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APPLICATION FOR VARIANCE FEE
REC' T # I s Via
HEARING DATE: Ip -02...1 -19
APPLICANT Out.,0A.M.SoJ • ADDRESS 2WO �' U0%•1t-r4sxr'
1 CITY & ZIPSEXr-rur' hu
PHONE LM-G339 Indicate type or degree of interest in the property: 0grL . a
OWNER: �1eram DANto q>j ADDRESS,CITY & ZIP PHONE 3.
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LOCATION OF PROPERTY(ADDRESS) J, 63 11 S
LEGAL DESCRIPTION OF PROPERY: ?oCZ`Ct�4n) 0F Ah-TANG. Kerb PAfLCC-L
LEGAL DESCRIPTION DESCRIPTION CHECKED & PPR ED f'
USE ZONE BY PLANNING DIVISION;
ZONING ORDINANCE REQUIREMENT: SA;2..
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VARIANCE REQUESTED: C S T► rJ G
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STATEMENT
OF CONDITIONS AND REASONS
FOR REQUEST,
IN ACCORDANCE WITH STANDARDS AND CRITERIA
ATTACHED:
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STATE OF WASHINGTON)ss. —
COUNTY OF SNOHOMISH
Signature of Applicant, Owner or Representative.
On this date, before me, the undersigned, a Notary Public in and for the State of
Washington, duly commissioned and sworn, personally appeared 0'r �_ no.,n,��sw, ,who, being
m� r,
duly sworn, on his/her oath deposes and says that (s)he has prepared and read the foregoing
statements and has acknowledged to me that the recitations contained therein are true, and has
signed this instrument as his/her free and voluntary act and deed for the purposes therein
mentioned.
Subscribed and sworn to before me thi s_�3�day of 191 Li
�residing at
Notary Public in and for the State of Washington.
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