HomeMy WebLinkAboutLand Use Permit Master Application.pdfPrint Form Reset Form Save Form
DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 980571425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME:
1oJ�N1 G� �1�Qc�.-t
ADDRESS:
CITY: �oZIP:
TELEPHONE NUMBER: U(P ,�� 6-1
l APPLICANT (if other than owner)
j NAME: DrV'-\)LAN � -C
COMPANY (if applicable):
ADDRESS:
CITY: ��,�f � ZIP:
TELEPHONE NUMBER: 4 4��. 110x1
CONTACT PERSON `�TJ
NAME:
COMPANY (if applicable):
i
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER AND EMAIL ADDRESS:
L�tv' Q- CcV ovgh�rG�r1e� (. C.
i)
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
-;\q Akar-,6it-' Utr 1 j
t;st ('bt.) , IIx IN -65&
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
15) 411101") i� 0 0
EXISTING LAND USE(S):
S,rjbL %�y
PROPOSED LAND USE(S):
�A w L*
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
EXISTING ZONING:
PROPOSED ZONING (if applicable):
SITE AREA (in square feet):
SQUARE FOOTAGt OF PUBLIC ROADWAYS' TO BE
DEDICITED:
N
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
N1is
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
.►.w• .a.w.w. 46
NUMBER OF PR0POSED LOTS (if applicable)'
NUMBER OF NE4 DWELLING UNITS (if applicable):
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017
PROJECT INFORMAT
NUMBER OF EXISTING DWELLING UNITS (if applicable):
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): G I t�]
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):,,,,,,
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable): V ID
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): fI
n
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable): �,, I,
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PROJECT (if applicable): N
ION [continued
PROJ�ECT VALUE:
j
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
❑ AQUIFER PROTECTION AREA ONE
❑ AQUIFER 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
al description on separate sheet with the following information included
SITUATE IN THE QUARTER OF SECTION, TOWNSHIP, RANGE 'G-, IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) --fR l S 4a ! ` l L' 1 , 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 nswers herein
contained and the information herewith are in all respects true and correct to the best of my knowledge and belief.
Signature of Ownerl epresentative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that ��
acknowledge it to be his/her/their free and voluntary act for the
CHRISTINA L GILTON
Notary Public
State of Washington
My Appointment Expires May 18, 2020
signed this instrument and
mentioned in the instrument.
and for the -State of Washington
. n i 1
(Print):
u LW
My appointment expires:
2
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017