LID Seg appCITY 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
Applicant: Denny Balascio, Property Owner: Fran Sherrill, Director,
Yelm Property Development, LLC Senior Multipurpose Center of Yelm
Mailing Address: 16422 Middle Road SE Mailing Address: PO Box 757
City, St., Zip: Yelm, WA 98597 City, St., Zip: Yelm, WA 98597
Telephone: (360) 458-0544 Telepone: (360) 458-7733
Current Parcels
(Tax Parcel No.)
Current Assessment Amount
New Parcel Description
(Tax Parcel No.)
Number
of ERU’s
64303600302
$18,717.66
84070003500
1 ERU
84070003600
1 ERU
84070003700
1 ERU
84070003800
1 ERU
84070003900
1 ERU
84070004000
1 ERU
84070004100
1 ERU
84070004200
1 ERU
84070004300
1 ERU
84070004400
1 ERU
84070004500
1 ERU
(if additional space is required, please attach the requested information on a separate sheet)
The undersigned holds an ownership interest in the above referenced parcels(s) located within a local improvement district in the City of Yelm, Thurston County, Washington.
The City of Yelm is hereby requested to segregate the assessment amount(s) listed above in accordance with the new property configuration.
This application for segregation of assessment is made under the provisions of § 35.44.410 of the Revised Code of Washington.
Applicant (please print) Signature Date
Owner (please print) Signature Date
ASSESSMENT SEGREGATION FEE
A segregation fee is due per § 35.44.410 of the Revised Code of Washington as a condition of final map approval. The fee for less than 6 new parcels is $850. For segregation requests
resulting in 6 or more new parcels, the fee is $1,000 plus $25 for each parcel over 10 parcels. Please include payment with this completed form. Questions may be directed to Public
Finance at (425) 885-1604.
CITY USE: RECEIPT # 32289 DATE: July 13, 2004 BY: TRM