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CITY OF EVERETT <br />PLANNINGANVD COMMUNITYDEVELOPMENT <br />LAND USE PERMIT APPLICATION <br />❑ Boundary Line Adjustment <br />❑ Lot Certification <br />❑ Nonconfonning Use(Building <br />❑ Planning Director Determination IIA <br />❑ Planning Director Determination 11B <br />❑ Planning Director Determination RC <br />❑ <br />Rezone <br />❑ <br />SEPA <br />❑ <br />Shoreline <br />❑ <br />Short Subdivision <br />❑ -Special Property Use JIB <br />❑ Special Property Use IIIB <br />❑ Subdivision <br />❑ Variance <br />3"Other <br />Applican <br />Address <br />FOR OFFICE USE ONLY <br />FILE 8 2. P_ L a# ej•*)c <br />Property Owner To <br />Address 5 t 31 t a g "g] _N' <br />Primary Contact (if other than appl'j <br />icamt) .l'4N <br />Svc rtrem,'ucoc.jAddress W7 6c16y Ac. Property Address or Location 6 vv4i.1 w t <br />Tax identification Number .557) — yU — 0 Z U— <br />Legal Description (attach if neceseary) 4d <br />.7ir' �.� <br />i IT01 HIM JUL - 5 19% DLOZ <br />Zoning 61 Comprehensive Plan Designation <br />Area of Property (Acrwtsquare Feet) 5 Qx l G <br />Project Description ? , <br />List the name of the planter you have discussed your proposal with <br />Phone 3 `17 - y 7 Z 7 <br />Fax <br />Phone <br />Phone 33et-01 Z3 <br />Fax 33Wf— FrfsUd <br />I am the owner or am authorized by the owner to sign and submit this application. I grant permission for City staff <br />and agents to enter auto the subject property for the sole purpose of making any inspection of the property which is <br />necessary to process this application. I certify under penalty of perjury of the laws of the State of Washington that the <br />information on this application and all information submitted herewith is true, complete, and correct and hereby agree <br />to defend, pay, and save harmless the City of Everett, its officers, employees, and agents from any and all claims, <br />including costs, expenses and attorney's fees incurred in investigation and defense of said claims whether real or <br />otherwise which may be hereafter made by any person including the undersigned, his successors, assigns, employees, <br />and agents, arising out of reliance by the City of Everett, its officers, employees, and agars upon any naps, designs, <br />drawings, plans or specifications, information or any statements, including the reasonable inferences to be drawn <br />therefrom contained in the application or submitted along with said application. <br />Signature by Owner/Applicant/Agent ltSD Date D t7102 <br />City and State where this application is signed EWE l✓A / <br />"City State <br />69 2930 Wetmore, Ste 100, Everett, WA 98201 4 (206)2594731, Fax (206)25"742 <br />