Land Use Application.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDMSION
® SHORT SUBDIVISION
❑ LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATIONIS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION 8616 196th Street SW, Edmonds, WA 98026
PROJECT NAME (IF APPLICABLE) Ta Short Plat
PROPERTY OWNER Dung t Ta & Hoa Phan PHONE # 425-829-8582
ADDRESS 2908 107th Street SE, Everett, WA 98208
E-MAIL joedinhta@yahoo.com FAX #
TAX ACCOUNT # 00549200000200
SEC. 19 T wP. 27N RNG. 4E
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) Short subdivision of
existing parcel into two lots. Project will retain existing residence on proposed Lot 1 and extinguish existing access to 196th Street.
Both lots will access 196th Street via a new shared driveway. Conceptual residence shown on proposed Lot 2.
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) Subdivision is
designed to comply with the RS-10 zoning. Drainage design will comply with city stormwater management code and 2014 SWMMWW.
APPLICANT Dung "Joe" Ta & Hoa Phan PHONE # 425-829-8582
ADDRESS 2908 107th Street SE, Everett, WA 98208
E-MAIL joedinhta@yahoo.com FAX #
CONTACT PERSON/AGENT Western Engineers & Surveyors, Inc. PHONE # 425-356-2700
ADDRESS 9740 Evergreen Way, Everett, WA 98204
E-MAII. jessej@wesi.co FAX # 425-356-2708
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
Property Owner's Authorization
DATE
I, 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 purggses of inspection and posting attendant to this application.
SIGNATURE OF
/t'1 GC�7hcyi, DATE '
Questions? Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Pave 1 of 1