HomeMy WebLinkAboutCLE201800223 Application 2018-11-202 P
Application f ff!nin Clearanc - ` ""yr
OFFICE U NL
PLEASE REVIEW ALL 3 SHEETS Check # Date:
Receipt # Staff:
PARCEL INFORM, j3IC
y(/�ON r t j�, j
Tax Map and Parcel:�`lUG Existing Zoningf I I� ki/',.iC`( D- iAM.
Parcel Owner: own�de �Qs.� 4. L - C> t '
Parcel Address: '� Ivy s J. City �� ��� State V� Zip2� 0_
(include suite or floor)
PRIMARY CONTACT !� /�
Who should we call/write concerning this project? Fr�v� S , )q c� qA_,
Address: 52o2` 4 Ty�j Rook City ll llJl �� State
Office Phone: () Cell # 43T_46�59lS9_'Fax # E-mail freeP�lS�etrr��.ci
APPLICANT INFORMATION
Check any that apply: D Change of ownership
Change of use Change of name New business
Business Name/Type:
Previous Business on this site Z a14,,,5
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional informatiy1hat you can ro vide:�,Cifg�lsi 5 (�1►1� pT(�Q,� M� — c�l�
i `J
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the est of my knowledge I have read the conditions of approval, and I understand them, and that I will abide by them.
�
Signature Printed Fr'e4iS+Ar", Ana— a�,LJ c5D,4.v aCA7T-4C.
APPROVAL INFORMATION
[ ] Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, xl 17.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official DateIF /�
Zoning Official Date 11/20/18
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 11/1/2015 Page 2 of
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y / N
Will there be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or public sewer?
Y/N
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper
Y / N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the following:
Reviewer to complete the following:
Square footage of Use:
Y / N
Permitted as:
K �,
Under Section:
Supplementary regulations section:
Parking formula: ' f
/ U00
Required spaces:
Y / N�YN
Items to be verified in the field:
Inspector :
Date:
Notes: ,
�i(iYN n
���i� -LAJ2%���
Violations:
Y/N
If so, List:
Y
If
PMist:
Variance:
Y / N
If so, List:
11s:
/ N
f so, List:
q q ,
Clearances:
SDP's
37
Revised 11/1/2015 Page 3 of 3
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning
Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
jj [County application name and number]
was provided to c�W �� I ��C_ S� LLC— the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number
manner identified below:
Hand delivering a copy of the application to
by delivering a copy of the application in the
[Name of the record owner if the record owner is a
person; if the owner of record is an entity, identify the recipient of the record and the recipient's
title or office for that entity]
on t
Date
Mailing a copy of the application to
[Name of the record owner if the record owner is a person;
if the owner of record is an entity, identify the recipient of the record and the recipient's title or
office for that entity)
on
Date
to the following address:
[address; written notice mailed to the owner at the last known address of the owner as shown on
the current real estate tax assessment books or current real estate tax assessment records satisfies
this requirement].
-7496/r
Sig ature o Applicant
Print Appli nt Name
Date
C�l� d-0 i �-Doaa3
IF
.STATE CORPORATION COMMISSION
Richmond, October 9, 2018
This is to certify that the ceiti cate of organization of
F&S Zazus Kitchen, LLC
was this day issued and admitted to record in this office and that
the said limited liability company is authorized to transact its
business subject to all Virginia laws applicable to the company
and its business. Effective date: October 9, 2018
State Corporation Commission
/. 4tATION
Attest:
N
1ttl �
a o i CCerkof the Conanri.rsion
1903
CISEMM
NOTICE TO VIRGINIA LIMITED LIABILITY COMPANIES
Congratulations on successfully forming a Virginia limited liability company ("LLC"). Please take a few minutes to
read the information below, which describes several statutory provisions applicable to limited liability companies.
Company name: The certificate of organization shows the exact name of the LLC as set forth in its articles of
organization. If the LLC intends to conduct business in Virginia under a name other than its exact name, it must
make the required filings under Virginia's fictitious name statutes. See § 59.1-69 et seq. of the Code of Virginia.
Registered agent and registered office: Each limited liability company is required to maintain in Virginia a registered
agent and a registered office at which the registered agent may be found during normal business hours. See §§
13.1-1015 and 13.1-1018 of the Code of Virginia. The sole duty of the registered agent is to forward to the LLC at
its last known address any process, notice or demand that is served on the registered agent. Official notices and
correspondence from the Commission to the LLC will be mailed to the registered agent at the registered office
address on file in the office of the clerk of the Commission.
The LLC may change its registered agent and/or the address of its registered office on the records of the
Commission by filing a Statement of Change of Registered Office and/or Registered Agent on form LLC-1016. The
LLC must promptly file a Statement of Change if its registered agent (i) moves his business office, (ii) resigns, dies
or ceases to be a resident of Virginia, (iii) ceases to be a member of the Virginia State Bar, a member or manager
of the LLC, a member or manager of a limited liability company that is a member or manager of the LLC, an officer
or director of a corporation that is a member or manager of the LLC, a general partner of a general or limited
partnership that is a member or manager of the LLC, or a trustee of a business trust that is a member or manager
of the LLC (when that was the basis for his qualification as registered agent), or (iv) is a business entity that has
had its existence canceled or terminated or its authority to transact business in Virginia canceled or revoked. The
Statement of Change form can be completed and filed online at scceflle.scc.virginia.gov or obtained in paper format
upon reguest from the Clerk's Office. There is no fee associated with the filing of this form.
Principal office: The principal office is the office where the principal executive offices of the LLC are located. See §
13.1-1002 of the Code of Virginia. It is also the location at which the LLC is required to keep a current list of the full
name and last known address of each member of the LLC, as well as the other limited liability company information
and records specified in § 13.1-1028 of the Code of Virginia.
The LLC may change the address of its principal office on the records of the Commission by filing a Statement of
Change of Principal Office on form LLC-1018.1. The Statement of Change can be completed and filed online at
sccefile.scc.virginia.gov or obtained in paper format upon request from the Clerk's Office. There is no fee
associated with the filing of this form.
Annual registration fees: Each year after the year of its formation, the LLC will be assessed an annual registration
fee of $50 by the Commission as of the first day of the second month preceding the month in which it was formed.
Notice of the assessment will be mailed to the LLC's registered agent at the registered office address. The
Commission must receive the annual registration fee payment on or before the last day of the month in which the
LLC was formed or a $25 penalty will be imposed. Postmarks are not considered. See §§ 13.1-1062 and 13.1-
1064 of the Code of Virginia. Annual registration fees may be paid online at sccefile.scc.virginia.gov.
Automatic cancellation: If the annual registration fee is not paid on or before the last day of the third month following
its due date, the LLC's existence will be automatically canceled by operation of law. See § 13.1-1050.2 of the Code
of Virginia.
Voluntary cancellation: The LLC may voluntarily have its existence canceled by delivering to the Clerk's Office
articles of cancellation along with the $25 filing fee. See § 13.1-1050 of the Code of Virginia. The articles of
cancellation can be prepared using form LLC-1050, which can be downloaded with its instructions from the Clerk's
Office Forms and Fees webpage or obtained in paper format by contacting the Clerk's Office. If articles of
cancellation are received, processed and filed with the Commission on or before the annual registration fee due
date, the LLC will not be required to pay the annual registration fee assessment for that year.
Additional assistance: For forms or more information, visit www.scc.virginia.gov/clk/index.aspx or contact the
Clerk's Office at (804) 371-9733 or toll -free in Virginia at (866) 722-2551.
Raisin,q capital: A person who intends to solicit money or property from other persons to finance the operation of a
business may need to first file certain information with the Commission's Division of Securities and Retail Franchising
pursuant to the Virginia Securities Act. See § 13.1-501 et seq. of the Code of Virginia. For more information, visit
www.scc.vir-ginia.gov/srf/lawsregs.aspx or contact the Division of Securities & Retail Franchising, P.O. Box 1197,
Richmond, VA 23218-1197, (804) 371-9051.
(Revised 03/13)
1 COMMONWEALTH OF VIRGINIA
`�
° STATE CORPORATION COMMISSION
to ro z
Office of the Clerk
1903 r
FRANCIS L BUCK
BUCK TOSCANO ET AL
211 EAST HIGH ST
CHARLOTTESVILLE, VA 22902
RECEIPT
RE: F&S Zazus Kitchen, LLC
ID: S780886 - 0
DCN: 18-10-04-0250
October 9, 2018
This receipt acknowledges payment of $100.00 to cover the fee for filing articles of organization
for a limited liability company with this office.
The effective date of the certificate of organization is October 9, 2018.
If you have any questions, please call (804) 371-9733 or toll -free in Virginia, (866) 722-2551.
RECEIPTLC
LLNCD
CISEMM
Sincerely,
tJoeT. Peck
Clerk of the Commission
P.O. Box 1197, Richmond, VA 23218-1197
Tyler Building, First Floor, 1300 East Main Street, Richmond, VA 23219-3630
Clerk's Office (804) 371-9733 or (866) 722-2551 (toll -free in Virginia) www.scc.virginia.gov/clk
ci,c - 9-0) 7 - 0 D0-1- a3
Z C1ZuS
199& Sy fr
COMMONWEALTH OF VIRGINIA,
VIRGINIA DEPARTMENT OF HEALTH
In accordance with the regulations of the Board of Health of the
Commonwealth of Virginia this certifies that
F & S Zazus Kitchen
is hereby granted a permit/license by the Albemarle County Health Department to operate a
Full Service Restaurant
Trading as:
ZAZUS
Located at:
2214 Ivy Road Unit 111
Charlottesville, VA, 22903
Mailing Address:
2214 Ivy Road Unit 111,
Charlottesville, VA, 22903
Conditions of Permit (if applicable);
Date of Expiration
November 30, 2019
Casandra Styles
Environmental Health Specialist, Sr.
THIS PERMIT IS NOT TRANSFERABLE FROM ONE INDIVIDUAL OR LOCATION TO ANOTHER
New owners are required to make written application for a permit.
Please Direct Questions or Concerns to the
Albemarle County Health Department
Environmental Health Services
1138 Rose Hill Drive
Charlottesville VA 22903
(434) 972-6219