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Land Use Application Form.pdfCity of Edmonds Land Use Application REC i DEVELOPMENT SERVICE- _ ARCHITECTURAL DESIGN REVIEW • X COMPREHENSIVE PLAN AMENDMENT CONDITIONAL USE PERMIT FILE # ♦ 1 OOO ZONE C ( HOME OCCUPATION DATE K) — (-L REC'D BY S V� FORMAL SUBDIVISION g SHORT SUBDIVISION FEE 3t � � (, C7 RECEIPT # LOT LINE ADJUSTMENT HEARING DATE PLANNED RESIDENTIAL DEVELOPMENT OFFICIAL STREET MAP AMENDMENT HE I. STAFF I _ PB L ADB L_ CC STREET VACATION REZONE SHORELINE PERMIT VARIANCE / REASONABLE USE EXCEPTION OTHER: PROPERTY ADDRESS OR LOCATION 120 - 190 West Dayton PROJECT NAME (IF APPLICABLE) Harbor Square Master Plan Comprehensive Plan Amendment PROPERTY OWNER Port of Edmonds PHONE # 425-774-0549 ADDRESS 336 Admiral Way, Edmonds WA 98020 E-MAIL bmcchesney@portofedmonds.org FAX # 425-774-7837 TAX ACCOUNT # SEC. 23 TWP. 27 N RNG. 3 E DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) See attached DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) See attached APPLICANT Port of Edmonds PHONE # 425-774-0549 ADDRESS 336 Admiral Way, Edmonds WA 98020 E-MAIL bmcchesney@portofedmonds.orq _ FAX # 425-774-7837 CONTACT PERSON/AGENT Bob McChesney PHONE # 425-774-0549 ADDRESS 336 Admiral Way, Edmonds WA 98020 E-MAIL bmcchesney@portofedmonds.org FAX # 425-774-7837 The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable anorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT .!� I�"`"1� DATE I © O I Pro erty Owner's Authorization I, . AAjf 0-e>"1-e a , certify under the penalty of perjury under the laws of the State of Washington that the following is a true ifind correct statement: I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspe�cttiio/n� and posting attendant to this application. SIGNATURE OF OWNER V " w DATE Questions? Call (425) 771-0220. Revised on 9114110 B - Land Use Application Page 1 of I