENTON, KING COUNTY, WASHINGTON
QUARTER OF SECTION 29 TOWNSHIP 24N, RANGE 5 wM. IN THE CITY
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s).Pyan Maas (PsE)declare under penalty of perjury under the laws of the State of Washington that
am (please check one) L 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.
615/322
Signature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON)
SS
COUNTY OF KING
DYLAN MARCuS 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.
signed this instrument and
15-3o3 eLetaa Fro
Dated Notary Public in and for the State of Washington
ww NiCHOLAS FLOeOS CHOLAS
ON Notary (Print): OMMISS
TAR
75243
8-39-0aa My appointment expires:
UBU 29-22ATE OF
HINGTO
WASH
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