HomeMy WebLinkAboutApplication_Application City of Tigard Case #: M 1 S 2O 25 Ooc
a COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Master Land Use Application
LAND USE APPLICATION TYPE
El Adjustment O Modification: U Type I ED Type II
❑ Annexation 0 Planned Development:
0 Comprehensive Plan Map Amendment O Consolidated Plan
❑ Conditional Use ❑ Concept Plan
❑ Downtown Development Review: O Detailed Plan
0 Type I O Type II ❑ Sensitive Lands Review:
O Adjustment O Type I fl Type II ❑ Type III
❑ Home Occupation -Type II 0 Site Development Review: 0 Type I O Type II
O Land Partition ❑ Subdivision
❑ Lot Line Adjustment/Lot Consolidation O Sublot Plat
0 Marijuana Facility Permit ❑ Temporary Use Permit
O Miscellaneous: '-a,,cQ Car 3 O Urban Forestry Plan:
C Type II LID Type III i I Modification O Discretionary Review
❑ Zoning Map Amendment
PROJECT INFORMATION
Project name: LEA`S 7.o ck_C co-
Brief description of project: AY)I-t-c f;-'0 '°r --('i7Ye-e_ 7--'( Car, l)I i`' S w
p4Ga-1- miff ; 79'i 6)2, 772-2- )
SITE INFORMATION
Location (address if available): j(53'� `i ti re(' ' ,, /-/Wr 7,f.5k"4.-- GA 3'7-2 t 3
Tax map and tax lot number(s):
Site size: Zone:
APPLICANT INFORMATION
Name: )(k j 1Au LLA
Mailing address: I I3-3° 5-' c�Pac '-�'c 1-! City/State: r;5(ir� a 1Z Zip: '7' 3
Phone: `j 3 - q6� 7 j ! Email: V J i/W-t-t .-Z. 0 Ya 4 o, G,,c--,
Applicant's representative:
Phone: Emai::
City ofTigard • 13125 SW Hall Blvd. • Tigard, Oregon 97223 • www:tigard-or.gov • 503-718 2421 • Page 1 of
PROPERTY OWNER INFORMATION ❑ Same as applicant
(Attach list for additional owners)
Name: Vt- Lt-+
Mailing address: /72 's Wiz-.Si lei I -- L3 r ( t ke u St€ /State: 6 Zip:
Phone: — G" ) S y Email: Oc )-) Q/VC 44-1
SUBMITTAL REQUIREMENTS
In addition to this application form, you must submit all required items listed in Subsection 18.710.030.0 of
Tigard's Community Development Code. If you are unsure what is required with your application, please contact
the planner on duty at 503-718-242] or tigardplanneronduty(&,,tigard-or.gov.
I certify that I am the property owner or I am eligible to initiate this application, as provided in the Tigard
Community Development Code. To the best of my knowledge, all the information provided within this application
package is complete and accurate. /
XGt i/.1N L� T/�/ZG 2 J
Applicant's signature* Print name Date
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Property owner's signature* Print name Date
Property owner's signature* Print name Date
*The owner must sign this application or submit a separate written authorization when the owner and applicant are
different people.
STAFF USE ONLY
Case No.: M\S2O7 5-Ono() \ Application fee: Received by: Date: Li l 2)25
Related Case(s): Determined complete by: Date:
City ofTigard • 13125 SW Hall Blvd. • Tigard, Oregon 9 223 • www.tigard-or.gov • 503-718-2421 • Page 2 of