Staff Decision PLN-2009-0047 Attachments 1-5.pdfcity of edmondz,
land use
application
0 ARCHITECTURAL DESIGN REVIEW
0 COMPREHENSIVE PLAN AMENDMENT
0 CONDITIONAL USE PERMIT
0 HOME OCCUPATION
0 FORMAL SUBDIVISION
0 SHORT SUBDIVISION
0 LOT LINE ADJUSTMENT
0 PLANNED RESIDENTIAL DEVELOPMENT
0 OFFICIAL STREET MAP AMENDMENT
0 STREET Vi• CATION
0 REZONE
0 SHORELINE PERMIT
0 VARIANCE / REASONABLE USE EXCEPT]
0 OTHER; __-- T, C CYfi'] (�! '` I
RECEIVED
f09
DEVELOPMENT SERVICESCOUNTER-
FILE # Y f -n zot3 q 6,oq I ZONE
DATE _-- 22 d-.1 REC'D BY
FEE 2-86. 00 RECEIPT# v�l 1'
HEARING DATE
8 HE ET/ 0 PB 0 ADB 0 CC
EC J 1 in �) I S Tl r\?,�- L,,b,0f'WIM4
PROPERTY ADDRESS OR LOCATION -A 102-L 110IND P L
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER R li. / h V�tQC,Ck y� PHONE# � 15 --INE -ffi
ADDRESS -156b 69A.. F'LOAJD �2 I WIN `p��( 90 2 � p�
E-MAIL ADDRESS FAX # 1,25 , ] sL `O"r1q
I i
`TAX ACCOUNT # 06 1 M 0600 1100 SEC. TWP, RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE
-rR - ReNOV A.t
APPLICANT R I � _ I k 10,_ PHONE # SAtj
ADDRESS 56 %i E_
E-MAIL ADDRESS 5AM e FAX # -5^ h
CONTACT PERSON/AGENT PHONE # ✓)fit
ADDRESS _5�A M1 G7
E-MAIL ADDRESS FAX # SSM E
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 onte behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT r�-4 DATE s V�
Property Owner's Authorization
By my signature, I certify that 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 inspeetio and posting endant to this application. (�
SIGNATURE OF OWNER !' DATE �f
Attachment 1
This application form was revised on 1/27/00. To verify whether it is still current, call (425) 771-0220. PLN -2009-0047
L:\LIBRARYu'LANNINGTOrms & Handouts\Publie Handouts\land Use Application.doc
C -
AL
00
UY:'P%µ :f�l*'., - w C r" L - '-Ei�„L:s2:�S” Y • �r ,^ . t � .. � l,� ',Z ..-cw.'?
Ll
' ` - .. -.{ fir i J l'. �,L f f — t' S� - ip f I• � ' - (.=t i
-� 1
�'__
7 9;a2
_x11 �.Y yit t l+Y• -
• - per' '-C_�_—' J'// Attachment 2
-`: - PLN -2009-0047
/6?V12z Zoe- P1,��
Attachment 3
PLN -2009-0047
-1, lV9 Q\--
QD
to
Attachment 3
PLN -2009-0047
~76
�jlr-A-
in
f�a1�o
Ropwo&N
V-Q—
v
fOt JUwPER h � �g •
Attachment 4
PLN -2009-0047
RECEOVED 76(,,6
DEC 112009
DEVELOPMENT SERVICES -
COUNTER