HomeMy WebLinkAbout616 Vernon Way - Application.
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COMMUNITY DEVELOPMENT DEPARTMENT • 501 PRIMROSE ROAD • BURLINGAME, CA 940'10
p: 650.558.7250 • f: 650.696.3790 • www.burlingame.org
APPLICATION TO THE PLANNING COMMISSION
Type of application:
� Design Review O Variance ❑ Parcel
❑ Conditional Use Permit ❑ Special Permlt O Other:
PROJECT ADDRESS: �P��P V�Nh� h �'vLtx.�� �E�jUr� IY�GiG,w�Q • i.F� `�j�1�1 U
APPLICANT project contact person'�
OK to send electronic copies of documents�
Name:�, . •-
Address: _ � f> ��� � �� ��> > �� "r�
City/StatelZip: ?L��Li��lnl"E, C� <-j �-�' jo
Phane: C w t�-D ��. � �`% �- l�� �;
Fax:
PROPERTY OWNER project contact person�
OK to send electronic copies of documents
Name: � �5�'l,c,�,,� � ��7_� an ��-j�,tn,S��+rlv�,i
Address t �(�;�
CirylState/Zip: B�'vl ���a,�v�-�� , CP< <� U jC
Phone: '13��--'r'}�7- �'�"'�`'1
Fax:
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ARCHITECT/DESIGNER proJectcontactperson`�
OK to send electronic coples of document�
Name: ��� �=t� t_ �-< <: c• �. t 1= � i� ,
Address: �;"% (>> i!� �= h-'� �� S I_ i I� i--- �
City/State/Zip: i�� i f'�l.- ��-I �= � l.s ry� L �� _� j��- !'��
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Phone: � � � � ) � �1 % - I � % ``
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Fax:
E-mail: �-.,�.f; ce-(�= ���-�'�i��-t_si'c=it:'t�i: �-�,���i
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* Burifngame Business L�cense #: `�5 % C
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PROJECT DESCRIPTION: � I `i � � ! � ]��=L' i < /1 �'� � j i ;= � -! � F'� i� i ; i'� 1� � �
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AFFADAVITISIGNATURE: I hereby certify under penaity of perjury that the information given herein is true and correct to the
best of my knowiedge and belief,�� ,- j.
Applicant's signaEure: ,,� .
f am aware of the proposed� lica� �hereby
Commission. �f '� �
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Date•_ � � _ ��. ` Z �' l S
the above applicant to submit this application to the Planning
Property owner's signature: � �^�- � Date: I Z�1cw 7,�1�
Date submitted:
* Veriflcation that the project arc itecUdesigner has a valid Burlingame buslness license will be requlred by the
Finance DepaHment at the time application fees are paid.
S �HANCOUTSiPC Applicotion. d oc