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0atu _S•3.5 S <br />I'LAlllllut :'•I'1'IALAI IUII <br />phone <br />APPLICANT: name%jL <br />address ti .�_}le�--- ------ <br />er[ (check Lox): <br />Interest prop Y (k aL, ie .t„ „peratur, manager <br />❑ owneerr of record ,urclrase <br />p contract for deed owner ❑ agt' n'-crnt to I'—^�+ <br />ET other (explain) __Cyi—Au- Aks-=O-� <br />be <br />Documentary evidence of •114"i.nnt's interr•Ifqut•st. <br />iu the property maY <br />required before final city action on thi; <br />R� Ncunsas�-= '--'•— <br />PPoPERTY: addresslganeral loverit)n •.Z134+_. N•Il�rust.•-- <br />legal owner: name/addre.". . JhSj j=S.- �r y�_.'-• <br />present use (check appropriate box): <br />❑ undeveloped <br />n Lusu:a:•s e•:Wblishren[ <br />+Ilia, ❑ indv•.ri,,,l e:.t.,hlishurant <br />IY3ingle family dw+ <br />❑ dupl <br />ex dwelling L7 apuruarri: •. <br />p other (explain) •------------...--- <br />JEST: (uxplain) <br />rtf U' - <br />I hereby declare that the above statements i3 - <br />FOR OFFICE USE ONLY: <br />_ nnSEF <br />subdivision, major <br />(5150) <br />subdivision, mirrur <br />(5w) <br />rezoning <br />conditional use: <br />(S50) <br />(S5o) _.... <br />variance <br />code appeal <br />_.- <br />subLutal `_.._.-... <br />*Base fees In pdrenthasls are non, <br />refundable. <br />park fund dedication-. - <br />date [laid <br />recuipL I <br />p,,prllb_�:,L FEES <br />it 1 <br />at inq ,,ot i cos �,_. <br />u <br />• r.�l I , et,altunt Ievicw, _ �Eel <br />,subtotal <br />10TAL FEES <br />date pdid <br />receipt 111!7� <br />