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COMMUNITY DEVELOPMENT DEPARTMENT • 501 PRIMROSE ROAD � BURLIN(3AME, CA 9401 O
p; 650.558.7250 • f: 650.696.3790 • www.burlingame.org
APPLICATION TO THE PLANNING COMMISSION
Type of application:
0 Design Review ❑ Variance ❑ Parcel #:
❑ Conditional Use Permit ❑ Special Permit ❑ Zoning / Other:
PROJECTADDRESS: ��G� iK-TU�15 D/z/✓'�, ,�3v12-c�io�/��� �• `7��/d
APPLICANT
Name: TA�/� yi� /Nf �`� c�S
Address: ���� A'�Vi�s1s D/�-/ v�
City/State/Zip: �lu���i�M� GA . 9�0/U
Phone:
E-mail: �/�i �'� lj''US 1 C�' aa� . G�rr
PROPERTY OWNER
Name: 7�Y� �i./L��IE� S�FiVI �+�l�j
Address: ���� �vTv�15 ,1�:-/�.f�
City/State/Zip: ����M� � • 9¢0/0
Phone:
E-mail: �f�u lyvS�L �o`. Ca.-r
ARCHITECT/DESIGNER
Name: }�S7 in� l�d'D/�
Address: /l� �Ul�� KG�/%J �- �d/?� /,b
City/State/Zip: ��l � A>�G �SG� G�= • �'�/0?>
Phone: _ ���• g��% �ZOU
E-mail: �ii'Jt�Ur� �A� /,�6tli(. - �/1 /� . L6i�'►
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Burlingame Business License
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MAY I 9 2017
CITY OF BURLINGAME
i;CC�-F'Lt°�Nid!(�s'��:, :),�J.
Authorization to Reproduce P�oiect Plans:
I hereby grant the City of Burlingame the authorlty to reproduce upon request andlor poat plana submitted with this
application on the City's website as part of the Planning approval process and walve any claims agalnst the City
arising out of or related to auch action. (lnitials of Architect/Deslgner)
PROJECT DE3CRIPTION: T��-�- ���O�f.� �"%ft�- �lLlIC'-�� �5 �� �''�1'/.� .��%v �/1�`�
�}��� A-,c�6 �t��F �-t�t-�:� , � Nfiv ,�i��c��r. �sn�, ��cx-� �n-� = v�a��
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AFFIDAVITtSIGNATURE: I hereby certify under pen of rjury that the information glven herein is true and co�ect to the
best of my knowledge and be�f. �'
Appllcant's signature: � �'" , � Date: S
I am aware of the proposed application and hereby authorfze the above applicant to submit his a plicat(on to the Pfanning
Commission. � �
Property owner's signature: �� ti�'. ������>,>-�� Date: � -� �
Date submltted: �' %��
5: �HANDOUTS�PC Appllcatlon.doc