LandUseApplication.pdfCity of Edmonds
Land Use Application
X ARCHITECTURAL DESIGN REVIEW
El COMPREHENSIVE PLAN AMENDMENT
El CONDITIONAL USE PERMIT FILE ZONE
Li HOME OCCUPATION DATE -REC'DBY
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0 PLEASE NOTE THAT ALL INFORMA TION CONTAINED H9THIN THE APPLICATION IS A PUBLIC RECORD 0
PROPERTY ADDRESS OR LOCATION 21605 76th Avenue West, Edmonds, WA 98026
PROJECT NAME (IF APPLICABLE) Swedish Medical Center - Edmonds, Ambulatory Care Center and
Emergency Department Expansion
PROPERTY OWNER Snohomish County Hospital District #2 PHONE # 425-640-4000
ADDRESS 21601 76th Avenue West, Edmonds, WA 98026
E-MAIL bryan.hail@providence.org FAX # N/A
TAX ACCOUNT# Snohomish County Parcel #00580700002500 SEC. 29 TWP. 27N RNG. 4E
DESCRIPTION OF PROJECTOR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
Please refer to attached cover letter for detailed project description.
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
Please refer to attached cover letter for code compliance information.
APPLICANT NBBJ - LP PHONE # 206-223-5009
ADDRESS 223 Yale Avenue North, Seattle, WA 98109
E-MAIL ckolb@nbbj.com FAX # 206-621-2314
CONTACT PERSON/AGENT Chuck Kolb, Project Architect —PHONE# 206-223-5009
ADDRESS 223 Yale Avenue North, Seattle, WA 98109 -
E-MAIL ckolb@nbbj.com FAX 4 206-621-2314
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, OFAPPLICANT/AGENTI Z,3
DATE
Property Own6r's Authorization
1, 60-6g 49 IV starer (( 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 and posting attendant to this application.
SIGNATURE OF OWNER A'11�1'�L,L'4DATE
Questions9 Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Page 1 of I