HomeMy WebLinkAboutA_Land Use_Application_Southport_Banner_180503_v1.pdfDEPARTMENT OF COMMUNITY CITY OF
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AND ECONOMIC DEVELOPMENTRenton
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) F� PROJECT INFORMATION
NAME:
b �r/�� PROJECT OR DEVELOPMENT NAME:
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ADDRESS:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
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CITY: Vevvkv^ ZIP: R eos-ko
TELEPHONE NUMBER: Lj2,T,_je,2_ _ 5
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APPLICANT (if other than owner)
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NAME: �QJIAl�2 Cit �h��
COMPANY (if applicable):
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER:
F� CONTACT PERSON
NAME: SGS �oSRNI.S �-
COMPANY (if applicable): *0 VRA)eAP APA4I UV1,
ADDRESS: Wd • N i
CITY: (21sA-61\, ZIP: qb 051p
TELEPHONE NUMBER AND EMAIL ADDRESS:
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KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
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EXISTING LAND USE(S):
PROPOSED LAND USE(S):
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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 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 INFORMATION continued)
NUMBER OF EXISTING DWELLING UNITS (if applicable): PROJECT VALUE:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL IS THE SITE LOCATED IN ANY TYPE OF
BUILDINGS (if applicable): ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
QUARE 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):
❑ AQUIFIER PROTECTION AREA ONE
❑ AQUIFIER PROTECTION AREA TWO
❑
FLOOD HAZARD AREA:.:
sq. ft.
❑
GEOLOGIC HAZARD
sq. ft.
❑
HABITAT CONSERVATION
sq. ft.
❑
SHORE -LINE STREAMS & LAKES
sq. ft.
❑
WETLANDS
sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on separate sheet with the following information
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
►, (Print Name/s) , declare under penalty of perjury unde he laws of the State of Washington that I am (please check one) El 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.
I--(
Si nature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that J G — Q OS-eA 510G�_ 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 X���� lel l 111 Notary Pu an for the State of Washington
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Notary (Print):
My appointment expires: 10 — 2-3 —
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev:08/2015