HomeMy WebLinkAboutHS202100010 Application 2021-04-05 (2)Albemarle County
opment
Short -Term Rental Registry �McIntire°le,dNMhW,`
Annual Application .Abemarleor,
Prior to opening for business. all operators of short-term rentals (including I_D it?j oj} and previously approved bed and breakfasts and
accessory tourist lodging rentals) must:
• Enroll on the Short -Term Rentals Registry with this form
• Obtain an approved , (requires VDH and building/fire safety inspection)
• Register for a,
Annually following the initial approvals. all operators of short-term rentals must:
• Renew their enrollment on the registry with this form
• Pass a(:rLaF(t tI-Inwej13n
• Renew their t_)��sme alisL)!andicm,,'reautne9i� a
Fields narked with an'asterisk are the minimum requlrrd for registration.
1. Short -Tenn Rental Information
A whole house rental is a short term rental of a tame during which the owner is not required to be present Whale house rentals are only permitted on Rural
Area parcels of 5+acres.
'APPROVED HOMESfAY INS). BED AND BREAKFAST IBNBI. OR ACCESSORY
TOURIST LODGING (ATLI CLEARANCE PERMIT NUMBER BF APPLICABLE):
'ADDRESS �g19 QiLIEP. INN LN
'CITY.STATE.ZIP:
TAX MAP PARCEL (IF KNOWN): �_--_— ZONING(IFKNOWN�—
GUESTSEDROOMS: 1 rWHOIE HOUSE RENTAL: ❑YES
2. Property Owner/Operator Information
,'NAME, (illvssr )-rrs%yLI -AE'H K_ILUk/J
'HOME ADDRESS: IbILi JeIUEe INN LN _.
F'CITY. STATE. ZIP:
Gk"ktioMU(I.LE , UA 2&10
PHONE: �303 b(Of�-1�59___ EMAIL
YNO
1 � glK.gii. rwy _ I
3. Responsible Agent Information
The responsible t must be available within N m11es.of the homeslay at all
resolve any coin aims within ¢O i-r ium1c; of being Contacted.
times during a homestay use. and must respond and attempt in good faith to
1 OWNEWOPERATORtS RESPONSIBLE AGENT: OYES ONO
IF NO. COMPLETE RESPONSIBLE AGENT INFORMATION BELOW
yam
NAME: �i1 rsC' ffS I�13 OVE
HOMEADORESS.
CITY,STATE ZIP
PHONE'. I EMAIL
FOR OFFICE USE ONLY Dale Paid: /�J/��
❑Accepted ❑Denied
Fee Amt: 0$27�s.,�rr 0�`r1s10.ifhdeararceapplicabon CkC ` A
ae
Revmd by:
Receiq a: 1 r,bOP\ Received by:_
Reglsbatron Drte: _/J_
—Aberealte.org4iomesb9s
v.9.17201 Page I of t