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App icati n fees are non-refundable, <br />fundalble, <br />Present Use of Pmp" <br />Prop" Clawificatia '. Abstrad 0 � omens <br />Owaiption of PropoSal (attach adpUnral suppo?ting doc #nentatllon 1f n smary) <br />ftLILUgal ,4pOlkadon (rras are pUUALMai • upAt:snk, are mqa%bla forag wiz to a! rwatic aoolc n fee ra,r;ed by <br />ifs, C1;y It ; p ssl t1 dP :hCS applfr Ei r.. Sum mxt6is furs are to bo MA _�wm r Lm.'WfA of & akxrwd , (rpm tN CIty Gk POW* <br />Vww. fa+,o,_s, ft�z may InJuder txA shall rent he hr.dted Wm pri4tgcopy , elf Eme, and leas for plaanlnp cJ nsuitari% AtG3mvis <br />an t ertgnee.°s, In vorm cases, a deposit my W m;;uA Wn advance to cover Gray anrt:lnaad a,ccQz 0Vj amdiiiW with Vs <br />applt't;pt#x (y S 4e0i; is requrrm, rre apoicant 5heAt errain respa slk far 61 ressonadie kmcurrtd Coate M wP34_; of t,t <br />app!lrat m fwaw deptIt amomt) <br />ACKUMLEi?aE'tiiAT I wt wd all tlfft Inrorrra#ran i S . �h r�� .kl Appkirctk�r 9-rid fu'ly WkTAKWtAI am •e5x-10Ie <br />fcr A-9gy Incu the (tinted to the Pjaa5airq Ql vil540r9 Aorl, <br />ipGl ' Cake <br />BY MY (OUR) SIGNATU ONTHIS APPLICATION, I HEREBY DECLARE THAT, TO THE <br />am or Mai KNOW EDOF'r THE INFORMATION PROVIDED IS TRUV AND ACCURATIE. <br />Name of Applf in (typed prl! d) <br />Nwn of Property owner' ed�p .tad 1 a- I �` <br />Si;riature qf Property Owner <br />Phone Numter of L ner ...._. <br />yak*.k��."+k;�r�■*x�n}�*�N:rtt+a� Ss�+k�Rn*rk#�++s*sw�rsk�k�l�;krkr��kx�dr#l��:��r��� Ik�Ac�lakikrt*�k*r�a��w��#+k*��t;le�*tab*:k <br />FOR OFFICE USE ONLY <br />Pa S Of Sij'wMW* <br />Wday I/ <br />k. <br />Plarwing Case Nulsj <br />roes PWd: <br />Park <br />Other: <br />Tom.l. <br />JAt rAunt <br />Deft of rice: <br />120-day 11mlt; <br />igried to: <br />Page 2 of'2 <br />Check erelr <br />