Garland Application.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
XCONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
❑ LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
9, PLEASE NOTE TRA TALL INFORMATION CONTAINED W
ITHIN THE APPLICA TION IS A PUBLIC RECORD a
PROPERTY ADDRESS OR LOCATIONS t"..W_ TPC
PROJECT NAME (IF APPLICABLE) T a v Z.0
PROPERTY OWNER 1" �k g U 1 (a ONE #1
ADDRESS
E-MAIL? ', I,t FAA#_
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SEC.
TAX ACCOUNT # ._._ cc ...��l,�ur��'�i7i�t
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TWP. RNG.
CESSARY
DESCRIBE HOW � E l�Ri>,lI°I;"9Ml f:`I`"a"APPLICABLE CODES (ATTACH COVER LETTER AS NE
APPLICANT' �.,, � -C _- PIIONF w, f q -,T 2
ADDRESSt*
E-MAIL'f" IM SG i r? fit" p -.. (r'— Von ._ wyl m FAX #
CONTACT PERSON/AGENT 'HONE #
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/her/its agents or employees.
By my signature, I certify that the information and exhibits hear wi0 � subuaia d are true and correct to the best of my knowledge
and that I am authorized to file this application of the behalf of die mea' as listed below.
SIGNATURE OF APPLICANT/AGENT WM-- DATE Z Z O
P perky O^trrnw- s Authorization
auaartte lna�lty of perjmuy under the laws of the State of
Waashnrgton haul the I'61lowin is a true mnid 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. '% f
SIGNATURE OF OWNER WLA�I DA t I -6' v(fJ 1 ` '`
Call (425) 771-0220,.
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