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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 I 425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Construction Industry Training Council of\ � ADDREssjita #, Bronson Way CITY: Renton I STATE WA PHONE NUMBER: (425) 285-2324
EMAIL ADDRESS*:
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[Z] I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME Kim Allen, Wireless Policy Group, LLC COMPANY (if applicable):For Seattle SMSA Limited Pc ADDRESS: 1420 W. Gilman Blvd. #9030 CITY I STATE: Issaquah WA PHONE NUMBER: (425) 628-2666
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EMAIL ADDRE SS*:kim.allen@wirelesspolicy.comD I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: Kim Allen COMPANY (if applicable)\/ . w· I enzon ire ess ADDRESS 1420 W. Gilman Blvd. #9030 CITY I STATE Issaquah WA PHONE NUMBER (425)628_2666
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EMAIL ADDRESS*lim.allen@wireless�olicr.com D I prefer to receive all cor respondence via S Mai .
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PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME: Verizon Wireless Cedar River COW PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE: 111 Meadow Ave. N Renton WA 98057
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S)
1352300060
EXISTING LAND USE(S): Vacant lot, commercial with Verizon Wireless � PROPOSED LAND USE(S) Continue Verizon Wireless site for Cell on Wh� EXISTING COMPREHENSIVE PLAN MAP DESIGNATION Commercial Mixed Use PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable) N/AEXISTING ZONING: Commercial Arterial PROPOSED ZONING (if applicable): No change SITE AREA (in square feet): 1225 SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS: N/A SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE DEDICATED: N/APROPOSED RESIDENTIAL DENSITY IN UNITS PER NET ACRE (if applicable) N/ANUMBER OF PROPOSED LOTS (if applicable) N/A NUMBER OF NEW DWELLING UNITS (if applicable): N/A NUMBER OF EXISTING DWELLING UNITS (if applicable) N/A PROJECT VALUE: $21,000
*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.
I PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUILDINGS TO REMAIN (if applicable): N/A
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
BUILDINGS (if applicable): N/A
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL BUILDINGS TO REMAIN (if applicable): N/A
NET FLOOR AREA ON NON-RESIDENTIAL BUILDINGS (if
applicable): N/A
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE
NEW PROJECT (if applicf,f�:
IS THE SITE LOCATED IN ANY TYPE OF ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE SQUARE FOOTAGE (if applicable):
0 AQUIFER PROTECTION AREA ONE
0 AQUIFER PROTECTION AREA TWO
□FLOOD HAZARD AREA
□GEOLOGIC HAZARD
□HABITAT CONSERVATION
□SHORELINE STREAMS & LAKES
□WETLANDS
__ s q.ft.
__ s q.ft.
__ sq.ft.
__ sq.ft.
__ sq.ft.
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
SITUATE IN THE NW QUARTER OF SECTION .J.L_, TOWNSHIP� N, RANGE �_.W.M. IN THE CITY OF RENTON, KING COUNTY, WASHINGTON I AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Halene Sigmund , declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) 0 the current owner of the property involved in this application or [Z] 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.
STATE OF WASHINGTON ) ) ss COUNTY OF KING )
Date Signature of Owner/Representative Date
I certify that I know or have satisfactory evidence that ±¼,\e,yt<('.' <;?r�V\IU.l-r'\c!_ signed this instrument and acknowledge it to be his/her/their free and voluntary act for the uses and purpse mentioned in the instrument.
Dated
Notary Public
r State of Washington
!BLANCA LIZAOLA
MY COMMISSION EXPIRES
01/28/2023
Notary Public in and for the State of Washington
L .
Notary (Print):
My appointment expires:
I
I
Ut:t'I-\K I IVlt:N I Ut l..UIVIIVIUNI I Y
AND ECONOMIC DEVELOPMENT -----�Renton@
ABATEMENT AGREEMENT
TEMPORARY USE
Planning Division
1055 South Grady Way, Renton, WA 98057
Phone: 425-430-7294 I www.rentonwa.gov
Michael Cunningham, on behalf of Verizon I, ___________________ being the Applicant for the Temporary Use Permit at the
Location of: 111 Meadow Ave. N., Renton WA
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 �# / {_:1;;;�,w�
Print Name: Michael Cunningham
Date: November 18, 2019
STATE OF WASHINGTON ) ) ss COUNTY OF KING )
I certify that I know or have satisfactory evidence thatMtchaeJ Ouil'lill and acknowledged it to be his/her/their free and voluntary act for r"1 signed this instrument d purposes mentioned in the instrument.
J/\NNETTE L CLARK
Notary Public
State of Washington
Commission II 173345
My Comm. Expires /\ug 29. 2022
e of Washington
Notary (Print)". Ittnndk L Ci.Ml--
My appointment expires: � /Jt{, / 2,/) 2,--L-/I I
17