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•~ <br />City of ~aicon Heights <br />Planning Application <br />Action Requested By: <br />Name of Property Owner <br />1 ~~~.. <br />a <br />[Page 5 of 18] <br />JUL 2 b ZQD1 <br />/~,~- ~ z~s~.3 <br /> <br />Phone (h) ~ _ - ~ {w) <br />Address of Property Owner '~ ~" ~ ` <br />Name of Applicant (if different} <br />Address Phone <br />Property Involved: <br />Address <br />Legal Description <br />i~-f,~.~.-~..~.. ~ c1 ~ GL1 <br />Property Identification Number (PIN} 2 ~ 27 2 ~ ~ 1 ~-~- - <br />Present Use of Property (check one): <br />t7 5ingle Family Dwelling O BusinesslCommercial <br />^ DuplexRwra Family Dwelling ^ GovernmenUlnstitutional <br />• <br />^ Multi Family Complex ^ Vacant Land <br />ACtIOn Requested (NON-REFUNDABLE: <br />00) d~ ~ ~~``'`-~~ <br />Variance ($100 C1 Lat Split ($250.00) <br />. <br />~~ itianal Use Permit $165.00) <br />l2 ^ Cand ^ Site Pian Review ($100.00) <br />~ <br />` D Rezoning ($500.00) ^ Other {Please Specify) <br />Brief Summary of Request (applicant may submit fetter to Planning commission with <br />details of request): <br /> <br />S:IFORNiSIZoning and Building Forms~PLANNING APPLICAYI(JPl.dx 3/29/2005 <br />1 certify th all statem on th's application are true and connect: - l <br />Q <br />Signature of Pro arty Owner (required) Signature of Applicant (if applicable) <br />