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DEPARTMENT OF COMMUNITY CITY OF
AND ECONOMIC DEVELOPMENT Renton
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: FIRST UKRANIAN PENTECOSTAL CHU
ADDRESS: 3811 NE 21ST STREET
CITY: RENTON ZIP: 98056
TELEPHONE NUMBER: (4.25) 239-0188
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER:
CONTACT PERSON
NAME: OSCAR V. GESTOSO
COMPANY (if applicable):IHB ARCHITECTS
ADDRESS: 21620 84TH AVENUE SOUTH
CITY: KENT ZIP: 98032
TELEPHONE NUMBER AND EMAIL ADDRESS:
(253) 709-7543
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
FIRST UKRANIAN PENTECOSTAL CHURCH
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
3811 NE 21ST STREET, RENTON, VSA 98056
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
042305-9237
EXISTING LAND USE(S):
PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
EXISTING ZONING:
A-3
PROPOSED ZONING (if applicable):
A-3
SITE AREA (in square feet):
64,340
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev:08/2015
PROJECT INFORMA
NUMBER OF EXISTING DWELLING UNITS (if applicable):
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): 1,689 S.F.
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): 17,211
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable): 18,900
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PROJECT (if applicable):
TION continued
PROJECT VALUE:
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
❑ 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.
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) IMAD H. BAHBAH , 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✓Q 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.
a," g..—&
August 17, 20'
Signature of Owner/Representative Date
STATE OF WASHINGTON
SS
COUNTY OF KING
Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that i� �r%�/Li [� signed this instrument and
acknowledge it to be his/her/their frel&qAq voluntary act for the uses and purpose n ' ne n the instrument?
PRp Mply III
Dated = �,= 4 �OTA,Q` .P%�N er5lic in ztid fo he to f Washington
A%
1 Notary (Print):
i a -09-2 A� -
-
////II 11WASN\\�S' My appointment expires:
2
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev:08/2015
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information included
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) IMAD H. BAHBAH , 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✓Q 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.
a," g..—&
August 17, 20'
Signature of Owner/Representative Date
STATE OF WASHINGTON
SS
COUNTY OF KING
Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that i� �r%�/Li [� signed this instrument and
acknowledge it to be his/her/their frel&qAq voluntary act for the uses and purpose n ' ne n the instrument?
PRp Mply III
Dated = �,= 4 �OTA,Q` .P%�N er5lic in ztid fo he to f Washington
A%
1 Notary (Print):
i a -09-2 A� -
-
////II 11WASN\\�S' My appointment expires:
2
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev:08/2015