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HomeMy WebLinkAboutApplication APPLICANT 3/2/2023jCity of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 Site Plan Review SPNINOFI6� 1 Application Site Plan Review Pre -Submittal: Ma -or Site Plan Modification Pre -Submittal: ❑ Site Plan Review Submittal: ❑ Required Project Information A licant Name: Ma'or Site Plan Modification Submittal: (Applicant., complete Phone: S"1'-IlpIII Company: J50S,4jfta- Email: ivifoeti t4bow(Ack-Co Address: 3Q2 Q e�'ty Applicant's Rep.: kvl& Phone• Company: Email: Address: Property Owner: 9*� Phone• Company: Email: Address: ASSESSOR'S MAP NO: TAX LOT NOS : 1AO0 Property Address: Size of Property: Acres ❑ Square Feet ❑ Proposed No. of Proposed Name of Project: Descriptiofl pf If you are filling in this form by hand, please attach your proposal description to this application. Pro OSaI: t}AAAil�1'�lld+r�LN Un,k Cv 2� �0� Rrcl-wv� V'A, c, ennl/�.vye• rvV-w,l nv.d. Existin '. Use: a-tV rcA( av(,lw✓ New 3imoervious Surface Covera a (Including Bldg. Gross Floor Area): sf Si natures: Please !on and i2rint vour name and date in the Required Project Information (Citytritake Staff., Associated Applications: ro riate box on the next a e. complete this section) Signs: Pre -Sub Case No.: Date: '�J : Reviewed by:, Case No.: a l 5' f1_6 Case Date: - Reviewed by: Application Fee: Technical Fee: A9 I Postage Fee: -0 TOTAL FEES: qqq I PROJECT NUMBER: Revised 1/7/14 KL 1 of 11 9 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. 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 time/lin/es, information, requests and requirements conveyed to my representative. Date: �a�2f23 Signa re Print I represent this application to be complete for submittal to the City. Consistent with the completeness check performed on this application at the 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 227.176 pertaining to a complete application. Date: Signature Revised 1/7/14 KL 2 of 11