HomeMy WebLinkAbout830 Walnut Ave - Application/4r` CIT 0
�R�N�,M� CITY OF BURLINGAME
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APPLICATION TO THE PLANNING COMIVIISSION
Type of Application:_Special Permit_Variance_Other ��uJo� w�c�D�r�c.A��l
Project Address: QX� wr4u�UT' hJLs.
Assessor's Pazcel Number(s): C�� i5 -���- - 1'7 C�
APPLICANT
�Name:�=1��4�.�D rJ�1A�c
Address: g30 t,.�Prc�.�ur ,4�1c. •
City/State/Zip: �p�, ��� � , � . �'i4Uib
Phone (w): .371 -�S90 �t���
PROPERTY OWNER
Name: �� ►ti �
Address:
City/State/Zip:
Phone (w):
(h): 3�-0�34
fa�c: 3�t3 -4�4
(h):
fax:
ARCHITECT/DESIGNER
Name: J •`� 3 ��Fs.T�S
Address: � � d4S �i-o �^'��
City/State/Zip: Bc�F�il1���, �, �f�t0
Phone (w): ,343 - C-d �'l
Please indicate with an asterisk * the
contact person for this application.
(h):
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PROJECT DESCRIl'TION
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AFFIDAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and conect to t est o y Irnow ge and belief.
ot � 7
Applicant's Signature Date
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Planning Co ission
ot�-47
Property Owner's Signature Date
----------------------------------------------FOR OFFICE USE ONLY -----------------------------------------
Date Filed: �/Z � f � 7 Fee: �¢ 2' I� D�
Planning Commission: Study Date: Action Date:_