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PI...: IPII''O-(.' '7 (rev 08/24 <br />Owner: <br />Name: RDD110DD0DrDEE1111DWV1M= ❑®C DBA: <br />Mailing Address: DDDEM � ® ❑CD5C <br />❑❑EMODID5❑C .�_.�, ��.... .Email: .. ®❑[SID r00=ffl ❑CII) <br />DD <br />Telephone #:..e — ... ..., .... .._........� <br />..__.�.,..... ... .w.... <br />Property Parcel(s) Proposed for Agreement: <br />No. LCAD # Adress Lot Block Addition <br />1, D5 DDD ❑❑CID❑CIDCID ❑❑15 ®❑® ❑®C➢IIIC]-111 <br />2. DE]DDD 0005®❑CIDCTID ®❑ HE ❑❑®O'®dd®C <br />Improvements: <br />Type improvements for new Construction (check one): O SF ❑ 2F ❑ MF <br />5 <br />Total Number of Dwelling Units: <br />Estimated Value of Improvements by type: ...�..,.,�... .........�.��........�.�...... .....___w <br />Estimated Start Date of Construction:0000 <br />.... <br />Estimated Date of Completion of Project(s) <br />❑EDERA®[. . <br />Description of Project (attach site plan, floor plan, etc.) _ _Ea=DLfE®ELIEdCID❑ EE]rI <br />D <br />Applicant's Signature: <br />c ate: .YeO. <br />e - ' Date: <br />Owner's Signature: ,,_.,_.._ _. - _ ........ .W_._.... .. , � �.._ ❑M❑❑5 <br />Page 7of7 <br />