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C�TY OF EVERETT <br /> t'LANNIPJG AND COMMUNITY DE vEL OPMENT <br /> LAND iISE PERMIT APPLICA TION <br /> ❑ Boundary Line Adjustment <br /> ❑ Lot Certification FOR OFFICE USE ONLY <br /> ❑ Nonconfortning Use/Building <br /> ❑ Planning Director's Review Process I Decision F��q �'P�� �(/�-�'� <br /> �Planning Director's Review Process 1[ Decision <br /> O Rezone FEE S y�� RECEIPT k /� �7Z <br /> ❑ SEPA ���� � <br /> ❑ Shoreline (^',�'� Ct � ti U <br /> ❑ Short Suodivision � U1 l5 <br /> ❑ Special Propem Use: Review Process I �/ <br /> O Special Property Use: Revfew Process 1I �U�- a 1 t�' <br /> ❑ Special Property Use: Review Proccss I❑ VERE'1�� <br /> ❑ Subdivision CIT��' �F�� nent. <br /> � �an�� SY'�INDATF_ <br /> ❑ Other <br /> Applicant _ D E�:�' �A7E �J`i I�L=� Phone '��r j�—� 31�5 <br /> Address_�'7 I O BAK�R AV E. E\'0.ET't Fax <br /> PropertyOwner (�C� )IJ '�.l\ rjU`1I I_�(^� Phone J'��. rl� 13 <br /> Address �'11C BAK� �rc. �-V�(�'�Tr, l,li ,�'yCl <br /> Primary Contact or��.r�r�n PI ��( Phone <br /> Address g� <br /> Property Address or Location_ I'71 D f�F1 KE.('c. AV L �V 1=� r 7�' <br /> Tax Identification Number f$t34��3,",;1�,�27— ���J <br /> Legal Description an,�n�r�.�..,�r�rs7J 71'!.-t/ . U«' •30�. �}/�-�7`E'T '�� /�//� ��(� �� <br /> Zoning /�'1 Comprehensive Plan Designation <br /> Area of Property ca�°q�+rc FM> <br /> Project Description �12� Lt I hJ�'. ,� �E hl GE !�fJ 1'�O l }I �,I 1�f= C A 1�1.�I <br /> �11�Dl11��1? TII � ��'O��T O� . TNE F''1�01'E'{LT`/� <br /> Name of the planner who conducted the°re-Application meeting ca�+�n w,��� <br /> I am the owner or am authorized by the owner to sign ar.d submit this application. I grant permission for <br /> City staff and agents to enter onto the subject property for the sole purpose of making any inspection of the <br /> property which is necessary to process this application. I certify under penalty of perjury of the laws of the <br /> State of Washington that the information on this application and all information submitted herewith is true, <br /> complete, and correct. <br /> Signatureby Owner/ApplicanUAgent �1�/��"�� ��. \��AC�CI'�tinlLl�-y Date '3� <br /> City and State where this application is signed 1- I�� KL�T L�if�S�/1 A�6 1't� (\� <br /> City State � <br /> � 2930 Wetmore, Ste 100, Everett, WA 98201 '� (206)259-8731, Fnx (206)259-8742 <br />