HomeMy WebLinkAboutLand use Permit Master Application-Signed-5-7-2021PPir; FQrrrt= Rene£ Forms . Sam I+Qz'rrt;;
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT R
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 ( 425-430-7200
www.rentonwa.gov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME-.
I
ADDRESS: I
I
CITY:
STATE: I ZIP:
PHONE NUMBER:
EMAIL ADDRESS`:
❑ I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
GAS
COMPANY (if applicable):
ADDRESS:
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C STATE: i zip-
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EMAIL ADDRESS": 0' C'2_t4DJ" rn rye` to-'e-M
❑ I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: i
y,
COMP NY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER
EMAIL ADDRESS': (� ((�YLLY:fY11^Yj,YY�,titrif'
❑ ! prefer to receive all correspondence via US Mail.
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ay'r
PROJECT INFORMATION
PROSECT OR DE�sELOPMEt�b� �4�9S3E.
1 1
PROJECT/AD RESS(S)/LOCATION AND ZIP CODE:
�- AD T1 I (IG "-� a-YJ PI"t
amp, �V'4 sz�
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
Su � L
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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): I
1
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 i
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_
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.
t-110"WETLANDS
sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach legal description on se arate 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 Namels) �r C (:, 6 , declare under penalty of perjury urleier,,the laws of the State of Washington that I
am (please check one) ❑ the current owner of the property involved in this application or e 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.
( C'}
Ignatur of Owner/Representative 1 ate Signature of Owner;Representative Date
STATE OF WASHINGTON )
) SS
COUNTY OF>KG;__ )
e � eer.e_ (I
I certify that I know or have satisfactory evidence that �� 2 e �itOc signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
rJ__j _Z07_
Dated l
AVA -LEE KROGH
Notary Public
State of Washington
My Commission Expires
August 11, 2.021 M
Public in and for the State
AILe-,c
Notary (Print):
ashington
appointment expires: Av