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A_RRFA_Fire_Impact_Fee_Master_Application_170922
LUAIoO%l9PROPERTYOWNER(S)NAME:ADDRESS:CITY:ZIP:TELEPHONENUMBER:APPLICANT(ifotherthanowner)NAME:CityofRentonCOMPANY(ifapplicable):Dept.ofCommunity&EconomicDevelopmentADDRESS:1055S.GradyWayCITY:RentonZIP:98057TELEPHONENUMBER425.430.6575CONTACTPERSONNAME:ChipVincentCOMPANY(ifapplicable):CityofRentonADDRESS:1055SGradyWayCITY:RentonZIP:98057TELEPHONENUMBERANDE-MAILADDRESS:425.430.6575(cvincent@ci.renton.wa.us)PROJECTINFORMATIONPROJECTORDEVELOPMENTNAME:RentonRegionalFireAuthorityFireImpactFeePROJECT/ADDRESS(S)/LOCATIONANDZIPCODE:CitywideKINGCOUNTYASSESSOR’SACCOUNTNUMBER(S):n/aEXISTINGLANDUSE(S):n/aPROPOSEDLANDUSE(5):n/aEXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:n/aPROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable):n/aEXISTINGZONING:n/aPROPOSEDZONING(ifapplicable):n/aCityofRentonLANDUSEPERMITMASTERAPPLICATION PROJECTINFORMATION(continued)SITEAREA(insquarefeet):NETFLOORAREAOFNON-RESIDENTIALBUILDINGS(ifn/aapplicable):n/aNUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicable):n/a_________________________________________PROJECTVALUE:n/aSQUAREFOOTAGEOFPUBLICROADWAYSTOBEISTHESITELOCATEDINANYTYPEOFDEDICATED:n/aENVIRONMENTALLYCRITICALAREA,PLEASEINCLUDESQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:SQUAREFOOTAGE(ifapplicable):n/an/aAQUIFERPROTECTIONAREAONEPROPOSEDRESIDENTIALDENSITYINUNITSPERNETJAQUIFERPROTECTIONAREATWOACRE(ifapplicable):n/a.FLOODHAZARDAREA_______sq.ft.NUMBEROFPROPOSEDLOTS(ifapplicable):n/aGEOLOGICHAZARD________sq.ft.NUMBEROFNEWDWELLINGUNITS(ifapplicable):n/aUHABITATCONSERVATION________sq.ft.NUMBEROFEXISTINGDWELLINGUNITS(ifapplicable):n/aUSHORELINESTREAMSANDLAKES________sq.ft.SQUAREFOOTAGEOFPROPOSEDRESIDENTIALUWETLANDS_______sq.ft.BUILDINGS(ifapplicable):n/aSQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):n/aSQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIALBUILDINGS(ifapplicable):n/aSQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):n/aLEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINTHE_________OFSECTION,TOWNSHIP,RANGE,INKINGCOUNTY,WASHINGTON.CitywideTYPEOFAPPLICATION&FEESListalllanduseapplicationsbeingappliedfor:1.EnvironmentalReviewAFFIDAVITOFOWNERSHIPI,(PrintName/s)CE.‘Chip”Vincent,declarethatIam(pleasecheckone)—thecurrentownerofthepropertyinvolvedinthisapplicationorXtheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandanswershereincontainedandtheinformationherewithareinallrespectstrueandcorrecttothebestofmyknowledgeandbelief.\JIcertifythatIknoworhavesatisfactoryevidencethat______________________________signedthisinstrumentandacknowledgedittobehis/her/theirfreeandvoluntaryactfortheusesandpurposesmentionedintheinstrument.(SignatureofOwner/Representative)Myappointmentexpires:(SignatureofOwner/Representative)