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% <br />> f <br />Initial Application f4^$175.00 <br />($50.00 per each addiCT^nal-^'riance) <br /># % S S.%- <br />A£ter-the-Fact Fees (Double application fee) <br />U50Z ‘0^OFFICE <br />^eceipmh ^^' you <br />:i223670 cool <br />nOPERTT LOCATION <br />Site Address iA 00^ /V SP <br />V* <br />Property identification Number (P.I.D.) 0? //7-^3 ^4 Ooq§ <br />Attach legal description to application if not included on <br />required survey. <br />Fhone (home)APPLICANT <br />Nut. J' T^/I-G-B^ ■ Phone (work) _ _ _ <br />^AA^...,uMr rf?- city! Mnt^HO /W zipigr^if: <br />i I *•(if different than ac'licant)Phone (home) <br />Name Phone (wor)c) <br />Address:. City:Zip: <br />Date Property Acquired (month/year) <br />I (do) (do not) also own the adjacent parcels of land. <br />PIS8INT OSBvOP PIOPBSTT <br />PresedtNzoning Oistric <br />' N V\ <br />\Present Use of Property <br />— ^ <br />Residential <br />Other (specify) <br />INST Estimated Construction Cost $ <br />D..crlb. in i. B QnC. <br />#* <br />Lot Area <br />Setback Variance <br />Lot Width <br />1 <br />' Hardcover <br />Side _ __ Reer) <br />Other <br />r • <br />Fa