Landuse application.pdfHYK-I6-GU11 IU::ib
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City of Edmonds
Land Use Application -APR 1 F 2011
—DEVELOPMENT SERACES
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Q AItCHITECTURALDES[ON REM
0 COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE' PERMIT FILE# �"�% ZONE 1;
0 HOME OCCUPATION DATE ? - /
C FORMALSU13DTVLSION RaC'DBY. �� P
❑ SHORT SUBDIVISION FEE F RECEIPT#
❑ LOT LINE ADJUSTMENT HEARING DATE
Cl. PLANNED RESIDENTIAL DEVELOPMENT
U OFFICIAL STREETMAP AMENDMENT Q )ROTAFF 0 PB 0 ADB Cl CC
0 STREET VACATION
0 REZONE
0 SHORELINE PERMIT
C1 VARIAN REASONABLE USE EXCEPTION
Q OTMR:
PROPERTY ADDRESSOk1AXATiO?N
PROJECT NAME (IF APPLICABLE) 03p�pl��i�y
PROPERTYOWNER_PHONE#
ADDRESS 920 �yj�tN gT. sttil �OMONb�iN�iep2-b..
FAX #
TAX ACCOUNT # 00 kQ 2 b 000027.,70 sac. 20 TWP. ��yyyP RNG.
DESCRIPTION OF PROJECTOR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) 'gym M.OD
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT
ADDRESS20Db b�gT Ali% ',�jlNyYGD�e II(Il4 036
E-MAILt3Yl dG.Q7WI 6i &0gfWCfr(A6,W FAX#® ': • i I'X? I
CONTACTPERSSO�N/AGE,Yf SAWA-a 6`2j[ t:4(1GhPLJP PHONE#_�//'7.1 (7• b9 .
ADDRESS s t Irt� 6
E -MAD Mhdk%@b 6 v[4(/.(f1tY N w,9*TMAzI.g0m FAx# moi• i2
The undersigned applicant, and bislherlits heirs, and assigns, in considorelion on the processing of the application agrees to
release, indemnify, defend and bold the City of Edmonds harmless front any and all damages, including reasonable attorney's
fees, arising from any action or infraction based in whole or part upon false, misleading, iowcuiate or incornplete information
fumisbed by the applicant, his/herfits agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and.conect to the best of my knowledge
and that I am authorized to file this application on. the
✓behaal_f of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE
Property Ow fnjees Authoiiretion
I, j 7-!!i ��, / `
.✓ tify Cerunder the penalty of perjury under the laws of the State of
Washington that the following is a true and t 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 eater the
subject property for the purpos :tw inspection and posting attendant to this application. / ry
SIGNATURE OF OWNER /4 DATE
QuestionsTCail (425)371-0220.
on 9114110 B - Lad the Appllcarfwt Page J of l
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