HomeMy WebLinkAboutA_Master_Plan_ApplicationDEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor | Renton, WA 98057 | 425-430-7200
www.rentonwa.gov
*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.
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S) PROJECT INFORMATION
NAME: PROJECT OR DEVELOPMENT NAME:
ADDRESS: PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
CITY: STATE: ZIP:
PHONE NUMBER: KING COUNTY ASSESSOR’S ACCOUNT NUMBER(S):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)EXISTING LAND USE(S):
NAME: PROPOSED LAND USE(S):
COMPANY (if applicable): EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
ADDRESS: PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
CITY: STATE: ZIP: EXISTING ZONING:
PHONE NUMBER: PROPOSED ZONING (if applicable):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
SITE AREA (in square feet):
CONTACT PERSON SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
NAME: SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:
COMPANY (if applicable): PROPOSED RESIDENTIAL DENSITY IN UNITS PER NET
ACRE (if applicable)
ADDRESS: NUMBER OF PROPOSED LOTS (if applicable)
CITY: STATE: ZIP: NUMBER OF NEW DWELLING UNITS (if applicable):
PHONE NUMBER NUMBER OF EXISTING DWELLING UNITS (if applicable):
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
PROJECT VALUE:
RECEIVED
11/06/2020 BGillia
PLANNING DIVISION
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable):
IS THE SITE LOCATED IN ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE4258
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):
SQUARE FOOTAGE (if applicable):
AQUIFER PROTECTION AREA ONE
AQUIFER PROTECTION AREA TWO
C]FLOOD HAZARD AREA
GEOLOGIC HAZARD
C]HABITAT CONSERVATION
SHORELINE STREAMS & LAKES
WETLANDS
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
sq. ft.
sq. ft.
sq. ft.
sq. ft
sq. ft.
SITUATE IN THE SW QUARTER OF SECTION _17 TOWNSHIP 23 N. RANGE 5 __,W.M. IN THE CITY
OF RENTON, KINÖÖOUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
l, (Print Name's)dedare under penalty perjury under the lays of the State of Washington that I
am (please check one) O fre current owner of the property involved in this application or the auttxyized representative to act for a
corporation (please attach proof of authorization) and that the foregoing statements and answers herein contained and the information
here are in all respects true and correct to the best of my knowedge and belief.
Sig l@tu )er/R epresentative
STATE OF WASHINGTON
COUNTY OF KING
/o/27/vzo
Date Signature of Owner/Representatjve Date
certfy that I know or have saisfactory evidence Igned this instrument and
acknowedge it to be his/her/their free and voluntary act r the u es and purpos ntion d in the instrument.
10 2b 26
Dated
•Jsst0N
PUBLIC
OR
Nota ublic in and for the State of Washington
Notary (Print):
My appointnent expires: