Fillable REZONE APPLICATION CITY OF LACEY Community & Economic (City of Lacey)

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REZONE APPLICATION CITY OF LACEY Community & Economic (City of Lacey)

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FORM: RZ-1
PAGE 1
CITY OF LACEY
Community & Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
REZONE
APPLICATION
DATE:
DATE:
DATE:
DATE:
SIGNATURE(S)
I (We), the above-signed, do hereby affirm and certify, under penalty of perjury, that I/we am/are one (or more) of
the owner(s) under contract of the below described property and that the following statements and answers are in all
respects, true and correct on my information and belief as to those matters.
OWNER NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
APPLICANT NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
SIGNATURE: DATE:
ENGINEER/ARCHITECT NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
SIGNATURE: DATE:
OFFICIAL USE ONLY
Case Number: ___________
Date Received: __________
By: ___________________
Related Case Numbers:
_______________________
_______________________
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FORM: RZ-1
PAGE 2
PROPERTY LOCATION
[ ]North [ ]South [ ]East [ ]West Side of between
(ROAD NAME)
and
(ROAD NAME)
Property Address:
Section: Township: Range: Assessor’s Parcel Number:
Full legal description of subject property:
(ATTACH SEPARATE SHEET IF NECESSARY)
AUTHORIZED REPRESENTATIVE:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
SIGNATURE: DATE:
NAME OF PROJECT:
SUMMARY OF REQUEST (List Type of Uses):
How does the rezone request conform to the Comprehensive Plan?
TOTAL SQUARE FOOTAGE OF THE REZONE AREA:
ACCURATE SITE PLAN DRAWN IN INK TO SCALE WITH DIMENSIONS MUST BE SUBMITTED
ALONG WITH THE APPLICATION. PLEASE SHOW THE FOLLOWING:
1. Location of proposed uses, buildings, parking areas, landscaping areas, ingress, egress, etc.
2. Location of all existing uses and structures on the property, with distances from property lines.
3. Major physical features of the property to be rezoned.
4. Barscale and north arrow.
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FORM: RZ-1
PAGE 3
PLEASE ANSWER THE FOLLOWING QUESTIONS
What is the relationship between the proposed use of the land to be rezoned and the surrounding land
use? (i.e., Is your proposed use of land significantly different than existing land uses surrounding your
property?) Please Explain:
Why is the property not usable as presently zoned, including the events that led you to this
conclusion?
How would the proposed zone change be in the interests of not only the applicant but also the
surrounding properties and the public as a whole?
FORM: RZ-1
PAGE 4
ADJACENT PROPERTY OWNERS LIST
PROJECT:
PLEASE SUBMIT AN ADJACENT PROPERTY OWNERS MAILING LIST
Include all property owners within 300 feet of exterior boundary
of the property involved.
Addresses are to be obtained from:
Office of County Assessor, Bldg #1, First Floor. Phone: 786-5410
* * * Please be sure to also include the mailing information for the:
OWNER, APPLICANT, ENGINEER/ARCHITECT & REPRESENTATIVE.
SEE EXAMPLE BELOW
SAMPLE
Joe Jones
PO Box 1900
Lacey, WA. 98503
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REZONE APPLICATION CITY OF LACEY Community & Economic (City of Lacey)

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Completed 3 August 2020

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