HomeMy WebLinkAboutApplication Applicant 6/21/2023City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
Time Extension Request
Certain improvements & Final Submittals
SPRINGFIELD 7--.-
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Required(Applicant:
Applicant Name:
complete this section)
Phone:
Company:
Fax:
Address:
Applicant's Rep.: Tanya Sorensen
Phone: 541-302-9830
Company: Metro Planning, Inc.
Fax:
Address: 874 A Street Springfield, OR 97477
Property Owner: Cynthia Koza
Phone:
Company:
Fax:
Address: 88489 Stephens Rd Springfield, OR 97478
ASSESSOR'S MAP NO: 18-02-03-11
TAX LOT NOS : 8000
Pro erty Address: N/A
Tentative Case #: 811-21-000184-TYP2
Reason for If you are filling in this form by hand, please attach your proposal description to this application.
Time Extension: addressing City/County review comments
Si natures: Please sicin and orint vour name and date in the alipronriate
.Required- - Staff:
Date: to '8 0 /AReviewed
box on the next nane.
complete this section)
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0
Application Fee: $ Technical Fee: SO
IlPostage Fee: O
TOTAL FEES: qtp-o,0
PROJECT NUMBER:
Revised 1/1/08 Molly Markarian 1 of 2
Signatures
Applicant:
Owner:
The undersigned acknowledges that the information in this application is correct and accurate.
Tanya Sorensen
Signature
Tanya Soresnsen
Print
Digitally signed by Tanya Sorensen
DN:a Tanya Sorensen,o Metro Planning, Ino ou.
emaiknanya@metraplanning. n U6 08:4
Date: 7073Date: 06/20/2023
,630 435 -0%OO'
the applicant is not the owner, the owner hereby grants permission for the applicant to act in his/her behalf.
Signature
Print
Date:
Revised 1/1/08 Molly Markarian 2 of 2