UNI Application & Plans.pdfCity of Edmonds
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ARCHITECTURAL DESIGN REVIEW ®'
COMPREHENSIVE PLAN AMENDMENT
J CONDITIONAL USE PERMIT FILE#ZONE C 6–
HOME OCCUPATION DATE _ i % REC'D BY ��� I U
FORMAL SUBDIVISION
SHORT SUBDIVISION FEE RECEIPT #
LOT LINE ADJUSTMENT HEARING DATE
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT HE T 1FF 5 PB ADB
STREET VACATION
1 REZONE AUG 2 17 z
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION �y DEVELOPMENT
V OTHER:
® PLEASE NOTE THAT ALL LYFORMATION CONTAI NED IVITHLV THE APPLICATION IS A PUBLIC RECORD
PROPERTY ADDRESS OR LOCATION–'—"3 t� /itj/Y 07 6, aJ, l 4 Y
PROJECT NAME (IF APPLICABLyE
PROPERTY OWNER �;�( .1_ 1�t�e LZe' PHONE#Z/1-1-(7 � • y
ADDRESS cg Zf A--
E-MAIL (d h 1 ! M � K ,w FAX #
TAX ACCOUNT # C)i"% 9(v 4e e7 l) SEC. TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
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DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
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APPLICANT (11/k 114h PHONE # i--&261 . 9,( -
ADDRESS ADDRESS
E-MAIL idl G�03 %fit a!s��y�j FAX #
CONTACTPERSON/AGENT 5-elaa, ey g ry 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 harniless 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
Property Owner's Authorization
I, --� certify under the penalty of pe]jury 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 proposes of inspection and posting attendant to this application. j
SIGNATURE OF OWNER DATE Ci
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