HomeMy WebLinkAbout20251119_PJA25-0072_App LAND USE APPLICATION
Gt�Y O�
ADMINISTRATIVE
7�iING�o� CONDITIONAL USE PERMIT
COMMUNITY & ECONOMIC DEVELOPMENT
18204 59th Avenue NE •Arlington, WA 98223 • Main Line 360.403.3551
PERMIT TYPE
Type of Permit ❑ Homeless Encampments Required Submittals ❑ Administrative Conditional
XrTemporary 1 Seasonal Use Use Application
I,Mobile Sales and Deliveries ❑ Submittal Requirement
Checklist
❑ Required Submittal Items
SITE INFORMATION
Project/Business Name:
❑ Vending Cart ' Food Truck ❑ Ice Cream Truck ❑ Mobile Espresso
Proposed Use: ❑ Retail Trailer ❑ Homeless Encampment ❑ Other(Please explain)
Other:
Offsite Storage Location Address: City: State:
If Applicable 6�j t Vq �( � Nv/ �� ��
Will you be utilizing the food truck court? ❑ Yes �% No ❑ NIA
". AY7*JWrk rIfflCOWo vl ❑ NIA �
Existing Business Use: 1 1✓i r 2 :7
Site Address/Addresses #2.
Please provide address for ❑ NIA
locations within City Limits Existing Business Use:
other than the food truck #3.
court,if applicable ❑ NIA
Existing Business Use:
#4:
❑ NIA
Existing Business Use:
OWNER •
Name
Full Address 5,1 S Ll Dr,
NC__ U
Phone Number U 6 d
b sly
E-mail r K��� Gc1q �l�� co
Relationship of
Applicant to Property *Owner ❑Lessee ❑Other:
check one_
City of Arlington
Administrative Conditional Use Permit Application
Page 1 of 2
Rev 1/2025
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APPLICANT CERTIFICATION
I certify that I am the Owner or Owner's authorized agent, If acting as an authorized agent, I further certify that I am authorized
to act as the Owners agent regarding the property at the above referenced address for the purpose of filing applications for
permits or review under the Arlington Municipal Code and I have full power and authority to perform on behalf of the Owner all
acts required to enable the City to process and review such applications.
I do hereby declare under penalty of perjury under the laws of the state of Washington that I have familiarized myself with the
rules and regulations with respect to preparing and filing this application and that the statements and information submitted
herewith are in all respects true and correct to the best of my knowledge and belief.
DATED AT �Y�( r)�TUi � IN C7 ,Washington on this date:
Applicant's Signature:
REAL PROPERTY OWNER CERTIFICATION
I do hereby declare under penalty of perjury under the laws of the state of Washington that I am the owner of the subject
property or an officer/member of the entity owning the subject property,that it is my desire to seek the subject land use permit,
and that I will abide by any requirements and conditions that may be part of the approval of this request. I also hereby grant
permission for City employees,agents of the City and/or other agency officials to enter the subject property, if necessary,for the
purpose of site inspections.
DATED AT Washington on this date:
Owner's Signature.
All other property owners of the subject property must also sign below(attach additional sheets if necessary):
1) Name Signature:
Address: Phone:
2) Name: Signature:
Address: Phone:
3) Name: Signature:
Address: Phone:
City of Arlington
Administrative Conditional Use Permit Application
Page 2 of 2
Rev 11/2021