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�� CITY OF E vER�.'T � ���
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<br /> ' PI,,ANNINGAIYD COMMUNITYDEVELOPMENT
<br /> LAND [IS,EPERMITAPPLICATION
<br /> ❑ Boundary Line Adjustrnent
<br /> ❑ Lot Certi6cation FOR OFFICE USEONLY
<br /> O Nonconforning UulBuilding
<br /> ❑ Planning Director Detemtination IIA FILE H �� �g -�
<br /> ,�Plnnning Dirator Deternunation IIB ao
<br /> ❑ Planning Dircctor De�crmination IfC FEE S � ({l���'�(/ 7 5�3�
<br /> ❑ Rezone p � U tfi 1 u Y-'
<br /> O SEPA
<br /> ❑ Shoreline NOV 2 01995
<br /> � Short Subdivision
<br /> O Speciai Property Use (IB CITY OF EVERETT
<br /> O Special Property Use IIIB
<br /> ❑ Subdivision Planning Dept.
<br /> ❑ Variance STA.11P/NDATE
<br /> � Othcr IL� - �ic8rti•�.1=-.c�J N<K
<br /> Applicant � co l� H , S, G f� A G � Phone�_{,— `L S 2"� I 6 6
<br /> Address.l�o/ [ a rr, � � K n �4 Y � L vP - W W 4��•�Fax
<br /> Property Owner�r�r..en,g��' �H G} 4 g \ o ,� 1�c N�Rl�ene � —
<br /> Address �3 � � � � ,.� ,� �2 v �ti ,i �
<br /> Primary Contact(ifotha uw�appltcan�)�,n1��� Phone
<br /> address F�
<br /> Property Address or Location �a o/ l.oiYl3f-1-/i� 7�,�}�G �'�7 ,, y(� Y�'�-�/
<br /> Tax Identification Number �-�,� .,r � 7 2 9 a f= `3 — 0 1 l�—o�e�
<br /> LegalDescription�siu:nicn«cu.cy� i1TT�CHl�'D
<br /> Zoning /'� � Comprehensive Flan Designation �!tc� �� � iYYl��.�7 �:By�J=4a.
<br /> ,vrea of Property(ncrcysqu8re F«i� 2l/�, OOa � _�� f �
<br /> Proje'�jt Description ,t v _ T �
<br /> � .Ql _ or� Lfi - it/,
<br /> List the r�am of the pianner you have dis ussed your proposal with
<br /> I am the owTer or am authoriud by the owner to sign and submit this application. I grant pertnission for City staff
<br /> and agents to enkr oaW the subject property for the sole purpose of rt�aking any inspection of the properry which is
<br /> necessary to procas this apptication. [certify under prnalty of pequry of the law�of the State of Washingtai thu the
<br /> infartnation on[his application and all infomiation submined herewith is true, complete, and cortect and hereby agree
<br /> to defend, pay, and save harmless the City of Everett, iu officers, employees, and agrnts from any and all t�aimq,
<br /> including cosu, expeases and attomey's fea incurred in investigaeion and defense of said claim4 whethec real or
<br /> olhcnvise which may be hereafter made by any person including the undersignc�, ttis successors, assigns, empl,yces,
<br /> and agents, arising out of reliance by the City of Everett, its officers, employees, anti agrnts upon any maps, designs,
<br /> drawings, plans or specifications, infortnation o� any statementa, including thr reasorable inlcrences to be drawn
<br /> thcrefrom contained in the application or submittcd along with said plication.
<br /> Signature by OwnedApplicandAgent J ' $ ' "��/G� Date / J � 6 r �J �
<br /> CiFy and S'tate where this application is signed _ 1- V e Q � T�, �u` Y�-. �i ff �.ts 1
<br /> Clfy SIdIC r
<br /> E9 2930 Wetmore, Ste 100, Everett, �VA 9�3E0( � (206)259-8731, FA: (206)259-8742
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