HomeMy WebLinkAbout2217 Adeline Drive - Applicationi�r� �T °w ,
euRunQw�c CITY OF BiTRI�INGAME
��. ,. APPLICATION TO T�� PLANNING COMIVIISSION
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Type of Application: Special Permit Variance Other �y I I�D �j�OC�I IG ����
Project Address:
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Assessor's Parcel Number(s): ��� I 1�T' �(�
APPLICANT
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ARCHIT CT/DESIGNER
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Name:
Address: �U � S� � OT�i ��.
City/State/Zip: j,_ �/l�s� � •%S � � �D
Phone (w): �� o� �� " / D�
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fax: ��`� �5�'f � �7'�� `i-
PROJECT DE5CRIPTION:
Please indicate with an asterisk * the
contact person for this application.
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AFFIDAVIT/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.
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Appli t's Signature Date
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Planning Commission.
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Prope Owner's Signature ate
---------------------------------------------FOR OFFICE USE ONLY ----------------------------------
Date Filed: Fee:
PROPERTY OWNER
Name: � I� �i�/� � �0
Address: � c� �
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Phone (w): �s' �� -' � (7 `
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Planning Commission: Study Date: Action Date:
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