Brackett's Corner - Land Use Application.pdfCity of Edmonds
Land Use Application
ARCHlTE'CTUTtAL DIISIGiN REVIEV
COMPREHENSIVE PLAN AmiI NI?SwEM'
C'ONDITI'ONAL USE PERMIT FILE # ZONE
I1C)ME OCCUPATION DATE R.EC'D BY
FORMAI, SUBDIVISION
SHORT STTBDIVTSTON FEF, RECi%tPT
LOT FINE ADJUSTMENT HEARING DATE
PLANNf-,,I7 RFSlDT3NTIAl, DEVELOPMENT
OFFICIAL STREET MAP Ami,, i)MENT HE STAFF PB ADB CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE: / REASONABLE [ISE EXCEPTION
OTHFR:
0 PLEASE NOTE THAT ALL INFQRKATI[)N CONTAINED WITHIN TIIL: APPLIi['ATION ISA PCIRLIC RECORD 0
PROPERTY ADD`z.t �4S`�� � �a�l� ��r++AV i i�crrss, ?�
PROJECT NAME (IF APPLICABLE) BPi ' 1f�$ RA/Ef
PROPERTY OihTsER?, ETA F9. LL.C- PHONE # I°1*,? - 447— - G053
ADDRESS. ?.e h`tolIT�Il Gr-eVITE-1 , tffi I2rl/'y/A TS 2-c,
E-MAILaA6E PR1PNV LLC!. v .....,.. FAX#
00393da�s
TAX ACCOUNT #C'g3734 3 °�1 �� SEC3 TWTP, Z7 RNo, �
00373G- 003 -001 m�
DESC',RipnoN OT PROSECT OR PROPOSECr (1SF (A f'I'ACff COVFR i,ETTER AS NECESSARY) J)"Em
DESCRIBE HOW THEPROJECT MEETS APPLICABLE, CODFS (ATTACTI COVER LETTER AS NECESSARY)
_�—�E7 -5,4�-r A �a
AP'PLICAvTlam? AC-r9� CV Ix� dwC� _ PEIONS#, L47-5-447,.'L
AI)I)RESS -�;Z' >-4Yr0- ST Sv'rE- logic El>11- o t!.3 wA V07-0
F MAII, : & PRlt>F_ i �G �. FAX #
CONTACT PERSON/AGENT L: Z7 ._ _..._.. mP'HONt # __=� z ✓' ., .,.., ...m_... _
ADDRESS 320 b' 9��A! ��� -5,L)ii'C' 1�Ia, E 0r�''ID.4
F -MAIL 4 P E aRr'es &U, C -V . 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 whale or part upon false, misleading, inaccurate or incomplete information
furnished by the applicant, hislher/its agents or employees.
By my signature, 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.
`it(NA7'TrRE C)F APPLTCAI IT7ACiENT � „.-.- " DATE.
Property Owner's Authorization
1, ...Cr.. _ __."±9/� . ....., _ .,..._....,.. ._.._w.....,,...,..,._, certify Linder the penalty of perjury Lander the lawws of the State of
Washington that the foilowing 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 inspection and posting attendant to this application..
SJGNATTTRF, OF OWNER �� DATE ]CIA //,Z -,
o, ion1? Call (425) 771-0220.
Reuised on 8 22 12 B- land Use Application I u e I of!