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SHORT PLAT APPLICATIONS ONLY <br /> 20. Number of Lots_ 21. Duplex lots oroposed? 22, Mod�cation requested7 Yes ❑ No❑ <br /> 23. Siqna�ure oi the Aoolicant: I hereby certify that the legal descriptlon of the land being divided a�M <br /> accomnanying ihis appiication shows the er.tire contiguous land in which there is an interest by reason <br /> ownership wntract for purchase,eamest money agreemenl,or option by any parson,firm,or corporation <br /> in any manner connected with he development,or the appticant(s),and the names,and addresses end <br /> telephone numhers of all such persons,firms,or corporations. <br /> Signature ot Applicant(s) <br /> SMORELINE MANAGEMENT PERMITS ONLY <br /> 24. Total cost or fair�arket value(whichever is higher)of project(please state total value of nll construction <br /> 5nishing work for�fi�r.h lhe permit will be issued, including all permaneM equipment to be instalied on lhe <br /> premises): <br /> S <br /> 25. Construction dates for which permit is requested(month&year): <br /> 6egin: End: <br /> 26. Does this project require a Shoreline/Floodplain Lowtian7 If yes,please explain. <br /> 27. Water Body: Shoreline Environment Designation: <br /> VARIANCES and SHORELINE MANAGEMENT VARIANCES ONLY <br /> 28. Code requiremenl involved: <br /> ALL PERMITS � <br /> Please list any additional information not covered above which might heip to clarify your request: <br /> 00()000000000 <br /> STATE OF WASHINGTON ) <br /> ) ss <br /> Cuunry of Snohomish ) I/ , <br /> I(We) �rt��f�l i (�1 �_�� , �/' ,being duly swom,depose and say that I am(we are)the <br /> APPLICANT(5)for this applic�t on,and thAi I(we)have tamiliarized myself(ourseivea)wdh tha rules and regulations <br /> with respect to preparing and filing this application and that the statements and infortnation submitted herewilh are in <br /> all respects true and cortect to the besl ot my(our)knowledge and belieL .. <br /> '-'� / <br /> Signed <br /> Appli nt <br /> Subscnbed and swa�i tpt'�,beJy�m\e this �- day of FE�-, . ,2005. <br /> /'%'�c;f�=�5'4H�a\„\ � �f� 'i. C.l�• C%��cfiJA�J' <br /> ��1 <br /> �� !'���N�T���� �! Notary Pub�ic in nd forthe State of Washington, <br /> , ' F � <br /> r IltU�14o i' Ji <br /> J� <br /> 1�:a\ o �. ��:yd�/: residingat y��IrGriL���`✓ �C�� <br /> �`�F�!��i% <br /> �� ��l::`{��'�„ UnnO00W()000 <br /> STATE OF WASHINGTON ) <br /> ) ss <br /> County of Snohomish )� <br /> I(We) �r�- ��/�cn,- �C•�ti'�SFO'� , being duly swom,Aepose and say lhat I am(we are)the <br /> OWNER(5) of the property involved in this application,and that I (we)have familiarized mysetf(ourselves)with the <br /> rules and regulalions with respecl ro preparing and filing this application and lhal the stalements and infortnation <br /> submitted herewilh are in all respects true and correct to the best ot�ny(our no le ge and belief. <br /> /.' <br /> syned L�C(' . �i, 'L, <br /> Owner or Conlraq Purchaser <br /> . <br /> Suoscn6ed and swum-to-before me this___( -���day of Ft=-- ,2005. <br /> �`. Cqq., /� r <br /> �.:i�;ion�I^'c.y� =�+f-n�+c. CP. Ci3-c<�6%f�'ti� <br /> �%`�` s Noiary Publit�in and for the State oi YJashington, <br /> I �, NOiAqy � �1 A <br /> 1 ��auui�c - residing at [� ��.�=C�'�_���d t C�H- <br /> ,.,.. - �� � <br /> �:, � .��; ,, . <br /> �. - <br />