HomeMy WebLinkAbout2317 Valdivia Way - ApplicationCity of Burlinga_ne Planning Department 501 Primrose Road P(650) 558-7250 F(650) 696-3790 www.burlin a,g me.org
�� cirr o
� �
BURIJNGAME APPLICATION TO THE PLANNING COMMISSION
k�.,m
Type of application: Design Review Conditional Use Permit Variance
Special Permit Other Parcel Number: a Z,�- /o Z%z_�>
Project address:
_� � �
�h
APPLICANT
Name: �'ti-� �� I.. i• � I
Address2-;� �'� �%�4�I71V V� ��
City/State/Zip: f5l! KU f���Y��-, � �t�o
/TT
Phone (w): G`S� - � � � ls� �5
(h): G 5�' ZS i-�-���-
(����c;}--���; , ��� ��,
ARCHITECT/DESIGNER
Name: C��i�.� �'�ii'/,Ut"�'Ci
Address: ��� ','�/ >"�'���� �� �
City/State/Zip: �".�1�/�/G? �'� ��lc %%
Phone (w): �/l� � � 5 � �-���'> /
(h): ��n -Gs;� -�r�<;-
��: y/C� � G�S'S'--��/
DESCRIPTION: �i�'� I ���-�
� � "r'�i tkP�-%
PROPERTY OWNER
Name: ��1i"I �
Address:
City/State/Zip:
Phone (w):
(h):
�fl�
Please indicate with an asterisk *
the contact person for this project.
��� C�c. �-JtJ� � �o
AFFADAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information
given herein is true and correct to the best of my knowledge and belief.
Applicant's signature: � ��' ` G� Date: J/���C� �
I know about the proposed plication and hereby authorize the above applicant to submit this
application to the Planning Commission.
Property owner's signature: ��� Date: � �� ��
Date submitted: � I G � �
r
PCAPP.FRM
GQ��iCQTv� "tbY
�
-�r a -rivst'
a- V1 ��� S i cLe C�. � e� Co n J'1ry cT �✓� p. e y n-� !-�
(� I
-}-�ov�/ o•c�c���1�"l