HomeMy WebLinkAboutApplication APPLICANT 7/28/2021 (2)SPRINGFIELD
'City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
Major Variance
Applicant Name: vvcy �owz Phone:
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ASSESSOR'S MAP NO: IF�'D1.'OY—OO -TAX LOT NO(S):
Pro%Perry Address:yO9
Size of Pro art B ZAA Acres ❑ Square Feet 91
Description of If you are filling in thiss�form by hand, please attach your proposal description to this application.
Pro osai: I°_nsfrv('4len Ot 4
Existin Use: ('ra✓LI �'✓ew�
Signatures: Please si n and print your name and date in the appropriate box on the next page.
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Associated Applications: Si ns:
Case No.:
Date:
Reviewed b
litie: Technical Fee: $ Posta a Fee: $
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PR07ECT NUMBER:
Revised 10.14.13 kl 1 of 4
Signatures
The undersigned acknowledges that the Information In this application is corrert and accurate.
Applicants -7
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Signatur
Is not the owner, the owner hereby grants permission for the applicant to aQ In
Date:
Signature
Revised IOA4.13 kl 2 of 4