Application.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
❑ LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
ar PLEASE NOTE THAT ALL INFORMATION
PROPERTY ADDRESS OR LOCATION
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER
ADDRESS, _ ..
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4
WITHIN THE APPLICATION ISA
PHONE #.Lb Ed � U- I
FAx #
Ig°y
TAX ACCOUNT # l "!(' SEC. TWP. RNG.
OF PROJECTOR OR P,ROPO F I) USE (A
AS
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY")„ .
PHONE#
CONTACT PERSON/AGENT LAe �PIiONE # •-- ''
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 applicatio on the behalf of tl o� or listed below.
SIGNATURE OF APPLICAN ' AGEN"� DATE
Propgrty i vner"� Atlthorizattiogt
I, 4 �° _� ld 'l ri / certify ander the Ircnalty of perjury under the laws of the Slate ofW—Ushingto'n chat the following is a tal nd con„ect statement I have authorized the above ApplicantlAgent to apply for the
subject land use application, and grant my permission for the public officials mid the staff" of the City of aimids to enter the
subject property for thepar psof Mavp�ttors& s tu ng Iattecr �
t
to tlus apphca:Oorr.
DATESIGNATURE OF OWNER Questions? Call (4 5) 771-0220.
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Revised on 8/22112
B - Lana use Appucaaon
...b o . ,I
September 4, 2015
City of Edmonds Development Services
It is with a sad heart that I am applying for a tree removal permit. My Japanese Maple has over
the years provided me with cooling shade in the summer and beautiful color in the fall. It will
be missed by me and my neighbors.
Attached are photos and a tree risk assessment report explaining its decline.
Varney Blake
11105 th Avenue South Unit 104
Edmonds WA 98020