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CITY OF EVERET'I' <br />PLANNING AND COMMUNITY DEVELOPMENT <br />LAND USE PERMIT APPLICATION <br />❑ Boundary Line Adjustment <br />❑ Lot Certification <br />❑ Nonconforming Use/Building <br />❑ Planning Director Determination IIA <br />❑ Planning Director Determination IIB <br />❑ Planning Director Determination IIC <br />❑ Rezone <br />❑ SEPA <br />❑ Shoreline <br />❑ Short Subdivist m <br />❑ Special Property Use IIB <br />❑ Special Property Use IIIB <br />❑ Subdivision <br />❑ Variance <br />W Other JSf✓ <br />Applicant 14 - 5DOh <br />Address <br />Property Owner LE 4L S <br />Address 96.11 - -r* eJ L. /h U/ <br />Primary Contact (if other than applicant) <br />Address <br />Property Address or Location / 7/6' - <br />Tax Identification Number 439/-9 46 - Dal -c <br />FOR OFFICE USE ONLY <br />FILE 90 -95 ZEJdf co <br />FEES %00 "> RECEIPT H <br />n; <br />J SEP 191995 D, <br />CITY OF EVERETT <br />Planning Dept. <br />STAAV IN DATE <br />Phone 2 46� -2 9/o <br />Fax _7 F3 91a <br />Phone <br />Phone <br />Fax <br />/-766- <br />Legal Description (attach ifnecmary) L-a S /r .2 ?LOCX '1 G i• PC/i r or cvtl E7r" <br />Zoning_ Comprehensive Plan Designation �^ <br />Area of Property (Acres/Square Feet) J-4 A I/ 9.'F% <br />Project Description ek1f; '(-F a( ( � l n �j_l ir'ING- 7)Ll ALEX ¢- ClFFICC <br />f1 ILI-� 4 <br />List the name of the planner you have discussed your proposal with <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 onto 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 attorrrey's fees incurred in invest gation 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 agents upon any maps, 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 , <br />City and State where this application is signed <br />City State <br />® 2930 Wetmore, Ste 100, Everett, WA 98201 W (206)259-8731, Fax (206)259-8742 <br />