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CITY OF EVERETT <br />PLANNING AND COMMUNITY DEVELOPMENT <br />LAND USE PERMIT APPLICATION <br />❑ Boundary Line Adjustment <br />❑ Lot Certification <br />❑ Nonconforming Use/Building <br />❑ Planning Director's Review Process I Decision <br />❑ Planning Director's Review Process II Decision <br />❑ Rezone <br />9RxSEPA <br />❑ Shoreline <br />❑ Short Subdivision <br />❑ Special Property Use: Review Process I <br />❑ Special Property Use: Review Process 11 <br />❑ Special Property Use: Review Process III <br />❑ Subdivision <br />❑ Variance <br />❑ Other <br />Applicant, <br />Address <br />FOR OFFICE USE ONLY <br />F7LE # <br />FEE S RECEIPT # <br />STAMP IN DATE <br />Phon 20(-3-9-10I <br />_ FaxC7o ) 34'l -ZOIcG <br />Property Owner Y K NP.NSEL,(_ �_- I v>< enone(-zcAo) `nD -e-Y <br />Address (q125 N09TN CVt_wP <br />.EK PAEK`( # L 113 1a1CT)+ -. ,WA <br />Primary Contact (if od+RwmwpliW[) 36rF-y WtESE Phone (2o1Q �53-COI <br />Address RP_ -1 i " SE. Fax (7_CU) 3(4l - tA)(pci <br />Property A c is or Location N.l,l) CORrJER S tll+t i SC 4 I1,4k 4,,J6 <br />Tax Identificatio., Number 1 q ZS - 05y - O L 8 - 0004 <br />Legal Desciption (aauh it ) 'SEE ATIRC+i E t) <br />Zoning _ g z- Comprehensive Plan Designation <br />Area of Property (Aawsq..rtFml 1 ACQt <br />Project Description RETAIL_ FUCL1lVG1 - COn1V/ Il STa�E-CAfLtA�AS+I <br />Name of the planner who conducted the Pre -Application meeting (m.ivwd-aim) fA II EEM 51 IAlll Q <br />I am the owner or am authorized by the owner to sign and submit this application. I grant permission for <br />City staff and agents to enter onto the subject property for the sole purpose of making any inspection of the <br />property which : necessary to process this application. I certify under penalty of perjury of the laws of the <br />State of Washington that the information on this application and all information submitted herewith is tnte, <br />complete, and correct. <br />Signature by Owner/Applicant/Agent� / ��� Date <br />City and State where this application is signed <br />City State <br />tI <br />09 2930 Wetmore, Ste 100, Ei crett, WA 98201 9 (206)259-8731, Fax (206)259-8742 <br />