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DEPARTMENT OF COMMUNITY
AND ECONOMIC DEVELOPMENT
Planning Division
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: Phetsamone Vilayvanh,Chau Vilayvanh
ADDRESS:451 1 NE 21st Pl
CITY: ftsn{on ZtP: 98059
TELEPHoNE NUMBER: (206) 353-0659
APPLICANT 1ir other than owner)
NAME:
COMPANY (if applicable):
ADDRESS:
CITY: ZIP..
TELEPHONE NUMBER:
CONTACT PERSON
NAME: Edjan Preut email: epreut@yahoo.com
COMPANY (if applicable):
ADDRESS;3021 SW Bradford ST #321
C|TY: Seattle ztP: Q$ll$
TELEPHONE NUMBER AND EMAIL ADDRESS:
(206) 6e6-0656
L
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PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
451 1 NE 21st PL RVMP
PROJECT/ADDRESS(S/LOCAT|ON AND ZrP CODE:
4511 NE 21st Place
Renton WA, 98059
KrNG COUNTY ASSESSOR',S ACCOUNT NUMBER(S)
/04 l9o0*st)
EXtSTTNG LAND USE(S):
$',n1 l € fcr-rrr', l'"-y Kasi*l-*'"rt.,u-
PROPOSED LAND USE(S)
Nft
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
K€D',rLa.& "al {Ye"l i w,vt Yers itw
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION
(if appricabre) fU h
EXISTING ZONING:
l{-(p
ffiotto ZoNING (if aPPlicable):
SJ]E AREA (in square feet)
7. ct"cn
SQUARE FOOTAGE OF PUBLIC ROADWAYS TO BE
DEDICATED:NA
SQUARE FOOTAGE OF PRIVATE ACCESS EASEMENTS
N,4
PROPOSED RESIDENTIAL DENSITY IN UNITS PER NETAWhff applicable)
NUMBER oF . flVA { ort.}.!'i rlnar{qt.r }
NUMBER OF IEW DWELLIN@fryNlfl$S applicable):NA I, i r:Xf:Ht-jiil.Tl,l,lu*,,^,*,
Rev: 08/201,5
PROJECT INFORMATION (continued
NUMBER OF EXISTING DWELLING UNITS (if applicable):
i
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL
BU)#'lGS (if aPPlicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL
BUI.LDINGS TO REMAIN (if applicable):NA
SQUARE FOOTAGE OF PROPOSED NON-RESIDENTIAL
B){}d)l N G s (if applicable) :
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIALBffitNcs To REMAIN (if aPPlicable):
NET FLOOR AREA ON NON-REStDENTTAL BUtLDtNGS ('f
a0oticabte).y4
NUMBER OF EMPLOYEES TO BE EMPLOYED BY THE NEW
PRoJECT (if applicable), Affi
PROJECT VALUE:
IS THE SITE LOCATED IN ANY ryPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
X" RourrreR PRorEcloN AREA TWo
A FLOOD HAZARD AREA _ sq. ft.
tr GEOLOGIC HAZARD _sq ft.
D HABITAT CONSERVATION --sq.ft.
tr SHORELINE STREAMS & LAKES -- sq. ft
A WETLANDS
-
Sq ft.
LEGAL DESCRIPTION OF PROPERTY'
Attach legal description on separate sheet with the followinq information included
SITUATE IN THE QUARTER OF SECTIO N 3 ,TOWNSHIP 23, RANGE 5 ,IN THE CITY
OF RENTON, KING COUNTY, WASHINGTON
AFFIDAVIT OF OWNERSHIP
l, (Print Name/s) Phetamone Vilayvanh, chau vilayvanh , dectare under penalty of perjury undeg!@ laws of the state ofWashingtonthatlam(prufficurrentownerofthepropertyinvolvedinthisappticationoiIltn"autno,i."o
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 WASHTNGTON )
)SScouNTY oF K|NG )
I certify that I know or have satisfactory evidence that
acknowledge it to be hisiher/their free and voluntary act for the uses
IrD Lt '2\"4 , ?4I(
hah wLq 4 signed this instrument and
purpose mentioned in the instrument
Dated
TERRAIIO KOilE
ilotrty Publlc
Stil. ol W$l$ngion
t y Appointncffi Eryircs thc 5, 2020
2
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Ttznq^'> kituh
My appointment expires: lZ /O-f/ ?pz-o .
Signature of Owner/Representative
Notary Public in and for the
Rev: 08/2015