01737r�1
To be filled in
CITY OF EDMONDS
by P1 Div ion:
SUBDIVISION APPLICATION
DATE ILEI/h—
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FEE RECT1110, 1 —1_
APO' S�/_TITLE RPT
LEGALS
Existing Proposed
MAP_IZGRADING PLAN
EA__. ENV.CKLST
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ENV.CKLST FEE TUv
HEARING DATE:
RECT ``\\
FEE: 1)Preliminary: $110 + $20 per lot
2)Final Plat Check: Same amount*as
IN -LIEU PARK FEE
preliminary
ENVIRONMENTAL
CHECKLIST FEE: $40.00
RECT # i•�
APPLICANT: Richard J. Blandau AADRESS:Edmonds.
Wa. PHONE: 778-0306
Indicate type or degree of interest in the property:
Owner
OWNER: ADDRESS:
PHONE:
(if other than applicant)
1. REQUEST THAT THE FOLLOWING DESCRIBED PROPERTY BE
DIVIDED INTO 6 LOTS.
LOCATION OF PROPERTY: 540 Edmonds Way
LEGAL, DESCRIPTION OF ENTIRE PROPERTY: See attached legal description.
To be completed by Planning Division:
ZONE:
2. MODIFICATION TO REQUIREMENTS OF DEVELOPMENT CODE.
A licant requests that the Hearing Examiner consider the following
mo ications to the requirements of the Development Code.
None requested.
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 agent or employees.
PERMISSION TO ENTER SUBJECT PROPERTY
The undersigned applicant grants his, her or its pe on for public officials a d
the staff of the City of Edmonds to enter the su ct po erty for e p os o
inspection and posting attendant to this appli atio
*Owner's authorization, by notarized 0_.
signature, is required for any application Signature of'1Pr arty Owner or Agent
submitted by an agent.
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