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~i~y ®~ i=aBsron B•Beigh~S <br />B•'Ba~~li~g ~p~Bi~~~im~ <br />• .fiction Requested. By: <br />Name of Property Owner ~ ~~ <br />Phone (h) ~P .~'/ - ~ ~~a - ~ ~ (w) <br />Address of Property Owner , ~ -~/ ~ ~ ~,~_ .~ <br />Name of Applicant (if different) <br />Address Phone <br />Properly lnvoived: <br />Address ~Le cz~- <br />Legal Description <br />Property Idenfiifica#ion Number (PIN) <br />Present Use of Property (check one): <br />o Single Family~Dweliing <br />o Duplex/Two Family Dwelling <br />o Multi Family Complex <br />o Business/Commercial <br />o Government/Institufiional <br />o Vacant Land <br />Action Requested (NON-REFUNDABLE): <br />o Variance ($100.00) <br />o Conditional Use Permit (165.00) <br />o Lot Split ($250.00) <br />o Sifie Plan Review ($100.00) ~ , <br />o Rezoning ($500.00) ~ Other (Please Specify) <br />-~.etitinn fir ~PG~ gnated. zesidentia], <br />permit .parking area ($150.00) <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />details of request): <br />certify that all statements on this application are true anr~ correct: <br />~% ~ ~~~' <br />Si_gnature~oi: Property Owner (required) Signature of Applicant (if applicable) <br />• <br />S:IFORMS\BLDG PERMIT RPTG FORMSIPLANNING APPLICATION.doc 3!5/2003 <br />