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j <br /> � <br /> CITY OF EVERETT <br /> PLANNING AND COMMUNITY DEVELOPMENT <br /> LAND IISE PERMIT APPLICATION <br /> � '� <br /> � Houndary Line Adjuspnent � <br /> O Lot Certi6cation FOR OFFlCE USE ONLY <br /> ❑ Nonconfortning Use/Building q � '�� <br /> 0 Planning Director's Review Process I Decision FILE� ��— + 6 <br /> � Planning Director's Review Process 1[Decision <br /> 0 Rewne FEE S`�S0.`�R RECEIPT R 12 40�1 <br /> 0 SEPA D If � �I �� n <br /> O Shoreline �� <br /> O Short Subdivision - S�P 1 2� <br /> O Special Property Use: Review Process I <br /> D Special PropeRy Use: Review Process[I <br /> ❑ Special Properry Use: Review Pracess lil CITY OF EVERETT <br /> O Subdivision PlBnning Dept. <br /> ❑ y�� STAMP!N DATE <br /> O Other_ <br /> Applicant ROY J. THORSEN Phone 206-348-4916 <br /> Address 2311 TAYLOR DRIVE — EVERETT WA 98203 F� <br /> PropertyOwner THORSEN/BMG TIT Phone206-348-4916 <br /> Address <br /> PrimaryContactcf�u+�*�■rv����> JACK N MOLVER, PE — KEGEL & ASS�ne 206-353-1119 <br /> Address 9800 EVERGREEN WAY — EVERETT wA 98204-3894 Fax 2n6-353-7149 <br /> Property Address or Location t1501 112TH STREET SW - EVERETT WA _ <br /> TaxIdentificationNumber 4429 003 Oi3 0004 6 4429-003-005-0509 <br /> Legal Description�w�na�r) SEE ATTACHEL <br /> Zoning GCN COMM Comprehensive Plan Designation HSC.HWAY BLCINRS� <br /> AresofPropeRytn�sq�,rcF�> 4 217 ACRES / 183 697 �OUARE FFFT <br /> Project Description onnvn�.ov r ruv an mCTMFNT - <br /> Name of the planner who conducted the Pre-Application meeting c«W�aw.�w.) DAVE TYLER <br /> I am the owner or am authorized by the owner to sign end submit this application. I grant pertnission 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 penalry of peryury of the Iaws o.`the <br /> State of Washington that the information on this application and all information submitted herewith is true, <br /> complete, and correct. <br /> Signature by Owner/Applicant/Agen Date 9—� '7�'� <br /> City and State where this application is signe �%v���� l�t�/� • <br /> City State <br /> � 2930 Wetmore, Ste 100, Everett,WA 9i201 * (206)239-5731. Fa:(206)2S9-i742 <br />