Rogstad Application + Materials.pdfCity of • • •
Land Use Application
I I ARCHITECTURAL DESIGN REVIEW
l COMPREHENSIVE PLAN AMENDMENT
V I CONDITIONAL USE PERMIT
I I HOME OCCUPATION
FORMAL SUBDIVISION
1 1 SHORT SUBDIVISION
I LOT LINE ADJUSTMENT
6 PLANNED RESIDENTIAL DEVELOPMENT
0 1 OFFICIAL STREET MAP AMENDMENT
I STREET VACATION
IREZONE
0 1 SHORELINE PERMIT
I VARIANCE / rEASONABLE USE EXCEPTION
OTIJE'R:
• PLEASE NOTE THAT ALL INFORMATION CONTAINED WITHIN THE APPLICATION IS A PUBLIC RECORD •
PROPERTY ADDRESS OR LOCATION714 I Oth PIS Edmonds. WA 98020
PROJECT NAME (IF APPLICABLE)
PROPERTY OWNER Ci—itaro PHONE#, 9nR-9d1-1Rn6
ADDRESS 714 IOth Pl R ocmn
E-MAIL cnroestadammail.com FAX#
TAX ACCOUNT # 27032_ 500104000 SEC- TWP. RNG.
DESCRIPTION OF PROJECT OR PROPOSED USE (ATTACH COVER LETTER AS NECESSARY)
Remodel amOrtion or the lower floor into an ay: 11 rma,nl.
DESCRIBE HOW THE PROJECT MEETS APPLICABLE CODES (ATTACH COVER LETTER AS NECESSARY)
APPLICANT Chris Roustad PHONE # 206 941 1806
ADDRESS 714 10th PI. S Fd'mttmds.,yY,. OR070
E-MAIL cproestad(aemail,com FAX#
CONTACT PERSON/AGENT PHONE
206 9t 1 1806
ADDRESS 714 10th PI. s. Edmondg. WA 98070
E-MAIL_ dram statdri mall cont 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 applicra tat aa,, c bcltalfo' c owner as listed below.
SIGNATURE OF APPLICANB'/AGENNC ✓ DATE
Property Owner's Alit or°ication
1, ✓? ?p w certify under the penalty of perjury under the laws of the State of
W h 'Bt n tlmt t-h;e 6 lollowitiis a true and correct s
� . tatement: I have authorized the above Applicant/Agent to apply for the
subject land use aplAcation, and grant my permission for the public officials rand the staff of the City of Edmonds to enter the
ro
subject
J property for the Purposes of m lie 11 and pos wattendamt to this application.
SIGNATURE OF OWNER DATE——
Questions?
Questions? Call (425) 771-0220.
Revised on 8122112 B - Land Use Application rage i oj i
3/6/2017
Edmonds Building Dept.,
714 10th' pl. S.
Edmonds, WA. 98020
h
MAR 0 r; 2017
COUNTER
m
Attached proposal to alter lower floor of my home into a rental apartment. This will
require no external alterations to the house. Tax # 27032500104000
Sincerely
Chris Rogstad
ACCESSORY DWELLING UNIT AFFIDAVIT
On my oath, I certify that I reside at �
�� L• S� Edmonds, Washington, in
the primary or accessory dwelling unit for more than six months of every year..
Assessor's Parcel Number: *dao 322-6 0 1 rr,14,,-e-N
0�40#1011M
nuatrrr•e of'Property Owrt.
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH )
Subscribed and sworn to before in
i this day of IN)a."
ota y11-tillfle. d"anti for ttte nate of was
Residing ate,
ADUAFFIDAVIT.DOC
C L BENDIKSEN
Notary Public
State of Washington
My Appointment Expires Jun 13, 2020