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FILE A s�'��� 96 S�sfA; s9• 9G Aa�cY L1sE ONLY <br /> AS�cy Refermce M: Date Received:� /2 �/�6 <br /> 4'tf.y e-�'�✓ FEE S: ,y S/'v� <br /> SEPA Lead Agenry: TF , <br /> Q�y�r: �('� �E RECEIPT li / Z 3 <br /> �.��� <br /> — JARPA APPLICATION FOR ,JUN ?�' �9QB <br /> - to� �� w�n;n�a s4u - <br /> CITY OF EVE2E'I'T <br /> pI,EpSE 'TYPE OR PRIIVT Qd BLUE OR BLACK IIdlC Pianrinc �ept__ <br /> Baud on the preceding chxkLst. I am amding copia of this appGcation W the following: (check a!!that aPP�Y) <br /> � Local Govemmenr. for shonline C� Subsuntial Development ❑ Canditional Uu ❑ Vuiance <br /> u^ Exemption; or O Floodplsin Manage�nt ❑ Cridcal Areu Ordinance <br /> Q Wuhington Department of Fish aad Wildlife for HPA <br /> � Wuhington Departmmt of Ecolo� Approval to Allow Temponry Exc«dance of Water Qualiry Shadards <br /> ] 401 Water Qua(iry C�ttifi�ation N�tionaide Pecmib <br /> � Cocps Engineers for Section 404 or Sxtion 10 permit(s) <br /> SECITON A - Uu for all permits coverod by this applicarion. Be sure to dso complete Section C (Signature Block) for <br /> all pecmit applications. � <br /> 1. Applicant <br /> MailingAddras 11419 — ' 9th Ave. SE Everett WA 9L?O1 <br /> WockPhone: (20� 258-6471. HomePhone. ( ) <br /> Fu Number: ( ) <br /> If an ageut is scting for the applicant duiing the permit proceta, complete#2 & 3. <br /> 2. Au�horized Agene Laura Brent AICP <br /> Mailing Addcess Shockev/Brent Inc 974 f nl h� n e , Euerett, Tr7,i1 °829' <br /> wort �oo�: �z o g a s a—q�o s _xo�reo�: ( > <br /> FuNumber. (20� ?59-444R <br /> 3. Designation of Authorired Agmt, if appliuble: <br /> I hereby dai�uute to ut �s my ageat in matters related to <br /> this application for permit(sl. I undentaad thu if a Fedenl permit is ieaued, I muat si� the permit• <br /> Si�aturo of Applir�nt �u I <br /> 4. Relatioaship of applicaat to pmperry: �J Owner O Ruchuer ❑ I.rssee ❑ Other ( _� � <br /> 5. Name, addrws, and phone number of pevperty owmer(s), if other than applicaat: i <br /> �/1 <br /> Applicadon P�ge I of 5 <br />