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Appellant's Exhibit 43 (as referenced in June 30, 2017 Appellant WPDC Cleveland LLC's Witness and Exhibit List) ---PAGE BREAK--- ■d , 3 all^-^jpplieation Form .-MRodmond Office Use Only LAND:2 Q16 - 01420 DATE: 7 / 2 7 / 2 01 6acCEPTED BY: CZ PAYMENT METHOD: o Check □ Credit Card Pre-Appmcation Conference with Technical GoMwiinEE Project Name: 4^ ^ifcAe.A^J -7Mmr^c>0< Project Adclress:_ Parcel Number(s): Square Footage Site: Acres;. Description OF Proposal (INCLUDE NUMBER of lots; buildings, proposed use, etc) MeJzAA Contact Information Owner: Applicant: Company Name: AruJ^/'^^ Mailing Address:, / Aafe . .£aM Cihp Company Name:, Mailing Address; _ City: State; Zio: Phone: 7 City: A Stole: AOfl Phone: Emoil: l>Ay7.\srJa^ . Zio: Fax; Fax:. Email: Select Billing Contact: I i Applicant i i Owner Authorised Agent The undersigned hereby certifies that all information submitted with this application is complete and correct lo the best of my knowledge. I have read the City of Redmond's "Purpose of the Pre-Application Conference" statement contained as part of this application. > r Print Name:. Dote:. Signature;, Page 1 of 3 ^ A ■■i\r Ci Appellant WPDC Cleveland's Exhibit 43 - Page 1 of 1