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Crr'v OF <br />2660 Civic Center Drive <br />Please check item or items for which you are applying: <br />Rezoning $100 Division of Platted Lot <br />Special Use Permit $100 Relocation of Dwelling <br />$ 50 <br />$ 50 <br />Vacation of right-of-way $100 Variance to zoning ordinance $ 50 <br />Preliminary & Final Plat $100 V/Minor Variance $ 25 <br />Please ccrrplete form by typing or printing in ink. If the spaces provided are insufficient, <br />use additional sheets, keying i nforr^ation to the proper item numbers. <br />Name of <br />Owner: First <br />(Middle) <br />Las <br />Pho: <br />2. <br />303 <br />N. <br />A vg <br />1fl ll� <br />��✓ <br />Address <br />of Gamer: (No. and <br />Street) <br />(City) <br />(State) <br />3. <br />-� <br />�� <br />T �� <br />63 <br />Narm of <br />.Applicant: (First) (Middle) <br />Las <br />(Pho: <br />4. <br />30 <br />/_ 1 v�1 <br />Ave- <br />' <br />1�as <br />Address <br />of Applicant: (no. <br />and Street) <br />(City) <br />(State) <br />.5. <br />0 32 <br />Ar, 0 Je OC IdA,, <br />41 A y <br />Ile, <br />treet <br />Address of Property <br />Involved <br />1 What <br />• • r change makes request - <br />it <br />