HomeMy WebLinkAbout462 Cumberland Drive - Application.4+� CIT �
DURUNQAMf CITY OF BURLINGAME
� APPLICATION TO TI� PLANNING CONIlVIISSION
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Type of Application: Special Permit Variance Other.
Project Address: �i-co2 C�..,•.1n�.e.�.a,�D 52�•�,0 � i3u�zL►►.� -,o.�..�c , c�. o��.o i o
Assessor's Parcel Number(s): 02�1 - ic�4 - 22n
APPLICANT
PROPERTY O WNER
� Name: � P,�� 2-r' 1���� Name: �o�E ���-,Y
Address: �}�2 C,�� Ez�e--� e.� Address: ���e ,,5 �,��,�.�.�1
City/State/Zip: R��21 ���,,ra �.�► , c�. a4ao City/State/Zip:
Phone (w): �4-��i 2 c.o -t - -�o co�
(h): C��L�3 - � �-s•
fax:
ARCHITECT/DESIGNER
Name: rl � A � �-� E�2
Address:
City/State/Zip:
Phone (w):
(h):
fax:
Phone (w):
(h):
fax:
Please indicate with an asterisk * the
contact person for this application.
PROJECT DESCRIPTION: M��2 1.�ofl���c�-�r,r� -�-o E i•.,-j-,,��, �,o��xE
- ADD 1 P��2.od►.� , 42�►.�0 �=L �c.�rc.�-► ..> 4 l7rJ �� �od�..-\
AFFIDAVIT/SIGNATURE: I hereby certify under penalty of perjury that the information given
herein is true and correct to the best of my knowledge and belief.
—.,,r,`� 1 S � 2 I � G
Applicant's Signature Date
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Planning Commission.
s -� � 2 i I �rR �
Property Owner's Signature Date
----------------------FOR OFFICE USE ONLY -------------
Date Filed:
Fee:
Planning Commission: Study Date: Acdon Date: