COOK + TAFRESHI APPLICATIONS.pdfCity of Edmonds
Land Use Application
❑ ARCHITECTURAL DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
X LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
o PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD a
PROPERTY ADDRESS OR LOCATION 10519 Alan A Dale PI., Edmonds 98020
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1101'If^.G'I ANIS (ft, APPLICABLE) --- NA
P RO IWM IN OWNER ,
Tafreshi)
0 Cook
� PHONE 206 546 8906
ADDRESS 10519 Alan A Dale Place Edmonds, WA- 9R02n-5108
TAX ACCOUNT# 00571300202200 SEC. 36 2 7 N RNG 3E.WM
DI SL I4Cwmf IN OF PROILC w OR,PROPOSED USE (ATTA(tI COVER LETTER AS Nt t ESSARY) Ad�ust the
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aDDllcation
APPLICANT
same as Prop"rty Owner PHONE#
..........
ADDRESS
E-MAIL
FAX #
CONTACT PERSON/AGENT sameasProperty Owner ,pI°TONE#
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
Property Owner's Authorization
DATE
11 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
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subject property for the Iruwlc of a s x„a,�lsua aad posting attendant his plicaalion
� � DATE � 7-3 —J 6
SIGNATURE OF OWNER »
ucstions a Cal l t2 j 771-0220.
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COUNTER
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DATE ) io
REC'D BY ,r h
RECEIPT#
HEARING DATE
❑ HE VTAFF ❑
PB ❑ ADB ❑ CC
o PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD a
PROPERTY ADDRESS OR LOCATION 10519 Alan A Dale PI., Edmonds 98020
.ww v
1101'If^.G'I ANIS (ft, APPLICABLE) --- NA
P RO IWM IN OWNER ,
Tafreshi)
0 Cook
� PHONE 206 546 8906
ADDRESS 10519 Alan A Dale Place Edmonds, WA- 9R02n-5108
TAX ACCOUNT# 00571300202200 SEC. 36 2 7 N RNG 3E.WM
DI SL I4Cwmf IN OF PROILC w OR,PROPOSED USE (ATTA(tI COVER LETTER AS Nt t ESSARY) Ad�ust the
n dh . lst lotitn-! as shor .._ with ppl ion r su_ry .y-
]� - �. ded WR Lot ince
wklaa wtftllalldiW tllfsw'Rt Ilr w r�trw ISALI'w 147 t__r ( iwrewmtent IC1CR AS l NECEs nth tits
�otmePa�anent
aDDllcation
APPLICANT
same as Prop"rty Owner PHONE#
..........
ADDRESS
E-MAIL
FAX #
CONTACT PERSON/AGENT sameasProperty Owner ,pI°TONE#
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
Property Owner's Authorization
DATE
11 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 Iruwlc of a s x„a,�lsua aad posting attendant his plicaalion
� � DATE � 7-3 —J 6
SIGNATURE OF OWNER »
ucstions a Cal l t2 j 771-0220.
9L4.,
II Lot .? 2
City of Edmonds [,-•� 0 S 261 i,j
Land Use ApplicatiorUEVEWNAN—I OL;,s
COUNTER
❑ ARCHITECTURAL. DESIGN REVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
❑ CONDITIONAL USE PERMIT
❑ HOME OCCUPATION
❑ FORMAL SUBDIVISION
�
❑ SHORT SUBDIVISION
�//
/LA LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ STREET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
FILE # ria
ZONE .._. ..
q�l
DATE a
Rfic, o By �
FEE A -
Rt Ess, #
HEARING DATE _
❑ HE STAFF ❑ PB ❑ ADB ❑ CC
0 PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD O
PROPERTY ADDRESsORLOCATION 23307 Friar Tuck Ln. Edmonds 98020
PROJECT NAME (IF APPLICABLE) NA
PROPERTY OWNER Tafreshi ok) PHONE#, 206 542 8683
ADDRESS 233.'07 Friar Tuck Ln., Edmonds. WA. 98020-5109
E -r All a afi'e C@ ma II. — .
- FAX #....... ...
TAX ACCOUNT #
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arnlication
APPLICANTsa.m.e as Property Owwn.er PHONE#
ADDRESS
E-MAIL.
FAX #
CONTACT PERSON/AGENT, same asmm Property Owner IrwNE#
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, Ire y� y..,C C t „��m a .f" 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 aru Invest ��I� attendant to this application. y
SIGNATURE OF OWNER ��m� ��w.. �...._DATE
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771-0220.
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