Prestige ApplicationCity of Edmonds
Land Use Application
XARCHITECTURAL DESIGN REVIEW
CONEMEHENSTVE PLAN AMENDMENT P LN 2oJ3 00T5-- cup
X CONDITIONAL USE PERMIT FILE # ? (-Na of 3oo- K -&%o ONE R MZI
HOME OCCUPATION DATE I% _ REC'D BY M., M^
FoRMAL SUBDIVISION ,o S + S� SYS
� SHORT SUBDIVISION FEE = 6 '�. 596 RECEIPT #
3 LOT LINE ADJUSTMENT HEARING DATE 1 2>D
:3 PLANNED RESIDENTIAL DEVELOPMENT
-3 OFFICIAL STREET MAP AMENDMENT )RI HE 0 STAFF 0 PB ,a ADB -1 CC
:1 STREET VACATION
:1 REZONE
:3 SHORELINE PERMIT
:1 VARIANCE / REASONABLE USE EXCEPTION
:1 OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WTMLY THEAPPLICATIONIS A PUBLIC RECORD s
PROPERTY ADDRESS OR LOCATION 21002' -74 tt- 14lrt W r14MMA44 4 06
PRo rEcT NAME (IF APPLICABLE).Prtil o t C�t r -, 1:Vi G
PROPERTY OWNER G,111, Tn C I AVI RtUr-wisen)PHoNE # (_c ioo �s— 7155 6 . I
ADDRESS 00 nr. Ssi T4r 7 00 IYWZ
E-MAIL_?raS v n ► _ o FAX # f 36d, 31 :f 0
TAxAccovNT # 00614 30 0001 S01 SEC. I L7 TWP. 27N RNG,
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY&ee C.bl/r/� CQf�CJ
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSI.—ky See ("oy1 k)
APPLICANT I (f r-PA-, IZOIS WWS�)� PHONE # (3 0) 7p3E — 7/-,;y ea 1',
ADDRESS (/ orjt Sul 3� V olve W/1 0 db 2
E-MAIL dg (Mo')� e - cAre - cG FAx#
V&19
CONTACT PERSON/AGENT Car ' (G I G . ' : t WILSOV)PHONE # � if Z4 -O3 ! �Aif104
ADDRESS 116 Fi S S►,:.A J14(70,- Ver1uh, I�YA , &7?77Y
E-MAIL kly dI v Colt Lear 17c0k- CDYh FAX # (3 6 c), 4Z4 - S 79
The undersigned applicant, and his/herrts 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
famished 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 applicationon
the behalf of the owner as listed below. /
SIGNATURE OF APPLICANT/AGENT !/ DATE 12
Property Owner's Authorization
I, �)4(%i_1} G. �-7 151 E SL` W , 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 purpos1es mspecti d p sting attendant to this application.
SIGNATURE OF OWNER / DATE
Questions? Call (425) 771-0220.
Revised on 8122112 B - Land Use Application Page 1 of 1