HomeMy WebLinkAboutApplication APPLICANT 4/30/2008
:City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
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SPRINGFIELD
Ti.me Extension Request
Certain Improvements & Final Submittals
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Requ"ired project Illform,ation . (API,licant: complete t!Jis section) I
A licant Name: EKc"rr f{.~l>eR-So.u
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Phone: SLlI-5"21- ~o S
Fax:
Address: -p ~
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Phone: 5'I/-t.$l{-1.{ 02-
Fax: 'l;l./t-&8'-/-'-{Qd1
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A licant's Re.: -s-
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Address: I 2-D
Owner:
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Phone: s -S"2..l- ~o ~
Fax:
Address: 7>0?0' Z"2.
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ASSESSOR'S MAP NO: I 70"2.- 3 '2.-
TAX LOT NO S
10
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Reason for If you are filling in this form by hand, please attach your proposal description to this application.
Time Extension:
Si natures: Please si
Date:'
A lication Fee: $
Technical Fee: $0
Posta e Fee: $0
TOTAL FEES: $
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PROJECT NUMBER: t?seJ''20l:l Y - 6i1ill
PRE-SUBMITTAl REC'O
APR 3 0 2008
,-
Revised 1/1/08 Molly Markarian
1 of 2
Signatures
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Applicant:
The undersigned ac.knowledges that the information in this application is correct and accurate.
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Si~ture
Date:
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-:.\e6se W;/Jor
Print
Owner:
If the applicant is not the owner, the owner hereby grants permission for the applica'nt to act in his/her behalf.
~. Date,
/Jrtl1T iI. /lrtcia,,~
Print
. PRE.SUBMITTAL-REC'O
APR 3 0 2008
. Revised 1/1/08 Molly Markarian
2 of 2