Gunn Application.pdfCity of Edmonds 'JUL 0 3 2017
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Land Use Application
,L&MENT SERVICES
❑ 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,, �, 3 /� „t jam,,, „C i A r w4
"
PROJECT NAME (IF APPLICABLE) � � ?mm p f .
PROPERTY OWNER _. �"'�V�tih `� PHONE #
ADDRESS. ' w ..... i ., _ I ,5 ., ❑wl 0
1-,:-MAIL...,_1-i --- °7 t� t!"" ' Otar y C„u FAx# ._,..m., '` ..y. _^�
TAx ACCOUNT # C &? ........ 0 00 1-®Q SEC. _ TWP. r+C / RNG. .
DESCRIPTION OF PROJECT OR I"Ito% )SW) USE ( "I'I'ACII COVER LEA`11t AS NI t N SSA
DESCRIBE HOW THE PROJECT S APPLICABLE (ATTACH COYM I�S 9�I SfiA..dY)�i/...
SNT�C PHONE#
ADDRESS
E-MAL — Q vOtlCa.. FAXG #
...^� .... ...._..,......
CONTACT PERSON/AGENT }� l��w_ PHONE #
ADDRESS _ Q. ®...._a d �p C rJ tr..... .....' �! _
E-MAIL, �, tAlth ��t�{la �. 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
SIGNATURE OF APPLICANT/AGENT✓ of the owner as listed below. DATE __
and that I am authorized to file this application on the behal
� ................_..__.
Property Owner's Authorization
"_ 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
sub
ect
operty
the
r^rl(r"ICWa1,�II$I; I �^f OTWNERurposes of inspection "1114 laos��sttendanrt to this application.
__ �DATE ..vv _ 7
Questions? Call (425) 771-0220.
Revised on 8/22/12 B - Land Use Application Page I of]