Application.pdfCity of Edmonds
Land Use Application
C..l ARCHITECTURAL DESIGN REVIEW
C.1 COMPREHENSIVE PLAN AMENDMENT
D CONDITIONAL USE PERMIT
D HOME OCCUPATION
i.J FORMAL SUBDIVISION
LY SHORT SUBDIVISION
LOT LINE ADJUSTMENT
D PLANNED RESIDENTIAL DEVELOPMENT
I OFFICIAL SIRE "I' MAP' AM1.NDM1�NT
D STREET VACATION
C] REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
D OTHER:
a PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION 8498 Talbot Road Edmonds, WA 98026
.. ..... ..................
Reed John ................
PROJECT NAME (IF APPLICABLE) son Short Plat
PROPERTY OWNER Teri Johnson
ADDRESS 8498 Talbot Road Edmonds, WA 98026
E-MAIL 321reed@gmail.com
TAX ACCOUNT # 00594400006400
PHONE # 425-7744000
FAX # 877-774-4050
SEC. 7 TWP, 27 RNG. 4
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
Pr000sed 2 Lot Short Subdivision
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) ,, ............
See Attachment
APPLICANT Teri and Reed Johnson
ADDRESS 8498 Talbot Road Edmonds, WA 98026
E-MAIL 321 reed@gmail.com
CONTACT PERSON/AGENT Jack Siebert, PLS
ADDRESS 4,610 200th St. SWSuiteA, Lynnwood, WA 98036
E-MAIL jack.tricoland@frontier.com
PHONE # 425-210-8888
FAX # _ 877-774-4050
# 425-776-2926
FAX # 425-776-2850
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
fumished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith subinitted I re true and correct to the best of my knowledge
I � I�....-..A � ,r aro rol below.
and that I am authorized to file this application on the behalf of �� DATE
SIGNATURE OF hf"I L..]t ANT'/A{"sf 14 the arowroroc
Property Owner's Authorization d
certify under the penalty of perjury under the laws of the State of
Washington that the following is a true and correct statement: I have authorized the above Applicant/Agent to apply for the
subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the
subject property for the purposes of inspa ctic and posting attendant to this application.
SIGNATURE OF OWNER 1 � t ITITmm m......... -DATE 7
Questions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application Page I of]
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