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EXHIBIT
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HEARING EXAMINER
APPLICATION FOR VARIANCE
APPLICANT
CITY & ZIP
DATE
FEE IZS.OD
RECT 16 %738
APO'S 1%
HEARING DATE: j O
ADDRESS //7�i
9 HONE_ —
INDICATE TYPE OR DEGREE OF INTEREST IN PROPERTY
LOCATION OR ADDRESS OF PROPERTY
LEGAL DESCRIPTION OF PROPERTY A-P-.Z OXO C,�
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VARIANCE REQUESTED:
FOR OFFICE USE ONLY: USE ZONE: 9r-J-IZ
ZONING ORDINANCE REQUIREMENT:
Release/Hold Harmless Agreement
The undersigned applicant, his heirs and assigns, in consideration for.
the City processing the application agrees to release, indemnify, defend and
hold the City of Edmonds harmless from any and all damages and/or claims for
damages, including reasonable attorneys' fees, arising from any action
or inaction is based in whole or in part upon false, misleading or incomplete
information furnished by the applicant, his agents or employees.
Permission to Enter Subject Property
The undersigned applicant grants his, her or its permission for public
officials and the staff of the City of Edmonds to"en er the §aall;�7ect_ roperty
for the purpose of inspection and posting attendan to t�ilis as y1
i 1i ion.
11.1 ��
nature or
resentati
DECLARATIONS OF APPLICANT
Please answer all questions
1. What are the physical characteristics, (i.e. topography, shape
of lot, etc'') which create a hardship for you in regard to
development.of your property? �i
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2
3
How does your property i fer from oth property in the same
vicinity?
Will this variance be detrimental to the public or damaging to
other property or improvements in the vicinity?
4. ®What hardships will result to you if the variance is not granted?
®Will these hardships have been caused by your own action?
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5. Can
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rancnnnhla rise of vour property without the variance
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ADJACENT PROPERTY OWNERS LIST
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On my oath, I certify that the -names and addresses provided represent
all properties located win 80 feet of th�bject�roperty.
'Signature of Ap 1'can or A plicant's Representative
Subscribed and sworn to before this L(a day of Q19 lg `•,
�Noy Public in and for the State of Washington
Residing at ��
My 09MMISSION EXPIRES g �g389'
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Marian Locke Syd Locke110 Pine Street
126 Pine Street Edmonds, WA 98020
Edmonds, WA 98020
Alan Wicks
Jed Whitley 3410 W. Blaine St.
P.O. Box 3093Seattle, WA 98199
Everett, WA 98203
• Dorothy Flatt J.H. DeYoung18409 64th Ave. N.E.
1020 2nd Ave. S. Seattle, WA 98155
Edmonds, WA 98020
R.V. Hendrickson
1005-2nd Ave. S.
Edmonds, WA 98020
Vernon Hahn
1030'3rd Ave. S.
Edmonds, WA 98020
Donald E. Nicholson
1011 2nd Ave. S.
Edmonds, WA 98020
Resident/Owner
1010 Third Ave. S.
Edmonds, WA 98020
F. Tupper
711 Daley
Edmonds, WA 98020
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