HomeMy WebLinkAboutWPO201900024 Preconstruction Form 2019-07-29 ;!^
Request for Pre-construction Meeting and Grading Permit A !
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from Albemarle County 1.:1410,11Pfl
47 At,
Approved Plan Number: WPO- 60D2.4
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Approved Plan Name: 1 iitire. - U'n2V /8 ov.8 Wadi/ PLC.
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: Ili 3 a0 l�
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:n
Print Name: I Y►o FF t)4 �x C�v��`.
State Certification Number: I\L\�- 01 144 Q (o-Y1-a 0 Adt,o4k WOW 6
Address 1 .3l0 NLw 1 jZQaa -
City State ll R Zip a41101
Daytime Phone(S140) Rt{3- .( 41 S E-mail ijak1.'Ko-c-r V.(,ONE -
Primary Contractor: T
Print Name -Mouc.i-vL b 17
1,1 -r .U41'e/1 S,/S 51 I,C.
Address 31 3 M T[rr ( towC�
City Lki4A4,'S� I State VA Zip ,VI5 as.
Daytime Phone(5`{0 ) b to-(3%3 E-mail MM �n g(7( 1,n23"
Permit Issuance and First Year Maintenance Fees: (,Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
d4 1 and less than 5 a$i93T
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
ly 7/1/14,Revised:8/29/14 Page 1 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
i c,4 Karm f Tr. TaqouolvL Miy-(0,149n MO-t3 I3g3
f,,s1,6; %c•nt, 5•‘--1-10 of o 61541 )
1,4C4.3e_ /i/eezispe to"
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit lamed Date
By who?
'". 7/1/14,Revised:8/29/14 Pane 2 of 3