HomeMy WebLinkAboutA_Applications_Land Use Permit Master Application_181221_v1.PDFDEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 980571 425-430-7200
W` vj. rc ntonwa.-gov
LAND USE PERMIT MASTER APPLICATION
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PROPERTY OWNER(S)
NAME: lflAev/? !'ELI B
F OQ %D cSG�NDDL�
ADDRESS:
CITY: TB I ZIP: �S
TELEPHONE NUMBER:✓L�ZS
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY: ZIP:
TELEPHONE NUMBER:
CONTACT PERSON
NAME: Ap y y_
iapplicable):
COMPANY (f a apipliicabbllee):
DOG -
ADDRESS: �SnA) jeO,4 /n
CITY: /,�� zIP: /�
TELEPHONE NUMBER AND EMAIL ADDRESS:
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PROJECT INFORMATION
ROJECTT OR DEVELOPMENT NNAME: + �/
Ulmpn� �xpeQ.5I A _
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
,��.2 3DS9D8/
EXISTING LAND
S-TWR PO — � SE.c1T LCS�
PROPOSED LAND USE(S):
EXISTING COMPREHENSIV)e PLAN MAP DESIGNATION:
PROPOSED COMPREHE�(SIVE PLAN MAP DESIGNATION
(if applicable) ' n /4
EXISTING ZONING
n/�
PROPOSED ZONING (if applicable): D
SITE AREA (in square feet)/
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED: NIX
SQUARE FOOTAGE PF PRIVATE ACCESS EASEMENTS:
ID
/100
PROPOSED RESIDENTIAL DE ITY IN UNITS PER NET
ACRE (if applicable) x
NUMBER OF PROPOSED IOTS (if applicable)A J
NUMBER OF NEW DWELLING KITS (if applicable):
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H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017
PROJECT INFORMA
NUMBER OF EXISTING DWELLING UNITS (if applicable):
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): /V
/I
f
SQUARE FOOTAGE OF EXISTING RESIDENTIAL J�
BUILDINGS TO REMAIN (if applicable):
SQUARE FOOTAGE OF PROPOSED NOWRESIDENTIAL
BUILDINGS (if applicable): /V/ f%
SQUARE FOOTAGE OF EXISTING NON--RESIDEpd� IAL
BUILDINGS TO REMAIN (if applicable):
NET FLOOR AREA ON NON-RESIDE?TIAL BUILDINGS (if
applicable): N/ jPl7
NUMBER OF EMPLOYEES TO BE EN)YED BY THE NEW
PROJECT (if applicable): X/
TION (continued
PROJECT VALUE: Z>1017X- 4'
DAo . DD '�PW '5Y6)
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.
I, (Print Names) "\ 6—r- 1 q L - G 0% _- , declare under penalty of perjury andr the ws 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 to the best of my knowledge and belief.
`� 6L-- g W. Uc f' I% /%P/11 Q
Signature of Owner/Representative u Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that U R.\\' signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the users and purpose mentioned in the instrument.
dl',/'.1%
Date
I
No=Dec2l,
State
JAR
My Appointmen
Public in and for the State of Washington
V
f -e J
Notary (Print):
My appointment expires: j q
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Master Application.doc Rev: 10/2017