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01_Master Application
KINGCOUNTYASSESSOR’SACCOUNTNUMBER(S):3124059004EXISTINGLANDUSE(S):RecreationPROPOSEDLANDUSE(S):RecreationEXISTINGCOMPREHENSIVEPLANMAPDESIGNATION:ResidentialmediumdensityPROPOSEDCOMPREHENSIVEPLANMAPDESIGNATION(ifapplicable)N/AEXISTINGZONING:R8-Residential8du/acPROPOSEDZONING(ifapplicable):N/ASITEAREA(insquarefeet):2,794q-ft_________________________SQUAREFOOTAGEOFPUBLICROADWAYSTOBEDEDICATED:N/APROPOSEDRESIDENTIALDENSITYINUNITSPERNETACRE(ifapplicable)N/ANUMBEROFPROPOSEDLOTS(ifapplicable)N/ANUMBEROFNEWDWELLINGUNITS(ifapplicable):N/ANUMBEROFEXISTINGDWELLINGUNITS(ifapplicable):N/APROJECTVALUE:$69,058.00PrintFormResetFormSaveFormDEPARTMENTOFCOMMUNITYANDECONOMICDEVELOPMENTPlanningDivision1055SouthGradyWay,6thFloorIRenton,WA98057I425-430-7200www.rentonwa.govLANDUSEPERMITMASTERAPPLICATIONPROJECTINFORMATIONPROJECTORDEVELOPMENTNAME:KennydaleBeachParkPlaygroundReplacemPROJECT/ADDRESS(S)/LOCATIONANDZIPCODE:3601LakeWashingtonParkBlvdNRenton,WA98056PROPERTYOWNER(S)NAME.RentonParks,PlanningandNaturalResoADDRESS:1055SGradyWayCITY:STATE:ZIP:RentonWA98057PHONENUMBER:(425)430-6611EMAILADDRESS*.b5everisenrefltoflwa.govUIprefertoreceiveallcorrespondnceviaUSMail.APPLICANT(ifotherthanowner)NAME:SameasaboveCOMPANY(ifapplicable):ADDRESS:CITY:STATE:ZIP:PHONENUMBER:EMAILADDRESS*:QIprefertoreceiveallcorrespondenceviaUSMail.CONTACTPERSONNAME:BetsySevertsenCOMPANY(ifapplicable):RentonParksandRecreatioiADDRESS:1055SGradyWayCITY:STATE:ZIP:RentonWA98057PHONENUMBER(425)757-6657EMAILDIprefertoreceiveallcorrespondnceviaUSMail.SQUAREFOOTAGEOFPRIVATEACCESSEASEMENTS:N/A*BYcompletingtheemailaddressfieldtheowner/applicant/contactpersonisoptingtoreceiveallformalnotificationsandprojectdocumentsindigitalformatviaemailunlessotherwiserequested. fPROJECTINFORMATION(CONTINUED)SQUAREFOOTAGEOFPROPOSEDRESIDENTIALISTHESITELOCATEDINANYTYPEOFBUILDINGS(ifapplicable):N/AENVIRONMENTALLYCRITICALAREAPLEASEINCLUDESQUAREFOOTAGE(ifapplicable):SQUAREFOOTAGEOFEXISTINGRESIDENTIALBUILDINGSTOREMAIN(ifapplicable):N/AElAQUIFERPROTECTIONAREAONESQUAREFOOTAGEOFPROPOSEDNON-RESIDENTIALElAQUIFERPROTECTIONAREAiWOBUILDINGS(ifapplicable):MMINHElFLOODHAZARDAREAsq.ft.SQUAREFOOTAGEOFEXISTINGNON-RESIDENTIALBUILDINGSTOREMAIN(ifapplicable):N/AElGEOLOGICHAZARDsq.ft.NETFLOORAREAONNON-RESIDENTIALBUILDINGS(ifElHABITATCONSERVATIONsq.ft.applicable):N/AElSHORELINESTREAMS&LAKESsq.ft.NUMBEROFEMPLOYEESTOBEEMPLOYEDBYTHENEWPROJECT(ifapplicJ:ElWETLANDSsq.ft.LEGALDESCRIPTIONOFPROPERTY(Attachlegaldescriptiononseparatesheetwiththefollowinginformationincluded)SITUATEINTHENEQUARTEROFSECTION31,TOWNSHIP24N,RANGE5E,W.M.INTHECITYOFRENTON,KINGCOUNTY,WASHINGTONIAFFIDAVITOFOWNERSHIPII,(PrintName/s)_____________________________,declareunderpenaltyofperjuryunderthelawsoftheStateofWashingtonthat)am(pleasecheckone)thecurrentownerofthepropertyinvolvedinthisapplicationortheauthorizedrepresentativetoactforacorporation(pleaseattachproofofauthorization)andthattheforegoingstatementsandnswershereincontainedandtheinformationherewithareinallrespectstrueandcorrecttothebestofmyknowledgeandbelief.iiSnatureofOwner/RepresentativeDateSTATEOFWASHINGTONSSCOUNTYOFKINGIcertifythatIknoworhavesatisfactoryevidencathatf)+gVsignedthisinstrumentandacknowledgeittobehis/her/theirfreeandvoluntaryactfortheusgsandpurposementionedintheinstrument.&JJ-NotaryPublicinandfoH’heStateofWashington5(LLtV1-1SignatureofOwner/RepresentativeDateDatedNotary(Print):/V[/2-Ol3Myappointmentexpires: