LandUseApplication_PLN20180039_CU.pdfCity of Edmonds
Land Use Application
❑ ARCHITEC IMAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT `,
X CONDITIONAL USE PERMIT 7DATE
QPa 6tS0o V ZONE C �
❑ HOME OCCUPATION - f ^ l DREC'DBY K2✓'r1.eMMMM7
❑ FORMAL SUBDIVL m
❑ SHORT SUBDIVISION FEE RECEIPT # __
❑ LOT LINE ADJUSTMENT HEARING DATE
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT 14 HE D STAFF ❑ PB ❑ ADB ❑ CC
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
! PLEASE NOTE THAT ALL INFORMATION CONTAINED WITEIIV TEE APPLICA 77ON IS A PUBLIC RECORD d
PROPERTY ADDRESS OR LOCATION 220 Railroad Avenue, Edmonds, WA 98020
PROJECT NANX (IF APPLICABLE) _ Edmonds Waterfront Center and Edmonds Waterfront Re -Development
PROPERTY OwNER City of Edmonds PHONE # 425-771-0256
ADDRESS 700 Main Street, Edmonds WA 98020
E-MAIL carrie.hiter�edmondswa.gov FAX # 425-771-0253
TAx AccouNT # 27032300104200 _ SEC. 23 TwP. 27 RNG. 03
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY )
See attached document
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
See attached document
APPLICANT Edmonds Senior Center (ESC); City of Edmonds PHONE # ESC: 206-239-4823; City: see above
ADDRESS ESC: 220 Railroad Avenue, Edmonds, WA 98020: City: see above
E-MAIL, ESC: danielrjohnson4@gmail.com• City: see above FAX# ESC: 425-774-2921; City: above
CONTACT PERSON/AGENT ESC: Daniel Johnson; City: Came Hite PHONE # see above
ADDRESS see above
E-MAIL, see above _ FAx # see above
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 employces.
By my signature, I certify that the infornuition 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 df of the owner as listed below.
DATE
SIGNATURE OF APPLICANT/AGENT , p
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/r o
Property Owner's Auth71amoo
'
I, - (� �'�� 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 fission for the public officials and the staff of the City of Edmonds to enter the
subject property for the purposes of ' and posting attendant to this application.
SIGNATURE OF OWNER f DATE L" l( f
Questions? Call (425) 771-0220.
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