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20190265 Falvey Mixed Use Bldg Signature Page Request for extension of current approval O Identify date of original DRC approval: Current expiration date: _ _ Org. App. No. O Describe why this extension is necessary and whether any significant changes have occurred either on the site or in the neighborhood. SEQR Environmental Assessment Form • Applicants proposing the following must complete "Fart 1" of the SEAR Short Environmental Assessment Form (available here: 1tt • . www.dec.n - ov dm/permits e. operations sdf seaf•artone. •df): - Construction or expansion of a multi-family residential structure units - Construction or expansion (exceeding 4,000 sq. ft. gross floor area) of a principal or accessory non-residential structure - Telecommunications facility, radio antennae. satellite dishes - Demolition Disclosure Does any City officer, employee or family member thereof have a financial interest (as defined by General Municipal Law Section 809) in this application? • No 0 Yes - if yes, a statement disclosing the name, residence, nature, and extent of this interest must be filed with this application. Certification l/we, the property owner (s), or purchasers lessees under contract, of the land in question, hereby request an appearance before the Design Review Commission. By the signature(s) attached hereto, I/we certify that the information provided within this application and accompanying documentation is, to the best of my/our knowledge, true and accurate. l/we further understand that intentionally providing false or misleading information is grounds for immediate denial of this application. l/`,ale hereby authorize the members of the Design Review Commission and designated City staff to enter the property associated with this application for purposes of conducting any necessary site inspections relating to this application. Furthermore, i we agree to meet all requirements under Article Vli for Historic Review or Article VIII for Architectural Review of the 7. .ng Co.. of the City of Saratoga Springs. f Date: 3/1I r plica - ignature) Date: (applicant signature) If applicant is not the currently the owner of the property, the current owner must also sign. Owner Signature: Date: Owner Signature: Date: Revised 01/2019