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APPLICATION FOR SITE PLAN PERMIT
if-/Aj Multi-familY residential project
Other -specify
P & Z Case No.
Date Received
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Appl icant:
f)41/1't{ GtJW6/'l
76017....... $aW-W1~ irA
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Address:
Phone:6f3- ?6~5
Owne r:
Yahl(t '15 C2t~?~.e
Address:
Location of Project: Lot{s)
of W;ttJws9' V{~1~
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Block (5)
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Present
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Appli cantcertif lestheabove information to be true and correct .
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Signature of applicant, owner or agent
IF APPLICATION IS FILED BY AN AGENT, A POWER OF ATTORNEY STATEMENT MUST BE INCLUDED
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