Land Use Application.pdfCity of Edmonds v
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT FILE# Ltv�l�i0� ��LONE
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION DATE z �'� �� REC'D BY W-)
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION FEE RECEIPT #
1� LOT LINE ADJUSTMENT HEARING DATE
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT ❑ HE ❑ STAFF ❑ PB ❑ ADB ❑ CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION FEB 2
OTHER:
nEVEOPMn
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD • COUH
L.
PROPERTY ADDRESS OR LOCATION 4oll WIE UrLW �i(aE%L W 41 COUN
PROJECT NAME (IF APPLICABLE) _ Ldf LINE ADUS'TJp A)r
PROPERTY OWNER T AVAL, 'FQI ( q. PHONE # 'LO6 321
ADDRESS LA" RALLIA/60L LJPrV., r^DM.NJIS LAj P'Lb
E-MAIL FAX # 1 ^' u
TAX ACCOUNT # 00 4 DS26 00 9 o It o v SEC. �� TWP. 2- /" RNG. 9
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
L-oT L/Ni' Prbs,;s inEN mu?ttalAt j ,%&6 ?'c
RfmovE EplCaommmeNT' nF RU%.0IN(3. MiArAlA/ SFT BAa LodrotZMR
op NE,141+80(- ,
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
L.L. A, F,Envic.FN NQ4 --Cu FvAmANCE OF 51vtl ►tomC AAI
MAIn1"lAI SI I ,QI}LK Go AI Jy,CrnRN(C 01: lourf liomG
APPLICANT PAVL- I-Alal PHONE# 2.d, 321 gS34
ADDRESS iyii LAIC Mi. -, Aok L,J$ Y
E-MAIL (� FAX #
Y/♦• CONTACT PERSON/AGENT tAL. 'TRIED. PHONE# 2-06 32A
ADDRESS StrmC
E-MAIL Pau '- 00A `� i VC . CAM 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 herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this applic111 of S listed below.
SIGNATURE OF APPLICANT/AGDATE Lb TAI
Property Owner's Authorization
I, P&I kL_ 'I Alai . 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 • o�speclion and=sum attendant to this application.
SIGNATURE OF OWNER DATE)
Questions? Call (425) 771-0220.
3VED
2019
RmE3
rER
Revised on 8122112 B - Land Use Application Page I of]
City of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
Eli
COMPREHENSIVE PLAN AMENDMENT Lhi � fi" 7 ZONE - f `
`�� - 4Z
❑ CONDITIONAL USE PERMIT FILE #
❑ HOME OCCUPATION DATE REC'D BY C
❑ FORMAL SUBDIVISION
EJ SHORT SUBDIVISION FEE RECEIPT #
V LOT LINE ADJUSTMENT HEARING DATE
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT rl HE rl STAFF rl PB ❑ ADB C
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT FEB 2 8 2
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER: DEVELOPMENT
• PLEASE NOTE THAT ALL INFORMAATION CONTAINED WI pTHIN THE APPLICATIOAN IS A PUBLIC RECOAQUNT E
PROPERTY ADDRESS OR LOCATION ` ,'.T.00* Lh�^ �JR�.I 4(N flt WA-1
PROJECT NAME (IF APPLICABLE) 1A1�1,...,�Ljeyf- j( 4DJ%jSrrn�ir� r -1 f Q Q n
PROPERTY OWNER S?EVE0 A MIt1AAYA) RWSC PHONE#_- I, s--1 7-J-- C)C}1�� o
ADDRESS. in fl l 9 - 6� S l v V� &rI MI) Vl cl f W A I 8
E-MAIL �- FAX # `-- c
TAX ACCOUNT # DO N oO A 0 I '� _ z O SEC. � TWP. -L* M RNG. G
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
L6f Hof AbInTmeyT mTUAI!.y A6t2 Td a&W--ye en c"c"i-cymeur
o N�I,�,A►G. MA,NjAIAI ro- 9A(K doNkfMRAIcC cF DWE►Gi Bok
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
L•c,A- Afout,ES NO4 -cE-)A1 "PAC15 OF 30I1 16ME _MAN MAInTAINS
APPLICANT Powt, , TP. I M PHONE # iS' (i
ADDRESSyI� 1�tc' AA•LL/A)6EK WAy , E3MM26 L-M "1901-j,
E-MAIL FAX #
CONTACT PERSON/AGENT PML eTAIEL . PHONE # L06 - 3 ')..I - 9 S(q
ADDRESS SSE
E-MAIL P cxul - ,ap_ VQ, M 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 info and exhibits herewith Submitted are true and correct to the best of my knowledge
and that I am authorized to file this appl cation o the owner as listed below. i I
SIGNATURE OF APPLICANT/AGENT DATE 1-b �Icl
Property Owner's Authorization
I, STEM o s- MTKOVAI h' wscif 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 purposes of inspection
and posting attendant to lh s application,
SIGNATURE OF OWNER_/"�
Questions? Call (425) 771-0220.
119
ERVICES
Revised on 8122/I2 B - Land Use Application Page I of]