HomeMy WebLinkAboutA_Master_Application_Varma_Short_Plat_210326_v1.pdfDEPARTMENT 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:
PROJECT INFORMAT案ON (CONTINUED)
謹認諾諒闇SEDRES’DENTIAし
SQUAREFOOTAGEOFEXiSTINGRESIDENTIAL
BUtLDINGS丁OR∈MAiN〈jfappticabie):NIA
SQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIAL
BUiLDINGS(ifappiicable)‥N/A
SQUAREFOOTAGEOFEXISTiNGNON-RESIDENTIAし
BUILDINGSTOREMAIN(ifapplicable):N/A
NETFLOORAREAONNON輸RESIDENTiALBUiLDINGS(if
applicabie):NIA
NuMBEROFEMPLOYEESTOBEEMPLOYEDBYTHE
NEWPROJECT(ifappiicabIe):N/A
iS THE SITE LOCATED iN ANY TYPE OF NIA
ENVIRONMENTALLY CRI丁ICAL AREA, PLEASE INCLUDE
SQUARE FOO丁AGE (if appiicable):
□ AQUiFER PROTECTION AREA ONE
ロ AQUiFER PROTECTION AREA TWO
□ FLOOD HAZARD AREA
ロ GEOLOGIC HAZARD _ Sq. ft.
□ HABITA丁CONSERVATiON
□ sHORELiNE S丁REAMS & LAKES _ Sq. ft.
□ wETLANDS _ Sq.ft.
LEGAL DESCR寒PT看ON OF PROPERTY
A糠ach le a葛descri 鮮on on se a富ate sheet wi紬請e followin jn書ormatioれjれC山ded
sITUATE IN THE NE QUAR丁ER OF SECTION 」L, TOWNSHIP_2L N, RANGE J2i__,W.M. 1N THE CiTY
OF RENTON, KiNG COUN丁Y, WASHINGTON
AFFiDAV看T OF OWNERSHIP
I, (Print Name/s)記∩久は.Vひ面映 I p.縁「a「。
am (PIease check one) □the Cu「rent OWner Of the
unde「 penafty of pe巾ury under the laws of the State of Washington that I
property invoIved in this appIication o「 □ the authorized representative to act fo「 a
corpo「ation (Please attach p「oof of authorization) and that the foregoing statements and answe「s herein contained and the information
he「ewith are in a= respects true and co「rect to the best of my k=OWledge and beiief.
ユl叫2つ斗
Signatu「e of Owner/Rep「esentative Date
STATE OF WASHINGTON
COUNTY OF KING
Notary (Print):
My appointment expires:う-午一つ」