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ADMINISTRATIVE PROCESS APPLICATION
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~Rid~re Department of Planning and Development
S 7500 West 29th Ave., Wheat Ridge, CO 80033
Phone (303) 237-6944 -
Applicant E5 ~ ~ Y"~' Address3 ~~4"~/~Y~C~y1 Phone ~~-d"?~'.'3
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Owner ~',~ y~-~p~ Address ~q yp 2~ Phone
Location of request ~~ gY~G1 L ~d
Type of action requested (check one or more of the actions listed below
which pertain to your request.)
^ Change of zone or zone conditions Variance/Waiver
Site development plan approval Nonconforming use change
Special use permit ^ Flood plain special exception
Conditional use permit Interpretation of code
Temporary use/building permit Zone line modification
Minor subdivision Public Improvement Exception
Subdivision Street vacation --
Preliminary Miscellaneous plat
Final Solid waste landfill/
** See attached procedural guide mineral extraction permit
for specific requirements. ^ Other
Detailed Description of request ~ICGLS2. yy,~~ ~~~~""
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List all persons and companies who hold an interest in the described real
property, as owner, mortgagee, lessee, o ptionee,-etc.
NAME ADDRESS PHONE
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I certify -that the information and exhibits herewith submitted are true and_
correct to the best of my knowledge and that in filing this application, I
am acting with the knowledge and consent of those persons listed above,
without whose consent the requested acti on cannot lawfully be accomplished.
Applicants other than owners must submit power-of-attorney from the owner
which approved of this action h's beh alf._
Signature of Applicant
SubscTikXed-a?id savor o me is day of 19
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ota ry Public
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commission expires L-/
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Date Received=- - }~L~"'7y'Receipt No. ~/(~~ ~f ~j ~,/ Case No.