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Segregation App.CITY OF YELM APPLICATION TO SEGREGATE LID ASSESSMENT PLEASE COMPLETE AND RETURN THIS FORM TO: City of Yelm, Community Development Department 105 Yelm Ave. W, P.O. Box 479, Yelm, WA 98597   Property Owner: Yelm Property Development LLC Mailing Address: P.O. Box 2950 City, St., Zip: Yelm, WA 98597 Telephone: 360-458-0544 Current Parcel (Tax Parcel No.) Existing Assessment   64303500200  $58,340.80     New Parcel Descriptions Number of ERUs   Willow Glen III Lots 69-78, 88-94, and 109-123  32 Total ERUs (1 ERU per lot)   The undersigned holds an ownership interest in the above referenced parcels(s) located within the City of Yelm, Thurston County, Washington. The City of Yelm is hereby requested to segregate the utility local improvement district assessment amount(s) listed above in accordance with the new property configuration. This application for segregation of assessment is made under the provisions of Section 35.44.410 of the Revised Code of Washington. Applicant (please print) Signature Date ASSESSMENT SEGREGATION FEE A segregation fee is due in accordance with per §35.44.410 of the Revised Code of Washington as a condition of final map approval. For segregations resulting in less than six new lots the fee is $885.00. For segregations resulting in six or more new lots, the fee is $1,035.00 plus $25.00 for each lot over ten lots. Payment must be remitted with this completed form. Please direct any questions to Public Finance at (425) 885-1604. CITY USE: RECEIPT # DATE: BY: