HomeMy WebLinkAbout1243 Cabrillo Avenue - Application06/10/2008 14:45 6506963790 PAGE 02/02
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� �OMMUNITY D�VELOPMENT DEPARI'MENT � 501 PRIMROSE ROAD • BURI.INGAM�, GA 94010
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p: 650.558.7250 • f: 650.696.3790 • www.buri ngame.org
AP� -LI�ATIUN `f4 THE PLANNIwG GOMMISSION
Type of a�plication:
� Design Review���%_i-, � Variance
C] Conditional Use Permit O Special Permit
PROJECT ADDRESS:._ �_�
17 Parcel #: C%��� —' �� ������ -
O �ther:
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.R�1 Please irldic�te the contact person ftir lhls praJeCt
APPLICANT prolsct contact porsv��
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Name: ��� ���
Address: � `� � � ��"��l ��-- �
City/State/Zip: ��• ' �
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phone: �� � l - I 12--�
Fax: �_ � �� _
PROPERTY OWNER projeot contact person O
OK to sehd eleelronlc coples of documenfs L]
Name: �?1< �� �1�%L,l� 1 �l�'il�..a�J� _
Address: ���� C�'���- ��� �
City/State/Zip: _ I�'��1� , n��19�4N� ��� � L�����
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Phone: Ff�t+�K � CC� % �� � '�-���1
Fax: _, �'�, �
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ARCHIT�Ct/DESI�,IVER prolo�ccont��t�rson�
OK to send e�dctrbnlc copfes of doCuments ❑
Name
Address;
City/State/Zlp:
Phone;
Fax:
E-mail:
* eur�ingame Business �icense #: 2 2���
PROJEC'i' D
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A�FADAVITl51GWATUR�: I F1e�eby certify under pena
best of my knowledge and belibf. �%%j
Applicant's slgnature:
I am awar�� of the propos�d apblication and
Commission.
Property owner's
r�
Date• Su�c. lfJ: ,�
Date submPtted:
��
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��that the information given herein is true and correct to the
s� Date: � /G' G�
he abpNe epplicant tv submit th(5 application to the I'lanning
�r Verlfic�ttion that thp projec�t architect/designer has a valld Burlingame business license will b� required by the
Finance Departtnent at thd tlme appllcation fees are paid.
O Please c�ark ona box abm►e 1�ith an X to lndlcato the contaCt perSon for this p�oJect. S:\Nandouts\PC Appllcatlon 2008-B.handout