Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Leiser Application.pdf
City of Edmonds Land Use Application ❑ ARCHITECTURAL DESIGN REVIEW X COMPREHENSIVE PLAN AMENDMENT ❑ CONDITIONAL USE PERMIT ❑ HOME OCCUPATION ❑ FORMAL SUBDIVISION ❑ SHORT SUBDIVISION ❑ LOT LINE ADJUSTMENT ❑ PLANNED RESIDENTIAL DEVELOPMENT ❑ OFFICIAL STREET MAP AMENDMENT ❑ STREET VACATION ❑ REZONE ❑ SHORELINE PERMIT ❑ VARIANCE / REASONABLE USE EXCEPTION ❑ OTHER: • PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APP`L,ICCATION IS A PUBLIC RECORD • PROPERTY ADDRESS OR LOCATION 2V11-0 PROJECT NAME (IF APPLICABLE) -V4 1f PROPERTYOWNER r ..a L!/SeA // PHONE fL�6 ADDRESS A© 4c-rC U S�ivre /i �r G✓/f , 9ri60 E-MAILGtiu[��E�LEn�t'Oi.`«r./Jtr FAX# Le*-�5�3`�J T 4X ACCOUNT # SEC TWP. RNG. DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTC: S NLCL„SSARY) / DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) APPLICANT �SNGrir�% LGI'SGR // PHONE# 2400- ZZ-7- LSO ADDRESS PD ��)C 7_/� s!S �t /i mil (� i.,�1� 0 E-MAIL/w,.J �?. Sf_ LF �e . i ..ye gor- FAX # CONTACT PERSON/AGENT saop*.- 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 and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT DATE . I Z�Z%f /Z Property Owner's Authorization 1,. 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 andposting attendant to this application. SIGNATURE OF OWNER DATE Questions? Call (425) 77I-0220. Revised on 8/22'12 B - Land Use Application Page I of]