22300_100TH_AVE_W.pdfCITY OF EDMONDS
APPLICATION FOR CONDITIONAL USE
HOME OCCUPATION PERMIT
HEARING DATE (IF. REQUIRED
APPLICANT: VA-;-0ADDRESS:A.?,3e9C? HONE:
Indicate type or degree of interest in the property; 1� Al EzC
0 ADDRFSS:,',)2,, -)r-) 4�2a7,rl- HONE:
WNER: D,
Use Zone (To be completed by Planning Department)
VICINITY SKETCH: PLEASE SHOW BELOW A VICINITY SKETCH AS PER EXAMPLE, INDICATING NORTH.
ST
Example:
ST
LOCATIOM OF 146L)15F-
INDICATE TYPE OF BUSINESS AND DETAILS OF PROPOSED USAGE:
-7a AA92
b (2'9 AI-LO 7-/ A/ -Z-:�
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 of the City whenever such 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 enter the subject property for the purpose of inspection
and posting attendant to this application.
A
Signature of Applicant, Owner
or Representative
CITY OV EI)MONDS
250 filth Ave. No.
WASlilliGIOIJ 98020
Mrs Caroline Petosa
1259 Birch St.-
Edmond6,-"WA'----:990:20:
Af
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