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LAND USE PERMIT APPLICATION <br /> CITY OF EVERETT PLANNING DIVISION <br /> EVERETT INSTRUCTIONS: Complete form, sign, and date. <br /> WASHINGTON See applicable land use application packet for all required checklist items. <br /> CONTACT INFORMATION <br /> APPLICANT .1 Ge -Z-/q� <br /> ADDRESS <br /> CITY F u eJ` STATE 0"4 ZIP <br /> PHONE Wt 5- --2-iv-7 -- 79 q 6 EMAIL OC- Z/4 L tea=�.Cc)--I <br /> OWNER --ZLLC <br /> ADDRESS S ZD -oc� 2 AweSu . G <br /> CITY fF d<JP•7/- STATE 1,/,4 ZIP �Z v j <br /> PHONE VZs - ZS 7 - 7 7Y6 EMAIL cj VC'- &q6 <br /> PRIMARY CONTACT: APPLICANT 12TOWNER ❑ OTHER, PLEASE SPECIFY BELOW <br /> NAME 36 t'_ 0-1,o4 <br /> PHONE H 2S-- - Z 0 -7- 7-1L16 1 EMAIL I L <br /> PROJECT SITE INFORMATION <br /> ADDRESS 1201 Aveilkg- iEve1'Pf}- 1'C)49 gee l <br /> PARCEL NO(S) 0 16 0 0 0 400 0 0L13 42 l G l 0190 7ev 00 K3 4 lel 00 1410c) <br /> C�C�4 39(((ova 200 <br /> PROJECT INFORMATION <br /> ASSOCIATED PREAPP# rw 2 101 - en Z:1 <br /> PROJECT NAME ack P lle- 2- <br /> PROJECT <br /> PROJECT DESCRIPTION 3 6 - `le- <br /> Authorization: I am the owner or am authorized by the owner to sign and submit this application. I certify under penalty <br /> of perjury of the laws of the State of Washington that the information on this application and all information submitted <br /> herewith is true, coll9plete, anAc2gq4. <br /> SIGNATURE DATE <br /> PRINT NAME Z",e Z I '0 <br /> 2930 Wetmore Ave,Ste 8-A © 425.257.8731 O planning@everettwa.gov <br /> Everett, WA 98201 425.257.8742 fax everettwa.gov <br /> UP1)AI'LD -.210 <br />