Applications.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:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION y�
PROJECT NAME (11, I'PLACABLE)_ ......._ � IMr
kAV6 LLA
PROPERTY OWNER 4 _
ADDRESS i 2n OAArur, P1 1". %"moi q9026.
E-MAIL
TAX ACCOUNT #
FAX # _
OF ➢tt,11t f ➢" OII Pl > t ISI'i➢ USE (A'Vf 'ACH E„ (IVEIR LETTER AS 'N
DESCRIBE HOW 1 V➢ pt4 l"
APPLICANT
ADDRESS
E-MAIL
CONTACT PERSON/AGENT
ADDRESS
E-MAIL
CODE SW_
A i q`A� tl COVER ➢. tl;l"I-I:°A AS NECESSARY)_m mmmIT__
PHONE #
FAX #
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 inforarttttresr ra',e qi 'ts herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this application o rw lf`t;rl" re owner as listed below,
SIGNATURE OF APPLICANT/AGENT ..m. DATE �%ITmm
olltow�sle�trueeandcertify under the penalty of perjury under the laws of the State of
w isWashington that the f worn,gct statement: I have �tidho't""zeai the above Applicant/Agent to apply for the
subject land use application am, rant my per . sion for the public of s and the staff of the City of Edmonds to enter the
subject property for the porpo r° o ispuetiot rid t�to f gig attendant( t5 pi tion r]
SIGNATURE OF OWNER ..... ATE
Questions? Call (425) 771-0220.
Revised on 6122112 H - Land Use Application Page I of I
City of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
�:6 �'�V�4rTt`G'"SR,�111�1V9S➢tial
" i of LJ'NE AV)JUS'l":MEW'
P1,ANM,,]')Rr!"slt7wrw,DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
0 PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION ISA PUBLIC RECORD •
PROPERTY ADDRESSOR LOCATION _ V„ .......1Nlw s"
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNERY i��",« � PHONE #
ADDRESS
C) tl�,�, � �....�- _.... .�...�_ � ..._.
["'-NX A I n FAX #
TAX ACCOUNT #�hr . "l" �„."" LIw.
DESCRIPTION OF PROJECT OR i'illi)9'di4'diilJ USE (ATTACH COVER LETTER AS N 4 I ,S.SAR.
t `% h A W , &OWL
DESCRIBE HOW THE PROJECT IA 16 «3 APPLICABLE CODES A t R A(71t COVER LETTER AS NECESSARY)
........
APPLICANT
ADDRESS 1
E-MAIL
PHONE # Z(yj � -.4 " Z. - -2-8Aq—
FAx #
CONTACT PERSON/AGENT lil IIIiNta #q Z_
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 amn<l ibils herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this applicatio try t aalh'a the owner as listed below.
SIGNATURE OF APPLICANT/AGENT r DATE!
Property vwner'sAtAorization
(
lity under the penalty of perjury under the laws of the State of
Washington that the ftrlloNving is a true and correct statement: I have authorized the above Applicant/Agent to apply for the
subject land use application,and carat my permission for the public officials and the staff of the City of Edmonds to enter the
SIGNATURE OF (}P,r�� purposes a ant to this application.
es
subject m for u� rm ltu.awtattcr, and posting attendant
® DATE
Questions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application Page I of I