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City of Woodburn Community Development Department 270 Montgomery Street Woodburn, OR 97071 Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] Visit the City of Woodburn Planning webpage for the most current forms and applications. City of Woodburn Uniform Application – Revised September 2023 Page 1 of 2 OFFICE USE ONLY File Number(s): Uniform Application Project Name: Address(es): Tax Lot Applicant Name: Title: Phone: Firm: Mailing Address: Email: Applicant’s Representative/Project Manager Name: Title: Phone: Firm: Mailing Address: Email: Landowner Name: Title: Phone: Firm: Mailing Address: Email: Architect Name: Title: Phone: Firm: Mailing Address: Email: Civil Engineer Name: Title: Phone: Firm: Mailing Address: Email: Landscape Architect Name: Title: Phone: Firm: Mailing Address: Email: ---PAGE BREAK--- City of Woodburn Uniform Application – Revised September 2023 Page 2 of 2 Requested Review(s): □ Annexation □ Phasing Plan □ Comprehensive Plan Map Change □ Property Line Adjustment / Consolidation of Lots □ Conditional Use Permit □ Planned Unit Development (PUD), Preliminary □ Design Review □ PUD, Final □ Type I □ RCWOD Permit □ Type II □ Significant Tree Removal Permit □ Type III □ Street Adjustment (formally EXCP) □ Grading Permit □ Variance □ Partition or Subdivision, Preliminary □ □ Zoning Adjustment □ Partition or Subdivision, Final □ Zoning Map Change Certification: I hereby declare that as applicant or landowner, I have read the foregoing application and know the contents of the application to be true. If applying on behalf of a corporation, Manager certifies that Manager has full power and authority (corporate or otherwise) to enter into this Agreement and to consummate the transactions contemplated by it. This Agreement has been duly authorized by all necessary action on the part of Manager and no other corporate or other action on the part of Manager is necessary to authorize the execution and delivery of this Agreement. The individual executing this Agreement for Manager has full authority to do so and thereby to bind Manager to its terms. If Applicant is different from Landowner, Applicant must also obtain Landowner certification. □ Landowner certification attached in lieu of form signature. □ Electronic versions of all application materials, which can be sent via zip folder in email or saved on a flash drive. Landowner’s Signature Applicant’s Signature Print Name Print Name Date Date