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PLANNING APPIKAIIIIN Date W- /7 1a. <br />• <br />i <br />APPLICANT: name �(Lac tL t""JW'u'n 7(r! 4 r3'r <br />address 25OS -277— A.,d aft• - `mil . r# +rio�y�p�_ - <br />Interest In pre. party (check appruprier•• tnri _ - <br />O owner of record O Ie,ser, upetetur, manager <br />O contract fur dead oarwr .F>[ayrre••rnt to Purchase <br />O other (explain) <br />Documentary evidunce of applicant's intrr.•st in the property ray t <br />required before final city actiun on thi♦ request. <br />PNOPEATY: address/general Irxatiun - AIiA2 /Y/.✓ /D l Go 04 v6/. <br />Ja ►t 2- s b4cdL 2 , Crae j,r wraw A* Lem. / r y „ / 4r if ; _ - <br />legal osnkr: name/addrr%s _ r�.�A�.wIO_�A.•i� s-±!.• <br />present use (check appropriate bnx): <br />undeveloped 171 bu••iness establishownt <br />O single family dwell;n.t O indu•.trial rstahlishment <br />O duplex Jwellin!: V µ.drimrut• <br />O other (explai„) <br />rdQUEST: (explain) <br />CAW dors.r/r.. . <br />I hereby declare that rite above stat.r.anr• .n t+u. <br />r0A OFFlcf USE ONLY: <br />OASE FCESa <br />subdivision, Wier (we150) <br />subdivision, mlrurr ($75) <br />reaoni"I ($SO) <br />conditional use mn) _Zty <br />variance MW __ y <br />code appeal ($50) —•_—,_ <br />subtutal <br />*Use fees in parenthesis are non <br />refundable. <br />Park field dedication r_- <br />date paid <br />—(Signawre) <br />pr,l.l i• +w-.,r IPA i.ril ir,;} <br />•.t !f, urn�.ull.rq reri.,r: �+_?t.,t%D <br />ai•.� rlldru•r.u• <br />subtnlal <br />TOTAL FEIS •%&Sp <br />date pall �1ij i r <br />receipt / Z )VO4 <br />