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�,R�N�,� CITY OF BURLINGAME
� a'° � APPLICATION TO THE PLANNING CONIlVIISSION
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Type of Application: Special Permit Variance Other S�_(�(�10►�
Project Address:
Assessor's Parcel Number(s):
APPLICANT
Name: �n )rnrl (� l 1('�A �� , `r�n l_' .
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Address: I o0 0�rr� v� h� ��-. �~7D (
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City/State/Zip: �j tn �Y'Lth I S�' n. �� �y � D�
Phone (w): I S � �U � �'60�
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ARCHITECT/DESIGNER
PROPERTY OWNER
Name: �► i rl ev ����T�} ��l � � i� KI Y(�
Address: �j,,� S� � 6 � �—
City/State/Zip: s(1 VI �,t V1P I�l'��A. �'�' ��
Phone (w): � IS— �S� ^ �� S
(h):
fax:
Name:�rCh'i �-e r �(.� io �'�� � [�li.��l
Address: � ��"in - �i E'VPr{('( /,/ ��_
City/State/Zip: �����5 , � �L��`{ g
Phone (w):_, I� 55"D - S�R� X Il� (
(h):
fax: 31 u-.5�v — S�(f�S
PROJECT DESCRIPTION:
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�I�se indicate with an asterisk * the
contact person
15'—
for this application.
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W.S�v�,�t�,�� � f V'q � � viCP O� v
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.
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Applic s Signature Date
I know about the proposed application and hereby authorize the above applicant to submit this
application to the Planning Commission.
/WiC-�r � �✓�-.�.P� �o a.l�
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Property Owner's Signature Date
----------------------------------------------FOR OFFICE USE ONLY -----------------------------------------•
Date Filed:
Fee:
R E C F �'�� ��� `��
NOV - � "i:;;;�
Planning Commission: Study Date: Action Date:
CITY OF BURL!N�A�J�E
PLANfJING GEPT.