Fillable Land Use Review Application (City of Portland)

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Land Use Review Application (City of Portland)

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U.S.A. forms for City of Portland

BROWSE CITY OF PORTLAND (OR) FORMS

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1
lu_app 10/07/21
City of Portland Oregon - Bureau of Development Services
Land Use Review Application
File Number:
FOR INTAKE, STAFF USE ONLY
Date Rec _________________by ___________________
Type I
Type Ix
Type II
Type IIx
Type III
Type IV
LU Reviews _____________________________________
[Y] [N] Unincorporated MC
[Y] [N] Flood Hazard Area (LD & PD only)
[Y] [N] Potential Landslide Hazard Area (LD & PD only)
[Y] [N] 100-year Flood Plain [Y] [N] DOGAMI
APPLICANT: Complete all sections below that apply to the proposal. Please print legibly.
Email this application and supporting documents to: LandUseIntake@portlandoregon.gov
Development Site
Address or Location ______________________________________________________________________________
Cross Street ________________________________________________Sq. ft./Acreage _______________________
Site tax account number(s)
R R R
R R R
Describe project (attach additional page if necessary)
Describe proposed stormwater disposal methods
Identify requested land use reviews
• Design & Historic Reviews - For new development, provide project valuation. $______________________
For renovation, provide exterior alteration value. $______________________
AND provide total project valuation. $______________________
• Land Divisions - Identify number of lots (include lots for existing development). ______________________
New street (public or private)? yes no
• Affordable Housing -
yes no N/A
Qtr Sec Map(s) _____________ Zoning ______________
Plan District _____________________________________
Historic and/or Design District ______________________
Neighborhood ___________________________________
District Coalition _________________________________
Business Assoc __________________________________
Related File # ___________________________________
For buildings containing ve or more dwelling units, will
50% or more of the units be affordable to households with
incomes equal to or less than 60% of the median family
income for the county or state, whichever is greater?
2
City of Portland Oregon - Bureau of Development Services
Applicant Information
• Identify the primary contact person, applicant, property owner and contract purchaser. Include any person that has an interest in your
property or anyone you want to be notied. Information provided, including telephone numbers and e-mail addresses, will be included
in public notices.
• For all reviews, the applicant must sign the Responsibility Statement.
• For land divisions, all property owners must sign the application.
PRIMARY CONTACT:
Typed Full Name ___________________________________________________________
Company/Organization _____________________________________________________________________________
Mailing Address __________________________________________________________________________________
City___________________________________________ State____________________ Zip Code _________________
Day Phone ________________________FAX________________________email ______________________________
Check all that apply Applicant Owner Other____________________________________________
Typed Full Name ___________________________________________________________
Company/Organization ____________________________________________________________________________
Mailing Address _________________________________________________________________________________
City___________________________________________ State____________________ Zip Code ________________
Day Phone ________________________FAX________________________email ______________________________
Check all that apply Applicant Owner Other_____________________________________________
Typed Full Name ___________________________________________________________
Company/Organization ____________________________________________________________________________
Mailing Address _________________________________________________________________________________
City___________________________________________ State____________________ Zip Code ________________
Day Phone ________________________FAX________________________email ______________________________
Check all that apply Applicant Owner Other____________________________________________
Typed Full Name ___________________________________________________________
Company/Organization ____________________________________________________________________________
Mailing Address _________________________________________________________________________________
City___________________________________________ State____________________ Zip Code ________________
Day Phone ________________________FAX________________________email ______________________________
Check all that apply Applicant Owner Other ____________________________________________
Responsibility Statement As the applicant submitting this application for a land use review, I am responsible for the accuracy
of the information submitted. The information being submitted includes a description of the site conditions. I am also responsible for
gaining the permission of the owner(s) of the property listed above in order to apply for this review and for reviewing the responsibility
statement with them. If the proposal is approved, the decision and any conditions of the approval must be recorded in the County
Deed Records for the property. The City of Portland is not liable if any of these actions are taken without the consent of the owner(s) of
the property. In order to process this review, City staff may visit the site, photograph the property, or otherwise document the site as
part of the review. I understand that the completeness of this application is determined by the Director. By my signature, I indicate my
under-standing and agreement to the Responsibility Statement.
Name of person submitting this application agrees to the above Responsibility Statement and acknowledges typed name as signature:
________________________________________________ Date: __________________________________________
Phone number: ___________________________________
I acknowledge this typed
name as my signature
I acknowledge this typed
name as my signature
I acknowledge this typed
name as my signature
I acknowledge this typed
name as my signature
Email this application and
supporting documents to
LandUseIntake@portlandoregon.gov
Submittal of locked or password
protected documents will delay
intake of your application.
lu_app 10/07/21
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Land Use Review Application (City of Portland)

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Completed 28 March 2022

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