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Application # <br />Date Received t -A o- <br />Amount Paid <br />” VARIANCE APPLICATION <br />ImUal Application Fee S220W”' 2-'$^*^ <br />(S50.00 per each additional variance) <br />Renewal Variance Fee SI20.00 <br />(no change from original application) <br />Variance for non-conforming structures $220.00 <br />*^fter-the-Fact Fees (Double application fee)" <br />PROPERTY INFORMATION <br />SiieAddress <br />Property Identification Number (P.I.D.) 7^ —i 77. (Tf /ySAo' <br />if noUncluded on required survey. <br />I (do) ^T^SO owTSe adjocnt ^3,4 if laid. --------------------------(month/year) ^ ' ^ <br />_____r— I' O <br />k t J <br />APPLICANT <br />Name W \ <br />Address:. \-5S^ ^lAgjc T->p <br />Phone (home)_<i52iU^ <br />Phone (work ) 2. M \ ^ <br />City:___QBQ^ <br />OWNER (if different than applicant) <br />Name <br />Zip: <br />Address:City: <br />Phone (home) <br />Phone (work)_ <br />v; • i <br />Zip:. <br />DESCRffTION OF REQUEST Estimated Constmction Cc.st $ 77 ~z < <br />VARIANCES REQUIRED <br />Lot Area -----Lot Width Hardcover ___^Lot Coverage <br />is <br />Setback:,I2L Side Rear Average Lakeshore <br />Wvv ^es r WWCmA^ <br />IL^S^/DESCRIPTION of imSUAL PROPERTY CONDITIONS <br />complia^crwilfr ZoSI'g C^de^re^^^^^^ conditions prevendrg <br />(attach additional sheets if necessary)