c i t y o f n e w h a v e n, c o n n e c t i c u t（c i t y o f n e w h v e n c o n n e c t i c t u）（10页）.docVIP

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c i t y o f n e w h a v e n, c o n n e c t i c u t（c i t y o f n e w h v e n c o n n e c t i c t u）（10页）.doc

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City of New Haven, Connecticut CITY PLAN DEPARTMENT | 165 CHURCH STREET, 5TH FLOOR, NEW HAVEN, CT 06510-2010 PHONE 203.946.6378 FAX 203.946.7815 Application for Development Permit DATA CHECK BOX ?WHERE APPROPRIATE. PRINT OR TYPE INFORMATION IN SPACE PROVIDED. ( Check Here if Fee Exempt. THIS BOX IS FOR CITY USE ONLY ( As-of Right File # Fee Paid Date [yy-mm-dd] ( Zoning Relief #_________ $_______ ____/____/____ ( Development Permit #_________ $_______ ____/____/____ ……This includes ( Site Plan Review. .…( CSPR …( SESC… ( IW ( Flood Development Permit #_________ $_______ ____/____/____ ( Performance Bond #_________ $_______ ____/____/____ ( Building Permit #_________ $_______ ____/____/____ 1. Project Address(es) A/K/A: Tax Map-Block-Parcel(s) Nearest Cross Street: Property Owner Information Consent Name Daytime Phone: ______________________________ Firm ( Business ( Home ( Answering Service Street Address ( Fax: ________________ ( Cell: _______________ City State ZIP` ( E-Mail: ___________________________________ As OWNER OF THE PROPERTY I hereby authorize this development permit application, and: 1. I consent to necessary and proper inspections of the above property by agents of the City at a reasonable time after an application is made, and 2. I certify that I am familiar with all of the information provided in this application, and 3. I am aware that any permit obtained through deception, inaccurate or misleading information is subject to revocation and penalties, and 4. I certify that this project conforms to zoning or has applied for or been granted zoning relief. Dated: _________________, 20 ___ _____________________________________________ Signature of PROPERTY OWNER 3. Applicant Information Certification ( Check here if SAME AS OWNER (Fill in only if not same as O