LanduseApplication.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT
D HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
I I LOT LINE ADJUSTMENT
-] PLANNED RESIDENTIAL DEVELOPMENT
J OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
REZONE
7 SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
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• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC �RECORD •
PROPERTY ADDRESS OR LOCATION _ uiv, Ise 51A) py
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PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER 60ea6 � Ir ( �u PHONE # Ci�� Z 3 1- q ? 't
ADDRESStt9± 4AU CI
E-MAIL t ti P i l ... 1 t FAX
TAX ACCOUNT # -M I, a ( C—Q, SI.C. 4 W'I'• 21: RNG. l_
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)J C7 �)
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) SPC
APPLICANT &9-1s Ete PHONE # LAU1 0-1 .aye ,Ue& 603
ADDRESS ItoQuo Y & *2) WA q9290
E-MAIL.I "J 4,AX #mTn
CONTACT PERSONIAGENT ff @ ,07- PHONE #
ADDRESS
E-MAIL 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 information and exhibits herewith submitted are true and correct to the best of my knowledge
SIGNATURE AI 8 @ @ '�.NJ"IAGENT the behalf of the owner as listed below,
SI that am OF authorized to et is application on t
SIOF
Property Owner's Authorization
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. Cmt tbtn M ' IYtK`` t a r
w — r tisV CC tU4 1 "C In VVope4
SIGNATURE OF OWNER DA°I I0,�-/0Zb0ttC
Questions? Call (425) 771-0220.
Revised on 8.122/12 B - Land Use Application Page 1 of]