HomeMy WebLinkAboutVerizon - special exception applicationory
CITY OF AUBURN
AOB r � T
Planning & Development Department
Auburn City Hall Annex, 2"° Floor
wASHR N
1 East Main Street
Auburn, Washington 98001-4998
Tel: 253.931-3090
Fax: 253.804.3114
eU mliICenterCriauburnwa.gov
WWrr'.auhurnwa.iiov
OFFICE USE ONLY
FILE #:
FILE NAME:
TYPE.
FEES PAID:
SUBMITTAL DATE:
LAND USE DESIGNATION:
RECEIVED BY
CHECKICASH:
SPECIAL EXCEPTION APPLICATION
APPLICANT: L Use mailing address far meeting notification. F. Check box if Primary Contact
COMPANY: 11-C"I (01l -e a`a
ADDRESS: ?,.24Y- l ;:ye,5f-'
(CITY, STATE, ZIP) ]�� j1r (/z[—
PHONE: '; it c � `r 11'i FAX: E-MAIL: � r ,< I'rr'r 'r. I} �tIa7P( � yc f• r �rf�
ri't f fr' � Ct'r;n
SIGNATURE: l' x'13 �`1�� PRINTED NAME: C• Tint=1=� '��t' �� !'�
(Signature Required)
APPLICANT'S REPRESENTATIVE: L?�-Check box if Primary Contact
7
COMPANY: �'q-"e.. elf i j'lr , (.' Jc t [. c�Y`r! •:�� t.r r'r ca
ADDRESS: `73 ..�Y�t --jr-e--
(CITY, STATE, ZIP)
PHONE: 1 5 FAX: E-MAIL: li�•a L'Cli'Y`lr�x� CCr°!c�'
SIGNATURE: PRINTED NAME: IGLU
(Signature Required)
PROPE'RT'Y OWNER(S); [Attach separate sheet if needed. L Check box if Primary Contact
COMPANY: r•ir L,.1.
ADDRESS:
�q' , i tz 1 --z
(CITY, STATE, ZIP)
PHONE: 1,,3,17 FAX: E-MAIL:
SIGNATURE: PRINTED NAME: i7+�cjr.:- �4iau7Gc1 r �.4
(Signat t
equired)
Noce: Applicant or representative must have property owner's consent to (rte this application form in order for it
to be accepted
PROPERTY INFORMATION (REQUIRED)
SITE ADDRESS: 1 i o ] fj =,►- 'V- r f�c/lf,J jtslc+7 EXISTING USE OF SITE:
ASSESSOR'S PARCEL ID# LOT SIZE ZONING DISTRICT
PROPOSED USE OF SITE:
AREA TO DEVELOPED js.f.j:
fare . lZ
CITY OF AUBURN SPECIAL EXCEPTION
Department of Planning 8 Oevelopment AF�F�LICATION
-�A—wAsi3lwcTOu Auburn City Flab Annex, 2"' Floor
1 East main Street
Auburn, Washington 980014999
Tel; 253.931,3990
Fax: 253.80a.3114
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SPECIAL EXCEPTION - LETTER OF AUTHORIZATION
LETTER FROM PROPERTY OWNER GRANTING AUTHORIZATION TO ACT
l (A copy off this letter must be submitted for each property owner involved)
l3 k -(I -i -LA declare under penalty of perjury under the
laws of the St to of Washington as follows;
1. 1 am the owner of the property that is the subject of the application.
2. Ihave not appointed anyone, or ] have appointed
to etas my agent regarding this application.
3. All statements, answers, and information submitted with this application are true and correct to
the best of my knowledge and belief.
4. 1 agree to hold the City of Auburn harmless as to any claim (including costs, expenses and
attorney's fees incurred in the investigation of such claim) which may be made by any person,
including the undersigned, and filed against the City of Auburn, but only where such claim arises
out of the reliance of the City, including its officers and employees, upon the accuracy of the
information provided to the City as part of this application.
5. 1 hereby grant permission for representatives of the City of Auburn and any other Federal,
State, or local unit of government with regulatory authority over the project to enter onto my
property to inspect the property, take photographs, and post public notices as required in
connection with review of this application and for compliance with the terms and conditions of
permits and approvals issued for the project.
Signature
Printed Nacos Date City and State where signed
1 � a S- - M :6 r- JIL,- 3
ALI h 1-4- r- n W�9- I
Address