PLN20120005 Old Mill Town LU application.pdfCity of Edmonds
Land Use Application
0
OFFICIAL USE ONLY
2' ARCHITECTURAL DESIGN REVIEW FOR
COMPREHENSIVE PLAN AMENDMENT
CONDITIONAL USE PERFILEMIT ZONE
HOME OCCUPATION DATE REC'D BY
FORMAL SUBDIVISION FEE RECEIPT
E] SHORT SUBDIVISION
LOT LINE ADJUSTMENT
HEARING DATE
L] PLANNED RESIDENTIAL DEVELOPMENT
�11 �a
1 E OFFICIAL STREET MAP AMENDMENT HE STAFF PB ADB El CC
STREET VACATION
REZONE
SHORELINE PERMIT
VARIANCE / REASONABLE USE EXCEPTION
OTHER:
PROPERTY ADDRESS OR LOCATION ---70i J-7� Aiz:F,- SOL-Lrd
PROJECT NAME (IF APPLICABLE) //,I�a -awg
PROPERTY OWNER
7,,L,CZ PHONE#
ADDRESS 9�310s/'Tf S01fF--ZLZ -
E-MAIL FAX �2570
TAX ACCOIJNT# SEC, TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT oid (k,10 -rowvl �50(A&k5 U'(— PHONE9 4Zr2- AEIADDRESS Po gay 5oo:A7 1361-evy,( VJ& qsooci
E-MAIL r05R-n2vQ DeV41C5 . C001 FAX 4
CONTACT PERSONIAGENT kj,�,L . 19F( I IFPF-Ja�(T.; 90 PHONE#�'L,
ADDRESS�rq
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
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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 V1 a(ctr xkuw ry 0 DATE
U
ume
Prope ty 0 r's AuthorizatiAuthorization1, �j
ab-1 laws of the State of
A "01AM0 certify under the penalty of perjury under the Im
Washington #t 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 and posting attendant to this application.
SIGNATURE OF OWNER Oak(4 DATE
U () 1
Questions? Call (425) 771-0220.
Revised on 9114/10 B - Land Use Application page I of I