To The Board:

The undersigned wishes to submit a Storm water Management Permit Application as defined in the Zonings Ordinances of the City of Everett Section and requests a review and determination by the Board of the Storm water Management Plan.

The Storm water Management Plan involves property where owner’s title to the land is derived under deed from, dated, and recorded in the [Insert] County Registry of Deeds, Book, Page, or Land Court Certificate of Title No., Registered in District, Book, Page.

Give a brief summary of the nature of the project.

The property (building) is described as being located at; it is currently used as, and the changes proposed to be made are.

The project is located on the parcel shown on Assessors Map, Parcel.

Applicant’s Signature Owners’ Signature(s)

Applicant’s Name (print) Owners’ Names(s)

Applicant’s Address Owners’ Address

Date Received by Town Clerk:

Signature

Please note: 1) An applicant for a Storm water Management Plan Review must file with the Board a completed Storm water Management Permit Application Form, a list of abutters, three (3) copies of the Storm water Management Plan Package, three (3) copies of the Operation and Maintenance Plan, and the Application and Review Fees as noted in the Storm water Management Plan Review Fee Schedule. 2) The applicant shall also file a copy of the Storm water Management Plan, Operation & Maintenance Plan, and the Application Form with the Town Clerk. The date of receipt by the Town Clerk shall be the official filing date. 3) This application grants the Board and its agents permission to enter the property for inspection and verification of information submitted in the application.

Storm water Management Plan Review Fee Schedule

The following fee schedules are minimum fees. The Board may require higher fees if deemed necessary for proper review of an application or to ensure compliance.

Lot Area Professional Review Fee Application Fee

1 and 2 family dwelling $ cost of consultant $ 50

Less Than 3 Acres $ cost of consultant $ 500

3 to 10 Acres $ cost of consultant $ 1000

Greater than 10 Acres $ cost of consultant $ 2000

Re-submittal/Amendment

Filing Fee $50

GENERAL

1. Any application not accompanied by the appropriate fee shall be deemed incomplete. Payment must be made to the Board in cash, money order, bank or certified check payable to the City of Everett.

2. An Applicant’s failure to pay any additional review or inspection fee within five business days of receipt of the notice that further fees are required shall be grounds for disapproval.

3. The Board will publish the public notice and send abutter notifications. Abutter notification shall be by certified mail-return receipt requested. The applicant shall pay all costs associated with the publication and notification requirements. These costs shall not be imposed on the applicant if the applicant completes the public notice and abutter notification requirements, and provides the Board with copies of the public notices and the return receipt cards.

Professional review fees include engineering review, legal review, and clerical fees associated with the public hearing and permit processing. A fee estimate may be provided by the Board’s consulting engineer.