HomeMy WebLinkAboutA_Updated Master LU Permit App Drake LLA_210629_V1Print Form Reset Form Save form
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT w�
Planning Division
1055 South Grady Way, 6th Floor I Renton, WA 98057 1 425-430-7200
www.rentonwa.eov
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME:
ADDRESS:
Sl2�D U
CIT�C—A
STiif�
ZIP:
/ 5
PHONE NUMBER: C57
EMAIL ADDRESS*:
I prefer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER:
CONTACT PERSON
NAME:
COMPANY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER
EMAIL ADDRESS*:
❑ I prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
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):
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
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.
❑
WETLANDS
sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach 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) AI&W I�/�, declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) ❑ the current owner 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.
6/28/21
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 SYLVIA DRAKE
acknowledge it to be his/her/their free and voluntary act for the uses and purp en ned in the isigned this instrument and
9n t.
6/28/21 _
Dated Notary is in sKd for the t f Washington
GARY P SCHUETZ
SCHV
gSION E.}grit,
0i
76410 N
2
Notary (Print):
My appointment expires: 05/04/23
Print Form Reset Form 'Save Farm
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
PROPERTY OWNER(S)
NAME:
ADDRtF1
CITY'
STATE:
ZIP:
PHONE NUMBER6 -13Q _% 9 /
EMAIL ADDRESS*:
EI I refer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER:
CONTACT PERSON
NAME:
COMPANY (if applicable):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE NUMBER
EMAIL ADDRESS*:
❑ I prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
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):
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
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.
❑
WETLANDS
sq. ft.
LEGAL DESCRIPTION OF PROPERTY
Attach legal descri tion 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 Name/s) 16"i I LL-Y , declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) a ie current owner of the property involved in this application or ❑ the authorized representative to act for a
corporation (plea a attach proof of authorization) and that the foregoing statements and answers herein contained and the information
herewitrespects true and correct to the best of my knowledge and belief.
0
41-y 6/28/21
ignatu 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 MILLY SABLOK signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and p elph the instru
6/28/21 _ --
Dated Norary is in an r the Sta of Wa ngton
GARY P SCHUETZ
Notary (Print):
A'T 10"
i 05/04/23
Qt� i
I;My appointment expires:
T6+10 r
�/III I p ;,W p�gN`\��