HomeMy WebLinkAbout219 Bloomfield Road - ApplicationCity of Burlingame • Communiry Development Department • 501 Primrose Road • p(650) 558-7250 • F(650) 696-3790 •
www.burlingame.org
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BURLINGAME ACCESSORY DWELLING UNIT APPLICATION
Project Address: �
Assessor's Parcel Number: n2� ' 2� 2'n�o Size of Property ��"��' �F ? p �
Zoning: 2—� Present Use of Property: �'" '�
� Please indicate the contact person for this project.
APPLlCANT (ArchitecUDesigner if app�icab�e) pROPERTY OWNER proJect contact �rson ❑
project contact person ❑ Ok to send electro�ic copies of documents ❑
Ok to send electronic copies of docume�ts ❑
Name: ." `��.W� ��i�'� Name: �C' r �� � G, �.�c�n Iz o
Address: . .�.,,: ,, h �
City/State/Zip: � ����� �� " � �'���� � �
Phone
Fax:
E-mail
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* Burlingame Business License #:
PROJECT DESCRIPTION:
Address: 12Q g���MF���
City/State/Zip: �� ��sN c Ar�� /C�4 ( R���
Phone:
Fax:
E-mail:
�5�-50'�-4002
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AFFADAVtT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and correct to th� best of my knowledge and belief.
Applicant's signature: �� ,<; -' Date: � ' '" �'� r i
�
,
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Gommunity Develapment Department.
Property owner's signature: N� Date: ��/2 b( �'�-
Date submitted: i°� �� �( a
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Verification that the project architect/designer has a valid Burlingame business license will
be required by the Finance Department at the time application fees are paid.
Please mark one box above with an X to Indlcate the contact person for this proJect.
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JAN 1 7 2018
S:IHANDOUTSISecond Units - New OrdinancelSecond Unit Application.doc
CITY OF BURLINUAME
CDD-PLANNING D11/,
City of Buriingame • Community Development Department • 501 Primrose Road • p(650) 558-7250 • F(650) 696-3790 •
ww�wwv.burlinqame.orq
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Project Address:
ACCESSORY DWELLING UNIT APPLICATION
Assessor's Parci
Zoning
��� Preseni Use ofi Property:
0 Please indicate the contact person for this project.
APPLICANT (ArchitectlDesigner if appiicable)
project contact person ❑
Ok to send electronic copies of documents ❑
Name_ �U' �� �'1� sl�L� �'I
Address: �� � � r�bl �Eve
PROPERTY OWNER project contact person ❑
Ok to send electronic copies of documents ❑
Name: `� ���(� �v ��c �►
Address: 12q `�L�or^��-��� De
l�'-�v'��,
s�
City/State/Zip: �'� � ��'i�' City/StatelZip: (3�2��-�c,�r�� /C�41 Qy���
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Phone
�D �J11 �� Phone: (� 5� - �2 5- f�988
Fax: Fax:
E-mail: �l�Gd�e'S'(,lavy��� '[8"�
E-mail: �c��--� ���4ps._ccr � YA�oo �a�^'1
* Burlingame Business L.icense #: � L I 2�"'
PROJECT DESCRIPTIQ N: NGw �p ��
�l tir�e ( v Ca-k � n r�� � o
t�cnc+ -�' 3�a S� ov►e — �cr
AFFADAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and correct to the o y knowledge and belief.
ApplicanYs signature: Date: �� g� l� ��
,
I know about the proposed applicatio and hereby authorize the above applicant to submit this
application to the Community Dev ent Department.
Property owner's signature� Date: 4l Z 3/��
Date submitted: � � � 2'� �7
*
�
Verification that the project architect/designer has a valid Burtingame business license will
be required by the Finance Department at the time application fees are paid.
Please mark one box above with an X to indicate the contact person for this praject.
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S:1NAtJDOUTS'�Second Units - New OrdinancelSecond Unrt Application.doc