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aPP# �c�C� <br /> SF# J��� <br /> Date� <br /> CITY OF PEQUUT LASES DWSMA� <br /> SUBDIVISIQN/REZOI�TING APPLICATION <br /> Name of Applicant_�J�� 4 rrS --� �C� %�ti � Phone` �C5 'g_���� <br /> Mat�ing Address �U ���� �G�S �'j'I N �Sc°� �.((�1 Ema.il <br /> c��,s,��,z�p o , ��y,� <br /> Appli.cant is: Tide Holder of Pro�e,^Yty: • <br /> Le�a1 Uwner ,� .�-��N�S. � � d`�d YI �' Gr� <br /> Coutract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address) <br /> Other ' <br /> Signatute of Owner,authozizing applica.tion: <br /> (BY si�ning the owner is cecbifying that they have zead and unde�stood the' accompanying tbis application.) <br /> Signatute of Applicant(if differen.t than owner): �� <br /> (BY signing the appiicaut is cettifyiag that they hzve read aad und«stood the insttuctioas ucaaapanying this application.) <br /> Location of property iavolved in this re�ues� <br /> ,��?��/ ��.rh.�v.rsti-� ,�a.P <br /> ��a� �,' y fI�GJ Y � ��'°-�-, ��� T/3G N , � z�G✓ <br /> PaxcelID No. fG�O�yZ,�oD600�o� zoning�� Tie <br /> Natute of request(select only one): <br /> Prelimina.ry P]a.t (X) <br /> Fina1 Plat ( ) <br /> Metes and Bounds ( ) <br /> Rez°rung ( ) <br /> '�°�Ple-ase see the att�ched Checklist on Page 4. <br /> 2 REV: FEB 2015 <br />