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CITY of EVERETT <br />E V E R E T T PLANNING and COMMUNITY DEVELOPMENT <br />WASHINGTON LAND USE APPLICATION <br />�Name ofApplicant 19,5er �jlL-�ZD <br />Address /t)/ <br />City ��G�� �_ State l�f/} Zip Code <br />Phone 5--J lam'-Z�_,-1-7 Alt ph <br />Email PF- ✓C C-C _c C' � <br />• Primary Contact (if other than applicant) <br />Address <br />City <br />9ITS l- <br />Zip Code <br />Email <br />• Property Owner(s) �� T V,yt&44��f!�_J40V <br />FOR OFFICIAL USE ONLY <br />TYPE: <br />FILE # <br />FEE $ RECEIPT # <br />ASSIGNED TO: <br />AddressoZ//,r 11lX6l1'1l/1-lhlz City State4&//"-'- Zip Code <br />Property Address or Location oZ1/1f 14k61-IV!/f <br />Tax Parcel No(s) OO ;T00 Area of Property (acres/sq ft) . '¢ C/�C—.S <br />Zoning (r S /�'GLC- �=''9/�1 / �y Comprehensive Plan Designation <br />/ D C- <br />* Brief Description of Project ram-/sy,[f ,5 <br />S5i xx scrf ,��l� ri/U'-, dos <br />• Name of the planner who conducted or waived the Pre -Application meeting <br />• 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 />hprpwith is trl Ip rmmnlptp and rnrrprt <br />Signature <br />Date aY <br />Please print name K©f3��T`� GAL./� Y a'Owner ❑ Applicant ❑ Primary Contact <br />City and State where this application is signed <br />City State <br />2930 Wetmore Avenue, Suite 8-A Everett, WA 98201 • 425.257.8731 * F 425.257.8742 • www.everettwa.org • Updated 2009 <br />