Real Estate Petition for Approval

REAL ESTATE PETITION FOR APPROVAL

1. Petitioner / Applicant

Petitioner Name:

2. Property Identification

Parcel / APN Number:

3. Type of Approval Requested

Check all that apply:

Subdivision / Parcel Map    Site Plan / Design Review    Variance    Conditional Use Permit    Conveyance / Sale Approval

4. Proposed Project / Action

Current Zoning:    Proposed Use:

Proposed Number of Units/Parcels:    Estimated New Building Area (sq ft):

Proposed Commencement Date:    Estimated Completion Date:

5. Financial / Fee Information

Application Fee Amount: $    Escrow / Deposit Amount (if required): $

Estimated Total Project Cost: $

6. Disclosures

Please indicate whether any of the following apply to the subject property:

Prior Structural Damage or Major Repairs — Yes No

Presence or Suspected Presence of Hazardous Materials — Yes No

Located within Flood Plain or FEMA Flood Zone — Yes No

Outstanding Notices of Violation or Unresolved Code Enforcement Actions — Yes No

7. Supporting Documents

The petitioner certifies that the following documents are attached with this petition (check):
Site plan / drawings    Boundary survey    Environmental Phase I / reports    Other supporting documents

8. Representations, Certifications and Conditions

By signing below, the petitioner certifies under penalty of perjury that the information supplied in this petition and any attached exhibits is true, accurate, and complete to the best of the petitioner's knowledge. Petitioner represents that they are the owner of the property or have been authorized by the owner to file this petition. Petitioner agrees to comply with all applicable local, state and federal laws, to pay required fees, and to indemnify and hold harmless the approving authority for claims arising from petitioner's acts or omissions related to the proposed project, except to the extent caused by the approving authority's gross negligence or willful misconduct.

Approval, if granted, may be subject to conditions and reasonable mitigation measures including, but not limited to, bonds, landscaping, traffic improvements, utility upgrades, and environmental protection measures. Approval may be revoked where it is shown that the application contained material misstatements, omissions, or false information. Any refunds of fees are governed by the approving authority's policies and are not guaranteed.

Governing Law: This petition and any approval shall be governed by the laws of the state and the ordinances and regulations of the local jurisdiction where the property is located. If any provision of this petition is held invalid, the remaining provisions shall remain in full force and effect.

9. Authorized Owner / Property Owner Consent (If different from petitioner)

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