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, ..,-- <br />(/�� ��� /r{[/A%L/�' /.,"/,(/,in�iC^7 <br />`: i!;�; ..,;,� <br />Ruiiding Type: j S'� r-- <br />1'l; ose cam p!etc nwn6eied Iterns �1 <br />1. Your name: <br />AddrFss Application <br />���New � �Revise � �Prelimin�ry�hiturc) <br />7�nndsubmitbyc�ninilto: ml�nfry�ci.cvcretlr.ri.org Ca1/4T5-257-8813Jorotbrroptfons. <br />/lvi/i'1���) P�vJ(m /�'il/kl<(�K�jb�c=��5 oate: j ��_./ 3 <br />2. (a) Mailing address: (b) Pf one (c) e-mail: <br />( %`1PC� !6^-t�.U/ .�T...'�.C.' !IZ% 'L(G�-fl�(j 7 L <br />, �7.•io /G��:91/,G2 !/�.'�J(i�"��!l:�-,'xr`/, <br />Jc���,«,,,r.i+� Gvl/. ia <br />3. Date needed (nlease allow up to h weeks for assignment or verification�: ,<f-.�%�/� <br />h. Addresssubmitedforreview: '](l�(� �3lc�_c.y (,Lpl� `�N/lGvl `d�('r/'• �'� <br />5. Current or proposed use of address submitted for review: <br />•%C- iin��k l�r�; ,u�oi �i/c �- i��G2��r /%� v�? •r7�= ilGGt P/_' /.s '/�t-° /11bi �= c� <br />i�'TRc-Er' /N (-'�[J�t%f [%(- f(0)i1C�, � �/u!!�/Li.Aa'I fJ/� � %7'C�zC-�bc= (%(' /l��'f.'O '%7� /iE: <br />'�� i/c.IG�ti�'�> �i��l,,) �-l�%c— �fil��'c=.:� 7c� ��� T'i�i� �r�� ��n� <br />6. Site plan attached (recommended to expedite requ �: ,�'�'es / No ❑ <br />7. (a) Owner name and mailing address: (b) Phone: �9 �� �c) e-mail: � <br />, �-lil�ilcu ni�ol�r�-�zs :nu; ; i�'l��=zy� �L4z� ,-:�i� f�ir-�{�/i�/�.�(t�?ot� <br />�9'1' 2 �7771 /ivL �l/E; ifltRLK <br />�li3�'-��Ltu.[� to��_ °�cz'7o <br />l���Ic: <br />Current Parrcl �Qdr��ss: <br />S.iGPcsir.tl Parccl P,:idress: <br />l7)R (,9/ /C7: ll;li ONl.y <br />ONmcr wriltc�n ripprov�il In rr.vi•;c pan.cl adch'cr:ti reccivr_cl: <br />Otvncv'vdiiUcn apprnwil for city propnse�l ,idch'ess receivr.d: <br />C(lii Nlaslcr Arlch'r,ss: <br />Gn ;ync (;IS Ma�� Aildress: <br />�� <br />� <br />I'r�i rriil'�.i�i ��ir����,: <br />I�i�•I�I u�l�li�r�,�.�d�vlfiivit'dllii�i�u�ln: <br />.� �_��.,�il�i�i��ai.,.I.�LL�iinhiu�.dhtlP://���wN.evcietl�e�a.orK/GetPDLatPx7Pd(ID=5A48 <br />l.ou A'u.: <br />I I Yes / Nu �� <br />I I Yes / No fl <br />I I Yas/IJ�� I I <br />