Initial Application Materials - Received 5-28-15.pdfCity of Edmonds
Land Use Application "lo ON
ARCHITECTURAL DESIGN REVIEW ®°
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT FILE #�L-� �� 1 7 i� C1Z- � ZONE
0N1E 0CCUP2 TION
DATE'S Z ( REC'D BY
FORMAL SUBDIVISION
SHORT SUBDIVISION FEE RECEIPT #
LOT LINE ADJUSTMENT HEARING DATE
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT HE$TF` PB ADB CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
OTHER:
® PLEASE NOTE TIIAT ALL INFORMATION CONTAINED WITIIIN TILE APPLICATION IS A PUBLIC RECORD 0
PROPERTY ADDRESS OR LOCATION rlLAak
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER e- 4Ik PHONE # q
ADDRESS L 6 ✓ c('oF6C)0- xq IA.;'a
E-MAIL aY i v ',� V10 FAX # � C4101
TAX ACCOUNT # nn'.e5 7 6 f o°' -r -x-) u V c) c> SEC. TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) p
LAR
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT bLt, �. 6 - t tee'L PHONE # -1
ADDRESS 9C6q�,k 9 d s-� ?'L v3 26,
E-MAIL mew "a ���y, :: f Baa FAX
CONTACT PERSON/AGENT =. �j a. Vic- W PHONE #
ADDRESS �q-4_) I j kL L
E-MAIL kr�-� FAX # '149 9 —71,E 8�
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 application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT %a DATE 1) -,x, -- IS'
Property Owner's Authorization
I, .Tu a " N W-"fw , 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 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.
(— 11
SIGNATURE OF OWNER DATE `5--
(J Que ions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application. doe Page I of I
CITY OF EDMONDS
QUESTIONNAIRE FOR ADMINISTRATIVE HOME OCCUPATION PERMIT
MAY 28 2015
Yes No gngVEIJOPM�NT SERVICE'
in,
1. 5( u Will the home occupation be carried on exclusively by a family member(s) residiin thOU41% unit?
2. 0 V Will there be employees working atOrvisif
Ing the subject property, who are not family members residing at the residence?
3. Nf C] Will there be customers or clients visiting the property",
4. Y D Vfili the home occupation be conducted entirely within the structures on the site, without any significant outside activity?
If no, please explain:
5. L3 Will there be heavy. equipment, power tools, or power sources associated with the. home occupation?
if yes, please list types:
6. C] N( Will vehicles be used in conjunction with the home occupation?
If yes, please list all types, including gross vehicle weight of trucks:
7. C3 - Id Will there be deliveries made to the property by commercial vehicles in excess of 20,000 gross vehicle weight,
(example: standard UPS truck)?
If yes, please explain:
8. 0 5� Will the home occupation create noise or Vibration?
If yes, please explain:
5� Will the home occupation produce dust, odors, or smoke?
If yes, please explain:
10. 0 1d Will the home occupation create any glare on public streets and neighboring properties, such as from lighting, welding, etc.
Iflyes, please explain:
11. L3 &( Will flammable and hazardous materials be handled or stored on the property?
If yes, please explain:
12. 0 5( Will materials in conjunction with the home occupation be stored outside of the dwelling?
It' yes, please explain how and where:
13. &( C2 Will there be a sign on the property in conjunction with the home occupation?
If yes,. please describe: 6,,-y%cx1t i S iCA ko'' 'A -k- ' -k "
The undersigned applicant for a business license certifies that the information provided within this application is correct and accurate.
L
The applicant acknowledges that his/her business license is subject to suspension or revocation if false or misleading information is
Ls of ECDC Chapter 20.20 will result in the loss of his/her business license
provided. Violation of any of the conditions and requirement
and the forfeiture of any fee paid.
APPLICANT: A -
Name (Printed)
Date