Land Use Application.pdfCity of Edmonds
Land Use Application v
❑ ARCHITECTURAL DESIGN REVIEW '
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT FILE # ZONE
HOME OCCUPATION DATE REC'D BY
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION FEE RECEIPT #
Cl LOT LINE ADJUSTMENT HEARING DATE
❑ PLANNED RESIDENTIAL- DEVELOPMENT
0 OFFICIAL STREET MAP AMENDMENT ❑ HE 7 STAFF 71 PB 7 ADB 7 CC
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
11 VARIANCE / REASONABLE USE EXCEPTIO)
OTHER: 15'rPSF='F
• PLEASE NOTE THAT ALL INFORAfATIION�COON)TAAIINEE,D WITHIN THE APPLICATION IS`A,�P/UBLIC RECORD •
PROPERTY ADDRESS OR LOCATION L--L/—I t/ i D J�k C Y V
PROJECT NAME (IF APPLICABLE) 1
PROPERTY OWNER C U M M I NC-7 D CY L LL PI IONS # 4 2S 0,4i O ,33\Cj, !:^
ADDRESS q Z 11 S L NTr=__1Z �y
E-MAIL StiG`�P�(-C►OM�WiQ (2h0+—M(XII . CVFAX#
TAX ACCOUNT # SEC. TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACI I COVER LETTER AS NECESSARY)
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
LoNt LJL7 W=ON 1 • S (_cam? '212E
APPLICANT( Mfg l_UMMI;V 6 7 PHONE# iZ C/�C� 33c1 7
ADDRESS `1�I�.2 5LA �Z A.i�C^, /�(F �ATZ��Npyv4 cj�p5
E-MAIL-j10. :ht �S^n ip L) /h0+-'kLL1II.CUM FAX# CONTACTP�ERSONN/AGENT M,PHONE # A ZS' e-q lV 33 -7
ADDRESS SLk E7_X4E /yE
WA t E%3?j
E-MAIL l�r Olf'►�'j GU(T1 �t(T� 1Mcl, l . U)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 informatio d exhibits herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this applicatio Jn th behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT' DATE
Property Owner's Authorization
1, / C1i 1,w1 1cZC- 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 ection and �attcndanis application.
SIGNATURE OF OWNER DATE 17
Questions? Call ( 25) 771-0220.
Revised on 8 22 12 R - Land Use Applicanon Page 1 Of 1