Application.pdfCity of Edmonds
Land Use Application �.
❑ ARCHITECTURAL DESIGN REVIEW •
-I COMPREHENSIVE PLAN AMENDMENT 1
�1 CONDITIONAL USE PERMIT' FILE #u I `/.ONE
I HOME OCCUPATION DATE i + 6 " — REC'D BY
1 FORMAL SUBDIVISION
X SHORT SUBDIVISION F EEC(' l� , t� RECEIPT 4
1 1 LOT LINE ADJUSTMENT I'IEARING DATE
CI PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT CI HE �4 STAFF ; PB ADB ❑ CC
STREET VACATION
I REZONE
11 SHORELINE PERMIT
VARIANCE, / REASONABLE USE EXCEPTION
LI OTHER:
PLEASE NOTE THAT ALL INFORAIAT101N CONTAINED IVITIIIN 7'71E APPLICATION IS A PUBLIC RECORD
PROPERTY ADDRESS OR LOCATION _1 6°0 6 's 4
r
PROJECT NAME (IF APPLICABLE)
ADDRESS 11,' ��kiONEf#{
,dd
PROPERTY OWiV'EIt
d
E-MAILE�" � �'.,, �,,�_ FAX #i _
..
y�
TAX ACCOUN 1 #_ (., (...If�8�/_' SEC._.l"WP _.. RNG.
( "RY
DESCRIPTION� + PROPOSED (ATTACH LT( GSS� )
OF PRO.I� C7� OR PROPO"$ SE (AT
��— HCOVER AS NE
� � f' �
b f IER ASNLCESSA
�� CODES 1CL1 COVER ] ET
TER DESCRIBE HOW THE PRO.IIECT N(FFTS A � � IPPLIC��ABLE J ES rAam+ f /
9� y d + rI
APPLICANT' ,1'1 �� �� lr`il>�(rl ✓l ���",�(1 /� Gp PHONE#—
r i p
ADDRESS1;:'yd
E-MAIL,.,-a� �� `� T �l' r „ #
Lt (, �k i". Yk r 9 FA`�##
CONI"ACTPERSON/AGENT''f f @ (l Ad --PHONE(a
ADDRESS—
r
E-MAIDri f 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 horn 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 signatUrC, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENTDA71 ref t d
Proper . weer s Autllop 1 tloil
I '
certify underthe penalty Of perjury under the laws of the State of
Washington that the following is Erie and correct statement: 1 have authorized the above Applicant/Agent to apply for the
subject land use application, and bi anI my permission for fhc ntl Itc officals and the staff of the City of Edmonds to enter the
subject property for the purposes of m pec ion nick posfing� att i d i t I� this Epp lication.
�,c
SIGNATURE OF OWNER ��.11,s DATE 41 IL
Questions? Call (425) 771-0220.
Revised on 8.22'12 B - Land Use Application Page I of I
o
fir,
JAN 08
vt
&on& Uffi(sWurfim
CUSTOMER - EIC
CONTACT
Form
...... ......... ...... ........
A coordinated utility environment which inaxiniLesjoint utility opportunities to provide quality service for the citizens of Edmonds
............................. I .................................... . ..... ... I .................................................... I ............... ... .
YOU WILL BE GIVEN A CONFIRMATION NUMBER BY EACHUTILITY ONCE
YOU HAVE INFORMED THEM OF YOUR PROJECT.
SITE ADDRESS:
Wo 11.11 ff, 31
WzM39MMMzMzW
Mary McAllister - 425-670-3216
You will need to provide PUD with a site plan and a completed New Service
4v /)(j
Questionnaire.
l)UG1`T
S 0 U N D
Z.
i
ENFRG
-`0 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.
6, c
'Mdrwwa) i1w, 1,kn-v i runli,.ti
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 i, required. A copy of your
—d
You will need to provide Conicast 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 Si 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 Vie", Service Area
complete a development information form.
THIS FORM MUST BE COMPLETED AND GIVEN TO DEVELOPMENT
SEE. VICESS"fAFFA'I'T'HE'riMEOFPERMI'I'SIJBMIVI'AL