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DEPARTMENT OF COMMUNITY
L.;R
AND ECONOMIC DEVELOPMENT
Planning Division 1055 South Grady Way, 6th Floor J Renton, WA 98057 1425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Anurag Singh
ADDRESS: 16018 SE 141st PI
CITY: Renton
STATE:
STATE:
ZIP:
198059
PHONE NUMBER: (206) 886-5601
EMAIL ADDRESS*:anurag67475@gmail.com
0 I prefer to receive all correspondence via US Mail.
L.APPLICANT (if other than owner)
NAME: Christine Leonard
COMPANY (if applicable): Pacific Arboriculture
ADDRESS:5101 S 372nd ST
CITY: Auburn STATE:
lP:WA 00
L481
PHONE NUMBER: (206) 909-2170
EMAIL ADDRESS*:Office@pacificarboriculture.com
0 I refer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: Christine Leonard
COMPANY (if applicable): Pacific Arboriculture
ADDRESS:5101 S 372nd ST
CITY: Auburn
STATE:
WA
ZIP:
98001
PHONE NUMBER (206) 909-2170
EMAIL ADDRESS*:Office@pacificarboriculture.com
l] I prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECTIADDRESS(S)ILOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
PROPOSED ZONING (if applicable).
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 QUARTER OF SECTION , TOWNSHIP N, RANGE _,W.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) ' W C , 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' f Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
certify that I know or, have satisfactory evidence that A 0tiv-A ✓i s ;,,16i'l signed this instrument and
acknowledge it to be is her/their free and voluntary act for the uses and purpose mentioned in the instrument.
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Dated Notary Public in and for the State of Washington
911H 7 VRANCES SIdIODA Si'�5l tom+ � 1c5 S�lli ?
Notyry public Notary (Print):
State of Washington
Commission # 20118154
My Comm. Expires Oct 29, 2024 My appointment expires: