HomeMy WebLinkAboutA_MasterLandUseForm_211206_v1Print FWn Ralwm Fin Save Fora
DEPARTMENT OF COMMUNITY
�
AND ECONOMIC DEVELOPMENT
Planning Division
1055 5uuth Grady Way, Rh Flavor I Keaton, DNA 98057 1 42543()-7200
w+r w. rent onw3_guv
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME even UlMahl
ADDRESS' 3719 Lake ke a sh i ngton Blvd N-
CITY : Ren to n
00 6
PHONE NLMBI�R (4 5) 60-1 79
EMAIL ADDRE Ss'i rw 1nlaInd use@gmait=m
r to Feoeiae all correspondence via U Mail,
nAAP P L I CANT (If other t Ira n ow ner)
NAME.
COMPANY (if apple lie)- -
ADDRESS.,
CITY.
STATE; 7IP;
PRONE NUMBER;
EMAIL ADDRESS'
refer to receive all cgrasparpdence via US Mail.
CONTACT PERSON
NAME'
Jay Irwin
COMPANY (if applicable �1 f vain Land Use Consulting
rLWSS -. po BOX 171
CITY, Bel Iingham STATE: SIP: w
A 87
PSI O NE NUMBER (60) 410 74 5
EMAIL ADD RESS`1rwlnlanduse gmail, com
Prefer to receive all correspmd6rice via US Dail_
PROJECT INFORMATION
PRQJECT OR DEVELOPMENT NAME:
i nda hi dock repair
I
PROD E CTIADDRESS($ j LO 4T10N AND ZIP CODE=
719 Lake Washington Blvd N 98056
KING COiJNTY ASSESSOR'S ACCOUNT NUMBER( ):
334270019006
EXISTING LAND USES):
Ingle Family Residential
I OPOSED LAND USE(S).
EXISTI NG GOAIIPR E HE N S NE PLAN MAP D ES I G NATION:
esidential
PROPOSED COMPREHENSIVE PLAN MAP
Df` SIGNATIO14 (if applicable)
EXISTINGZONING:
R-8
PROPOSED ZONING (if apph�,-able) :
rTE AREA (an square feel):
,112
SQUARE FOOTAGE OF PRIMATE ACCESS EASEMENTS:
not known
SO DAME FOOTAGE OF PU BL I C RCAD AYS TO BE
DEDICATED-0
PROPOSE D RESI DENTAL DENSITY IN U N ITS P E R N ET
ACRE (if applicable)
NUMBER OF PROPOSED LOTS (d applicadla)
NUMBER OF NEW DWELLING UNITS (if applicable):
N LIME E R OF EX I STI NG DWELLI N G UNITS (if ap pli ra ble)-
PROJECT VALUE,
* By complet In g th a emai I address field t he owner/a ppl iea nt/oo n tact person is o pti n$ to reca ive al I form all n of if eat i C] A S
an d project doe u me nits in dig ital format via em al I u in less of he rw i se req ue5ted.
PROJECT INFORMATION (CONTINUED)
SQUARE FOOTAGE D F PROPOSED RESIDENTLAL
BUILDINGS (if applicable) - 0
SQUARE FOOTAGE OF EY� STl FAG REMDE"AL
E U I L D INGS TO RE MAIN (if aWl"bile): NIA
SQUARE FOOTAGE OF PROPOSED NON. RESIDENTIAL
BUILDINGS (if a pplicabla4/ 474
SQUARE FOOTAGE OF EXISTING NON-RESIDENTIAL
BUILDINGS TO REMAIN (if applicable)'
14ET FLOOR ARE A ON N O N- R ES IDE N TLAL E UI L DI NGS (if
applicable):
N U MSE R O F EMPLOYEES TO BE EMPLOYED BY TH E
NEW PROJECT (if applicable):
IS THE SITE LOCATED IN ,ANY TYPE OF
ENVIRONMENTALLY CRITICAL AREA, PLEASE INCLUDE
SQUARE FOOTAGE (if applicable):
[I AQUIFER PROTECTION AREA ONE
0 AOU IF E R PROTECTION AREA TWO
❑ FLOOD HAZARD AREA � sq. PL
GEOLOGIC HAZARD _ sq. ft.
HAISITAT CONSERVAT1 ON aq, f.
0 S44ORELINE STREAMS & LAKES sq. ft.
❑WET -LAN DS __ , sq. ft.
LEGAL DESCRIPTION F PROPERTY
(A# ch legaI doscrtption on separate sheet with the foll low ing information indyded)
SITUATE IN THE NYY QUARTER OF SECTION 3 _-, TOWNSHIP 24 N, RANGE 5 ,W-Ike. IN THE CITY
OF RENTON, KING COUNTY. WASH IN 70N
AFFIDAVIT VIT OF OWNERSHIP
1, Prink Narnele Le�fV + I b .H
� � ,declare under panslty Of pequry urr-daf the lawns of the State of Washington that I
arn (phase chock one) [a the curren t owner of th a property i nwolve d i n th is eppl Icatlon or 0 the aethaonzed rig presen Wive to W for a
corporation (please attach prof of avthonzation) and that the forEgoing statewrits and answers herein contained and the infccrimi[ion
herewith are in all rmpects true and correct to the hest of my knowledge and belief.
Signature of
STATE OF WASH IN GTON )
j SS
COUNTY OF ICING �
uartify that I know or have 9atisFai;1cry evidence that � r� L111,0
auknowledq$ it to be h0erAheir free and voluntary act for fhe uses and purpose
� � jf2 j
Dated
Notary Public
fsft of Washington
HAMEED ISMAILZADA
LICENSE # 188414
MY COMMISSION EXPII
NO VE MBE R 9, 2024
r+} �Prinlj:
resentetia$
Data
s igned th is instru meat and
in the i nstru mont-
in and for the State of Washington
My appointment expires: I I a (!�