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PLANNING PwPLIt MOM • o.,tn _2 /7 GY <br />FtDLT&.! phone 7�+I • 4l: <br />APPLI[ANt: name — - <br />7 qa�yic{jSC._ <br />address -- <br />Interest In property (check approprihle LOP): <br />O owner of record <br />O It,:er, upelotur, manager <br />O contract Fur deed owner au •'r &fit Iu purchase <br />13 othe, (explain) — ---- - -- <br />0ocumenta,r evidunce of applicant'♦ inter.-.' in the property G-ay L - <br />required betora final city at"un on Ili"' ".Quest' <br />N6A.1 /1w ia_ 0 Co /CC �• -• -- <br />Pk01•EATY: address/general Incatiun •__—_ ___..._...�.--- <br />ZN <br />legal gnu•r; name/aAJrr,s,�/rw+a_.i9 �Aw�` -. <br />present use (check aPProPriale box). <br />J16-unJrvelupeJ <br />O 1,usiness establisltaaent <br />1J single (molly dw�l!in,; (3 indu••lria establishment <br />EJ dupicx dwtl Iiiui U .{,artmrnl. <br />E) other (explain) <br />,lEQl1EST: (explain) <br />1 herelry, declare that the.d,uve stsle•waI•. .ue hu•.—j;iynature) <br />raft ema 115E ONM <br />VASE FEFSs <br />eubdiviston, 'major ($150) — <br />subdivision, minor ($75) _ —_. <br />rezoning (550) <br />conditional o.w 050) - • sy <br />variance <br />code Weal <br />subtotal <br />*past fees In parenthesis art nay` <br />rrfuadablt. <br />Park fund d&ditation <br />date paid ._ .. <br />recelllt A _ <br />AuG,lll'I-1 rf.t. <br />u.!,l iw;aip, •"tire} _ <br />•.I If, uar,ullant review:-__it7Q.. <br />nis.�llaneeu• .. <br />subtotal _ _. _• <br />10TAL FFIS ifIsSv _ <br />date Paid fyj_,/�[ <br />reeelpf ► Z-Y Vy_ <br />