02341CITY OF EDMONDS FILE #
BOARD OF ADJUSTMENT DATE 7 r
APPLICATION FOR VARIANCE FEE 25,Cr0
REC' T #
HEARING DATE:_ / D ' L 7 9
APPLICANT LV ADDRESS�M &ZIP 9,pD�O
PHONE % 7 ��^S/(%Indicate type or degree of interest in the property:
OWNER: ADDRESS,CITY & ZIP PHONE
LOCATION OF PROPERTY (ADDRESS) WO S/&A7- s f FjgM6A1Pn zofJ f;1W
LEGAL DESCRIPTION OF PROPERY : 4. 0 t S ,30 — 3 /
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USE ZONE
ZONING ORDINANCE REQUIREMENT:
BY PLANNING DIVISION
STATE OF WASHINGTON)ss.
COUNTY OF SNOHOMISH
Signature of ApplicanOwner or Representative
On this date, before me, the undersigned, a Notary Publicpa/dd f the State of
Washington, duly commissioned and sworn, personally appeared ,who, being
duly sworn., on. his/bei- oath deposes and says that (.&)he has pre &—red--ancr r620 the foregoing
statements and has acknowledged to me that the recitations contained therei are true, and has
signed this instrument as his/ free and voluntary act and deed for the purposes therein
mentioned. .�
Subscribed and sworn to before me this,2, —day o 19
residing aty�1 d 1.
otary Pub is in and for the State of Washington.
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