HomeMy WebLinkAboutApplication APPLICANT 1/15/2014 ;City of Springfield SPRINOFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477 �/
Site Plan Review
Application Type (Applicant: check ones
Site Plan Review Pre-Submittal: ❑ Ma-or Site Plan Modification Pre-Submittal:
Site Plan Review Submittal: ❑ Ma-or Site Plan Modification Submittal: ❑
Required Project Information (Applicant: complete this section)
A licant Name: IPhone: 0 -724P-7449
Company: IEmail: rin
Address: (coo Ca o
Applicant's Rep.: Q 0.O ( Phone: 4.1)697-9(o00
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a o tc. ��G�+t1� i�� ��ln��h ct Email: c✓1 ha o a c,
Address: I 't• Q,r1f� V CDYY1
Property Owner: " ` ^I Phone s 4
as Company: e; Email: ww � cram
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Address: Sv OE7 —el
ASSESSOR'S MAP NO: TAX LOT NOS : 1 200
Property Address: I Qi00- FIA ` • 5 M&F, I-JAY
Size of Property: 'r. �3 Acres R Square Feet ❑ I Proposed Density: —
Proposed Name of Project: "�-BLLO(OStAigOPPLOF,5 A tTtCtA"
Description of If you are filling in this form by hand, please attach your proposal description to this application.
Proposal: 11 1500 SIJCI-10t-i - t E LL-OWSH 19 NP•LL G 6,
,Existing Use: CAA"?,C.tA
New Im ervious Surface Coverage (Including Bldg. Gross Floor Area): 1 \ 500 sf
Si natures: Please sign and grint your name and date in th prOlDriate box on the next ape.
Required Project Information (City Intake Staff. complete this sectionr
Associated Applications: p E q- 15 W t)b SM Signs:
Pre-Sub Case No.: VC6 I I -CCIM > Date: I /S Reviewed b :
Case No.: I Date: Reviewed by:
2
00-
Application
0A lication Fee: U' Technical Fee: Posta—14
TOTAL
Fee:
TOTAL FEES: $ 3�110°� P CT NUMBER: PIQ�J I`► - 00
Revised 5/21/13 KL ,JAN 15 204 1 of 12
Owner Signatures
This application form is used for both the required pre-submittal meeting and subsequent
complete application submittal. Owner signatures are required at both stages in the application
process.
An application without the Owner's original signature will not be accepted.
Pre-Submittal
The undersigned acknowledges that the information in this application is correct and
accurate for scheduling of the Pre- Submittal Meeting. If the applicant is not the
owner, the owner hereby grants permission for the applicant to act in his/her behalf.
I/we do hereby acknowledge that I/we are legally responsible for all statutory
timelines, information, requests and requirements conveyed to my representative.
Owner:
Date:
Signature e4 _Oddo
Print
Submittal
I represent this application to be complete for submittal to the City. Consistent with the completeness check
performed on this applicationatthe Pre-Submittal Meeting, I affirm the information identified by the City as
necessary for processing the application is provided herein or the information will not be provided if not otherwise
contained within the submittal, and the City may begin processing the application with the information as ' ,
submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a
complete application.
Owner:
Date:
Signature
Print
PRE-SUBMITTAL RECD
JAN 15 2014
Revised 5/21/13 KL 3 of 12