By signing, the undersigned certifies 'that he/she has read and understood the splbmittal requirements outlined, <br />and that he/she understands that cf :sion of any listed item may cause dela( )rocessing the application. I <br />(We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to <br />the best of my (our) knowledge. <br />OWNER (Also the Applicant? ® Yes /F] No): <br />Name (print): ~C~k~ ~tt1 v% t C>nir Phone: CS 4 1) G 6~ ' 3 54b &F6.~ <br />Address: 2~- 0'J ' ~ a, vv- <br />City/State/Zip: EU <br />Signature: <br />V Ct <br />G r 9 +o 2- <br />X41)0 -5g6~ <br />APPLICANT / APPLICANT'S REPRESENTATIVE F-1 (Check one): <br />Name (print): e-1 q,\/, C U Li I L L <br />Company/Organization: ` <br />Address: 3 U o 3Acl.L- r -3[ v C <br />~ u E-mail (if applicable): <br />City/State/Zip: 2?qfLAL <br />Ct ')'4d - <br />Z_-Phone: 5 4( "'t! ! 9 ;,5 4-6 Fax: ( (S I ~ ~ S Z Z Z 3 (oc 1I <br />Signature: ` I C' <br />APPLICANT'S REPRESENTATIVE / DESIGNATED CONTACT PERSON ❑ (Check all that apply): <br />Name (print): GLv C1 C - D i X , A kA <br />~(U n ~~Gi~t L L, L <br />Company/Organization: `v l I (6vrJ C O c <br />Address: X00 b~c.f►r 'MJC~- <br />' COI <br />City/State/Zip: EV 0~ E-mail (if applicable): iAJC-Ck' lw w i l a.rd C CI 1 X UO • rvi <br />C1 SAO L <br />Tentative Planned Unit Development Last Revised 7/2009 Page 7 of 7 <br />AAQ&tion Form <br />