Westgate Application.pdfCity of Edmonds
Land Use Application
ARCHITECTURAL DESIGN REVIEW MUMNEEN Ll Elm 102211
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERMIT 1°Itl C'. I'# E°LSP yt l ,.rr ZONE--- a Ic)
7 HOME OCCUPATION
DATE CS a'"ACJ/pC REC'DBY re,,
,
I FORMAL SUBDIVISION
SHORT SUBDIVISION FEE 6,-7- � RECEIPT#
I LOT LINE ADJUSTMENT HEARING DATE
I PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT 'J HE „TIPSTAFF ❑ PB ADB C CC
1 STREET VACATION
REZONE
I SHORELINE PERMIT
1 VARIANCE / REASONABLE USE EXCEPTION
7 OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WIT�HIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION 40 r�patP4 wit y,%
PROJECT NAME (IF APPLICABLE), Si. zhff r
PROPERTY OWNER
yy iCi i/� p t1 PHONE #
ADDRESS.
E-MAILr 1 FAX #
TAX ACCOUNT # .__._ ._ _.. �....... ._.. SEC:. ., TWP. 2-7 RNG.
DESCRIPTION OF PROJECT Olt � kOlOSED USE (A fAcH COVER LETTER AS NECESSARY)
9 �� ���
DESCRIBE HOWTHE PROJECT MEETS APPLICAB ,I', CODES (ATTACH COVER LETTER AS NECESSARY),_
APPLICANT Lu,0 PHONE # � J
ADDRESS,_ .... __.... .:.........@...............
E—MAIL ted. FAX # rq;;
CONTACT PERSON/AGENT PHONE # � RSi �: 91
ADDRESS 1 N". G ° 1;Jfvt4
.ttr l .. _..., FAX # (kai) H 6„' s'1
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 tarniless from any and all damages, including reasonable attorney's
fees, arising from any action or infraction based in whole )r part upon false, misleading, inaccurate or incomplete information
furnished by the applicant, his/her/its agents or rnployees.
By my signature, I certify that the 'informati n and c. i s�herewith submitted are true and correct to the best of my knowledge
and that 1 am authorized to file this appl ica 1, on I I tf of the owner as listed below.
i
SIGNATURE OF APPLICANT/AGENT DATE
Property Owner's Authorization
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 GS�m.... DATE,.
Questions? Call (425) 771-0220.
Revised on 8/22112 B - Land Use Application Page 1 of I