Application.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
C COMPREHENSIVE PLAN AMENDMENT
C CONDITIONAL USE PERMIT 7DATE
1 t, ZONE
Li HOME OCCUPATION ��� `y REC'DBY�
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION FEE 3 3 -� RECEIPT #
❑ LOT LINE ADJUSTMENT HEARING DATE
C PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT [_ HE J STAFF 1-1 PB ❑ ADB IQCC
F STREET VACATION
❑ REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED�WI,THIN THE APPLICATION IS A PUBLIC RECORD 11
PROPERTY ADDRESS OR LOCATION Ls7 �p d V YAKS l� t�uJ Ct „
PROJECT NAME (IF APPLICABLE C� f-
C/Lt )c LCs-' LI V14u v a'" y Lt C S -e 5t.
PROPERTY OWNER dT Q Elf 1.1 S PHONE # Z °J --7 —o2- SLp
ADDRESS —700 AL�-{—
E-MAID t v I e , (/1 r�( uvt C vt S ext wtn1 FAX #
TAX ACCOUNT # i SEC. TWP. RNG.
,��CLSS Ii l')
ESCRIPII 4✓ETR( U iATTACCI �� C(SI It LETTER S NI''
DESCRIBE HOW THE PROJECT MEETS APPI ABLE' CODES (ATTACH COVER LETTER AS NECESSARY) 9
APPLICANT a ` 1 --5, I ,,100 PHONE # 0 2-� "-7-7
ADDRESS _ � 0 A ivi
E-MAIL e v✓J ..i( " ,fMtht a� tiQ FAX#
CONTACT PERSONJAGENT P'HON E #4Z2
ADDRESS -700 V&A I N
E-MAIL Gx Y'`.. vG�; % Vt .,_ FAX #
The undersigned applicant, and his/her/its heirs, and assigns, in conskleration 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
furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits 1 erewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this application on the be of the owner as listed below.
SIGNATURE OF APPLICANTIAGENT DATE T
Property Owner's Authoriza ion.
certify under the penalty of perjury under the laws of the State of
Washington that the foHowing is a true and correct statement: I have authorized the above Applicant/Agent to apply for the
subject land use applicatif�vQuestions?TCall(425)771-0220,
for the public officials and the staffof the City of Edmonds to enter the
subject property for the pung attendant to this application.
SIGNATURE OF OWNER DATE Call (425) 771-0220,
n - Lana Use Application page I of I