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PLANNING APPLICATION
�IJRLINGAME COMMUNITY DEVELOPMENT DEPARTMENT—PLANNING DIVISION
501 PRIMROSE ROAD, 2ND FLOOR, BURLIN�AME, CA 94010-3997
TEL: 650.558.7250 � FAX: 650.696.3790 � E-MAIL: PLANNINGDEPTCcDBURLINGAME.ORG
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PROJECT ADDRESS ASSESSOR'S PARCEL # IAPNI
PROJECT DESCRIPTION
ZONING
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PROPERTY 0 NER NAM APPLICANT? ADD ESS
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E-MAIL
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ARCHITECTIDESIGNER APPLI AN AD�ESS
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BU NILR GAME BUSlNESS LICENSE #
*FOR PROJECT REFUNDS' - Please provide an address to which to all refund checks will be mailed to:
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NAME ADDRESS �'�r`��(� �� r
n- I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION GIVEN HEREIN IS TRUE AND CORRECT TO THE BEST OF MY
y KNOWLEDGE AND BELIEF.
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� APPLICANT'S SIGNATURE (IF DIFFERENT FROM PROPERTY OWNERI DATE
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� I AM AWARE OF THE PROPOSED APPLICATION AND HEREBY AUTHORIZE THE ABOVE APPLICANT TO SUBMIT THIS APPLICATION TO THE
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Q PLANNING CO I 10 /DIVISION.
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� PR ERTY OWNER'S SIGNATURE DAT
AUTHORIZATION TO REPRODUCE PLANS
I HEREBY GRANT THE CITY OF BURLINGAME THE AUTHORITY TO REPRODUCE UPON REQUEST AND/OR POST PLANS SUBMITTED W�TH THIS
APPLICATION ON THE CITY'S WEBSITE AS PART OF THE PLANNING APPROVAL PROCESS AND WAIVE ANY CLAIMS AGAINST THE CITY ARISING
OUT OF OR RELATED TO SUCH ACTION -- f�/� �INITIALS OF ARCHITECTIDESIGNERI
� APPLICATION TYPE
Z❑ ACCESSORY DWELLING UNIT (ADU) ❑ VARIANCE (VAR)
W❑ CONDITIONAL USE PERMIT (CUP) ❑ WIRELESS
� ' [, V6ESIGN REVIEW (DSR) ❑ FENCE EXCEPTION
Q❑ HILLSIDE AREA CONSTRUCTION PERMIT ❑ OTHER:
y �MINOR MODIFICATION ci11� Y1� �( �iS��
❑ SPECIAL PERMIT (SP)
DATE RECENED:
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