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Applications & Plans.pdfCity of Edmonds Lard Use ,Application ❑ ARCHITECTURAL DESIGN REVIEW COMPREI'IENSIVE PLAN AMENDMENT�_� I ZONE � LI CONDITIONAL USE PERMIT FILE4 r '"�u " G LlHOME OCCUPATION & DATE d f REC'D BY I I FORMAL SUBDIVISION "f I I SHORT SUBDIVISION FEE RECEIPT # I I LOT LINE, ADJUSTMENT HEARING DATE ❑ PLANNED RESIDENTIAL DEVELOPMENT I I OFFICIAL STREET MAP AMENDMENT f ] HE / K$TAFF I I PB I) ADB I CC ❑ STREET VACATION Ll REZONE ❑ SHORELINE PERMIT ❑ VARIANCE / REASONABLE USE EXCEPTION 11 OTHER: APR 08 0 PLEASE NOTE TIJATALL INFORMATION CONTAINED WI7IIIN 771E APPLIC9 TION LS A PUBLIC RECORD PROPERTY ADDRESS OR LOCATION PROJECT NAME (IF APPLICABLE) g, PHONE # '' �' PROPERTY OWNER ADDRFSS 4 E-MAIL_k( FAX �# 'I _ TAXACCOUN# .) ,I �I i` j ) k:P>" SEC. TWP. RNG. DESCRIPTION OF PROJECT OR. �ROPOS 1D USE ( TTA TI OVER LETTER AS NECESSARY) / DESCRIBE FIOW THE PROJECT MEETS APPLICABLE CODES (A'I"TACH COVER LETTER AS NECESSARY APPLICANT PHONE # ADDRESS E-MAIL FAX # CONTACT PERSON/AGENT PHONE # ADDRESS F -MAIL FAX # The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indernnify, defend and hold the City of Edmonds harmless frons any and all darnages, 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 intorrrkion and ex ib Is here Vi I subotjA �d are true and correct to the best of my knowledge and that I arrr authorized to file this applihon on he t. alf of tl ov ner sstecl ow. SIGNATURE OF APPLICANI'/AGENT __. _ DATE _ l) c ' I y h oriviifiq I ro ler t rr�. '� A�At6 T, �. ify Under the penalty of perjury under the laws of the State of Washington that the followi ig is a true an(] correct statement: I have authorized the above Applicant/Agent to apply for the subject land use application, axd gr4.t my per ion for tl ° ublicla +crass and the staff of the City of F hnonds to enter the subject property for the purpo'es of nsf � posting, tion. ection r d rostin tb tl s� pI rl c ttend it SIGNATURE IJRL; OI OWNER w° -�1� _'t., DATE iestio s? C',I (425) 771-0220. Revised on 5/22/12 i B 1.11and Use Appliunion Page I of'] 2014 S F?VICES City of Edmonds Land Use Application ❑ ARCHITECTURAL DESIGN REVIEW • ' • •Elm ❑ COMPREHENSIVE PLAN AMENDMENT ❑ CONDITIONAL USE PERMIT FILE # VU4,140`4001 ZONE ❑ HOME OCCUPATION DATE t I++? - �' RECD BY . ✓ ❑ FORMAL SUBDIVISION ❑ SHORT SUBDIVISION FEE©)(��'11 10 RECEIPT# W LOT LINE ADJUSTMENT HEARING DATE ❑ PLANNED RESIDENTIAL DEVELOPMENT ❑ OFFICIAL STREET MAP AMENDMENT ❑ HE STAFF ❑ PB ❑ ADB ❑ CC ❑ STREET VACATION ❑ REZONE RECEIVED ❑ SHORELINE PERMIT ❑ VARIANCE / REASONABLE USE EXCEPTION APR 0 E 2014 ❑ OTHER: DEVELOPMENT SERVICES ® PLEASE NOTE THAT ALL INFORMATION CONTAINED IVIT-7HIN THE APPLICATION IS A PUBLIC RECORD PROPERTY ADDRESS OR LOCATION 17306, / 1� �� Al&-�U-- 4V PROJECT NAME (IF AP/PPLLI�CA�BQLE) PROPERTY OWNER "" ' -" ' PHONE # ADDRESS (da, % /, ��i 7Q 7 7 E-MAIL g0at'e- (d a ,/ Ii%��`v 1 , t 7 FAX # `T�� �.2 ~ / ( C v` TAX ACCOUNT # �0-� 0d 0 -' l 3 ?— , (S O I SEC. TWP. RNG. DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) geP7T7'/E o�CWAA16 16-r L1A4E DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) APPLICANT PHONE # ADDRESS E-MAIL FAX # CONTACT PERSON/AGENT PHONE # ADDRESS E-MAIL 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 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/Iyer/its agents or employees. By my signature, I certify that the information nd exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file this applicatio h alf g owner as listed below. SIGNATURE OF APPLICANT/AGENT / DATE l U i Property Owner's Authorization I, , certify under the penalty of perjury under the laws of the State of Washington that the following is a ue and correct statement: I have authorized the above Applicant/Agent to apply for the subject land use application, and gr eWati/6sGtflattendant for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of tq to this application. SIGNATURE OF OWNER 'u/ DATE Qu ions? C l (4 5) 771-0220. 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