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CIT'YOFEVERE� .' <br />,PLANNIIVGAND COMMUNITYDEVELOPMENT <br />LAND t'ISE PERMIT APPLICATION <br />a eoaodary ��oe Aaju��,me <br />�Lot Catifieuim <br />N°°conE°mw�{ Uu/B°�du� <br />`❑ P�anoio6 Dirator Ddemiwtion IIA <br />❑ Pluwng D'ua.�wr Determination IIB <br />O Plaonic� Diroctor Detertninuian IIC <br />❑ Reuoe <br />❑ SEPA <br />O Shoneline <br />a sn� s��.�.� <br />O Special Property Uu IIB <br />❑ Special Propaty Uu IIIB <br />�� Subdivisian <br />Vuiance <br />O Other �SE ��`'��� <br />�v��c H n t h <br />Addrar / 3 /_f� <br />Property Owner �l n t hv. <br />Addreu /'i /S' Z .3 ''`� c i <br />Primary Contact (i[aecte.o.pptiemc) <br />Addrcs� <br />� <br />FOR OFFICE GCS£ 01V1P <br />F7t� � nK6+M 96 ,�• P. r"' �-9C <br />�s Z.4�9°' �c�rx izz73� <br />�[�Qf�Od� !� <br />� +� <br />uu �uN ��,�s <br />CITY OF EVERETT <br />ST .1 E <br />Phone �l 33�i -/S"i8 <br />Fax <br />Phone %cXv� .�39 -/S'y �r <br />Phone <br />Fax <br />Property Addres� or Location 3G 3/ WzL`�oi- � L� '�/4 ( <br />Tax Idmti6cation Number 5�5`/�1 - CO�! - di�— �a S <br />Legal Dexripntion (uuchifmwrry) �-iZr��AYs r 3 Tav�. �E✓E,�,-r L3�.K 9 LoTS I,$-d-/6 <br />Zoning /� — 3 Comprehensive Pl�n Designation �. G <br />Ara of Property (�ndsquue Fe�+) � 700 7 7��•�`� <br />Project Dexription <br />List the name of the planner you luve discussed your proposal with . St�/x �hr�_ <br />I am the mmcr a am authaized by the owoer w sign aod submit chis application. I 4raort permission for CiN suff <br />and agrnts w mter aafv th subjax propaty for the wk puryae of rtuking aoy in�pection of the property which is <br />necusary m procat thi� application. I artiCy under penalty of pujury of the la� of the State of Wuhingtcn thu the <br />infomutioa on thi� �pplicatian aod all infomudoe submitted herewith u we, canplete. aod cortect aod hercby agree <br />to defe�d. WY. aod uw humlat the Ciry of Evertt, its offian, anPbYoa, a�d agenu Cmm aoy and all claims, <br />including costs, expedes aod attoroey'i foa incurred in invatiguioa ud defeme of said elaimf wMher ral or <br />otbernix witich may be heraRa r.uc7e by any penan including the widersigned, his sucauors, usigus, anP�aY�. <br />ard agmv, arising wt of relianee by the City of Everett, iu ot5cm, anployea, �od agrnu upon sey mapi, daigns, <br />dnwing�, Plw or �paificatiaoi, informuim or any statenxnn, including the reasooabk iofe� to be drawn <br />therefram conuined in the appGcatiaa or submitted along with said applicuion. <br />Signature by Owner/Applicant/Agmt_ <br />City and State where this application ia <br />� 2930 Wetmore, Ste 104, Everctt, WA 9b201 4(206)259-8731, Fa: (206)259-8742 <br />