HomeMy WebLinkAbout1537 Cypress Avenue - Application,.r� T �
�URLJNQAMi � CITY OF BURLINGAME
�, °:: APpLICATION TO 1'�� PLANNING COMNIISSION
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Type of Application: Special Permit Variance Other
Project Address: � 5�% � Y P 12L: � S �i-UL�
Assessor's Parcel Number(s): �� �' �v � ` Z4C9
APPLICANT
Name: (i�c � �f3� Y �—I r')'I�Nti�
Address: l5 � ''7 � ��fL(=.�5 79-U(..�
City/State/Zip: � 1�2u�C�►�!�'It� C� �f ya �i
Phone (w): (D S� � 5� (o • !� '7'7 !
PROPERTY OWNER
Name: �'' � �7YI c��S' —
Address:
City/State/Zip:
Phone (w):
(h): Lv 5 � 3 H'�S �513�i
f�: (�5� �3�� � � 7�
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fax:
ARCHITECT/DESIGNER
Name:
.� �j�� �
Address:
City/State/Zip:
Phone (w):
Please indicate with an asterisk * the
contact person for this application.
(h):
fax:
PROJECT DESCRIPTION: (G � TC t+L rU I�u�l pp t� L� %i7j� �yQ� �C1 � IL� p�?��;
AFFIDAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and conect to ,the best of my kn wledge and belief.
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A li t's ignature Date
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Plannin� �bmmission,, �/i`
Date Filed: 3 g�� F�: � 2 I v, o0
Planning Commission: Study Date: Action Date:
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