APPLICATION.pdfRECEIVED
IN
City of Edmond
SEP 4 201
Load Use Application
DEVELOPMENT SEFIVICES
H ARCHITECTURAL, DESIGN REVIEW ri
C] CONDITIONAIIVE PLAN U4EI'F,IZMIMINDMEN'I' I1LE# tV ')I+1r�6 IL�"LONE ' " f'7
hl HOME OCCUPATION �• N..
DATE 12EC'D13Y I w
I FORMAL SUBDIVISION
'L4, SHORT SUBDIVISION FEF RECEIPT#
I I LOT LINE ADJUS'T'MENT HEARING DATE
Ll PLANNED RESIDENTIAL. DEVELOPMENT
H OFFICIAL. STREET MAP AMENDMENT ❑ HE S"I'APF ❑ PB El ADB 17 CC
U STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE/ REASONABLE USE EXCEPTION
❑ OTHER:
0 PLEASE NOTE 771AT ALL INFORAIA77ON CONTAINED WITIHN THE APPLICATION LS A PUBLIC RECORD a
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PROPERTY ADDRESS OR LOCATION � ��" � ," ❑ . �. �."�" �AF� � Ty � r"`"'�) "E �"" '
PROJECT, NAME (IF APPLICABLE) p a$?0 "J
PROPERTY OWNER S o yr ) ,w PHONE# :r e',) o S.., .w..
ADDRESSC:2 " ,
E-MAIL, ..�,
FAX #_
TAX ACCOUNT# ... a�u kFrm;a I°q SEC. MTWP .b 1�, RNG.
DESCRIPTION OF PROJECTOR PROPOSED USE (AT"i'ACLI COVER LE'I"TER AS NECESSARY)
tialDFSCRI�l IO THE 'R� a'E•fl I sf . C6�t APPLICABLE" CODES (AAI Il AC�I^I CO�VtLR LETTER AS NECESSARY)
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APPLICANT T"'"°('l ,.d� .,✓�° _PHONE# -J �S } ����� (
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CONTACT PERSON/AGENT PHONI #
ADDRESS 4t1'"", �"A V afro,'
E-MAIL. FAX 4
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 d-umages, 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/ifs agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are tFUc and correct to the best of my knowledge
and that I am authorized to file this application on the behaY of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT �%,?"f s'""� _DATE
Property owner's Authorization
L, 1,'"' Ot J certify under the penalty of perjury under the laws of the State of
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Washington that the i'ol owing s 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
subIect property for thepur. Fose_s of mspe_cC"U�ron ^atn_d
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ednRdant.to th_is_.a� 7
lica_t._i.o.n.
SIGNATURE OTOWNER
DATE
Questions?
Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Page 1 o/'I
RECEIVED #E28
SEP 0 4 2014
OPMENTSEFjVjor:,,�
OEU C"�, EdmoWs Ub% Nnim
I
CUSTOMER — EUC
CONTACT
A coordinated utility environnient which nuixiinizesJoint ittilit.), opportunities to provide quality service.for the citizens ofEdniondy
.............................................. ... I ................... ............. I..............
YOU WILL BE GIVEN A CONFIRMATION NUMBER BY EACHUTILITY ONCE
YOU HAVE INFORMED THEM OF YO
,,,11, E
SITE ADDRESS,:
Mary McAllister - 425.670-3216
You will need to provide PUD with a site plan and a completed New Service
Questionnaire.
4 11 [ J G F 11,
1tol(t
New Customer Construction
Call to verify gas availability and to coordinate service install. You will need to
Department- 1.888-321-7779
provide parcel number, contact phone number and mailing address.
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v kkuwo �a lhc, Ncmfror6er
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2, '
You will need to provide Frontier with the location Of Your project, total line
Jeremy Fallt - 425-263.4024
requirement, and the date in which service is required. A copy of your
You will need to provide Comcast with the location of your project, a copy of
Mike Fontenot 425.263-5482
your development and site plan (digital copy if available.) The date in which
service is required and a list of contact names, phone numbers & mailing
Steve Dunphy - 425-774-7769 ext. 110
You will need to provide OVWSD with the survey map of your site and
For customers in Olympic View Service Area
..... . ..... I-- . . . ............ . .
complete a development information form.
. .............. . . . . . . .. . . . . ............. -- . ..... .. . ................. .. . . .........
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THIS FORM MUST BE COMPLEITI) AND G �,N rf0 D E'V E L 0 P M E, N'I`
MIrl 'T A -L i�,, i o/ i / t
SERVICES STAFF ATTHE TIME OF PERMIT SUB