Development Application
Deadline for agency action
60 Days: _________________ 120 Days _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Planner _________________ DRC _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Case no.
■
Standard
■
Staff approval
■
Hearing Examiner
■
Plan Revision
■
Amended
■
Reapplication
■ Rezoning ■ Conditional Use Permit ■ Variance ■ Ordinance Amendment
■ Preliminary Development Plan ■ Interim Use Permit ■ Comprehensive Plan Amendment ■ Subdivision
■ Final Development Plan ■ Final Site and Building Plan ■ Other ______________________________________________
Property address Common name
Business address
PIN Lot Block Plat name
Owner name per property title E-mail
Mailing address City State Zip
Business address City State Zip
Daytime phone Cell phone FAX
________________________________ ______________________________ __________________
Typed/printed name Signature Title
Business name/name E-mail
Mailing address City State Zip
Business address City State Zip
Daytime phone Cell phone FAX
________________________________ ______________________________ __________________
Typed/printed name Signature Title
Type of application
Site location ■
Additional addresses on back
■
Legal description attached
Proposal
Full documentation must accompany application
NOTE: Applications only accepted with ALL required support
documents. See Instructions.
Shaded areas are for office use only
Received: Date By
Reviewed: Date By ■ PC ■ CC ■ HE
Fee paid: Date $
■ Admin. Date By
approval:
■ Comm. Dev’t Dir. ■ Planning Div. Manager
■ Other ___________________________________
Complete all applicable sections —
Select only ONE person as primary contact
■
Primary
contact
■
Additional
owners
on Back
■
Primary
contact
Community Development
Planning and Economic Dev.
1800 W. Old Shakopee Road
Bloomington MN 55431-3027
PH 952-563-8920
FAX 952-563-8949
TTY 952-563-8740
E-MAIL planning@ci.bloomington.mn.us
www.ci.bloomington.mn.us
web_52_001 pg1 of __ (07/09)
Fee property owner
User/occupant
