HomeMy WebLinkAboutI-17 Land Use Permit App. - 052521Print Form Reset Form Save Form
DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
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Planning Division ;R
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' Clover Creek Homeowners Association
ADDRESS:1125 North 27th Place
CITY: Renton
TATE:
AA
F9z8'p6
56
PHONE NUMBER: (425) 271-4016
EMAIL ADDRESS*:clovercreekhoa1 @gmail.com
0111 refer to receive all correspondence via US Mail.
APPLICANT (if other than owner)
NAME: Ashifa Nurani
COMPANY (if applicable):
ADDRESS:2708 Williams Avenue North
CITY: Renton
STATE:
WA
P:
W056
PHONE NUMBER: (425) 830-2387
EMAIL ADDRESS*:cc2708wan@gmail.com
❑ I prefer to receive all correspondence via US Mail.
CONTACT PERSON
NAME: Stephen Siebert, P.E.
COMPANY (if applicable)-
AESI
ADDRESS:911 5th Avenue
CITY: Kirkland
ATE:
AA �98033
ZIP:
PHONE NUMBER (425) 827-7701
EMAIL ADDRESS*-ssiebert@aesgeo.com
❑ I. prefer to receive all correspondence via US Mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
Hirani Residence Retaining Wall
PROJECT/ADDRESS(S)/LOCATION AND ZIP CODE:
KING COUNTY ASSESSOR'S ACCOUNT NUMBER(S):
King County Parcel # 164450-TRCT
EXISTING LAND USE(S):
Undeveloped
PROPOSED LAND USE(S):
Undeveloped
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP
DESIGNATION (if applicable)
EXISTING ZONING:
PROPOSED ZONING (if applicable):
SITE AREA (in square feet):
650 area to be restored
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS:
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED: 0
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.
0
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 NW QUARTER OF SECTION 5 TOWNSHIP 23 N, RANGE 5E _,W.M. IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) Clover Creek HOA , declare under penalty of perjury under the laws of the State of Washington that I
am (please check one) EI 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.
" / _� -2�
0 h 'Y 11
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 W t W,CtVA CX_-Acy\ signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpos,p,i9entioned in the instrument.
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Dated
tvotary ruouc
State of Washington
HAMEED ISMAILZADA
LICENSE # 199224
MY COMMISSION IRES
NOVEMBER 9,
Public in and for the State of Washington
Notary (Print):
My appointment expires: � ` log % 2--) 2_LJ