u1sclosure Development ProJect
INCOMPLETE OR LATE SUBMISSION OF DISCLOSURE STATEMENT COULD RESULT IN CONTINUANCE OR DELAY OF YOUR PROJECT.
Sill:: • ·, •
Addn:ss or APN(s):
Short Titk or Name of proposed project: _....,,C"----1t'-----�-'-'"-"'--2,_,.,_,..._p,_h __ 6._-J-'---h_P-_/_e,; _____________ _ Summary description of the propost:d project: ________________________ _ PROPERTY OWNER(S): • · ·
If more than t\\ o owners. please provide information and signature(s) on a separate sheet.
Name (print) D/1M/ If. L- � l,/?/;.
Mailing Address "2-b o / /l,oa.� I?, Z
v,� ale,. Ch 'f3 l fl
Phont: -----------------
Name (print) /,..,t:w/l-e N r;:,1, <,t,7=
Mailing Address z,t, 9° / /l.oo.c( I 3 '2. -----------�-- Phont:
VI f 4 /t q CA "��z.
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Statem1..:nt: I/We declare under penalty of perjury that I am/we arc the legal owner(s) of the property involved in this application. I/We authorize the person named in this application as the Project Main Contact to act as my/our representative with City Staff regarding the processing of this application. q/r,/ 1,.b
�-_4 ________ _ Date Property Owner Signatun:
Dt+ N t Gt- -,;,, 1..,.1, e. I ,.,, ,,.. w,,. t,. e n
Print Name & Title
Uvc�1<----
Fill in all !hat apply.
La.0r� �\o�
Print Name & Title ULJ
It is planned that the property will be sold to -ffi ..... D..,___ _____________________ _ (Write "none .. if property owner(s) do not plan to sell property.) Developer/Builder
Mailing Address----------------------------------
Phone fax --------- ---------