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DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT
Planning Division °
1055 South Grady Way, 6th Floor Renton, WA 980571425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Mike Dang
ADDRESS: 17127 114th Ave SE
CITY: Renton ZIP: 98055
TELEPHONE NUMBER: (206) 653-6688
APPLICANT (if other than owner)
NAME: Rene Pham
COMPANY (if applicable):
ADDRESS: 6324 Shaffer Ave S
CITY: Seattle ZIP: 98108
TELEPHONE NUMBER: (206) 265-1131
CONTACT PERSON
NAME: Rene Pham
COMPANY (if applicable):
ADDRESS: 6324 Shaffer Ave S
CITY: Seattle ZIP: 98108
TELEPHONE NUMBER AND EMAIL ADDRESS:
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PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
Dang Residence Remodel
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
16927 114th Ave SE, Renton 98055
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
2923059013
EXISTING LAND USE(S):
Mobile Home
PROPOSED LAND USE(S):
Mobile Home
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
EXISTING ZONING:
R-8
PROPOSED ZONING (if applicable):
SITE AREA (in square feet):
7767
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
N/A
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
N/A
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: 10/2017
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): 1300
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):
TION continued
PROJECT VALUE:
30000
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 followinifll information included
SITUATE IN THE SE QUARTER OF SECTION 29 , TOWNSHIP 23 , RANGE 5 IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Mike Dang , 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.
^�U January 11, 2C
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 /'-'� ` r`' L 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 �O Z/f �11� Notary Public in and for the State of Washirigton
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at 2 Notary (Print):
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w My appointment expires:
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the followinifll information included
SITUATE IN THE SE QUARTER OF SECTION 29 , TOWNSHIP 23 , RANGE 5 IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Mike Dang , 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.
^�U January 11, 2C
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 /'-'� ` r`' L 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 �O Z/f �11� Notary Public in and for the State of Washirigton
� �y9 BAR►. ��,��y /�i ` lVl i. ; s+ L
i
at 2 Notary (Print):
.vs 0
w My appointment expires:
,,'q{rE OF �Pg 2
�%\�....�
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017