HomeMy WebLinkAboutApplication APPLICANT 3/2/2023jCity of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
Site Plan Review
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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