HomeMy WebLinkAboutA_Master_Application_190506_v1.pdfDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: PROJECT OR DEVELOPMENT NAME:
ADDRESS: PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
CITY: ZIP:
TELEPHONE NUMBER: KING COUNTY ASSESSOR’S ACCOUNT NUMBER(S):
APPLICANT (if other than owner)
NAME: EXISTING LAND USE(S):
COMPANY (if applicable): PROPOSED LAND USE(S):
ADDRESS: EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
CITY: ZIP:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if applicable)
TELEPHONE NUMBER: EXISTING ZONING:
CONTACT PERSON PROPOSED ZONING (if applicable):
NAME: SITE AREA (in square feet):
COMPANY (if applicable):
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
ADDRESS: SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
CITY: ZIP:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
TELEPHONE NUMBER AND EMAIL ADDRESS: NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
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PROJECT INFORMATION (continued)
NUMBER OF EXISTING DWELLING UNITS (if applicable): PROJECT VALUE:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (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.
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):
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE __________ QUARTER OF SECTION ____, TOWNSHIP ____, RANGE ____, IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
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 to the best of my knowledge and belief.
Signature of Owner/Representative Date Signature of Owner/Representative Date
STATE OF WASHINGTON )
) SS
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:
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