Land Use Application.pdfCity of Edmonds
Land Use Application
X ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL 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:
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FILE# F_(NZO)WO-70ZONE —9
DATE 12126118 REC'D BY
FEE yr.RECEIPT #
HEARING DATE
❑ HE ❑ STAFF ❑ PB ❑ ADB ❑ CC
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION (,.s 6 2 tf L C. .Sr -
PROJECT NAME (IF APPLICABLE)
L.Lc PROPERTY OWNE,R/ V o1 s 1'91CLLST PHONE #
`7 ADDRESS YU (.,L- N L�%✓�
L/Zr?796,67,�
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TAX ACCOUNT# t✓�f�!? }/2 &JA6 / 7G00 SEC. TWP. l' RNG. _
DESCRIPTION OF PROJECTOR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) T I 11 u }l �u m S
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)_
APPLICANT L Tf Q it L-0i Uh/\i 62errl e t7r / PHONE # / 7 1 �% ,`6 '�^
ADDRESS J- D zg m & ry Fd1la A/c Ji 0.4 ���y Ps V
E-MAIL tlb1. , (-(1 t '/' ('1 NAIL-� /ri► IUAI FAX # _
CONTACT PERSON/AGENT FYY %y 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
furnished by the applicant, his/her/its agents or employees.
By my signature, 1 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
DATE
Property Owner's Authorization
I, �F _ F`�� S l�i� ✓ GOf- WeP certify 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 pu fnspection a posting ttendnnt to this application.
Tzp,g.�')SIGNATURE OF OWNER*1C DATE
Questions? Call (425) 771-0220.
Revised on 8122/I2 B - Land Use Application Page I of I