HomeMy WebLinkAbout2405 Valdivia Way - Application4rc c�r �
�R���.M� CITY OF BURLINGAME
�� a APPLICATION TO 1� PLANNING CONIlVIISSION
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Type of Application:_Special Permit_Variance � Other "; ��
Project Address: � 1 C1Jr Vf� L l��i VI fI �i� Y
Assessor's Parcel Number(s): V.� J�%;� Z— i� 9 V
APPLICANr
Name: �/5�/�i/'cLES ��,ELM
Address: 5,��,�� �✓7�L v �/
City/State/Zip:
Phone (w):
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ARCHITECT/DESIGNER
PROPERTY OWNER q � ,
Name:_ /�/�=K� �%ERRY V(//f.1.5/�lr�l/,/
Address: ..2 �G>� f/,¢�.�71 �/T-,¢ ��t �'
City/State/Zip: �L(/iL .�lV �Al�/►E �/�l
Phone (w): ��S '- % 3 % — � `/� 6 /
�h,: ��s - 6� yz - 3 � ; I
f�: �i.� - 8 73 -� T3 /
Please indicate with an asterisk * the
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Name: CNAiR L E S �,EL /S/�
Address: ��� .S; ��pA��S
City/State/Zip: 5,9N . �s � . �'� /g-� ��,
Phone (w): � �,� — � �� — 7-Z5Ci
PROJECT DESCRIFTION:
contact person for this application.
AFFIDAVIT/SIGNATiTRE: I hereby certify under penalty of perjury that the information given
herein is true and conect to the best of my kno�ge and belief.
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Applicant's Signature Date
I lmow about the proposed application and hereby authorize the above applicant to submit this
application to the Planning Commission.
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Owner's Signature D�
�----------FOR OFFICE USE ONLY
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Date Filed: `� �� �,�;G, Fee: k� ��
Planning Commission: Study Date: Action Date:
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