Laserfiche WebLink
Ar)FC 117 <br />REMO <br />SPECIAL EXCEPTION SITE PLAN (SPSE) APPLICATi T37 &0"�KENT <br />PROJECT NAME (Please Print): CC2 7-0 <br />PROPOSED PROJECT USfi: ALF <br />CORRESPONDING PRE - PLICATION CONFERENCE PROJECT NAME AND CDPLUS ASSIGNED FILE NUMBER (IF <br />ANY): -T 2 L I - / S- - l7 <br />PROJECT#: a 016 470 0 7 3 SP -SE - 17 <br />OWNER: (PLEASE PRINT) <br />Vero 53 L.464,4ys � L L C <br />NAME <br />3f0µ sr�'7���c� <br />ADDRESS <br />AGENT (PLEASE PRINT) <br />ADDRESS <br />o" 1-qycly i rL , 3 ;[ s-, 14- -- <br />CITY, STATE, ZIP CITY, STATE, ZIP <br />o7- 519- 4444 - <br />PHONE NUMBER <br />M c v II -ove,C ecvll�c�,4�o,oer ��,e.t. cv'I', <br />F2vML ADDRESS <br />CONTACT PERSON <br />PHONE NUMBER <br />EMAIL ADDRESS <br />CONTACT PERSON <br />SIGNATURE OF OWNER OR AGENT <br />PROJECT ENGINEER: {PLEASE PRINT} PROJECT SURVEYOR: (PLEASE PRINT) <br />MCP Des;r,0. C,[. L _ . _._ Ce,,4- 4- Assvim, <br />NA lE ' NAME <br />47 e �% 13� St .2a 62 1709 P l" 51,ee;-� <br />ADDRESS ADDRESS <br />CITY, STATE, ZlP CITY, S'T'ATE, ZIT' <br />604 779- 5-6a - 4 M <br />PHONE NUMBER($) PHONE NUMBIWs) <br />w, c (s cies � s►� t o 6 ;�' � � a; f co �, _ `��••� ���r`ter�.s s ©c . o r�, <br />EMAIL ADDRESS EMAM ADDRESS <br />el- e <br />COlftACT PERSON CONTACT PERSON <br />180127' Street, Vero Beach FL 32460114 <br />FXommunity DentlopmQnAAPPLICATIONS\CtvDov opp. ication ftso app onlyie RcvWd A,pcfi 2016 l� i of 3 <br />