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• 4 S <br /> CITY of EVERETT <br /> EIS <br /> PLANNING and COMMUNITY DEVELOPMENT <br /> EVERETT LAND USE APPLICATION <br /> WASHINGTON <br /> 1) Name of Applicant, ,c I5 ,Z7aw41 <br /> Address <br /> a Qie / �y��/ FOR OFFICIAL USE ONLY <br /> d� J� <br /> City CaeVe, State 4"'.9 Zip Code fea2 G TYPE: <br /> Phone l 7o 'e—2&2ff— Alt ph � FILE# <br /> Email FEE$ RECEIPT# <br /> 2) Primary Contact(if other than applicant) ASSIGNED TO: <br /> Address = - <br /> City State Zip Code <br /> Phone Alt ph <br /> Email <br /> 3) Property Owner(s) <br /> Address City State Zip Code <br /> 4) Project Address or Location ��i(� O� ee—S- �: <br /> Tax Parcel No(s) '9/5'.7eoo7 7 2 Area of Property(acres/sq ft) <br /> Zoning Comprehensive Plan Designation <br /> 5) Brief Description of Project a/e/7 D (71 06y//a. /4/ lacZ <br /> 6) Name of the planner who conducted or waived the Pre-Application meeting <br /> 7) Authorization: I am the owner or am authorized by the owner to sign and submit this application. I grant <br /> permission for City staff and agents to enter onto the subject property for the sole purpose of making any <br /> inspections of the property which are necessary to process this application. I certify under penalty of perjury <br /> of the laws of the State of Washington that the information on this application and all information submitted <br /> herewith is true, co lete, and correct. <br /> Signature Date <br /> Please print name �, .0/e 'Gr/ 0 Owner .0'Applicant 0 Primary Contact <br /> City and State where this application is signed /rroVe'fj/ , /7/4,S-1 <br /> City State <br /> 2930 Wetmore Avenue,Suite 8-A Everett,WA 98201 • 425.257.8731 • www.everettwa.gov • Updated 2016 <br />