RECEIPT STAMP

APPL. # ____________

PROJECT NAME: ______________________________________

STREET ADDRESS: _____________________________________

Applicant ADDRESS	_________________________ _________________________ _________________________	PHONE FAX eMAIL	__________________________ __________________________ __________________________
OWNER ADDRESS	_________________________ _________________________ _________________________	PHONE FAX eMAIL	__________________________ __________________________ __________________________
Agent ADDRESS	_________________________ _________________________ _________________________	PHONE FAX eMAIL	__________________________ __________________________ __________________________

PROPERTY INFORMATION

Map_____ Street_______ Lot_______

Zoning District(s)___________________

PROPOSAL DESCRIPTION - Use the space below to write a complete, detailed description of the development proposal and how it will affect the existing use of the property. Use a separate sheet if necessary. Include a scaled plan with this form showing the property, buildings and other improvements. If any drainage work, grading, etc. is to be done two plans must be submitted.

1. Existing use(s:)

2. # of units existing __________ Sq. footage of each unit _______________________

3. #of proposed units _________ Sq. footage of each unit ________________________

4. Existing parking spaces _____________ Striped _____ Unstriped __________

4. Proposal:

_________________________________________________________________

_______________________________ _______________________________ __________

Print Property Owner name Signature of Property Owner Date