Agenda - Council - 11/14/2023 - Laserfiche WebLink

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, ' 1 . ' + i Property �rOwner Information ;N zz!! ■ 3: t (If different than Applicant) [ir I r A,► e Name; g ii. Street Ad§Tess: Not,_)44k eri- Nu d , 1 t r City,Statq,Z1P■ PMJt 65303 r r HoMe Phone: , , 'J Work Phone:A'. �• - trnkil: r" Fax Nu r i I O i Please provide a detailed description of your request and attached a copy of a scaled site plan , 5 Cz r -7 KWYVt 0 C ........... f r c r �I �f � , 'J r? qG ro Y1&_ e, ede?e \J A "Land U e,Si nl'will be laceResidents. ; � g p don the Subject Property �'o allow Ramsey the *' opportunity to obtain information abou t your request. Applicant Signature Co-Applicant Signature Printed Name Printed Name eves Ca 10 re!5e_ , 4 ry G Title Title Date 's Date 1 i 1 una0erstarid that the application fee is non--refundable. All costs associated with the processing of this application are the . , . �� " p g pp h responsibility ofA_e applicant:,hether this application is approved or denied. Any excess of escrow account deposits over expenditures v 91'b refunded at the time of account closure, i also understand that as the applicant,it is rn responsibility o o y pp y p yt obtain _ .all other permits or licenses required by any applicable regulatory agencies for this Land Use Application.With notice from the City, I � Y ' understand the City may need to access the property for purposes related to the application, f R Property owner: Property owner ' Signature �! Signature k Print d Name � � `� . anted Name �r , , Title �� , - Title oil Date Date 1 hereby certkjfih, i I a"k the fee title owner/contract for deed vendee of record for the above-mentionedproperty. Failure to prove' ownership *,r d a6y,a&eoments entered Into the City and I will be held liable for any and all costs incurred by .the City. t � • r Y A