HomeMy WebLinkAbout1016 Toyon Drive - ApplicationiA�L CIT �
�R�N�AM�� CITY OF BURLINGAME
��. "° �_. J APPLICATION TO THE PLANNING COMIVIISSION
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Type of Application: Special Permit Variance �Other ��.s �q r, 12� �,c�,.�.- -�-
Project Address:
14i� Tc��on ,17r'. ���k'�VCtrra✓1C�.
Assessor's Parcel Number(s):_ � z� '�'�� -' � 5 0
APPLICANT
PROPERTY OWNER
Name: G'' �� �.� N�1� '
Name: . � � =�- �
Address:_ �(� /��%�� Address:�
City/State/Zip: , `'�'� E�ity/State/Zip:
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Phone (w): � � � Phone (w):_
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fax:
ARCHITECT/DESIGNER
%�` Name: C' c� �� j ��
Address:_ ,�4- ,d �_���,
City/State/Zip: S'L�.-< c� .r k?��- �'4-0� �
Phone (w) : ( S,� � 3 -- �3S %
(h): S'ct �`h �
fax: i��.��_ .�d�� -- .�`� �.� d
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fax:
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Please indicate with an asterisk * the
contact person for this application.
PROJECT DESCRIPTION: 'I s�' �z 2 ti.��Z,T r���� .�j n G�
AFFIDAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and conect to the e t of my knowledge and belief.
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Appl' s Signature Date
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I know about the proposed
application to the Planning S
and hereby authorize the above applicant to submit this
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Owner"'s Signature D�ate
�----------FOR OFFICE USE ONLY
Date Filed: �� I q- - CC� o F� 3��y f�iC�C> +�� � �. s ��
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Planning Commission: Study Date: S- g-o� Action Date: � fl•� o• o 0