HomeMy WebLinkAboutA_MasterApplication_170824DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
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CITY 'ento It R
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNERS)
NAME: PACCAR
ADDRESS: 485 Houser Way North
CITY: Renton ZIP: 98057
TELEPHONE NUMBER: (425) 254.-6092
APPLICANT (if other than owner)
NAME: Jairnie Levin
COMPANY (if applicable): Center for Transportation an
v
ADDRESS: 1960A University Avenue
CITY: Berkeley ZIP: 94704
TELEPHONE NUMBER: (510) 851-0625
CONTACT PERSON
NAME: Bob Gurney
COMPANY (if applicable): Kenworth
ADDRESS: 485 Houser Way North
CITY: Renton ZIP: 98057
TELEPHONE NUMBER AND EMAIL ADDRESS:
(425) 254-6092
Bob.Gurney@PACCAR.com
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
Temporary Mobile Hydrogen Fueling Station
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
485 Houser Way North
Renton, WA 98057
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
Research Center and Parking
PROPOSED LAND USE(S):
Temporary Mobile Fueling
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):
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PROJECT INFORMATION (continued
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):
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):
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) George E. West ,declare under penalty of perjury under the laws of the State of
Washington that I am (please check one) Lj the current owner of the property involved in this application or Lyj 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.
Say
Signature of Owner/Representative Date Sign e Owner/Representative ate
STATE OF WASHINGTON
SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that Georq e E. Wes+ signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses nd purpose mentioned in the instrument.
Dated , S S LqM 4 Notary Public in and for the State of Washington
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` N ; Notary (Print):
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T'14r?.29,1 ,e t appointment expires: ) Z 2
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 08/2015
SECRETARY'S CERTIFICATE
I, Michael R. Beers, certify that I am the Assistant Secretary of PACCAR Inc, a Delaware
corporation (the "Company"), and that, as such, I am authorized to execute this certificate on
behalf of the Company, and do hereby further certify that the person named below is a duly
elected, qualified and acting officer of the Company holding the office set forth opposite his
name below
Name
George E. West
Title
Vice President
IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of August, 2017.
STATE OF WASHINGTON
ss.
COUNTY OF KING
Michael R. Beers
Assistant Secretary
I certify that I know or have satisfactory evidence that Michael R. Beers is the person
who appeared before me, and said person acknowledged that s/he signed this instrument, on
oath stated that s/he was authorized to execute the instrument and acknowledged it as the
Assistant Secretary of PACCAR Inc, a Delaware corporation, to be the free and voluntary act of
such party for the uses and purposes mentioned in the instrument.
Dated: August 24, 2017
Q�X4 Y -
(Signature of Notary Public)
Printed Name: Kate S. Lamb
My Appointment Expires: Dece