ROSE RIDGE APPLICATIONCity of Edmonds
Land Use Application -
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT FILE # ZONE
❑ HOME OCCUPATION DATE REC'D BY
❑ FORMAL SUBDIVISION
SHORT SUBDIVISION FEE RECEIPT #
❑ LOT LINE ADJUSTMENT HEARING DATE
PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT ❑ HE a STAFF E! PB ❑ ADB ❑ CC
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
OTHER:
♦ PLEASE NOTE THAT ALL INFORMATIONCONTAINED WITHIN THE APPLICA`TIO/N IS PUBLIC RECORD •
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PROPERTY ADDRESS OR LOCATION Z t .y 15D (�- A
PROJECT NAME (IF APPpPLI,�/C�ABBLE) F— (� 1 C0/1s' � r P11 4Q
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PROPERTY OWNER 'f' 1ft X a�aF�- • � • 1 S7-
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TAX ACCOUNT # U l U L-V ME-� SEC. z' TWP. RNG.
DES OR PROPOSED USE (ATTA H COVERLETTER AS NECXSSARY) O S )
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DESCRIBE�OW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS � CES AeRY} �./14 r
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APPLICANT !J� � � �D 14 PHONE # Zblr� `
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CONTACT PERSON/AGENT 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 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 appiicati u th half of �t o n as 1 ted below.
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SIGNATURE OF APPLICANT/AGENT r DATE
Property Owner's Authorizatio
I, { f� P " P certify under the penalty of perjury under the laws of the State of
Washington that the f6l1dvdng7 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.
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SIGNATURE OF OWNER � ,s IS, `I DATE
Questions? Call (425) 771-0220.
Revised on 8/22112 B - land Use Application Page 1 of I