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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division ;
1055 South Grady Way, 6th Floor I Renton, WA 98057 1 425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
*sy 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.
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 ):31 OQ
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): 12
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
ch legal description on separate sheet with the following information included
SITUATE IN THE QUARTER OF SECTION TOWNSHIP N. RANGE W,M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Cot'r' 1 Br' a ' declare
c are under penalty of perjury under the laws of the State of Washington that I
am (please check one) Rthe current o er 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.
Ak�eo 7� Road
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 C. Gw1 V` signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and�rpose men;ioned in the instrument.
0� - 211 -?,OZ0
Dated
SAMANTHA LUO
NOTARY PUBLIC
STATE OF WASHINGTON
License Number 208424
My Commission 5xpires May 13, 2023
Notary Public in and for the
�a vvici v+ i rf w-b
Notary (Print):
of Washington
My appointment expires: 134 hod 3