Chase Application.pdfCity of Edmonds
Land Use Application °Y
ARCHITECTURAL DESIGN REVIEW
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT
1 HOME OCCUPATION
FORMAL SUBDIVISION
I SHORT SUBDIVISION
I LOT LINE ADJUSTMENT
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT
[J STREET VACATION
I REZONE
SHORELINE PERMIT
I VARIANCE/) 1ASONABI+USE EXCEPTION
1 OTHER: C) =___
• PLEASE NOTE THAT ALL INFORM9A rT-ICON CONTA^�I,NED WITHIN THE APPLICATION
" IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION _ J k y �_� ;.Ad (h_ � � . � 0 _ �_ ry+� I �"""� °�'"� °I � ......•.
%. ....
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER
ADDRESS
1 1 C e PHONE m, .. _ ! a
)7"1ar i « C0'01 FAX#
I
d �,.,Y ° , I ".. ..�....n lio SEC. TWP. I RNG.
13
TAX ACCOUNT# U (
CtY 1) USE ATTACH t't,7VFR LETTER AS N'1 C I l-SARY f
DESCRIPTION OF PROJECT OR PROPOSE.�
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT, 1�)iA, Yy �� C Vl I1 PHONE #� �10 1 -1 �3�5�`
ADDRESS
E-MAIL IC7 C"� V)aSe. � I 1_ -' ..off,- ._.. _. 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
famished by the applicant, his/her/its agents or employees.
fly my signature, I. certify that the mfhrmtttion and exhibits herewith submitted are trite and correct to the best of my knowledge
and that I am uudaoriZed to file this application on the behalf of the owner as lasted below,
SIGNATURE OF APPLICANT/AGENT
DATE
Ptul . l PAuthoriotio"._
Washington that the following lowin is a true and cmrccl statcnIcrIC certify
haveramborizdt Ira above Applicant/Agent at/Agent of
the
�for athe
the ilia Na State of
g It to
subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to anter the
SIGNATURE OF OWNER
of mspa�clioat tlma7,pa&tiatJt attcndantau,.tYris annl¢Cataon.
subject property .�. 17A"f E,A.?""��
Questions? Call (425) 771-0220.
Revised on 8122/12 N - Land Use APPnca on • -s. 1 1
ACCESSORY DWELLING UNIT AFFIDAVIT
On my oath, i certify that 1 reside at // Edmonds, Washington, in
the primary or accessory dwelling u@t for more than ix months of every year.
Assessor's Parcel Number: O() 7 -211 U 06) 0 6 9' 1 0
-. .
Signature o Property Owner( )
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH )
Subscribed and sworn to before me this day of - Y,
.o ry Public iti and for t + tpte, of Washington
s� �ug a _
ft^t
Y tp�tlRECEIVED
tow�1 I
MAR 13 2017
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DEVELOPMENT SERV10ES
COUNTER
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