HomeMy WebLinkAboutA_Land Use Permit Master Application_Page 2_181109_V1PROJECT INFORMA
NUMBER OF EXISTING DWELLING UNITS (if applicable):
ONE
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): 860
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):
TION continued
PROJECT VALUE:
$1,000.00
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
on separate sheet with the following information i
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Names) Vdettr4i6 d HrY'D 19 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
tai nd the information herewith are in all respects true and confect to the best of my knowledge and belief.
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Signa tu of Owner/Representative Date Signature of 00vnedRepresentafive bate
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that TVA� � AZA W% - signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument
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Notary (Print):
My appointment expires: Q-3( 2�, --
H:\CED\Data\Forms-Templates\$elf-Help HandoutslPlanning\Master Application.doc Rev: 10/2027
LEGAL DESCRIPTION OF PROPERTY
on separate sheet with the following information i
SITUATE IN THE QUARTER OF SECTION , TOWNSHIP , RANGE , IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Names) Vdettr4i6 d HrY'D 19 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
tai nd the information herewith are in all respects true and confect to the best of my knowledge and belief.
�� g Zt/
Signa tu of Owner/Representative Date Signature of 00vnedRepresentafive bate
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that TVA� � AZA W% - signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument
til
Dated +� �."..������� //
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A, s Cp 4P141", %9 j
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� � f
� iV r•r � r
i N AVst�C' " z
=0.
/it;, o
%W
Notary Public in and for the State of Washington
1`"' l+ .
Notary (Print):
My appointment expires: Q-3( 2�, --
H:\CED\Data\Forms-Templates\$elf-Help HandoutslPlanning\Master Application.doc Rev: 10/2027