Mazda Application.pdfCity of Edmonds
Land Use Application
ARCHITECTURAL DESIGN REVIEW
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT
0 HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
LOT LINE ADJUSTMENT
PLANNED RESIDENTIAL DEVELOPMENT
0 OFFICIAL STREET MAP AMENDMENT
0 STREET VACATION
REZONE
SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
0 OTHER:
FILE # QUN2:19ra. (DONE
DATE 3/��/t D REC'D BY n l7,
FEE t jg,4:� RECEIPT # __
HEARING DATE A/pD A
❑ HE jeSTAFF PB ADB CC
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION _ 22130 HWY 99, EDMONDS, WA 98026
PROJECT NAME (IF APPLICABLE) Doug's Mazda BLA
PROPERTYOWNER IKEGAMI PROPERTIES LLC PHONE# 425-744-3551
A,,,Fss 11115 KULSHAN RD, WOODWAY, WA 98020
E-MAILbecky@dougs.com FAX# 425-774-9429
TAx AccoUNT # 270429003056/57/58/59/60/61/62/64 _ SEC. 29 TWP. 27N RNG. 04E
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
Boundary line aggregation: B lot lines adjusted to make 2 larger lots.
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) See attached
Letter
APPLICANT Daniel Roupe, PLS PHONE# 425-408-1152
ADDRESS P.O. Box 1059 Lake Stevens, WA 98258
E-MAIL danr@grp4.com
FAx # 428-877-1341
CONTACT PERSON/AGENT Daniel Roupe, PLS PHONE# 425-408-1152
ADDRESS P.O. Box 1059 Lake Stevens, WA 98258
E-MAIL danr@grp4.com FAx# 428-877-1341
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 hulf of Ilse o% as listed b, ++
SIGNATURE OF APPLICANT/AGENT 1 ��'��' ___I1ATE
Daniel Roupe, PLS
Property Owner's Authorization
I Doug Ikegami _ certify under the penalty of perjury under the laws of the State of
Washington that the following is a true and correct st icnt I have authorized the above Applicant/Agent to apply for the
subject land use application, and grant my permiss f tltc 4pblic officials and the staff of the City of Edmonds to enter the
subject property for the purposes of it n at po ng at idant to this application.
SIGNATURE OF OWNER DATL• •� 2 �—
Questions? Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Page I of 1