Application.pdfCity of Edmonds
Land Use Application
[I ARCHITECTURAL DESIGN REVIEW
[I COMPREHENSIVE PLAN AMENDMENT
[I CONDITIONAL USE PERMIT
0 HOW OCCUPATION
D FORMAL SUBDIVISION
[I SHORT SUBDIVISION
>< LOT LINE ADJUSTMENT
0 PLANNED RESIDENTIAL DEVELOPMENT
L1 OFFICIAL STREET MAP AMENDMENT
[I STREET VACATION
0 REZONE
D SHORELINE PERMIT
L] VARIANCE / REASONABLE USE EXCEPTION
n OTHER:
F , ILE # ZONE —E� �-' -:, —
1) ATIi '2 R E, C'D 13 Y
RECEIPT
HEARING DATE
U HE >kISTAFF 0 PB 0 ADB 0 CC
9 PLEASE NOTE THAT ALL INFORMATION CONTAINED 97THIN THEAPPLICA TION ISA PUBLICRECORD 0
PROPERTY ADDRESS OR LOCATIONf
PROJECT NAME(IF APPLICABLE) ww,51p 3c -J Ave. A/
0 2i"?
'
PROPERTY ONVNKR -OPHONE # WL
ADDRESS
E,MAIL FAX #
. . . . ....... . . . . . . ...... L15 �'-P
TAX ACCOUNT # SEC. TwP. RNG.
f)F1 , 7RIPTION ()IZ PKQJF,CT OR PROP I sl tj,r (ATTA(J'l'X)VFR LETTER AS NECESSARY)_
T A I 'i— T"M �1!-- . .........
DESCRIBE HOW THE PROJECT MI [`,TS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY) . .. . ..........
APPLICANT _PHONE
ADDRESS..
E-MAIL . ....... FAX#
CONTACT PERsoN/AGENT . ...... . . 10NE, #
1Z ADDRESS
E-MAILFAx#
..... . . . . ...... . ......... . ............
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 lrom any action or I , Aqian based whole or part upon false, misleading, inaccurate or incomplete information
furnished by the applicant, his/he its a, nts or ci p yees, I
By my signature, I certify that the hil'or < ion, at , c I , its herewith sat , iftled are true and correct to We be ft of my knowledge
an, fhaklam authorized to file this pl Ica a on th 1 c r I c owwr listed below,
SK ATIJ EOF PI I(,'AxI,/A(i DATE
. ....... +—
...... Pro at
(tl al rt s -5 .
certify Ii—l'. .— 11-1—
C hms ol"the Slate of
aslaMr t. hat th )H( In N a I e eel st en ent, I have authorized the above ApplicarlVAgent to apply for the
subject I Ind use applic is n, art glart ei Ili 1 11 for the pi lie officials and the staff of the City aal" 1' d onds to enter the
subject p perty for the luta aosc::I p i Id I s I ata dup to this application.
SIGNATT'n
OWN) ATE
OF OWN),
D
tic,l Inn Call (425) 771 -0220 -
Revised on 8122112 B - d Use Application Page 1 of 1