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DEPARTMENT OF COMMUNITY L;R AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 1425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: J
ADDRESS: G
) K) P
CITY:
'V1 1 1
SLif
PHONE NUMBER:
EMAIL ADDRESS*:
❑ I refer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable): (�
ADDRESS:
CITY:TATE:
C 404,'
01N
ZIP:
9so,S 7
PHONE NUMBER: �
-�35 - ll (Doo (4 ba
EMAIL ADDRESS*: (-C iy6k— Sa"o
❑ I refer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: —
COMPANY (if applicable):
ADDRESS:
t
CITY:
STAT
ZIP:
PHONE NUMBER
as - ab - 16)l
EMAIL ADDRESS*: " t AV 10 SCx0r,, C U r"A
��c
❑ I prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJ T OR DE ELOPME T NAME:
Fc `r
PROJECT/ADDRESS S)/LOCATION AND ZIP CODE:
t- S
LJA 9 90 5'l
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 PRIVATE ACCESS EASEMENTS:
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (if applicable)
NUMBER OF NEW DWELLING UNITS (if applicable):
NUMBER OF EXISTING DWELLING UNITS (if applicable):
PROJECT VALUE:
*By completing the email address field the owner/applicant/contact person is opting to receive all formal notifications
and project documents in digital format via email unless otherwise requested.
expiration of the Temporary Use Permit and understands construction of the model homes is at
Owners' own risk.
7. The provisions of this agreement shall bind the parties, their legal heirs, representatives,
successors and assigns and shall expire upon the recording of the final plat of
I, (Print Name) R11 c,-��C&r-/C)L"declare that I am (please check one) ❑ the owner of the
property involved in the application, rA the authorized representative to act for the property owner (if a
corporation, please attach proof of authorization to sign), and that the foregoing statements and answers
herein contained and the information herewith submitted are in all respects true and correct to the best
of my knowledge and belief.
l�
Sign t re of Owner/Representative Date
STATE OF WASHINGTON
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence t
and acknowledge it to be his/her/their free and vo
instrum nt.
q i KI
Dated
S E BROh��i
O N FA;26 'rr
alutA
OF tNA
Signature of Owner/Representative Date
,"1"` Lw,igned this instrument
e uses and pu_rpose mentioned in the
Gi.w
Notary Public in and for the qlate of Washington
Notary (P
My appointment expires:
04 -17 izj
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Temporary Use Tier 1.doc Rev: 02/2017
DEPARTMENT OF COMMUNITYiryof p
AND ECONOMIC DEVELOPMENT """'" """""�,, Jail, I -`
Release and Indemnification Agreement for Model Homes
This agreement is made by and between the City of Renton, Washington, a municipal corporation of the
State of Washington ("City") and
Recitals
("Owners").
The Owners own real property in the City legally described in Exhibit A, attached.
The Owners have submitted an application for building permit(s) and/or a Temporary Use Permit to
construct model homes on the real property prior to recording of a short plat or final plat. Since changes
to the short plat or final plat may be necessary after construction of the model homes rendering the
homes illegal, there is some risk in building the model homes.
In consideration of the inherent risks associated with the construction of buildings in advance of the
recording of the plat, the City requires the owner to execute an indemnification agreement prior to any
model home construction activities.
Agreement
The parties agree to the following:
1. The City authorizes the Owners to do the work as described in the Temporary Use Permit
Application No.
once building permits have been obtained.
2. The owners assume the risk that the model home(s) must be removed or reconfigured and
therefore release and discharge the City and its representatives from all known and unknown
losses, claims, damages or causes of actions which the owners have or may have relating to
buildings or structures authorized by the Temporary Use Permit.
3. As a condition of granting Owner permission to construct model homes, Owner agrees to
indemnify, defend and hold the City of Renton Harmless from any claims or liens that may be
exerted against the property as a result of construction of model homes and use of the unrecorded
plat of
4. Owners understand and acknowledge that, should the model home construction not comply with
the proposed lot configuration of the final plat, no variances to development standards for either
the lots or the homes may be granted as such a situation would be considered a "self-induced
hardship".
5. Owners acknowledge that they understand that any construction begun prior to the recording of
the final plat must be in compliance with all City zoning and subdivision requirements (e.g.
setbacks, lot coverage, etc.) or removed prior to recording of the final plat. If the final plat is not
recorded prior to the expiration of the Temporary Use Permit, Owners acknowledge that the
homes must be removed unless complying with all applicable code requirements (e.g. one home
per lot, etc.).
6. Applicant will also provide an Abatement Agreement and a security device acceptable to the City
to ensure removal of any structures not in compliance with City regulations at the time of
H:\CED\Data\Forms-Templates\Self-Help Handouts\Planning\Temporary Use Tier 1.doc Rev; 02/2017
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable):
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):
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
(Attach legal description on separate sheet with the following information included)
JI 1 UA I t IN I HE QUARTER OF SECTION TOWNSHIP N, RANGE W.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
P '
I, (Print Name/s) ++G LG ,r� rl` 0 declare under penalty of perjury under laws of the State of Washington that I
amlease check one) ) ❑the current owner f the property involved in this application or he 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.
q,--- L'p `�J [
Signature Owner/Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence that 7(+
acknowledge it to be his/her/their free and voluntary act for the ses and
Dated Notary P
SOV!k
so
F�
fi WASlrw
Signature of Owner/Representative Date
Z 11
V It,�
signed this instrument and
p e mentioned; the
% V
Ic 1n aria Tor the S ate of Washington
Ate 0W1,
My appointment expires: 0 11 2 i
DEPARTMENT OF COMMUNITY 0000110 CITY OF
AND ECONOMIC DEVELOPMENT
--------'�Renton}
ABATEMENT AGREEMENT
TEMPORARY USE
Planning Division
1055 South Grady Way I Renton, WA 98057
Phone: 425-430-7200 I Fax: 425-430-7231
beingthe Applicant
/ R
fir the Temporary Use hermit at
the Location of:`��
Hereby authorize the City of Renton to summarily eliminate the Temporary Use and all evidence of the use if
it has not been removed as required by the terms of the permit. I also agree to reimburse the City for any
expense incurred in abating this Temporary Use.
Signature: (/
Print Name: L LCA1 /')-� II
Date:
STATE OF WASHINGTON
) SS
COUNTY OF KING )
I certify that I know or have satisfactory evidence tha
and acknowledge it to be his/her/their free and vol htry act f the uses and
instrument. I
Dated
, , , , � N % % k I I . . .
T�> 1
oXN 4
�qSt~
H:\CE
signed this instrument
rpose mentioned in the
Not ry Public in and for/the State of Washington
(tel i,j q Lvw4
Notary (iPrint):
My appointment expires: 0� -1G1-�7i
emplates\Self-Help Handouts\Planning\Temporary Use Tier 1.doc
Rev:02/2017