HomeMy WebLinkAboutSE202100016 Application 2021-04-05•
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P APPLICATION FOR A SPECIAL EXCEPTION
0 Request for a waiver, modification, variation ❑ Variation to a previously approved Planned
or substitution permitted by Chapter 18 = $457 Development rezoning application plan or
Code of Development = $457
OR
❑ Relief from a condition of approval = $457
Provide the following
0 3 copies of a written request specifying the
section or sections being requested to be
waived, modified, varied or substituted, and
any other exhibit documents stating the
reasons for the request and addressing the
applicable findings of the section authorized
to be waived, modified, varied or substituted.
Project Name :
Provide the following
❑ 3 copies of the existing approved plan
illustrating the area where the change is
requested or the applicable section(s) or
the Code of Development. Provide a
graphic representation of the requested
change.
❑ 1 copy of a written request specifying the
provision of the plan, code or standard for
which the variation is sought, and state the
reason for the requested variation.
Overlook Hotel
Current Assigned Application Number (SDP, SP or
Tax map and parcel(s):
78-73A7
Applicant / Contact Person Kelsey Schein
Address
912 E Hioh St.
Daytime Phone# ( 434 ) 227-514o Fax# (
Owner of Record
Address 3600 Pacific Avenue
Daytime Phone# ( 757 ) 754-4878 Fax# (
City Charlottesville
WS Four LLC
ZMA2020-00013
State VA Zip 22902
Email kelsey@shimp-engineering.com
City Virginia Beach State VA Zip 23451
Email doug@subcap.com
County of Albemarle
Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
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0
APPLICATION FOR A SPECIAL EXCEPTION
APPLICATION SIGNATURE PAGE
If the person signing the application is someone other than the owner of record, then a signed copy of the
"CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE
LANDOWNER" form must be provided in addition to the signing the application below. (page 3)
Owner/Applicant Must Read and Sign
By signing this application, I hereby certify that I own the subject property, or have the legal power to act
on behalf of the owner of the subject parcel(s) listed in County Records. I also certify that the information
provided on this application and accompanying information is accurate, true, and correct to the best of my
knowledge. By signing this application, I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does
not preclude such written communication from also being sent via first class mail.
Signature of Ow r Agent / Contract Purchaser
Kelsey Schlein mtP{Rt,>mw , f._e.
Print Name
FOR OFFICE USE ONLY APPLICATION#
04/05/2021
Date
434-227-5140
Daytime phon
Fee Amount $
By who? Receipt # Ck#
number of Signatory
Date Paid
L'
•
APPLICATION FOR A SPECIAL EXCEPTION
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany this zoning application if the application is not signed by the owner of the property.
I certify that notice of the application for, Overlook Hotel Special Exception
[Name of the application type & if known the assigned application #]
was provided to WS Four LLC
[Name(s) of the record owners of the parcel]
the owner of record of Tax Map and Parcel Number 78-73A7
by delivering a copy of the application in the manner identified below:
X Hand delivery of a copy of the application to Doug Ellis Jr.
[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]
Date
Mailing a copy of the application to
Date
[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]
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].
Signature of l
Kelsey Schlein, Shimp Engineering, P.C.
Print Applicant Name
Date
04/05/2021