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SUM-PLAN MUSTSIOW ALL PROPERTY LINES AND DIMENSIONS, <br /> ❑ Drawn.:to Scale- t"square . . Feet Not Drawn.to-Scale:Total Acres <br /> • <br /> 1 certIfy that the above information is accurate to:the best:or my:knowledge. 'I AM-TI E: [: Owner :I l Authorized Agent <br /> Name;(please;punt) _ tzz ; 1. My telephone-number is 6 3 7 Lf �`10 <br /> Applicant Signature:. 41 <br /> `-3'�a'`"� Date fric/z fc 60cr is I it�D City eck t::tr 1-. dip: 97L)1}. <br /> Applicant's Mailing Address. ' !) (s ra . <br /> FOE OFFICE USE ONLY <br /> • PLANNING: Date:: <br /> PUBLIC WORKS; ..:.. . <br /> BUILDING INSPECTION(Acceptable:for Planmmng:requirements.only) Dater, <br /> Page 4.of 5 <br /> A:33D <br /> Rev 692011,09/201=2. <br />