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CITY OF RENTON Ι PERMIT SERVICES
LAND USE PERMIT MASTER APPLICATION
PROPERTY OWNER(S)
NAME: PHONE:
MAILING ADDRESS: EMAIL:
prefer to receive all correspondence via US mail.
APPLICANT (if other than owner)
NAME: COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
I prefer to receive all correspondence via US mail.
CONTACT PERSON
NAME: COMPANY (if applicable):
PHONE: EMAIL:
MAILING ADDRESS:
I prefer to receive all correspondence via US mail.
PROJECT INFORMATION
PROJECT OR DEVELOPMENT NAME:
PROJECT/ADDRESS(ES) AND PARCEL NUMBERS:
EXISTING LAND USE(S): PROPOSED LAND USE(S):
EXISTING COMPREHENSIVE PLAN MAP DESIGNATION:
PROPOSED COMPREHENSIVE PLAN MAP DESIGNATION (if applicable):
EXISTING ZONING: PROPOSED ZONING:
SITE AREA (in square feet):
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:
SQUARE FOOTAGE OF PROPOSED RESIDENTIAL BUILDINGS (if applicable):
SQUARE FOOTAGE OF EXISTING RESIDENTIAL BUILDINGS TO REMAIN (if applicable):
rentonwa.gov/permitservices | planningcustomerservice@rentonwa.gov | 425-430-7294 10/24/2023 | Page 2 of 2
LAND USE PERMIT MASTER APPLICATION
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
SQ. FT. ________________ FLOOD HAZARD AREA
SQ. FT. ________________ GEOLOGIC HAZARD
SQ. FT. ________________ HABITAT CONSERVATION
AQUIFER PROTECTION AREA TWO
SQ. FT. ________________ SHORELINE STREAMS & LAKES
SQ. FT. ________________WETLANDS
LEGAL DESCRIPTION OF PROPERTY
(Attach legal description on separate sheet with the following information included)
N, RANGE ,
W.M IN THE CITY OF RENTON, KING COUNTY, WASHINGTON
__, TOWNSHIPQUARTER OF SECTIONSITUATE IN THE _____________________________ ______________
AFFIDAVIT OF OWNERSHIP
I, (Print Name/s) _____________________, 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.
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 signed this instrument and
acknowledge it to be his/her/their free and voluntary act for the uses and purpose mentioned in the instrument.
Dated Notary Public in and for the State of Washington
Notary (Print):
My appointment expires: