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❑ HOME OCCUPATION )'.)ATE �" REC'D BY,
❑ FORMAL SUBDIVISION
h'1F �., � . 4 '�� RECE[PT #
❑ SHORT SUBDIVISION ---• •-�----•.•••••••••—••••••-
❑ LOT LINE ADJUSTMENT HEARING DATE
❑ PLANNED RESIDENTIAL DEVELOPMENT
EI OFFICIAL STREET MAP AMENDMENT ❑ HE"q"AFF ❑ PB ❑ ADB ❑ CC
I STREET VACATION
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PROPERTY ADDRESS OR LOCATION1
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PROPERTY OWNER. ----------------
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CONTACT PERSON/AGENT®VL AA VX41r°'
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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, 1 certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge
�1'�ll'��N"I low,
1 pp - . DATE ®�S
and that I am authorized to file this application on the beha t o t e owner as listed e
e �Z/SIGNATUREtltI J4@ I L.14:`�1 j "� ._-. __.__.�
Property Owner's Authorization
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 permission for the public officials and the staff of the City of Edmonds to enter the
subject property for the purposes of inspection and posting attendant to this application,
SIGNATURE OF OWNER
Revived on &22112
Questions? Call (425) 771-0220,
H - Land Use Application
DATE
Page / of I
City of Edmonds
Land Use Application
FEB
i kid l f'°
❑ COMPREHENSIVE PLAN AMENDMENTyypI r�
11FILE# ' CONDITIONAL USE PERMIT " I ZONE t�
❑ HOME OCCUPATION )'.)ATE �" REC'D BY,
❑ FORMAL SUBDIVISION
h'1F �., � . 4 '�� RECE[PT #
❑ SHORT SUBDIVISION ---• •-�----•.•••••••••—••••••-
❑ LOT LINE ADJUSTMENT HEARING DATE
❑ PLANNED RESIDENTIAL DEVELOPMENT
EI OFFICIAL STREET MAP AMENDMENT ❑ HE"q"AFF ❑ PB ❑ ADB ❑ CC
I STREET VACATION
I REZONE
❑ SHORELINE PERMIT Y
El VARIANCE / REASONABLE USE 1 XCRI I JON �Y L `9>
%1' OTHER: y mw
"fe,c, JLQa #A
• PLEASE NOTf-, 01APALL INFORMATION CONTAINED 11T1I11V /AdC:APPLI('A'd1ONIV°AI'Villdt Hd" WRD 0
PROPERTY ADDRESS OR LOCATION1
PROJECT NAME (IF APPLICABLE)�� le -3 c�'l3YLG� o ►r t �� i �-r►^5
_..._7 irtltbNl # a�J ��i. 7 5
PROPERTY OWNER. ----------------
ADDRESS r_+
E-MAIL. q 2 ,� f --,i Oe FAX #
TAX ACCOUNT# SEC. ......_..._..._TWP. RNG.
Dl,' RIPt ION OF PROJECTOR PROPOSED USE(ATTACH COVER ('F
AS N1` 0 SSARY)
_^_"'^�," -7 f �t hit ";I.m': m...:.,.'t�"-."•a"'`,..,.,.,,,.,,.'."."",...
HOW THE PROJECT MEETS
APPLICANT Al
ADDRESS
CODES (ATTACH COVER
°f -WA -U-27
AS NECESSARY),,_, _ _
dM �raVf .. i�Ht7Nh#
y Sr G�'%d- f�• %r
E-MAIL )®0. 11.:"..._ ¢ I� S ! f .... ...,. ,. FAx # -. ..
1-111, ....
CONTACT PERSON/AGENT®VL AA VX41r°'
PHONEf s
ADDRESS .'5 „ """ Wj-5
E-MAIL r " 'A { O N ew �;
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, 1 certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge
�1'�ll'��N"I low,
1 pp - . DATE ®�S
and that I am authorized to file this application on the beha t o t e owner as listed e
e �Z/SIGNATUREtltI J4@ I L.14:`�1 j "� ._-. __.__.�
Property Owner's Authorization
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 permission for the public officials and the staff of the City of Edmonds to enter the
subject property for the purposes of inspection and posting attendant to this application,
SIGNATURE OF OWNER
Revived on &22112
Questions? Call (425) 771-0220,
H - Land Use Application
DATE
Page / of I