HomeMy WebLinkAboutRP 83-05; Roberts Gift Shop; Redevelopment Permits (RP)REQUEST
• Zone Change
•General Plan Araendment
•Tentative Tract Map
• Planned Unit Development
•l-lajor Condominium Pennit
•Minor Condominium Permit
•Master Plan
•Major Condominium Conversion
CjMajor Redeveiopmc 'it Permit
(check other boxes if appropriate)
ElM: [Minor Redevelopment Permit
•Precise Development Plan
• Specific Plan
• Site Development Plan
• Conditional Use Permit
• Variance
•Planning Commission Determination
• Special Use Permit
•Administrative Variance
Complete Description of Project (attach additional sheets if necessary)
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DDcation of Project
Legal Description (complete)
iAssessors Parcel Number
i.
Zone
Proposed Zone
General Plan
C60
Proposed General Plan
Existing Land Use
Site Acreage
0^';ner Appiicant
Nair.e (Print or Type)
Mai. ling Address ^
city and State , Zip Telephone
"I CEkTlFY T^IATT N\ THE LEGAL a^lvlER AND
IHAT AL.L THE ABOVE IWroRNWIION IS TRLIE
AND CORRECT TO lliS BEST OF MY KWa-JI.EDGE.
SIGfMJRE
31:.
Dote ApDlicatio'i Uec'd
imTE
a.
vJe«;;fii'~/<2d By
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Name (Print or Type)
M<a;iiTng Adciress
City and State Zip Telephone
I CEKflFY THAT I AM THE a\^-ER'S REPRSSPlNiTATIVE
ATs^D ITIAT AliL TIIE ABO^/E IWPOimTION IS TRUE
AND COJ^ECr TO THE BEST OF MY KNa^LEK^.E.
SIGNATURE DATE
Receipt NO.
.
APPLICANT DISCLOSURE FORM
In order to assist the members of the Planning Commission and
City Council to avoid possible conflicts of interest, all appli-
cants are required to complete this disclosure form at the time
of submitting their application. When this form has been com-
pleted and signed, the information will be relied upon by them in
determining if a conflict may exist, so please ensure that all of
the information is completed and accurate. If at anytime before
a final action on your application has been rendered, any of the
information required by this disclosure changes, an amendment
reflecting this change must be filed.
If the applicant is an individual, or a partnership (either gen-
eral or iimited) or a joint venture, please state the full name,
address and phone number of each person or individual (including
trusts) who own any beneficial interest in the property which is
the subject of this application. Should one or more parties to
the application be a partnership or joint venture, then please
state the full legal name of the partnership or joint venture,
its legal address and the name and address of each individual
person who is a general and/or limited partner or member of the
joint venture.
Should one or more of the parties be a privately held corporation
(10 shareholders or less) or a real estate syndication, then
please state the state of incorporation or syndication, corporate
number, date of incorporation or syndication, corporate or syn-
dicate address, and the full names and addresses of each
individual shareholder or syndicate member. Should the corpor-
ation be a publically held corporation, then state the full name
and address bf the corporation, the place of its incorporation,
number of shareholders, and the name and address of the officers
of the corporation.
Should you feel that additional information needs to be provided
in order to provide a full disclosure, please include it.
If after the infonnation you have submitted has been reviev/ed, it is detenninecL
that further information^ required, you wi.ll be so ad'^|ed.
APPLICANT: 9 t "2 ' T - 'Sl' ^ t "? 1 i
AGENT:
Name (individual, partnership, joint venture, corporation, syndication)
Businass Address
9Hf ^><^'SY
Telephone Nuinber
Name
Business Addres:
MEMBERS:
Telephone Nuinber
Name '(individual, partner, joint:
venture, corporation, syndication)
Home Address
Business Address
Telephone Number Telephone Muraber
Eome Address
Business Address •
Telephone Nuiober Telephone Jiunber
(Attach more sheets if necessary/)
I/We declare under penalty of perjury that the infonnation contained in this di:
closure is true and correct and that it will remain true and correct and itiay be'
relied uoon as being true and correct until aniended.
, Applicant
y ^-
BY
Agen t, 0-.;ner, Par tner