By signing, the undersigned certifies that he/she has read and understood the sp.,bmittal requirements outlined, <br />and that he/she understands that c.' ;sion of any listed item may cause delay, ,)rocessing the application. 1 <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): I' "L&UWf Phone: C 41) G 6 3 5 Z} ~j m ~ GL' <br />Address: ~o U LR.t1'r Bj V J , <br />4~) 0-5W0 <br />/State/Zip: EV <br />Signature: <br />0(1- 9_~_ +0 _2__ <br />APPLICANT[[ / APPLICANT'S REPRESENTATIVE ❑ (Check one): <br />Name (print): p NY_ ~ e l G) In Kce Li L <br />Company/Organization: <br />Address: '30o 5ta' c,Y- zt V <br />City/State/Zip: !Ey es tQ' U E-mail (if applicable): <br />C 9-4 0 2-- l <br />Phone: 3 5 4-6 Fax: l ~ S I~ ~ S Z TlL Cal} 's 1 <br />Signature: <br />APPLICANT'S REPRESENTATIVE / DESIGNATED CONTACT PERSON E-1 (Check ail that apply): <br />Name (print): CkX_( C - t X Q`n , A A <br />v <br />Company/Organization: V t I lard C. t 3(Uv\ Av-G~ c 4Gt f L L_ C_ <br />Address: 00 GZ,t <br />City/State/Zip: CLr- 0~ E-mail (if applicable): WC), CO W t C.4 C d 1 Y00 . CL) V0 <br />1-40'2-- <br />Tentative Planned Unit Development Last Revised 7/2009 Page 7 of 7 <br />AAG&tion Form <br />