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APPLICATION FOR CONDITIONAL USE PERMIT
YMultifamily residential project
Other - specify
P&Z Case No.
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Applicant(" ·
Address
Date Received
Owners of property within 200 feet of all property lines of subject property
according to present tax rolls:
Name: Address:
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If applicant 1S
agent
The applicant certifies
an agent, a power
APPLICATION FOR CONDITIONAL USE PERMIT
~,~~ttifami1y residential project
"'Other - specify
P&Z Case No.
Date Received
Applicant JAK~r---;;=~D~ Phone IYf~r?bf(P
Address . .1J:J/f'01. e. ~cr-tft SF 8f<rMl
Owner ~)z'r f,/rli//)!)Y . Address S~
Location of project ?tv! ~!6 .J<. . . Sdl11lf.~ p/(J!/6-
Present use of property
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Owners of property within 200 feet of all property lines of subject property
according to present tax rolls:
Name: Address:
Application Fee:
The applicant certifies the above information to be true and correct.
Signature of applicant, owner, or agent
If applicant 18 filedby,an agent, a power of attorney statement must be included.