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� CITY OF EVERETT <br /> PLANNINGAND COMMUNITYDEVELOPMENT <br /> I.AND IISE PERI�IITAPPLICATION <br /> O Boundsry Line Adjutunent fOR OFFICE USE ONLY <br /> O Lot Certifiution <br /> O Noneor.fortnin�UselBuilding FILE M_�' 9� <br /> p p�sruiinng Direcror Dctermirution IIA <br /> ' O PlsnninQ Dircctor Detem�wtion IIB <br /> ❑ Plannin�Director Deunninaaon 11C FEE f_ 7-f.'0 '� RECEIPT M�73�C <br /> ' 0 Rarane R ry► R <br /> � OSEPA � � � tSD �/ l5 O : _ <br /> O Shorcline D <br /> 0 Short SubdiH�ion OCT N 6 1995 <br /> D Speeial Property Use IIB <br /> 17 Spoci�!Property Uu IIIB ` '`Gl'1`�Y :Q:E EVER�TT ' . <br /> O Subdivision .g ; .,; .;..:. : <br /> O Vui�nce <br /> �Ot�er /�/3Anvs iK �.f.�l1� , , : . •;. <br /> Applic4nt The Everett Clinic Phone 339-5460 <br /> Addrea� 3901 Hoyt Ave. FiX 339-5405 <br /> Property Owna S� Phone s� <br /> Address S� <br /> P�meryContact(ifoilkrd,.n.ppl�unq,teff '�-t AIA PhO�! (206) 823-2244 <br /> Address 9750 N.E. 120th P1. Suite i6 1Cirkland, MA 98034 F�% �Z06) 821-1715 <br /> Property Address or Location 3924 Colb Avenue Everett WA 98201 <br /> Tuc identificetion Number 4113-006-020-0009 <br /> Legel Description(uueh itnewwr) See "Attach�eat A^ <br /> Zoning R4Co Comprehensive Plan Designstion 2•s <br /> AreaofPropecty(�aaisv�.�sF«+) 105 Aares/4 552 5 F - <br /> ProjectDescription Convertin s1n le fa�il residence to rkin Lot for au rt of <br /> ad acent Nedical Clinic. <br /> List the neme of the pltnner you htve diecussed your propoul with xr � r8lac+oe - <br /> 1 iun the owner or am�uthorisod by ihe owner to �ign and submit thi� applicstioe• 1 irant pem�itsion for Ciry ita�' <br /> and aQrnU to cnta onto the �ubjcet propeRy for the sole purpou of m�kinQ uny inspeetion of the property µ'hich u <br /> neaasary to procen thit apPlication. I artify under penalty of pequry o[the law�of the Snte of WesAingeon th�t ihe <br /> infortnetion on thi�appliudon uid all information submittcd hercwith is tnu.complNe� and correce wid henby °Broe <br /> to dcfend, pay, end uve humlas the City of Everett, iu otCicen, employas, and a4rnu from any +nd �ll d�ims� <br /> includinj wrts, expaucs a�d ittome�� fxs incurred in investi�sdon �nd deMue of iaid claims wl►�SAer ral or <br /> otherwiu which may be herafter mede by �ny penon includinQ the undeniywd,hit successor�, usig�u, emplo�roa. <br /> and agenu, ari�inQ out of reli�nce by the City of Everctt, iu offian, emploYas. �nd a�nu upon �ny maPi� daiPu. <br /> dtawingi, plw or speci6cations, information or �ny sutemenu, includinQ the *asonabk inferences w be dnw�n <br /> therefrom containod in the spplicetion or�ubmittod tlong wtith said�Ppliution. <br /> �,� � �� -v/ <br /> ' ,/ � Date l0/25/95 <br /> Signeture by Owner/ApplicanUAgent 2<�7 �i7�— - <br /> City and 5tate wherc this npplication is si��- �ixtland v-��+-�acon <br /> ���y State <br /> � 24101Vetmore, Ste 100, Everett, VVA 93201 4 (206)259•8731, Fa: (206)259-s712 <br />