Land Use Application ICity of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
•
T 1 GARD Master Land Use Application
LAND USE APPLICATION TYPE
❑ Adjustment/Variance (II) ❑ Minor Land Partition (II)
❑ Comprehensive Plan Amendment (IV) ❑ Planned Development (III)
❑ Conditional Use (III) ❑ Sensitive Land Review (II or III)
❑ Development Code Amendment (IV) ❑ Site Development Review (II)
❑ Downtown Design Review (II,III) ® Subdivision (II or III)
❑ Historic Overlay (II or III) ❑ Zone Change (III)
❑ Home Occupation (II) ❑ Zone Change Annexation (IV)
NOTE: For required submittal elements,please refer to your pre-application conference notes.
PROPOSAL SUMMARY (Brief description)
The intent of this submittal is to obtain approval of a 10 lot subdivision from the 3.35_acres comprised of
tax Jots 600, 900, 1100 and a portion of 1000 2S1 11 BB
PROPERTY INFORMATION (where proposed activity will occur)
Location (address if available):
Tax maps and tax lot #s: 2S1 11BB tax lots 600.900 and 1100
Total site size: Zoning classification: R-3.5
FOR STAFF USE ONLY
APPLICANT INFORMATION
Case No.:
Name: Pacific Evergreen Homes Related Case No.(s):
Mailing address: 7410 SW Oles n Road, Suite 133
Application Fee:
City/state: Portland. OR Zip: 97223 Application accepted:
Phone number: 503-713-86.2.7
By: Date:
Primary contact name: Harlan Borow
Phone number: 503-713-8627 Application determined complete:
By: Date:
Email: harlan@pacificevergreenhomes.com
I:\CURPLN\Masters\Land Use Applications Rev.11/25/2014
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 2
PROPERTY OWNER/DEED HOLDER INFORMATION (Attach list if more than one)
Name: Mary J Kastel _
Mailing address: 14259 SW 100th Avenue
City/state: Tigard, OR Zip: 97224
Phone: Email: c • of •,
•When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in
possession with written authorization from the owner or an agent of the owner.The owners must sign this application
in the space provided on the back of this form or submit a written authorization with this application.
THE APPLICANT(S) SHALL CERTIFY THAT:
• If the application is granted,the applicant shall exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,map be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application(s).
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Ap,'licant/Agent/Representative's signature Print name Date
Applicant/Agent/Representative's signature Print name Date
SIGNATURES of each owner of the subject property required
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Owner's ri'nature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
MASTER LAND USE APPLICATION
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 2
PROPERTY OWNER/DEED HOLDER INFORMATION (Attach list if more than one)
Name: Mary R Johnson —
-
Mailing address: 94300 SW j.11ardAyenue
City/state: Ti and OR Zip: 97224
Phone: Email:
*When the owner and the applicant arc different people,the applicant must be the purchaser of record or a lessee in
possession with written authorization from the owner or an agent of the owner.The owners must sign this application
in the space provided on the back of this form or submit a written authorization with this application.
THE APPLICANT(S) SHALL CERTIFY THAT:
• If the application is granted, the applicant shall exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,map be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application(s).
Applicant's signature Print name Date
Applicant/Agent/Representative's signature Print name Date
Applicant/Agent/Representative's signature Print name Date
SIGNATURES of each owner of the subject property required
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Owner's sig ure Print nam E Date
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
MASTER LAND USE APPLICATION
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 2
PROPERTY OWNER/DEED HOLDER INFORMATION (Attach list if more than one)
Name: Joyce Coiling
Mailing address: 3350 SW Bond Avenue#1506
City/state: Portland, OR Zip: 97239
Phone: Email:
*When the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in
possession with written authorization from the owner or an agent of the owner.The owners must sign this application
in the space provided on the back of this form or submit a written authorization with this application.
THE APPLICANT(S) SHALL CERTIFY THAT:
• If the application is granted,the applicant shall exercise the rights granted in accordance with the terms and subject to all
the conditions and limitations of the approval.
• All the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,map be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application(s).
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AP nt',` igmature Print nar4 U D to
Applicant/Agent/Representative's signature Print name Date
Applicant/Agent/Representative's signature Print name Date
SIGN RES of each owner of the subject property required
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Own- s •gn. ' re Print narn Da
Owner's signature Print name Date
Owner's signature Print name Date
Owner's signature Print name Date
MASTER LAND USE APPLICATION
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 2