landuse application.pdfCity of Edmonds
Land Use Application
11 ARCHITECTURAL Dt,'siON REVIEW
11 COMPREHENSIVE PLAN Aw"NDMENT NEINESOMMENEM
FILE # luiL-11-17— ZONE
CONDITIONAL USE PERMIT
Ll Ho-mr,, OCCUPATION DATE J42--/ LLL REC'D BYLAI?-
Ll FORMAL SUBDIVISION
11 SHORT SUBDIVISION FEE t RECEIPT #
El LOT LINE ADjUST1,,1ENT HEARING DATE
1-1 PLANNED RESIDENTIAL DLV i--,LoPJ,4FNT
I I OFFICIAL, STREET MAP AMENDMENT 11 HE PSTAFF El PB El AD13 11 cc
U STREET VACATION
H REZONE
11 SHORELINE PERMIT
11 VARIANCE / REASONABLEUSE ExcFPI-ION
11 OTHER:
PRol,ERTY ADDRESS OR LOCATION
1) '" I L.A.
PROJECT NAME (IF AppmCABLE) Sf:* K, fli-wa o 11 3
D PHONE #
PROPERTY OWNE1 ibea-) n ?77S
ADDRESS L4 AA- Ili
-42a�z Jna Ave
`f'AxAC( .,ouNTfl 0 S C) SEC. TWP.—RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTA( 1 711 COVER 1 141 I'TER AS NECESSARY)
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DESCRIBE HOW THE PROJECT MEETS APPLICABLE (-'ODES (ATTACI I (,OVER LETTER AS NECESSARY)__
v �cAe
APPLIcANr '7-77S
ADDRESS
E-MAIL'n
'An
CONTACT PERSON/AGENT'
DRESS
E-MAIL FAX #
The undersigned applicant, and his/lier/ils 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, Hs/fier/itsagents or cilip1qyees.
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 autAPPLa
rizeto file thisappli5zt1oll oil the belliall'offlic owner -,is listed below.
DATE
r
SIGNATURE OFANT/AOFNT A 10 4—
Property Ow'ner's Authorization
W-Ae'LAA, certify under the penalty of perjury under the laws ol"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 ofinspection and posting attendant to this applicafion.
SIGNATURE OF OWNER i44);—)fq
Questions'? Call (425) 771-0220.
Revised on 9114110 B - Land Use Applicfion Page 1 of