FOR CITY USE ONLY:
File # ________________
Date Filed: ____________
Received by: __________
APPEAL OF ADMINISTRATIVE DECISION
APPELLANT(S): _________________________________________________________________ MAILING ADDRESS: _____________________________________________________________ CITY: ___________________________________ STATE & ZIP CODE: __________________ TELEPHONE #: __________________________ FAX #: _______________________________ Describe the action being appealed and state the reasons for the appeal. (You may attach a letter or other exhibits to describe or justify this appeal.) APPELLANT(S) SIGNATURE: ____________________________ DATE: _______________ ____________________________ DATE: _______________
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FOR CITY USE ONLY:
Fee Paid (_________) $445.00 Notice of Public Hearing:
Receipt # _________________ Mailed (_______) Date: _________ Date: ____________________ Published (_______) Date: _________ Posted (_______) Date: _________
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PLANNING COMMISSION ACTION: DATE:
________________________
Approve: ________________________
Deny: ___________________________
Table: __________ Until ___________
Receive & File: ___________________