landuse application.pdfcity of edmonds
land use application
El ARCHITECTURAL DESIGN REVIEW •I We) 0
0 COMPREHENSIVE PLAN AMENDMENT EM
0 CONDITIONAL USE PERMIT FILE # V ZONE
0 HOME OCCUPATION DATE
RECD BY .gar
Ll FORMAL SUBDIVISION P_
0 SHORT SUBDIVISION RECEIPT#
0 LOT LINE ADJUSTMENT HEARING DATE T ,,
0 PLANNED RESIDENTIAL DEVELOPMENT
El OFFICIAL STREET MAP AMENDMENT fifffM 0 STAFF 0 PB 11 ADB 0 CC
0 STREET VACATION
11 REZONE
0 SHORELINE PERMIT
IN VARIANCE / REASONABLE USE EXCEPTION
0 OTHER:
PROPERTY ADDRESS OR LOCATION 1101 12th Ave. N. , Edmonds, WA 98020
PROJECT NAME CLF APPLICABLE) Jackson Residence Improvements
PROPERTY OWNER Mark Jackson pHONEW 206-940-1859
ADDRESS 1101 12th Ave. N., Edmonds, WA 98020
E-MAIL mark@westernindustrialinc.com FAx#
TAxAccGuNT# 00548900001911 -SEC. 24 Twp, 27 RNG. 03
DESCRIPTION OF PROJECT OR PROPOSED.USE (ATTACH COVER LETTER AS NECESSARY)
See attached
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
See attached
APPLICANT Mark Jackson PHONE # 206-940-1859
ADDRESS 1101 12th Ave. N., Edmonds, WA 98020
E-MAIL mark@westerniridustrialinc.com FAx#
CONTACT PERSWAGENT Mark Jackson PHONE # 206-940-1859
ADDRESS 1101 12th Ave. N., Edmonds, WA 98020
E-MAILF =k@westerni.ndustrialinc.com 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 e bits herewith submitted are true and correct to the best of my knowledge
and that I am authorized to file this application q th 'chalf of the owner as listed below.
SIGNATURE
'111-1 11 to
OF APPLICANT/Acoj�,�� DATE
Property Owner's Authorization
1, Mark Jackson certify under the penalty of perjury under the laws of the State of
Washington that the following is a true a correct statement: I have authorized the above Applicant/Agent to apply for the
's
subject land use application, and grant m ermission for the public officials and the staff of the City of Edmonds to enter the
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subject property for the purposes o i cc on and posting attendant to this application.
. ...... A'd I
SIGNATURE OF OWN)" DATE
This application form was revised on 8/10/09. Questions? Call (425) 771-0220,
L:\L1BRARY\PLANN1NG\Foms & HondautsTublic Hmdouts\Land Use Applicatiomdoc