Applications.pdfCity of Edmonds
Land Use Application C,
ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
)4 LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD O
PROPERTY ADDRESS OR LOCATION -1,11 / w 1'.., I c
PROJECT NAME (IF APPLICABLE) ,,4"M4-1r7H df+ °r p i�, "'k "" a'e,
PROPERTY OWNER �/, 41i1°„ . 1 I i '' M WA6;;�?- PHONE # F e> , wq22.- raw a
ADDRESS?. I li',. t1-" d n ,° "w", r IIS
E-MAIL 'IV. L J ........ FAx #
TAX ACCOUNT #d71„ %7 6'2 SEC. TWP, RNG,
DESCRIPTION OF PROJECTOR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY "I a, 1 ❑ i'," t7'7 C-
z�7, 1-j � JV sr ' m -a ems_"
DESCRIBE HOW THE PROJECT MEETS APPLIC ARIA CODES (ATTACI-I COVER LI 1TEIi AS NECESSARY) L 2 7 ...
.:ems
APPLICANT IFI IrPHONE#
ADDRESS 71111A',
a
E-MAIL k rc_ 6 1ra n 1 M,"4°tet ........................... FAX #
CONTACT PERSONIAGENT IWm A- ir' 1 f "" Pi ON'E #
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 application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT ✓ ..._,."""" DATE
Property Owner's Authorization
I, , 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 posting attendant to this application.
SIGNATURE OF OWNER "° 1 µ'"" -W- DATE rc
Questions'�'C° 11 (425) 771-0220.
Revised on 8122112 B - Land Use Application Page I of]
City of Edmonds
Land Use Application
ARCHITECTURAL DESIGN REVIEW
COMPREHENSIVE PLAN AMENDMENT p
CONDTTIONAL USE PERMIT FILE # A)? Q b QV2 ZONE
HOME OCCUPATION DATE ( -6— f,6 REC'D BY
FORMAL SUBDIVISION
SHORT SUBDIVISION FEE RECEIPT #
LLOT LINE ADJUSTMENT HEARING DATE
,N PLANNED RESIDENTIAL DEVELOPMENT
OFFICIAL STREET MAP AMENDMENT HE I I STAR PB I ! ADB I ] CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
OTHER:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION kb
PROJECT NAME (IF APPI IC" Itl I;} ( - tVia"/ �% + .�" + -A ktJ7b�y�J^lj��
PROPERTY (D"44"NFN j� " `d" ' r PHONE # " " v ` g'0
ADDRESS "
E-MAIL s& 0 "C FAX #
TAxACCOUNT# ��I,siIO SEC. TwP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY) thF Vii` i^, +,�
-72 -140A7-
DESCRIBE
0APDESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT ►+/tap, PHONE # 2-19 ' ft 9
ADDRESS --n" dI✓ - 07-0
E-MAIL ' 141 I2 ` ®........... FAX #
CONTACT PERSON/AGENT it4n'I, /45 p+0 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
pp the behalf of the owner as listed below,
anthat I am authorized to file this application on
SIGNATURE OF APPLICANT/AGENT m„, . DATE I
Property Owner's Authorization
I, X & i"t i -Syk-( certify under the penalty of perjury under the laws of the State of
Washington that the following islinsectio
nd r°ect statement: I have authorized the above Applicant/Agent to apply for the
subject land use application, an gpe fission for the public officials and the staff of the City of Edmonds to enter the
subject property for the purpose of nd po ing attendant to this application.
SIGNATURE OF OWNER DATE )Z v,
Questions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application Page I of I