Land_Use_Application.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT FILE # tol"637ONE p.S-8
❑ HOME OCCUPATION DATE 1 REND 13Y ?, Q 04
❑ FORMAL SUBDIVISION
SHORT SUBDIVISION FEE �Z ,, qL S RECEIPT
❑ 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
❑ OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION 20020 83rd Ave W, Edmonds, WA 98026
PROJECT NAME (IF APPLICAnLF.) Evans ShortPlat
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PROPERTY OWNER Slason Evans PHONE # 734-846-6181
ADDRESS 20020 83rd Ave W, Edmonds, WA 98026
1 MAII. sjevans242@gmail.com FAX #
TAX ACCOUNT# 00431200000201 SEC. 19 TWP. 27N RNG. 4E
DESCRIPTION OF PROJECTOR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) Short subdivision of
existing parcal into two lots Project will retaain existing residence on proposed Lot 2 and extinguish access to 83rd Ave.
Both lots will access 83rd ave via a new shared driveway. Conceptual residence shown on proposed Lot 1
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) Subdivision is
dayynaa to rnmply vAth thra RSA 7nnlog nrainagd �•(In vAll rmmply with ritygtnrmwator manaaemant mite and 2n14RWMMWW
APPLICANT Simon Evans PHONE # 734-846-6181
ADDRESS 20020 83rd Ave W Edmonds WA 98026
E-MAIL sjevans242@gmaii.com FAX#
CONTACT PERSON/AGENT Western Enolneers & Surveyors. Inc. PHONE # 425-356-2700
ADDRESS 9740 Evergreen Way, Everett WA 98204
E-MAIL 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 app] ication o1�. U half of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE 6 l l 0
Properly Owner's Authorization
I, t r t7 t V A N S 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 pnd poslin allendanl to this application.
SIGNATURE OF OWNER ` 2-1 DATE111�, 1
uc lions? Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Page I of I