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Site Revitalization Program Site Nomination/Application Form In 2013, the City of Everett was awarded a $400,000 U.S. EPA Brownfields Community-Wide Assessment Grant to support the assessment, cleanup, and revitalization of underutilized sites throughout the City. Grant funds can be used to complete Phase I and II Environmental Site Assessments (ESAs), cleanup planning, and a variety of property reuse planning activities. Funding will be available through summer 2016, for approximately 10 high priority sites. Section A – Site Nomination/Information Request Do you know of a site (or sites) in the City of Everett that you think would benefit from environmental assessment, cleanup, or reuse planning? If so, please provide address/location description: Do you own the site(s)? Yes No If yes, please complete Section B. Are you interested in learning more about the Site Revitalization Program and grant funding? Yes No If yes, please provide contact information: Section B – Environmental Site Assessment Application Property Owner Owner Phone Property Current What year did you purchase the Please describe the past uses of the Are you aware of any contamination on the property? If so, please 1 I P a g e ---PAGE BREAK--- Have any environmental assessments been completed on the property? If so, please provide details, including the date(s) of prior Has there been any regulatory enforcement by the US Environmental Protection Agency or Washington Department of Ecology? If so, please Why is environmental assessment needed on the property Please describe the financial need for Site Reuse and Revitalization Program grant funding to complete environmental How will the redevelopment benefit the community? Please reference any removal of blight or health and safety hazards, new jobs, private investment, new uses, open space, and/or other benefits that will What is the anticipated schedule for planned sale, reuse, or Are there other important factors that should be considered by the City and the EPA in reviewing your request for grant Applicant For more information contact: Jim Hanson, Senior Planner City of Everett Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] Program Webpage: www.everettwa.gov/675/Brownfields-Assessment-Grant or Planning Department Office: [PHONE REDACTED] 2 I P a g e