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Contact Info

First Name

Last Name

Address Line 1

Address Line 2

City

State

Postal Code

Phone

Email

Phone number of owner (leave blank if same as above)

Description of improvements

See instructions for additional required supporting documentation.

Name of first affected property owner

First Name

Last Name

Acknowledgement of at least two property owners who are most affected because they are adjacent and/or have a view of proposed change is required. This does not imply approval or disapproval, but merely indicates an awareness of the applicant’s intent. We will contact these two property owners to discuss any concerns or objections.

Address of first affected property owner

Address Line 1

Address Line 2

City

State

Postal Code

Name of second affected property owner

First Name

Last Name

Address of second affected property owner

Address Line 1

Address Line 2

City

State

Provinces

Postal Code

Date

Contact Information