HomeMy WebLinkAboutA_Land Use Master Application_180620_v1.pdfPROPERTY OWNER(S)
NAME:
ADDRESS: j `� r1� P—DVI
CITY:
TELEPHONE NUMBER: (' �) Gj 0 4 —15
APPLICANT (if other than owner)
NAME: \ Du
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COMPANY (if applicable):
ADDRESS: / VG2 1 EVCv 11K�PID
CITY: ZIP:
TELEPHONE NUMBER: rid U `lj
CONTACT PERSON
NAME:
COMPANY (if applicable):
ADDRESS: !
P
CITY: ZIP: yo
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TELEPHONE NUMBER AND EMAIL ADDRESS:
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vlLi U'i*, w 3 c c C"'. b fl)1-Cli; ,Kt. )U -t
PROJECT INFORMATION
PRWECT OR DEVELOPMENT NAME:
b C_7
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
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KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
EXISTING LAND USE(S):
PROPOSED LAND USE(S):
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
U
n.'r-'n'"®M 11014 (continued
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
SITUATE I Attach legal description on se arate sheet with the followin information incl�,N
N THE QUARTER OF SECTION ,TOWNSHIP
OF RENTON, KING COUNTY, WASHINGTON ,RANGE ,E CITY
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) 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 ❑ 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 t the best of my knowledge and belief.
ature of Owner/Representative Date
STATE OF WASHINGTON )
COUNTY OF KING SS
Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that tV N U N6 UJAYW4 _signed
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrrumenfs instrument and
t
A I
Dated
LESLIE A KAHOUN
Notary Public
State of Washington
My Appointment Expires
Oct 16, 2021
Notary
Notary (Print):
and r for the State of Washington
My appointment expires: _ ' Who I z oz !
2
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc
Rev: 08/2015