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(�/' �C�L� <br />i � <br />���9� ��� ��p���� u ��� <br />o I�ame of lapp�6icant � �;+,:;�n a, ��� �����t�.�c.� <br />Address � �-C.'� � � ����-�-� l�.,,V-�'- �� I�� <br />City �V����� �-��� S�ate � "�� _ Zip Code � �`� � <br />Phone �(��_ - ���i l -- , j��� � % Alt ph <br />' � ♦ �'� "l.� J JV� 6-• , �� <br />Email jC:��� ie� �c,o�. �;�,�., �°,'t-�-�a�fi�, [�rVa� <br />� PYiO'Yla�y COnf2Ct (if other than applicant) <br />Address <br />City _ <br />Phone <br />State Zip Code <br />Alt ph <br />Email <br />o Property Owner(s) 5�- -��-r�-���`�t.- � L--�St� �lc�l�; <br />Address <br />m Prmp�erty Address or Loca�iora S� <br />City <br />� <br />� ' <br />FOR OFFICIA US ONLY _ ` <br />TYPE: <br />FILE# �,�� ��'D�U� <br />t�� �� <br />I <br />FEE $ f� 5 RECEIPT # � � �� � � <br />ASSIGNED TO <br />� ���..� �e � �9 ,��� ��'� ° '� �'� <br />s� � � � � �� <br />� �� � <br />_. � : � J U f'�! �� � i j� i � ��::� � <br />��� d °�` ��Gu �:�i`:T����:�µ �� <br />�� <br />,� ��_��tp��� �y��"l+` r ���.� _ � <br />State Zip Code <br />Tax Parcel No(s) E-.�U�-! �,�� �� r�G��� �:� � f� ( Area of Property (acres/sq ft) .� <br />Zoning Comprehensive Plan Designation <br />o B�rief D�scrip�$io�a of Proj�2c�t �C'a.te �� �� { J��•�-�� da�,� G� _`� � C'c°i�c^v� c�' F��2�c:�� ��� ����� <br />1� /�' i� 4��i 7� L`�' i' � l� `L S iv-c^' �� i�/� 1..� �G i� �F ���� C� ��-i' S 1 �� C �l •r- �.1 E'.t.. ? J$:: � �'4-�h ((� <br />�C' � i'�" �L�- }b ,� c C � e�� �� �' ' (�( e �^ �"'e'� �' C-,..<- �a �'Y•' � /' � y� !� �. � a •�?., v .. �G cG � �) Ri'4_ � i (.�-n., <br />LCj �e � � t v-� ?3Z �r' �. <br />P <br />f y-L:��, �,1. � �'+-�._ <br />o I�asne of �hp p�anner vvho conducted or waived the Pre-A�placario� rr��e�are� <br />� Authorizaii�re: 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 th State of Washington that the information on this application and all information submitted <br />herewith is true, complete^ and correct. <br />Signature � _�, ������ Date �r..� �`J C"�-�%�� <br />Please print name - �����i�€�.-�-- � �7��z �=�'� `�Owner ❑ Applicant ❑ Primary Contact <br />i <br />City and State where this application is signed �i °f -��"�'-6�� , �-��-�' <br />City State <br />�• <br />