HomeMy WebLinkAboutMaster Application Form (439 Renton Ave S).pdfPrlntform ,f,esct Form Sarre Fonn'
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way,6th Floor I Renton, WA 98057 I 425-43G-72OO
www.re!tonwg.gov
PROPERTY OWNER(S)
NAME: Rick Miller, sarah Miller
ADDRESS:43g Renton Ave s
clw'Renton STATE:WA ZIP:
98057
PHoNE NUMBER: (253) 50g-3270
EMAIL ADDRESS.: 11"L.rillerg2@qmail.comE lorebrto raceive all conesoondeilce-via US Mail.
APPLICANT fir other than owner)
NAME: Brett wiemann
COMPANY (if applicable)6rett wiemann Design LLC
ADDRESS:3$5 s Edmunds st.
clw'seatfle STATE:
WA
ZIP:
98118
PHoNE NUMBER; (206) 640,4736
EMAIL ADDRESS.:61616ry;emann@omail.com
El I orebrio rceive all conesoondenEVia US Mail.
CONTACT PERSON
NAME' Brett wiemann
COMPANY (if applicable)6wDesign LLC
ADDRESS:ams s Edmunds st
cltr'seattle STATE:
WA
ZIP:
,8118
PHoNE NUMBER (206) 6404190
EMAIL ADDRESS*:6r"thrieman n @Omai l.comlll I oretur to receive all coruesoondenEVia US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT }.IAME:
Miller Residence
PROJECT/ADDRESS(S/LOCAT|ON AND ZtP CODE:
+39 Renton Ave S, Renton, WA 98057
KING COUNWASSESSOR'S ACCOUNT NUMBER(S):
7221404166
EX|STTNG LAND U$E(S):
SINGLE FAMILY
PROPOSED ISND USE(S):
SAME
EXISTING COMPREHENSIVE PI.AN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PISN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
R8
PROPOSED ZONING (if applicable);
SITE AREA (in square bet):
15.000 i
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
0
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:$
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if appliceble)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW Dl /ELLING UNITS (if applicable):
NUMBER OF EXISTING DWELLING UNITS (if applioable):
1
PROJECTVALUE:
$410,000
LAND USE PERMIT MASTER APPLICATION
*By completing the email address field the owner/applicant/contact person is opting to receive all formal notifications
and project documents in digital format via email unless othenarise requested.
PROJECT TNFORMATTON (CONTTNUED)
SQUARE FOOTAGE OF PROPOSED RESIDENT]AL
BUILDINGS (if applicable): A,Sg0
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): 1,42s
SQUARE FOOTAGE OF PROPOSED NON.RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING NON.RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
NET FLOORAREA ON NON-RES|DENT|AL BUILD|NGS (if
applicable):
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NBA, PROJECT (if applicable):
otary Public
State of Washington
ANTOWAN THOMAS
LICENSE # 20108143
MY COMMISSION EXPIRES
JUNE 2,2024
IS TI*IE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PTEASE INCLUDE
SQUARE FOOTAGE (if applicable):
fI nOuIrrR PRoTEcTIoN AREA oNE
E nqutren PR0TEcToNAREATWo
E FLOODHAZARDAREA _ sq.ft.
EI oEoLoorc HAZARD _ sq.ft.
E HRS|TATCONSERVATION _ sq. ft.
E suonrlrNE STREAMS & LAKES _ sq.fr.
fl wETLANDS _ sq.ft.
LEGAL DESCRIPTION OF PROPERTY
on separate sheet with the information incl
qIUATE IN THE QUARTER OF SECTION TOWNSHIP
-
N, RANGE
-_,W.M.
IN THE CIfi
OF RENTON, KINGCOUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
l, (Print Name/s) RICK ilflLLER , declare under penalty of perjury under the laurs of the State of Washington that I
am (please check one) @ the current owner of the property involved in this application or I the authorized representative to ast for a
corporation (please attach proof of authorization) and that the foregoing statemenb and answers herein contained and the information
herewith are in all respects true and @rec{ to the best of my knowledge and belief.
Signature of Owner/Representative Date
STATE OFWASHINGTON )
couNwoF KING i t*
Ieertiffthatlknoworhavesatisfactoryevidence 1611 t r'.4.'-( /\r'l l.ey - signedthisin$trumentand
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the inEtrument.
l lrylzo'- .
Dated
W/
Notary Public in and forthe State of Washington
Notary (Print):
Myappointnentexpires: 7, "e- ?/ TQLY