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� ��1o3-cxil <br /> CITY of EVERETT <br /> PLANNING and COMMUNITY DEVELOPMENT <br /> LAND USE APPLICATION <br /> Name of Applicant Sp11MCS + ChGvt tllxvSG(n11�✓ <br /> FOR OFFICIAL USE ONLY <br /> Phone 4ati• `1-39-9 (299 Alt ph _t[15-139-6099 <br /> Address 103 7���+ 5� TYPE__--_— ----- <br /> Cityfy6YLH .— State QA Zip Code If 203 FILE#--__ _ --- <br /> EmaiI C VxCrt . K:L �SC�Yk-y @ �-O"+ e-f . conn <br /> FEES _ RECEIPT#._ <br /> ASSIGNED TO: <br /> Primary Contact (it other than appkant) -- — <br /> Phone Alt ph <br /> Address — <br /> City State _ Zip Code <br /> Email <br /> ')roperty Owner(s) TA S :- C hest — <br /> Address 103 14et-t S+ 50 _city be-re-ft StateL.1 h Zip Code g82.0'-;k_ <br /> Property Address or Location 103 q Lo+A" �* t.� V CyG+�,W P, 91LP3 <br /> Tax Parcel No(s) 00 53`i-0 0 0 00 5 O D <br /> Brief Description of Project r <br /> Name of the planner who conducted or waived the Pre-Application meeting <br /> Authorization: I am the owner or am authorized by the owner to sign and submit this application. I grant <br /> permission for City staff and agents to enter onto the subject property for the sole purpose of making any <br /> inspections of the property which are necessary to process this application. I certify under penalty of perjury <br /> of the laws of the State of Washington that the information on this application and all information submitted <br /> herewith is true, complete, and correct. , <br /> Signature Date I7-- 7— ( C7 <br /> Please print name -�NatE3 F Rd!� P (Ed Owner Ztkpplicant OIPrimaryContact <br /> City and State where this application is signed I W A - -- <br /> City State <br /> If' J <br /> 2930 Wetmore Avenue,Suite 8-A Everett,WA 98201 • 425.257.8731 • F 425.257.8742 0 www everettvva.ore 0 Updated\\2009 <br />