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Previous editions are obsolete form HUD-7015.15 (1/99)
<br />Request for Release of Funds
<br />and Certification
<br />U.S. Department of Housing
<br />and Urban Development
<br />Office of Community Planning
<br />and Development
<br />OMB No. 2506-0087
<br />(exp. 04/30/2027)
<br />This form is to be used by Responsible Entities and Recipients (as defined in 24 CFR 58.2) when requesting the release of funds, and
<br />requesting the authority to use such funds, for HUD programs identified by statutes that provide for the assumption of the en vironmental
<br />review responsibility by units of general local government and States. Public reporting burden for this collection of information is estimated
<br />to average 36 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
<br />maintaining the data needed, and completing and reviewing the collection of information. This agency may not conduct or sponsor, and
<br />a person is not required to respond to, a collection of information unless that collection displays a valid OMB control numbe r.
<br />Part 1. Program Description and Request for Release of Funds (to be completed by Responsible Entity)
<br />1. Program Title(s)
<br />Project Based Vouchers (PBV), Public Housing Capital Fund
<br />(CFP), Moving to Work (MTW)
<br />2. HUD/State Identification Number
<br />WA006
<br />3. Recipient Identification Number
<br />(optional)
<br />4. OMB Catalog Number(s)
<br />14.871 PBV, 14.872 CFP, 14.881 MTW
<br />5. Name and address of responsible entity
<br />City of Everett, Community Development
<br />2930 Wetmore Ave, Ste 8A
<br />Everett, WA 98201
<br />6. For information about this request, contact (name & phone number)
<br />Vicki Dorway, 425-257-7185, vdorway@everettwa.gov
<br />8. HUD or State Agency and office unit to receive request
<br />Seattle HUD CPD Office
<br />909 1st Avenue, Ste 310
<br />Seattle, WA 98104
<br />7. Name and address of recipient (if different than responsible entity)
<br />Everett Housing Authority
<br />3107 Colby Ave
<br />Everett, WA 98201
<br />The recipient(s) of assistance under the program(s) listed above requests the release of funds and removal of environmental
<br />grant conditions governing the use of the assistance for the following
<br />9. Program Activity(ies)/Project Name(s)
<br />Everett Housing Authority, Ben Young Senior Apartments
<br />10. Location (Street address, city, county, State)
<br />3826 Rucker Ave, Everett, WA 98201
<br />11. Program Activity/Project Description
<br />The proposed project includes the development of approximately 1.2 acres of property for the construction of a new 6 -
<br />story, 140-unit, affordable senior-housing apartment building with at-grade parking.
<br />The project will include the demolition of the existing commercial buildings and two single-family residences. It will also
<br />involve grading and shoring improvements, utility work, internal access driveways, parking areas, lighting,
<br />open/recreational space, landscaping, and frontage improvements.
<br />Part 2. Environmental Certification (to be completed by responsible entity)
<br />With reference to the above Program Activity(ies)/Project(s), I, the undersigned officer of the responsible entity, certify t hat:
<br />1. The responsible entity has fully carried out its responsibilities for environmental review, decision -making and action pertaining
<br />to the project(s) named above.
<br />2. The responsible entity has assumed responsibility for and complied with and will continue to comply with, the National
<br />Environmental Policy Act of 1969, as amended, and the environmental procedures, permit requirements and statutory obligations
<br />of the laws cited in 24 CFR 58.5; and also agrees to comply with the authorities in 24 CFR 58.6 and applicable State a nd local
<br />laws.
<br />3. The responsible entity has assumed responsibility for and complied with and will continue to comply with Section 106 of the National
<br />Historic Preservation Act, and its implementing regulations 36 CFR 800, including consu ltation with the State Historic Preservation
<br />Officer, Indian tribes and Native Hawaiian organizations, and the public.
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