US Dept of Housing & Urban Development (HUD) 1/2/2018

Request for Release of Funds U.S. Department of Housing OMB No.2506-0087 and Urban Development CITY (exp.03/31/2020) and Certification Office of Community Planning and Development This form is to be used by Responsible Entities and Recipients (as defined in 24 CFR 58.2)when requesting the release of funds, and requesting the authority to use such funds,for HUD programs identified by statutes that provide for the assumption of the environmental review responsibility by units of general local government and States. Public reporting burden for this collection of information is estimated to average 36 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.This agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number. Part 1. Program Description and Request for Release of Funds (to be completed by Responsible Entity) 1. Program Title(s) 2. HUD/State Identification Number 3. Recipient Identification Number Project Based Voucher&Veterans Affairs Supportive Housing funds (optional) 4.OMB Catalog Number(s) 5. Name and address of responsible entity City of Everett, Washington 6. For information about this request,contact(name&phone number) 2930 Wetmore Avenue, Suite 8A Rebecca McCrary 425-257-7133 Everett, WA 98201 8. HUD or State Agency and office unit to receive request 7. Name and address of recipient(if different than responsible entity) Housing and Urban Development Everett Housing Authority P.O. Box 1547 Everett WA 98206-1547 The recipient(s)of assistance under the program(s) listed above requests the release of funds and removal of environmental grant conditions governing the use of the assistance for the following 9. Program Activity(ies)/Project Name(s) 10. Location(Street address,city,county,State) Everett Safe Streets Supportive Housing project 6107 Berkshire Drive , Everett WA 98203 Project Based Vouchers 11. Program Activity/Project Description The proposed 65-unit building will be four stories tall and have twenty-one off-street parking spaces. It will house formerly homeless individuals in a "low barrier" environment. Construction cost for the project is expected to be $16,962,494. Between the Housing Authority of Snohomish County and the Everett Housing Authority sixty Section 8 Project Based Vouchers and five Veterans Affairs Supportive Housing Project Based Vouchers will be provided for the project. There are no HUD funds included in the construction funding package. Previous editions are obsolete form HUD-7015.15(1/99)