Land Use Application.pdfCity cf Edmonds
Land Use Application
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F ARCHITECTURAL DESIGN RF.ViEW
C COMPREHENSIVE PLAN AN-tENDMENT
CONDITIONAL USE PERMIT FILE # "�1° �' /,�� ➢ ZONE 'Ce
C HOME OCCUPATION
I FORMAL SUBDIVISION
, VC 'w SHORT SUBDIVISION FEE t 6 Z0.,0 `--' RECEIPT#
C LOT LINE ADJUSTMENT HEARING DATE
C PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT HE FS'"i X'W ", I PB I I ADB I I CC
C STREET VACATION �"
F RE✓ONE
L SHORELINE PERMIT
I VARIANCE / REASONABLE USE EXCEPTION
C OTHER:
0PLEISENOTE TIIATALL INF O ALATION CONT-IINED1V7THIN® THryqENPPLICATIONISAPUBLjI®CRECORD0
PROPERTY ADDRF,SS OR LOCATION
IAf �� �✓ ��� �(1 �✓
PROJECT NAME (FF APPLICABLE) o
PROPERTY , ONVNRR 1 ° PHONE #q /J��- q -2
ADDRF,SSHoS �3 q_ 1rcw t �^,4nn1IA) NA l/
E-MAIL FAX #
TAX ACCOUNT # °�°°yyoho / SEC.3Q TU1P. RNG. 09
DESCRIPTION OF PROJECT OR PROPOSED USE (AT`T'ACH COVER LETTER AS NECESSARY)
DESCRIBE HOW THE PROJECT MELTS APPLICABLE CODES (A'I'I'ACll COVER LETTER AS NECESSARY)
APPLiCANTes\ PHONE # 0
ADDRESS w5si 13"hgv'P uj Livi"wopA,wA 9180.3
E-MAIL # /p
CONTACT PERSON®®/AGENT QPHONE # d q .d4
ADDRESS It1015�® V 0
FAX
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to
release, indernrift, 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 ' T PP
h at ion on �too t o owner as lis�tIe.d below.
SIGNAIUIZEOFAPI LCAN/,AGENt ---Illfff�s
DATE
—
Property Owner's Authorization
I, �(f+ LA ('J N ,y R(aw N "WI certiA, under the penalty of perjury under the laws of the State of
Washington that 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 purposgs of inspection and posting attendant to this application, p
SIGNATURE OF OWNER
_J'G.,. DATE
Q(tzstions�? Call (425) 77J1-0220.
Revised on 822112 B - Land Use Application Page I of]