City Of Topeka Planning Department, Conditional Use Permit (Cup) Application Form printable pdf download

Conditional Use Permit (CUP)

Application Form

(Includes CUP Amendments)

____________-

City of Topeka Planning Department

620 SE Madison, 3

Floor (Unit #11)

Topeka, KS 66607-1118

Phone 785-368-3728

Fax 785-368-2535

Applicant Information

Property Owner(s): ___________________________________________________________________________________

____________________________________________________________________________________________________

Street Address: _______________________________________________________________________________________

City:_______________________________ State:________ Zip: ____________ E-mail:_____________________________

Work phone: _____________________

Home phone: _____________________ Fax: __________________________

Authorized Owner Representative (if any): ________________________________________________________________

____________________________________________________________________________________________________

Street Address: _______________________________________________________________________________________

City:_______________________________ State:________ Zip: ____________ E-mail:_____________________________

Work phone: _____________________

Home phone: _____________________ Fax: __________________________

Authorized Professional Agent (Engineer, Architect, Attorney, etc.) – if different from above

___________________________________________________________________________________________________

Street Address: _______________________________________________________________________________________

City:_______________________________ State:________ Zip: ____________ E-mail:_____________________________

Work phone: _____________________

Home phone: _____________________ Fax: __________________________

Authorization

I (we) am (are) the owner(s) of record for the subject property and hereby authorize filing of this application and any agent listed in

this application to represent the owner(s). I (we) allow posting of signage on the property by the City of Topeka for the requested

zoning change. I (we) declare that all submitted information is complete and accurate. I (we) hereby acknowledge that all zoning

application procedures have been reviewed and understood as part of this submittal.

Owner 1 Name: ______________________________________________________________________________________

Owner 1 Signature:_________________________________________________

Date:______________________

Owner 2 Name: ______________________________________________________________________________________

Owner 2 Signature:__________________________________________________

Date:______________________

Conditional Use Permit Application Form (2-15-12)

City of Topeka Planning Department

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City Of Topeka Planning Department, Conditional Use Permit (Cup) Application Form