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PLANNING APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT—PLANNING DIVISION
501 PRIMROSE ROAD, 2ND FLOOR, BURLINGAME, CA 94010-3997
TEL: 650.558.7250 � FAX 650.696.3790 � E-MAIL: PLANNINGDEPT(a�BURLINGAME.ORG
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ARCHITECTIDESIGNER APPLICANT?
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BURLINGAME BUSINESS LICENSE #
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*FOR PROJECT REFUNDS* - Please provide an address to which to all refund checks will be mailed to:
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I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION GIVEN HEREIN IS TRUE AND CORREC7 TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
APPIICANT'S SIGNATURE (IF DIFFERENT FROM PROPERTY OWNERI DATF
I AM AWARE OF THE PROPOSED APPLICATION AND HEREBY AUTHORIZE THE ABOVE APPLICANT TO SUBMiT THIS APPLICATION TO THE
PLANNIN� COMMISSION/DIVISION. _
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AUTHORIZATION TO REPRODUCE PLANS
I HEREBY GRANT THE CITY OF BURLINGAME THE AUTHORITY TO REPRODUCE UPON REQUEST AND/OR POST PLANS SUBMITTED WITH THIS
APPLICATION ON THE CITY'S WEBSITE AS PARz10F THE PLANNING APPROVAL PROCESS AND WAIVE ANY CLAIMS AGAINST THE CITY ARISING
OUT OF OR RELATED TO SUCH ACTION � (INITIALS OF ARCHITECTIDESIGNERI
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APPLICATION TYPE
�ACCESSORY DWELLING UNIT (ADU)
❑ CONDITIONAL USE PERMIT (CUP)
[' DESIGN REVIEW (DSR)
❑ HILLSIDE AREA CONSTRUCTION PERMIT
❑ MINOR MODIFICATION
❑ SPECIAL PERMIT (SP)
❑ VARIANCE (VAR)
❑ WIRELESS
❑ FENCE EXCEPTION
❑ OTHER:
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DATE RECENED:
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PROJECT ADDRESS ASSESSOR S PARCEL #(APNI 20NING