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, �..� _..� ..�e.v.4 . .� � .x . .. . . ... .. . .. .t. ..T , .. . .. r .w.,. <br /> � � <br /> � 7 � � ' <br /> !� :vereit �-- ��Z� � �? �' ,.�Q�� � ��.��" . <br /> I ,� . <br /> e �""`�� f��L��,.U� �'G G�C� �8� �C•3��a'�' ���h�e���u(��� <br /> ---� .. <br /> , <br /> FII3LIC WORKS DEPT. <br /> City Hall Work Order No./��-��� 7� <br /> Everett WA 98201 � <br /> Phone 259-881.1. � Reccipt No � � , <br /> DEVEIAPER DOtV ZEVBJBr,RG'r,�^! Enginecring Consultant �, .,,��/ <br /> Address <br /> Address 2606 SUN'u�ffT Telephone <br /> Telephone 252-7008 <br /> SEiORT SUBDIVZSION N�lt•SE Section-Township-Ranqe <br /> (Optional) • <br /> Gr.�"Li'1L IAG.TION S�+=l� GL�4700� DRIVE <br /> niT applications shall be accompanied by the fol2owing: To be slgned by appli.cant <br /> :�pplications Fee($25.00 Per•LoQ) ;3/„�, � Z hereby certify that the declai-a- <br /> �•r��• tion of ownership ir.cludes the <br /> Vicinity SY,etch ' names of all persons, Eirns or <br /> (1 original-6copies) � 3 � corporations who nave an S.nterest: <br /> by reason of ownership, r.ontr.acL- <br /> *Short Plat, signed by reg. Land Sarveyor Eor purchase, earnest ruoney <br /> 8�,x14 (1 Orig. 6 Copies) �1 �� agreement, option or ].ien in L•hi.s <br /> � � proposed Short Subdi.vi�ion and/ox <br /> L•�gal Descriptiun havc any inheresL• in any oi L-1:c j <br /> (1 Orig. 6 Copies) � 3�[, entire contiguous ).ands, ; <br /> 7_�_ <br /> Declaration of Ownership �/� � <br /> (1 Orig, 2 Copies) // o/G� : <br /> -t��. <br /> Short Sub-Division Ceztificate ,,�� • � <br /> (I..orig. 6 copies) � �/� ; <br /> �—. , <br /> iSeparate drzwing showing existing rlpFlzcant's <br /> and proposed public improvenents �-y�^� � Naise DOPI'LEVFrVBERGII'i ' <br /> (1 Orig. 6 Copies) B�Sx14 � ��' y A3dress �'L O�b 5�i�hii�'_____^ <br /> � Telepltone . 5Z,700 <br /> Soi1 data, if required � <br /> Require:�ent waived by � � Applicant's � <br /> — -�—� -:-- signatvre .�'�"��,��~^ �J '�i <br /> Health District certification that ' / I <br /> each lot is suitable for a sewage <br /> ' disposal system. (If public sc�vcrs � <br /> are not required) . ? � J— � <br /> hereby waive the 37-day processing regui.ze�ent <br /> policant's siqr.ature (Optional) . � <br /> � --- — . . . �`._� --._ ..._._- -' . <br /> nP � �& <br /> EPA �eview fce, if required, - � � <br /> 25 per each arplzcation U.t __ •• <br /> City Engineer. <br /> Receipt Ko. --- __ _ ��-_ .._ ...._----�..I_rb/�9. � <br /> — ---- � <br /> �� � <br /> FIN,1L PL7�t7S SEIAI.L I�E ON TR7ICIWG CL(ITII <br /> �R MYI.AR <br />