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— - - — -- — -- -- — - — Pctgc 2 of 2 <br /> IV. Property & Contractor Information: <br /> Street Location/Address of Property: �vs�� C e(�� ' i- pew 7 i-) , 471-0,2 , <br /> Property Identification Number (PID): _ Zoning District: <br /> Legal Description (From Deed or Certificate of Title): ❑ Please see attached <br /> Lot: // Block: g Addition: SoriA4 144AI i, �;o rT � , <br /> Property described is by: ❑Abstract ❑ Torrens—Certificate#: <br /> Location of Certificate: <br /> Architect(if applicable): /0 4 /lcrs h Phone: "76'3- sG 7- 3»y <br /> Surveyor/Engineer(if applicable): /4i4 &'rVe.'/wC. Phone: 76 s—7 ?-97d? <br /> Builder(if applicable):--/ta ,')d//'1 ' 44 jld&r 5 Phone: 642,97a 9 7y <br /> V. Main Contact Person <br /> ❑ Property Owners <br /> Other(if other, please fill out the information below) <br /> Title(Position or relation to property owners): <br /> fr adoliefey �.c' /�r.7 l��sc4 5-4 /Zc `s 3e 3 <br /> (name) (address) (st) (zip) <br /> ib_ 976$— 's-7y 1—.sd,.—90 7.4 tip Joe gym.. <br /> (phone#) (fax#) (email) hu•Lte2> ,�. <br /> VL Notice of Fees <br /> As set forth in the City Fee Schedule and pursuant to applicable law,the property owner shall be responsible to reimburse the city for all related <br /> miscellaneous costs incurred pursuant to the processing of this application. Note that these reimbursements may exceed the amount of the original land <br /> use application fee. Such expenses may include,but are not limited to,direct city payroll and overhead costs,tees paid to consultants and other <br /> professionals,and the cost of printing,mailing,and supplies. These miscellaneous fees are due immediately upon notification by the City. The City shall <br /> provide,upon request,an itemized statement of the various expenses incurred by the City. The City may withhold final action on a land use application <br /> and/or rescind prior action until all miscellaneous fees are paid. The City may require additional deposits,if deemed necessary. The property owner <br /> agrees to allow city staff and commission members to access the property per this application for inspection. <br /> I acknowledge that I have read the above statement and fully understand that I am responsible for all costs incurred by the City in the processing and <br /> reviewing of this application. <br /> Property Owners Signatu Date: 6 —z <br /> ADMINISTRATIVE USE ONLY: <br /> Date Application Received: PC Date: <br /> Fee Paid: CC Date: <br /> Esc i vw Paid: <br /> Receipt Number. Form Last Updated 10.18.18 <br />