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City of Jerome 152 E Avenue A, Jerome, ID 83338 Off: [PHONE REDACTED], Fax: [PHONE REDACTED] CITY OF JEROME PLANNING & ZONING APPLICATION $75 Filing fee is required with completed application Request Type Annexation Variance Rezone Zoning Ordinance Amendment Special Use Permit Other Preliminary/Final Plat for Subdivision: Filing fee is $150.00, plus $1.00 for each proposed lot in subdivision Applicant Information Applicant Name: Mailing Address: Physical Address: Street Address: Telephone Number: Legal Description: Present Use of Property: Present Zoning: Date Property Acquired: Ownership I am the recorded owner of the land (Escrow number, if applicable) I am the purchaser therof, under a contract in writing, duly acknowledged by both the buyer and the seller I am the lessee in possession of the property and have the written consent of the owner of record to make the application. Copy of written authorization must be attached I am the agent of any of the foregoing, duly authorized thereto in writing. Written authorization must be attached ---PAGE BREAK--- Write a complete description of your request: Prepare a written statement about your request. The statement should evaluate the impact your request may have regarding safety issues, such as increased traffic, noise or air pollution or other concerns. Notification of adjacent property owners. It is necessary that you make an attempt to secure signatures of adjacent property owners of your property line within: 500 feet, if property is zoned Residential - 1, Residential - 2, Residential - 3, or Multi-Family Residential (RM) 750 feet, if property is zoned General Business High Density Business or Central Business District (CBD) 1,000 feet, if property is zoned Neighborhood Business (C-1) 1,500 feet, if property is zoned Public/Semi Public (PS), Mixed Use (MU) , Light Industrial (M-1) or Heavy Industrial (M-2) Penalty Clause and Applicant Signature ANY PERSON INTENTIONALLY VIOLATING A PROVISION OF A ZONING ORDINANCE AMENDMENT SHALL BE DEEMED GUILTY OF A MISDEMEANOR. AT ITS OPTION, THE JEROME CITY PLANNING AND ZONING COMMISSION MAY , UPON NOTICE AND HEARING, AND WITH GOOD CAUSE APPEARING THEREFORE, REVOKE A ZONING AMENDMENT IF THE TERMS THEREOF ARE BEING VIOLATED. I hereby certify that I am the applicant named herein, and that I have familiarized myself with the rules and regulations with respect to preparing and filing this application, and that the foregoing statements and answers herin contained, and the information on the attached maps, are in all respects true and accurate to the best of my belief. Applicant's Printed Name Applicant's Signature Date SIGN