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Applicant: <br />-zx .... .... .... .... . <br />DBA -k <br />Name: <br />...... . . . .... <br />j"Ji <br />1 C' a <br />Mailing Address <br />. . . . . ........ <br />Email: <br />Telephone . ...... <br />Owner: <br />-4 <br />Name: I .......... <br />Mailing Address-.'-�' .......... <br />Ema fl: <br />Telephone .................. ......... ...... - <br />Property Parcel(s) Proposed for Agreement.4 <br />No, LOAD # <br />Adress <br />Lot Block <br />Addition <br />ww_2. <br />. . ........ . <br />4. <br />. .. . ................ . . .... .. <br />. ....... <br />. . .... . .... <br />50 <br />A " d - d d diti , ona , I s " heets If n e - cessary. Full Legal Description- Include as an attachment a full legal description with metes and <br />bounds or a copy of the deed, if available. <br />Improvements: <br />w <br />Type improvements for new Construction (check one)., 0SF U 2F D MF <br />Total Number of Dwelling Units: <br />Estimated Value of Improvements by type: <br />Estimated Start Date of Construction: J0. ri Lv-z'(c �3 <br />. ......... - — --- ---- XIN <br />Estimated Date of Completion of Project(s) .::N , -v <br />v --j <br />Description of Pro , <br />ert (attach site plan, floor plan, etc.): <br />j <br />App „� �. . . ........ i D a t e <br />ficant"s Signature'. <br />Da <br />Ownees SIgnature: tow <br />Page 7 of 7 <br />77/;-�i,,'�,TT/ " .... . ... . ............... <br />F7, 'T <br />7; <br />IT77 <br />��7;,77 ip <br />