Land Use App.pdfCity of Edn,,lnds
Land Use Application 02 2019
DEVELOPMENT SERVICES
❑ ARCHITECTURALDESIGNREVIEW
❑ COMPREHENSIVE PLAN AMENDMENT
V CONDITIONAL USE PERMIT
5--TIOME OCCUPATION
❑ FORMAL SUBDIVISION
❑ SHORT SUBDIVISION
❑ LOT LINE ADJUSTMENT
❑ PLANNED RESIDENTIAL DEVELOPMENT
❑ OFFICIAL STREET MAP AMENDMENT
❑ S IIZI'.ET VACATION
❑ REZONE
❑ SHORELINE PERMIT
❑ VARIANCE / REASONABLE USE EXCEPTION
❑ OTHER:
FILE # rW d b 170M ZONE
DATE 19 REC'D BY Cjno v-,
FEB A 9< RECEIPT #
HEARING DATE
❑ HE 'STAFF ❑ PB ❑ ADB fl CC
• PLEASE NOTE 77IATAU INFORMA jTIION CONTAINED W17MN_THE APPLIIC[ATION IISA PUBLIC RECORD
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PROPERTY ADDRESS OR LOCATION { Z 3 i g 8/ � r ,V c k/, GQmv 1j, , �t%��"SiU_ % %_
PROJECT NAME (IF APPLICABLE) 9 dal IAf Illp-si
PROPERTY OWNER Eld,r46 W llw 6am
&W4 C/ I PHONE # qa5�-6 `fib - 2g6y
ADDRESS 1 c%2 3-1 e fl # Au (A/ G u IYIO I 3� 1,14 '18-0 g4
I ntAtt.tlG]6LIJ///agLP FAX#
TAX ACCOUNT# 0-0�0- ot)o SEC. TWP. RNG._
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSAR
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT C 101fW r
ADDRESS 1 q.23/ 9V'-
E-MAIL rla ine,wl i ComeASf, At t FAx #
CONTACT PERSON/AGENT Ala 1 ► t I kh* de N // PHONE #
ADDRESS M-3 1 894"- v{- (A% Ednul7Us Nk q'y z&
E-MAIL e aine)wl` l l c CO Mc04j" A _ 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 OFAPPLICANT/AGENT [ J4v.�e tfY/ � DATE 1 Z 1119
n
Property Owner's Authorization
I, _fin ("t ?aI � 1 { , 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 alid posting attendant to this application.
SIGNATURE OF OWNER w uti'` DATE.
ue. ions? Call (425) 7 1-0220.
Revised on 8122112 B - Land Use Application Page I of]