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iiiso Citv <br />Louisville <br />!f A Dv. t:eA I €ry s a <br />LAND USE APPLICATION <br />APPLICANT INFORMATION <br />Firm: <br />Contact: V - r4 <br />Address: '�6, Z <br />Co€ fs, 11ls CO a oczn <br />Mailing Address: (, ! <br />1 4 cSur LK. QOO z? <br />Telephone: 3.3 'GGy`- /9 a 2- <br />Fax: 3 5 -(f to - 3Yl4 <br />Email: ',cad, Al-►*rly <br />OWNER INFORMATION <br />Firm: <br />Contact: L ;r s* ,�,, ', t <br />Address: S2 _9 <br />'r� t7 <br />Mailing Address: <br />_La 2,7 <br />3v - Yi'v - 'Y6 <br />Telephone: <br />Fax: <br />Email: <br />REPRESENTATIVE INFORMATION <br />Firm: <br />Contact: <br />Address: <br />Mailing Address: <br />Telephone: <br />Fax: <br />Email: <br />' fee <br />PROPERTY INFORMATION <br />Common Address: ( to Srrt S <br />Legal Description: Lot <br />Subdivision The, k <br />Area: 2.0 ©i/'t Sq. Ft. <br />Department of Planning and Building Safety <br />749 Main Street • Louisville CO 80027 • 303.335.4592 • www.Ioursvilleco.gov <br />s <br />SIGNATURE <br />Applicant: <br />Print: <br />Owner: <br />Print: <br />Representative: <br />Print: <br />CASE NO. <br />TYPE (S) OF APPLICATIO <br />❑ Annexation <br />❑ Zoning <br />❑ Preliminary Subdivision P <br />❑ Final Subdivision Plat <br />❑ Minor Subdivision Plat <br />❑ Preliminary Planned Unit Development <br />(PUD) <br />❑ Final PUD <br />❑ Amended PUD <br />❑ Administrative PUD Amendment <br />❑ Special Review Use (SRU) <br />❑ SRU Amendment <br />❑ SRU Administrative Review <br />❑ Temporary Use Permit: <br />❑ CMRS Facility: <br />4 Other: (easement / right -of -way: floodplain; <br />variance; vested right; 1041 permit: oil / gas <br />production permit) <br />MAR 2 5 201 <br />PROJECT INFORMATION <br />Summary: 1 1 <br />ow 4- <br />et re_ tr 4u ct kiwi- t VG .•: 4 <br />t l3N !/ /ECG ✓ 6 s <br />Current zoning: Proposed zoning: <br />CITY STAFF USE ONLY <br />❑ Fee paid: <br />Check number: <br />❑ Date Received <br />