File No.
PETITION TO THE PLANNING & ZONING COMMISSION
CITY OF BRIDGEPORT, CONNECTICUT
1. NAME OF PETITIONER:
2. Is the Petitioner’s name Trustee of Record? Yes No .
If yes, a sworn statement disclosing the Beneficiary shall accompany this application upon filing.
3. Address of Property:
(number) (street) (state) (zip code)
4. Assessor’s Map Information: Block No.
Lot No.
5. Amendments to Zoning Regulations: (indicate) Article: Section:
(Attach copies of Amendment)
6. Description of Property (Metes & Bounds):
7. Existing Zone Classification:
8. Zone Classification requested:
9. Describe Proposed Development of Property:
Approval(s) requested:
Signature: Date:
Print Name:
If signed by Agent, state capacity (Lawyer, Developer, etc.) Signature:
Print Name:
Mailing Address:
Phone: Cell: Fax:
E-mail Address:
$
Fee received Date: Clerk:
□ Completed & Signed Application Form □ A-2 Site Survey □ Building Floor Plans
THIS PETITION MUST BE SUBMITTED IN PERSON AND WITH COMPLETED CHECKLIST
□ Completed Site / Landscape Plan □ Drainage Plan □ Building Elevations
□ Written Statement of Development and Use □ Property Owner’s List □ Fee
□ Cert. of Incorporation & Organization and First Report (Corporations & LLC’s)
PROPERTY OWNER’S ENDORSEMENT OF APPLICATION
Print Owner’s Name Owner’s Signature Date
Print Owner’s Name Owner’s Signature Date
Rev. 6/18/2016
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