HomeMy WebLinkAboutApplication_Application City ofTigard
Case #: N 1S2c7L5'�b3
_ Ill COMMUNITY DEVELOPMENT DEPARTMENT
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,�AK>, Master Land Use Application
LAND USE APPLICATION TYPE
❑ Adjustment ❑ Modification: Type I ii Type II
❑ Annexation ❑ Planned Development:
❑ Comprehensive Plan Map Amendment O Consolidated Plan
O Conditional Use 0 Concept Plan
❑ Downtown Development Review: ❑ Detailed Plan
O Type I Li Type II ❑ Sensitive Lands Review:
O Adjustment O Type I O Type II O Type III
O Food Cart Type II ❑ Site Development Review: 0 Type I O Type II
O Home Occupation —Type II ❑ Subdivision
❑ Land Partition ❑ Sublot Plat
❑ Lot Line Adjustment/Lot Consolidation ❑ Temporary Use Permit
❑ Marijuana Facility Permit D Urban Forestry Plan:
,Miscellaneous: fcr C.o.- - POO O Modification O Discretionary Review
Type II D Type III O Zoning Map Amendment
PROJECT INFORMATION
Project name: - / 9- - c1 ( r-FiS Ph S'1 ci i cty
Brief description of project: A I
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SITE INFORMATION ,, " "n
Location (address if available): // ,9 Zt—) 7 7-C-1- tom f7a7 S
Tax map and tax lot number(s):
Site size: Zone:
APPLICANT INFORMATION
Name: n ,,/, -�. $ l /. .,/, __.7-
Mailing address:�Qg-� `S / <' ty/ � C p:
Zi 7?E
!� (u<.�S Ci State:
Phone: 53-3_Sti - /.�32 Email: / -72/,-. 57cc )by[c 5 & 9i-7-140_,/
Applicant's representative:
Phone: Email:
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of2
PROPERTY OWNER INFORMATION 9LSame as applicant
(Attach list for additional owners)
Name:
Mailing address: City/State: Zip: _
Phone: Email:
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 2421 or tigardplannerondutyfg.tigard-or.gyv.
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. TT
a_•, /. �([ LA / c�/ , -�/L1L�,_As sgfta * Print name Date
Property ow er's signature* Print name Date
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Property owner's signature* Print name Dat
*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.: Pt t 2616 '0503 Application fee$.sl D 00. 00 Received by: kr- Date: 4i/296
Related Case(s): Determined complete by: Date: _
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of