Chung Application.pdfCity of
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EdmondsJUL 1/
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Land Use Application DEVELoPMEiyr .��( -W
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❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
N SHORT SUBDIVISION
❑ LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION 1S A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION „EdMQnds, WA 98020
PROJECT NAME (IF APPLICABLE) .... ...............------. ,- ....... -__,_.�
PROPERTY OWNER Thomas Chuna PHONE It (206) 708-5538
ADDRESS 771 Edmonds _Way- _Edmonds, WA 98020
E-MAIL thomaschung_1999@yahoo.com FAX #
TAX ACCOUNT # 00745300000500 SEC. - 25 TWP. 27 RNG. 3
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSAR
Three Lot Short Subdivision
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY).
See submittal plans and report.
APPLICANT _wThOmasChuna, PHONE # (206)708-5538 ww_,
ADDRESS 771 Frlmnnric Way, Frimnnric A .
.n
E-MAIL thomaschuna 19990vahoo com FAX #,W ,,m,mmmm mmmmm_m_m_mmITITIT�
CONTACT PERSON/AGENT Jeff Beckmann. P.E. PHONE # (425) 392-8055
ADDRESS 455 Rainier Rlvri N,• Iccani iah Wl QRQ77
E-MAIL e.�anleacor ul)ar g-com FAx 425) 392-0108
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/her/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 appltc�a (;,)) qV
Qw,tA4VIl'ofthe owner as Vis c)9 below.
SIGNATURE OF APPLICANT/AGENT
Property Owner's Authorization
DATE
I, Thomas Chuna certify under the penalty of perjury under the laws of the State of
Washin Won the
gt t 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 Edmonds to enter the
subject property for the purposes of insp4!c tkin and l,ulsung attendant to this application
SIGNATURE OF OWNER
Revised on 8/22/12
Questions? Caliw, 425) 771-0220
B - Land Use
DATE 7— t S — Z o It
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