3a - Subdivision_Application_SIGNED TOM.pdfCity of Edmonds
Land Use Application
[1 ARCHITECTURAL DESIGN REVIEW
I I COMPREHENSIVE PLAN AMENDMENT
l ➢ CONDITIONAL USE PERMIT FILE # ZONE
[. HOME OCCUPATION DATE REC'D BY
1..1 FORMAL SUBDIVISION
9 SHORT SUBDIVISION FEE RECEIPT #
f I LOT LINE ADJUSTMENT HEARING DATE
1.1 PLANNED RESIDENTIAL DEVELOPMENT
a OFFICIAL STREET MAP AMENDMENT 1-1 HE C..1 STAFF PB 1.1 ADB I I CC
0 STREET VACATION
[] REZONE
u .l SHORELINE PERMIT
0 VARIANCE / REASONABLE USE EXCEPTION
[I OTHER:
PROPERTY ADDRESS OR LOCATION 9801 Edmonds Way (NE comer of 100th Ave West & Edmonds Way)
PROJECT NAME (IF APPLICABLE) SH 09020 Walgreens Edmonds WA
PROPERTY OWNER Tom Rocca - Seven Hills Properties PHONE # 415.247.7377
ADDRESS 88 Perry Street, San Francisco, CA 94107
E-MAIL FAX #
TAX ACCOUNT # 27033600113200 SEC. 36 TWP. 27 RNG. 03
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
See attached cover letter
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
See included narrative
APPLICANT Tom Rocca - Seven Hills Properties PHONE # 415.247.7377
ADDRESS 88 Perry Street, San Francisco, CA 94107
E-MAIL troccaFAX#
William M. Ruecker
CONTACT PERSON/AGENT Baysinger Partners Architecture PC PHONE # 503.546.1600
ADDRESS 1006 SE Grand Ave #300, Portland, OR 97214
E-MAIL FAX # 503.546.1601
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 application on the behalf ofthe owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE
Property Owner's Authorization �
I, ;/`� yy , 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 stin attendant to this application.
SIGNATURE OF OWNER DATE y
Questions? Call (425) 771-0220.
Revised on 8<14110 B - Land Use Application Page I of]