Application.pdf11
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City of Edmonds
Land Use Application
ARCHITECTURAL DESIGN REVIEW
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT
HOME OCCUPATION
FORMAL SUBDMSION
SHORT SUBDIVISION
LOT LINE ADJUSTMENT
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
OTHER:
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FILE # P" 7O1b Dd-TWONE iZ5
DATE i6lill t -i REC'D BY
FEE RECEIPT #"
HEARING DATE
❑ HE ❑ STAFF ❑ PB ❑ ADB ❑ CC
• PLEASE NOTE THAT ALL INFORMATION CONTAINED 97TJMV TAE APPLICATIONIS A PUBLIC RECORD 0
PROPERTYADDRESsORLOCATION 926 WALNUT ST, EDMONDS WA 98020
PROJECTNAME(IF APPLICABLE) LAUGHTLAND RESIDENCE
PROPERTYOWNER LAUGHTLAND RESIDENCE PHONE# 425-773-8835
ADDRESS 926 WALNUT ST, EDMONDS WA 98020
E-mAIL HARLIELA GH M' Im M FAX#
TAX ACCOUNT # APN: #00434207200700 & 00434207200900 SEC. TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
CONDUCT LOT LINE -AW 11111111uw 9
TAX PARCEL APN: #00434207200700 & 00434207200900. ADJUST LOT LINE OF TOTAL
x
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)-
NEW-LOILINES-WILLN I MAKE ANY EXISTING IMP
TO THE REGULATIONS OF THE ZONING ORDINDENCE. PROPOSED LOT LINE
ENT -MI CO A1C R
LL REGULATIONS OF ZO C"RUINANCE-
APPLicANT JOSEPH NGUYEN PHONE # 206-782-6959
ADDRESS 3929 STONE WAY NORTH, SEATTLE WA 98103
E-MAIL JOSEPH CRDDESIGNBUILD.COM FAX#
CONTACT PERSON/AGENT JOSEPH NGUYEN PHONE # 206-782-6959
ADDRESS 3929 STONE WAY NORTH, SEATTLE WA 98103
E-MAIL JOSE PH@CRDDESIGN BUILD.COM FAX#
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 attorney's
fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information
fiunished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitte a and correct to the best of my knowledge
and that I am authorized to file this application on the behalf of the j st=d below.
SIGNATURE OF APPLICANT/AGENT
DATE 10/13/2016
Author ation
I
Pro r er Sd ( certify under the penalty of perjury under the laws of the State of
Wasbington that the ::allowing is a true and correct statement: I have authorized the above Applicant/Agent to apply for the
subject land use application, and grant my p=rmis="an for the public officials and the staff of the City of Edmonds to enter the
subject property for the purposes of inspection and sting attendant to this application.
SIGNATURE OF OWNER "� ) "" % DATE � 1f % /2016
t) estions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application Page I of I