4. INITIAL DETERMINATION REQUEST PAB-0214.PDF

MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION
2901 W. Durango Street e Phoenix, AZ 85009
Phone: (602) 506-4889

PATENT EASEMENT ABANDONMENT INITIAL DETERMINATION

Note: Completed forms may be submitted to MCDOTPlanning@Maricopa.gov or mailed to the MCDOT office.
Incomplete applications may result in delay of review.

Contact Information
Applicant Name: Ni { cK Suwy ia
Mailing Address: 24 04 WN. “| | by +h Av e.

City: SUN) CN State: AL _ _ zip: 8 hs) 4 _
Phone (02% ) 4 4 Bost Email: Nick@pyomineo tech
Parcel Detail |

Assessor’s Parcel Number: LOL * 22 : 02% E

1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix)

Q41xx we 4th Ave. fun cH. Arizona 84314
OS ANd Wop Valley

2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A)

Abandon Easement bo dering the East and North
sides of Parcel QOl- AI-NIVE

3. Access Certification:

I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property
will occur if the County grants the patent easement abandonment requested in this initial determination.

Signature

Mp2 eZ W/1S/ 20doL
Signature of Applica’ Date

| Maricopa County Use Only

PAB Number:

Initial Determination Fee*: $250.00

Check #: AOS Total Received: BASD.00 pate: 2ObRec'd By: 2
Kietiat 10lott C)

* The Initial Determination fee is NOT refundable. Make checks payable to: MCDOT 2901 West Durango Street Phoenix, AZ
85009.

Maricopa County Department of Transportation
2901 W. Durango Street, Phoenix, AZ 85009

Receipt
Payer Name: Receipt #: 101077
NICK & CHERRISH SUWYN Payment Date: 711412022
10963 W MARIPOSA DR Receipt Type: Patent Easements
PHOENIX , Arizona 85037 Reference #: APN 201--22-028E
Description Payment Type Transaction # _ Amount:
PATENT EASEMENT ABANDONMENT INITIAL Check 205 $250.00

DETERMINATION / NICK SUWYN
Total: $250.00