Raisin' Angels DaycareCERTIFICATE OF ZONING COMPLIANCE REPORT
DATE: November 22, 2010
TO: Thomas D. Hill
FROM: Sonya Wafters, Associate City Planner
SUBJECT: CZC-10-068 -Raisin' Angels Daycare
OWNER: Capitol Hill Holdings, LLC
DESCRIPTION OF APPLICANT'S REQUEST
Cl~ea'K-
E IDIAN
11A1~~
The applicant, Thomas D. Hill, requests Certificate of Zoning Compliance (CZC) approval of a 2,187
square foot daycare facility for up to 60 children in a C-C zoning district.
The site is located at 1125 E. Pine Avenue.
DECISION
The applicant's request for CZC is approved with the conditions listed in this report.
Note: This is not a building permit. Please contact Building Services at (208)887-2211 to verify if any
additional permits antUor inspections will be required If a building permit is required, two (2) sets of
the approved plans is to be submitted to the Building Department with the permit application.
Site Specific Conditions of Approval
1. The applicant shall construct all proposed fencing and/or any fencing required by the UDC,
consistent with the standards as set forth in UDC 11-3A-7, 11-3A-6B, and 11-4-3-9B.
2. The maximum allowable number of clients cared for during the day is 60 children in accord with
CUP-10-010.
3. The hours of operation shall be restricted to the hours between 6:00 am and 11:00 pm in accord
with UDC 11-4-3-9A.5.
4. Subsequent to issuance of Certificate of Occupancy, the applicant shall submit a fire inspection
certificate to the Planning Department as required by UDC 11-4-3-9A.4.
Process Conditions of Approval
1. No signs are approved with this application. Prior to installing any signs on the property, the
applicant shall submit a sign permit application consistent with the standards in UDC Chapter 3
Article D and receive approval for such signs.
2. The applicant shall complete all improvements related to public life, safety, and health as set
forth in UDC 11-SC-3B. A surety agreement may be accepted for other improvements in accord
with UDC 11-SC-3C.
3. The conditional use may only be transferred or modified consistent with the provisions as set
forth in UDC 11-SB-6G. The applicant shall contact Planning Department staff regarding any
proposed modification and/or transfer of ownership.
4. Upon installation of the landscaping and prior to inspection by Planning Department staff,. the
applicant shall provide a written certificate of completion as set forth in UDC 11-3B-14A.
5. The site/landscape plan prepared by Johnson Architects on November 2, 2010, is approved
(stamped "approved" on November 22, 2010 by the City of Meridian Planning Department) with
no changes.
Conditions Document 1 Raisin' Angels Daycare CZC
6. The approved site/landscape plan may not be altered without prior written approval of the City
of Meridian Planning Department.
7. The applicant shall pay any applicable impact fees prior to the issuance of a building permit.
8. If any changes must be made to the site plan to accommodate ACRD requirements, the applicant
shall submit a new site plan to the City of Meridian Planning Department for approval prior to
issuance of the building permit.
9. The applicant shall complete all required improvements prior to issuance of a Certificate of
Occupancy. It is unlawful to use or occupy any building or structure until the Building Official
has issued a Certificate of Occupancy.
Ongoing Conditions of Approval
1. The applicant and/or assigns shall have the continuing obligation to provide irrigation that
meets the standards as set forth in UDC 11-3B-6 and to install and maintain all landscaping as
set forth in UDC 11-3B-5, UDC 11-3B-13 and UDC 11-3B-14.
2. The project is subject to all current City of Meridian ordinances and previous conditions of
approval associated with this site (1tZ-10-002; CUP-10-010; PFP-10-003).
3. The issuance of this CZC does not release the applicant from any previous requirements of the
other permits issued for the site.
4. The applicant and/or property owner shall have an ongoing obligation to prune all trees to a
minimum height of six feet above the ground or sidewalk surface to afford greater visibility of
the area.
5. The applicant has a continuing obligation to comply with the outdoor lighting provisions as set
forth in UDC 11-3A-11.
6. The applicant and/or property owner shall have an ongoing obligation to maintain all
landscaping and constructed features within the clear vision triangle consistent with the
standards in UDC 11-3A-3.
7. The applicant and/or assigns shall have the continuing obligation to meet the specific use
.standards for the proposed use as set forth in UDC 11-4-3-9.
CITY COUNCIL REVIEW
The applicant, Director, or a party of record may appeal this decision or a condition of approval by
requesting City Council review of this decision. All requests shall be filed in writing with the Planning
Department within fifteen (15) days of the date of this report and comply with the provisions of UDC 11-
SA-6B.
EXPlI2ATION
Certificates of Zoning Compliance issued in conjunction with a proposed use shall expire if said use has
not commenced within one year of the date of issuance of the Certificate of Zoning Compliance.
Certificates of Zoning Compliance issued in conjunction with construction or alteration of a structure
shall expire if said construction or alteration has not commenced within one year of the date of issuance
of the Certificate of Zoning Compliance.
In accord with the above provisions, the subject Certificate of Zoning Compliance is valid until (insert
date).
Conditions Document 2 Raisin' Angels Daycare CZC
EXIIIBITS
A. Vicinity Map
B. Site/Landscape Plan (dated: 11/2/10)
Conditions Document 3 Raisin' Angels Daycare CZC
A. Vicinity Map
Conditions Document 2 Raisin' Angels Daycare CZC
B. Site Plan (dated: 11/2/10)
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Conditions Document 3 Raisin' Angels Daycare CZC
~,t„l11~,~ Planning Department
t n ~ t•t ~ ADMINISTRATIVE REVIEW APPLICATION
Type of Review Requested (check all that apply)
^ Accessory Use
^ Alternative Compliance
p Certificate of Zoning Compliance
^ Certificate of Zoning Compliance Verification
^ Conditional Use Permit Minor Modification
^ Design Review
^ Private Street
^ Property Boundary Adjustment
^ Time Extension (Director)
^ Vacation
^ Other
Assigned Planner; 5onvu.. .~Q~ fiCr~" ~:
Related files: {~2-io --002.,.;G~Q tea -~-~',
FOP- tee -`003
Applicant Information
Applicant name: Thomas D. Hill Phone: 208-362-3040
Applicant address: 12400 W. Overland Rd., Boise, ID Zip: 83709
Applicant's interest in property: ~ Own ^ Rent ^ Optioned ^ Other
Owner name: Capitol Hill Holdings, LLC Phone: 208-362-3040
Owner address: 12400 W. Overland Rd., Boise, ID Zip: 83709
Agent name (e.g., architect, engineer, developer, representative): Walt Lindgren
Firm name: Johnson Architects Phone: 208-846-9033
Address: 440 E. Comorate Dr., Suite 102, Meridian, ID Zip: 83642
Primary contact is: ^ Applicant ^ Owner ^ Agent ^Q Other Owner's Assistant
Contact name: Alicia Parker Phone: 208-362-3040
E-mail: aliciaparker(c~esiconstruction.com Fax: 208-362-3113
Subject Property Information
Location/street address: 1125 E. Pine Ave., Meridian ID 83646
Assessor's parcel number(s): 51107417301
Township, range, section: 3N1E7 Total acreage: 0.96 Total/0.43 this app per PFP-10-003
Current land use: Industrial/Office Current zoning district: I-L
33 E. Broadway Avenue, Suite 210 • Meridian, Idaho 83642
Phone: (208) 884-5533 • Facsimile: (208) 888-6854 • Website: www.meridiancity.org
1 (Rev. 11/4/OB)
Project Description
Project/subdivision name: Raisin' Angels Daycare
General description of proposed project/request:baycare facility with fenced exterior play area
Proposed zoning district(s): C-C
Acres of each zone proposed: 0.43 C-C per PFP-10-003 (Other 0.56 acre parcel remains I-L)
Type of use proposed (check all that apply):
^ Residential ^~ Commercial ^ Office ^ Industrial ~ Other Daycare
Amenities provided with this development (if applicable): N/A
Who will own & maintain the pressurized irrigation system in this development? Property Owner
Which irrigation district does this property lie within? Nampa and Meridian Irrigation District
Primary irrigation source: City Water Secondary: N/A
Square footage of landscaped areas to be irrigated (if primary or secondary point of connection is City water): Anu. 1400 (exist.)
Residential Project Summary (if applicable)
Number of residential units: N/A
Number of building lots: N/A
Number of common and/or other lots: N/A
Proposed number of dwelling units (for multi-family developments only):
1 Bedroom: N/A
2 or more Bedrooms: N/A
Minimum squaze footage of structure(s) (excl. gazage): N/A Proposed building height: N/A
Minimum property size (s.f): N/A Average property size (s.f.): N/A
Gross density (DU/acre-total land): N/A Net density (DU/acre-excluding roads & alleys): N/A
Percentage of open space provided: N/A Acreage of open space: N/A
Percentage of useable open space:
(See Chapter 3, Article G, for qualified open space)
Type of open space provided in acres (i.e., landscaping, public, common, etc): N/A
Type of dwelling(s) proposed: ^Singie-family ^ Townhomes ^ Duplexes ^Muiti-family
Non-residential Project Summary (if applicable)
Number of building lots: 1 Other lots: 0
Gross floor azea proposed: 2,187 Existing (if applicable): 2,187
Hours of operation (days and hours): 6:00 AM - 11:00 PM 7 Davs a Week Building height: 14' to Peak
Percentage of site/project devoted to the following:
Landscaping: 27 Building: 32
Paving: 41
Total number of employees: 8 Maximum number of employees at any one time: 8
Number and ages of students/children (if applicable): 60 Seating capacity: N/A
Total number of pazking spaces provided: 8
Authorization
Number of compact spaces provided: ~
Print applicant
Applicant sign
l/~ . I~ ti v«.o~ i ~n
Date: 11/01/2010
~/ 33 E. Broadway Avenue, Suite 210 • Meridian, Idaho 83642
Phone: (208) 884-5533 • Facsimile: (208) 888-6854 • Website: www.meridiancity.org
2
JohnsonArchitects
1 A PROFE3810NAL CORPORATION
r~
August 3, 2010
Sonya Wafters
City of Meridian Planning and Zoning
33 E. Broadway Ave.
Meridian, ID 83642
RE: Combination Plat, Rezone, and Conditional Use Applications
1125 E. Pine Street
Meridian, Idaho
Sonya:
Please find attached the application for a Rezone Application in conjunction with a Combination Plat and
Conditional Use applications. The existing structure located at 1125 E. Pine Street is one of two structures
within this 0.83 acre lot, which is currently zoned as Light Industrial (I-L). Ttie primary and more immediate
purpose of this application is to allow the use of a daycare center on this property. The current zone does
not allow this use, nor would a rezone to a commercial zone, such as a Neighborhood Business District (C-
N) allow the warehouse-type use, prevalent in the adjacent structure on the same lot. To address this, we
are proposing a lot split through a combination (pre and final) plat application, which will create two, distinct
properties, paving the way for a rezone to a Neighborhood Business District (C-N) for the property serving
the 1125 E. Pine structure, while maintaining the existing Light Industrial (I-L) designation for the newly
platted adjacent property serving the existing 1129 E. Pine structure. Assuming the rezoning of this property
is approved, a Conditional Use permit is required to allow for a daycare center use, which is the ultimate
goal of this submittal.
Proposed Daycare Center
The proposed daycare center tenant, Raisin' Angels, is seeking to occupy the entire 2,187 s.f, building. The
center will house up to 60 children and will provide an outdoor play and activity area along the west edge of
the building. This play area will be fully enclosed by a 6' high, non-scalable fence consistent with the City's
prescribed swimming pool fence requirements. The proposed operating hours of the daycare center shall be
between 6:00 AM to 11:00 PM.
We conducted a neighborhood meeting on July 6'~, which was attended by two local residents, who reside
to the north of this site across Pine Street. While there was interest in this proposed use, there was no
opposition expressed.
We are providing for your review and comment a site development concept plan. There are no plans to alter
the existing structure or site, with the exception of the proposed fenced-in activity area. Please note that this
.proposed use is still subject to Certificate of Zoning Compliance (CZC), Design Review (DR), and Tenant
Improvement (TI) applications before the tenant can occupy and operate this daycare. Any additional
information addressing such areas as additional landscape, fencing, or occupant load requirements will be
provided in more detail under these applications.
440 E Corporate Drive, Suite 102, Meridian, Idaho 83642 r (206) 848 9033 r (208) 848 9475 w www,johnsonarchitects.com
Thank you again for your review and consideration of this Combination Plat, Rezone, and Conditional Use
applications. We believe this daycare center use is an appropriate use for this site and will prove to be a
complementing use to the adjacent residents and businesses alike. Please do not hesitate to contact me if
you have any questions and/or comments regarding this submittal.
Sincerely,
Walter Lindgren AIA, Principal
JOHNSON ARCHITECTS, PC
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1
C.L. "Butch" Otter- Governor
RICHARD M. ARMSTRONG - DirecWr
Jayne Sackett
1533 W. Rainbow Trout St.
Meridian, ID 83642
Applicant: Jayne Sackett
p.2
D A H O D E P A R T M E N T O F
HEALTH & WELFARE
C~Q~
NOTICE OF CLEARANCE
Verification Number.499255
The Department has completed the criminal history background check and the applicant has
passed effective 12!18!2009. No Disqualifying Crimes were revealed. Items revealed solely
from the FBI, are listed for the applicant. The agency issuing your license or certification may
request you provide them with the specifics of any FBI information.
11!16/2010
The background check is fingerprint based and includes information obtained from the FBI, National
Criminal History System, Idaho Bureau of Criminal Identification and Idaho Driving Records, Idaho
Child Abuse Registry, Idaho Adult Protection Registry, Sex Offender Registry, Idaho Nurse Aid
Registry and the National Medicare/Medicaid Provider Exclusion List.
If there are any questions about the process or results, contact the criminal history unit at (208)
332-7994, or toll free at 1-800-340-1246. Additional information abautthe criminal history background
check process and applicant status is available at the web site. httDS://chu.dhw.idaho.gov.
Sincerely,
Susan Altman
Susan Altman
DAVID TAYLOR -Deputy DlreGtor
Bureau of Audits & Inveslfgatians
Cnminat Hlstary l3nlt
1720 Wastga4sDr., Ste A
Bolse, ID 82704
PHONE 20t3-332-79!30
70LL FREE 1-800-340-1246
FAX 208-332-7991
Page 1 of 1
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Meridian Development Services
Meridian City Hall, Suite 102
33 E. Broadway Avenue
Meridian, Idaho 83642
PW100 FORM
Date: 11/09/ 10
Ph: (208) 887-2211
Fax: (208) 887-1297'
www.meridiancity.org~
The following property has been researched by The City of Meridian Public Works
Department.
Project Name: RAISIN' ANGELS DAYCARE
Address: 1125 E. Pine Ave.
Zip Code: 83642
1) The address has been assigned based on available information.
T This address should be considered temporary (Development
process has not been completed, so the address may change)
2) This address will be required to connect to municipal services.
Water and Sewer mains are available for connection to the
Municipal System.
This property does not currently have services available.
(Development process has not been completed)
3) _X_ This is an existing structure that is connected to municipal services.
EACH SET OF PLANS WILL BE REQUIRED TO CLEARLY REFLECT THE CORRECT
ADDRESS AND SUITE NUMBER (IF APPLICABLE).
Terri Ricks
Land Development Services
tricks@meridiancity.org
~~Vl E ~DIAN-
IDAHC7
C
Planning Department
CERTIFICATE OF ZONING COMPLIANCE
Application Checklist
Project name: Raisin' Angels Dayoare Pile # x.25, ~'D ~:
ApplicanUagent: Capitol Hill Holdings, LLCRhomas D. HIII
All applications are required to contain one copy of the following unless otherwise noted:
Applia~tit;_ "~k ~~di"t~1t a -
.~ p Com feted & si ned Administrative Review A lication -
3ee Narrative fully describing the proposed use of the property, including the following: `~,risr =
fy"'~ - Information on any previous approvals or requirements for the requested use - _
i.e.,a liable conditions ofa royal or Devele men[Agreement -
CW~ Recorded warran deed for the sub'ect ro e
NSA Affidavit of Legal Interest signed & notarized by the property owner (If owner is a wrpomtion,
submi[aw yoftheArticlesoClnco ration or otherevidencemshowthatthe rsonsigningisanauthoriaeda ent.
CuPAPP Scaled vicini ma showin the location of [he sub'ect ro e
~xisl+' Fire Marshall a royal for access and tum azound (stamped, inu size site plan) _
EKisii Sanitary Service Company approval for trash enclosure & access drive (stamped, fuu size site
Ian
Civil Site/Dimension Plan -1 full size co folded to 8 %z" x 11"size
~ ~~ A photomefric test report for any light fixture(s) with a maximum output of 1,800 lumens -
ormore see UDC 11-3A-1 l
`i~ s Co of the recorded fat the roe lies within 8 '/:" x I I"
^7 Address verification letter from Develo men[ Services 887-2211
Site Plan-* 1 copy (folded to 8 %x" x 11" size)
_
The followin items must be shown on the site fan:
• Date, scale, north arrow, and ro'ect name (scale not less than 1"=50')
• Names, addresses, and telephone numbers of the developer and the person and/or
firm re arin the fan
• Parkin stalls and drive aisles
Ekt~ h' • Trash enclosures location
i sH Detail of trash enclosure (must be screened on 3 sides)
• Location and specifications for underground irrigation (Pressurized irrigation can only be
waived iF ou rove na water ri hts exist m sub~ec[ ro
/ • Sidewalks or athWa S(proposed and existing)
• LoCa[lon of ro osed buildin on lot (include dimensions to property lines)
• Fencin (proposed and existing)
• Calculations table including the following:
- Number of parking stalls required & provided (specify handicap & compact stalls)
- Building size (sq. tt.)
- Lot size (sq. R.)
- Setbacks
- Zonin district
• Reduction of the site Ian 8'/:" x 11"
Landscape plan - * 1 copy (folded to 8 %z" x 11"size)
/ Plan must have a scale no smaller than 1 " = 50' (!" = 20' is preferred) and be on a standard
1/ drawing sheet, no! to exceed 36"x 48" (24"x 36" is preferred). Aplan which cannot be drawn in
its entirety on a single sheet must be drawn with appropriate match lines on two or more sheets.
The followin items must be included on the landsca a fan:
• Date, scale, north arrow, and ro'ect name
33 E. Broadway Avenue, Suite 210 Meridian, Idaho 83642
Phone: (208) 884-5533 Facsimile: (208) 888-6854 • Website: www.meddiancity.org
• Names, addresses, and telephone numbers of the developer and the Person and/or ~_
firm re azin the tan
N/A Stamp/signature ofa landscape architect, landscape designer, or qualified
nurse man re arin the Ian
/ Existing natural features such as canals, creeks, drains, ponds, wetlands,
flood loins, hi h roundwater aeeas, and rock outcro ins ~*
• Location, size, and species of all existing frees on site with trunks 4 inches or
greaterin diameter, measured 6 inches above the ground. Indicate whether the _
free will be retained or removed
NfA A statement of how existing healthy trees proposed to be retained will be _ _
rotected from dama a Burin consfruc[ion - - --
• Existing structures, planting areas, light poles, power poles, walls, fences, berms
parking and loading areas, vehiculaz drives, trash areas, sidewalks, pathways, _ -- _
stormwater detention areas, si ns, street furniture, and other man-made elements -
Existing and proposed contours for all areas steeper than 20% slope. Berms shall = "_'_
~ /A be shown with one-foot contours - ~~;,~..~_;
l a A • Si t Trian les as defined in 11-3A-5 of this ordinance =-_--
• Location and labels for all proposed plants, including trees, shrubs, and = ~~=: a
}4/A glOnndCOVerS (trees must not be planted in City water orsewer easements). Scale shown for =~="~+
lant materials shall reflect a roximate mature size - '
• A loot list that shows the lant s mbol, uanti botanical name, common name, "'°°
Iva minimum planting size and container, hee class (I, II, or III), and comments (for - ~~°'
~°~-
°
s acin , stakin ,and installation as a ro riate -
-
Planting and installation details as necessazy to ensure conformance with all
N /~ re wired s[andazds
• Desi drawin s of all fencin ro osed for screenin u oses
• Calculations of project components to demonstrate compliance with [he -
requirements of this ordinance, including: -~_
- Number of street trees and lineal feet of street frontage
- Width of sheet buffers (exclusive ofright-of--way) -
N~
~ - Width of parking lot perimeter landscape strip
-
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- Number of parking stalls and percent of pazking area with internal landscaping
- Total number of trees and tree species mix -
- Mitigation for removal of existing trees, including number of caliper inches -
bein removed
N Reduction of the landsca a tan 8 %:" x I1"
Buildin elevations showin conshuction materials-*1 w folded to 8'h" x 11" size
Reduction of the elevations 8 %:" x 11"
/ Electronic version of the site plan, landscape plan, & building elevations in pdf format
submitted on a disk with the files named with project name & plan Type (i.e. site plan,
landsca a Ian, elevations, etc.. We encoura a ou to submit at least one color version.
If applying for approval of a public school, provide additional information as required by
N ~~` the Public School Facili su lemental checklist er 67-6519
Fee If this ro'ect had rior a royal on a site Ian, reduced fees ma a 1
*Once an application is accepters staffwill contact you to let you know how many additional copies afplans are
required All plans are required to be aided to 8 %z"s II "size.
ACRD Acceptance: Applicant shall be responsible for meeting the requirements ofACHD as they pertain to this
app/ication. Al! impact fees, if airy, shall be paid prior to the issuance ofa building permit Ifarry changes must be
made to the site plan to accommodate the ACHD requirements, a new site plan shall be s:tbmilted !o the City of
Meridian Planning Bc ZoningDepartment for approval prior to the issuance of a buildingpermil. Your buildingpermit
wiq not be issued until ACHD has approved your plans and all ossocia[edfees have been paid
33 E.~Broadway Avenue, Suite 210 • Meridian, Idaho 83642
Phone: (208) 884-5533 • Facsimile: (208) 868-6654 • Website: www.meridiancity.org
(Rev. 1/II/2070)
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DDIND BEYOND
s l s l w. Rlnettwt Avf. J Bolin, Wales aTO4 J lea) m-27oo
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Fa Vatue Reulved
QUITCLAIM DEED
Jody G CWk, wlff of Vklor A. CWk
do hepby oonvry, please, pm W and forever quit chins unto
Caplbl Hill Holdinµ LLC, an Idabo Lknlpd Lhbllky Company
whom addnae h 12f00 W. Overland Rd., Bohe, ID p709 ,
the Wlhwln/ dsxrlbad ppmiaet, b-wlt:
SEE EXHIBIT A ATTACHED HERBTO AND MADE A FART HEREOF.
bSether whh thsk appurtetunoa.
Dated: Fsbtuary 20, 2007
J L. Clad
STATE OF Idaho, County of Ada, d.
On 0th r~ r Ipte4 nasty pubho pnaonalty
~C dry of Ftbrwry, h the yes of 2007, befog me dte tuden
appeared Jody L. Clark ktrown a kkatlned b me b Nt panat/gnona whom twos Wap aubacrRed b dte
whhm Immnnenl, and aeknowkd/ed to me dtat Ae/ h~'Nry tatatpd 9u
NtaxtMrv~,
,r*' a v . 6EN~.'ti. a
FO" ~OTAR} ~ ~ GJert r v$-ennfA
Notary Nblk M Wabo
• ~•_ • RahBt~alCt-~
'U^Lt~' aF
'~ „„ q0 ~(~/~~~t~ A7` 8TAR, IpAlfp
~~,~ Of 10~' ~Md1819tAtt r.....-
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h
R6BIDIFp AT. STAR, IDAHO
oo1M86810N 19fMRH6: L17f7000
~ ~ ~
AFFIDAVIT OF LEGAL INTEREST
STATE OF IDAHO )
COUNTY OF ADA )
1, ~ani}al l~i~~ 1-~o~~i~s. ~L.C.. 12~1C0 W Oye~'~~ I~
~D1S(i (name) Zda~o u)
(city) (stew)
being fast duly sworn upon, oath, depose and say:
1. That I am the record owner of the property described on the attached, and I grant my
permission to:
~' Oll(l~an ~tltt~- (I {~lel~ ~D E. ~ncpoca~.De. nl~ YYla~to~~.+`
(name) (address)
to submit the accompanying application(s) pertaining to that property.
2. I agree to indemnify; defend and how the City of Meridian and its employees hermlesa
from any claim or liability resulting from any dispuu as to the stetentents contained
herein or as to the ownership of the property whkh is the subject of the application.
3. I hereby g~nnt permission to City of Meridian staff to enter the subject property for the
purpose of siu inspections rekted to processing said application(s).
Dated this ~~day of ~ ~/ . 20 ~ ~
~Q
(Signature)
I~'taYnaS {~. {-I.;ii t ivlwn~~~K9 Wle...,lpe.r'
SUBSCRIBI'.D AND SWORN to before me the day end year fast above writun.
J'. ~~' ~ ~^(Notary Publie ror d.ho)
N~T~ey pp
~r~ Residing at~l'11AV~!).~ ~Y~
~, p.U91,tG t
~~y ,~0~° My Commission Expires: ~ ~73C~ ~ -+
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1-DAHO
33 E. Broadway Ave. • Meridian, Idaho 83642
200/688-4433
Applicant Date ~'
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S-d/ NAME ON CHECK IF D FF ENT THAN APPLICANT
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