Application.pdfCity of Edmonds
Land Use Application
ARCHITECTURAL DESIGN REVIEW EMMMMMM
COMPREHENSIVE PLAN AMENDMENT
FILE #� a ZONE
X' CONDITIONAL USE PERMIT J ` t
HOME OCCUPATION DATE 1 B l�, REC'D BY
FORMAL SUBDIVISION r (+
SHORT SUBDIVISION RECEIPT
LOT LINE ADJUSTMENT HEARING DATE
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT HE w, STAFF PB ADB CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
OTHER:
® PLEAS'E.VOTE TH IT ALL INFORAEITION CONTAINED WITHIN THE APPLIC47I01\' IS A Pr BLIC RECORD
PROPERTY ADDRESS OR LOCATION 18908 OLYMPIC VIEW DR. EDMONDS WA 98165
PROJECT NAME (IF APPLICABLE) _ REMODEL - ADU ADDED
PROPERTY 0'%'V1NT,,R DAVID HELLENE PHONE €f 206 - 349-1665
ADDRESS 4019 NE 92ND ST SEATTLE WA 98115
E-MAIL dhellene(@gmaii.com _ FAX
TAX ACCOUNT # 27031300401600 SEC. TwP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
—REMODEL OF EXISTING HOUSE PROPOSED ADU AT BASEMENT LEVEL CONVERT ONE
BEDROOM TO A BATHROOM AT MAIN LEVEL, PER PLAN.
?DESCRIBE HOW THE PROJECT ME �S APPL (ABLE C�ODE—S'TACH COVERR AS N SS�ARY)
APPLICANT PHONE #
ADDRESS
E-MAIL FAX #
CONTACT PERSON/AGENT Mark Travers AIA PHONE, # 206-763-8496
ADDRESS 2315 E. Pike St. Seattle WA 98122
E-MAIL mark@marktraversarchitect.com FAX 8
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
famished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exlijbits herewith submitted are true and correot to the be-Af my ki �4edge
and that I am authorized to file this applicati n o Itiellaffof the&1hIedLbol .
SIGNATURE OF APPLICANT/AGENT / DATE
Property Owner's Authorization
1 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 dmon s to enter the
subject property for the purposes f44spection and po 'ng aIt xl nr to this application.
SIGNATURE OF OWNER 4 DATE J
Questions? Call (425) 771-0220.
Revised on 8/22./12 is - L(lild Use APpuuCanon