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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 Com an 7. 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 QS 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