HomeMy WebLinkAbout3-Land Use Permit Mast Application signed and notarizedDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT t1055
Planning Division
South Grady Way, 6th Floor I Renton, WA 98057 1425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
FPROPERTY OWNER(S)
TRUDEL LLC
ADDRESS:
1404 EAST SPRING ST
CITY: ZIP:
SEATTLE 98122
TELEPHONE NUMBER:
4256437780
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER:
f CONTACT PERSON
NAME:
WAYNE
SEMINOFF
COMPANY (if applicable):
ADDRESS:
P0 BOX 956
CITY: KIRKLAND WA ZIP:
98083
TELEPHONE NUMBER AND EMAIL ADDRESS:
425 843 7780
WAYNEcIS0MEDIACOM
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
1847200005
EXISTING LAND USE(S): VACANT
PROPOSED LAND USE(S):
I SINGLE FAMILY HOME
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
RES.
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
EXISTING ZONING: RESIDENTIAL
PROPOSED ZONING (if applicable):
SITE AREA (in square feet): 4500 SOFT
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable) ONE/4500 SO FT
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable): -
1
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):
I NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PROJECT (if applicable):
PROJECT VALUE:
200K
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
LI AQUIFER PROTECTION AREA ONE
LI AQUIFER PROTECTION AREA TWO
Fj FLOOD HAZARD AREA sq. ft.
LI GEOLOGIC HAZARD sq. ft.
O HABITAT CONSERVATION sq. ft.
O SHORELINE STREAMS & LAKES sq. ft.
L] WETLANDS sq. ft.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATED IN THE SW QUARTER OF SECTION 18, TOWNSHIP 23, RANGE 5, IN THE CITY OF RENTON,
KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) TRUDEL LLC BY USA SEMTNOFF , declare under penalty of perjury under the laws of the State of Wash4ngton that I
am (please check one) )(XO the current owner of the property involved in this application or 0 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.
Sign wn tative Date Signature of Owner/Representative Date
STATE OFWASHI TON
58
COUNTY OF KING
I certify that I know or have satisfactory evidence that 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
Notary Public in and for the State of Washington
Notary (Print):
My appointment expires:
CALIFORNIA ALL-PURPOSE I:1'
JU!LUJ
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of
befor e me,_______________ On
Date Here Tnsert Name an Title of the Officer
personally appeared Lis . Nki'e tiyt'R
Name() of Signer()
who proved to me on the basis of satisfactory evidence to be the person(p) whose name( is/ate
subscribed to the within instrument and acknowledged to me that -he/she/they executed the same in
144s/her/hetr authorized capacity(ies), and that by h4s/her/ther signature() on the instrument the person(
or the entity upon behalf of which the person) acted, executed the instrument.
all uii [if UtUhII$IlIIII1fltflhIIHII
WOUWtN
comm. #2153857
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My oommison woea2oN
iiiiiiiIiIlIIII$IIIIIlIIIIIIIIII*III?
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and cial seal
Signature
eofNtar b/ic
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
TI Corporate Officer - Title(s):
Partner - III Limited IT General
IT Individual IT Attorney in Fact
IT Trustee IT Guardian or Conservator
Ii Other:
Signer Is Representing:
Signer's Name:
IT Corporate Officer - Title(s):
IT Partner - IT Limited IT General
IT Individual IT Attorney in Fact
IT Trustee IT Guardian or Conservator
IT Other:
Signer Is Representing:
02014 National Notary Association www.NationalNotary.org 1-800-US NOTARY (1-800-876-6827) Item #5907