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ARB201500003 Application 2015-01-14
it402,4,4„ Community Development Department Albemarle Courit'-v 401 Itire Road Charlottesville,VA 22902-4596 :(434)296-5532 Fax:(434)972-4126 Planning Application PARCEL J OWNER INFORMATION IMP 056A2-01-GG-02200 Owner(s): SQUARE LL ,THE Application# AR13201500(303 PROPERTY INFORMATION Legal Description ACREAGE Magisterial Dist, White Hall 7 Land Use Primary Office EEIiI Current AFD Not in A/F District Current Zoning Primary Downtown Crozet District APPLICATION INFORMATION Street Address 5785 THE SQUARE CROZET,22932 Entered By Emily Lantz 13 Application Type Architectural Review Board Project Georgetown West Received Date 01/14/15 Received Date Final Submittal Date 01/20/15 Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type I Sub Applicatio I Comment County-wide Building Permit 01/20/15 APPLICANT /CONTACT INFORMATION ContactType I Name Address I CityState I Zip Phone I PhoneCell rer,■' ppliza nt SQUARE LLC,THE 3374 MIDDLE MOUNTAIN RD CROZET A 22932 Primary Cr..1-1:5ct ROSS L.STEVENS 3374 MIDDLE MOUNTAIN RD 'CROZET VA :22332 4349915268 Signature of Contractor or Authorized Agent Date ArchitecturalIeview Board Application I ' - ivory Part A: Applicant, Contact and Parcel Information' Project Name: V e��� Lj1\ Lies' y h0 Tax map and parcel(s): 05-67 PC'7■ -d \ -©O '�6 Physical Street Address: er7 5 1 4C--S(art.- Contact Person: ' -0(S �t tr._) e Business Name: -7/� Q� Address 33741 I $4 &1 _i44+ '"" `City ^�(rc � State V if Zip Z' - 3 C Daytime Phone(10 1) q S (' -' `-'��Fax#(q31) I /? ©S 3 -mail 5 Gra c:c .AApcv,y (I �--�-- --� L . keA Owner of Record: �������� ,�/ / 5* /,/� Address 31 Ltit-ad ie_C t`4- City `l &ZL--e- State/,V A Zip�2-ei -+ Daytime Phone("4) e �J��,`�b Fax#(�-3(4 q 7 7't� E-mai 13 /e Q&S e GtAc co A paAy ,Part B: Review Type and Fee Select review type Review by the Architectural Review Board Conceptual Plan/Advisory Review(for a Special Use Permit or a Rezoning) No Fee Preliminary Review of a Site Development Plan No Fee Final Review of a Site Development Plan $1000.00 Amendment to an approved Certificate of Appropriateness $225.00 Building Permit Review $590.00 County-wide Certificate of Appropriateness Structures 750' or more from the EC,no taller than 5 stories No Fee Structures located behind a structure that fronts the EC No Fee Personal wireless service facilities No Fee Fencing or Equipment or Lighting No Fee Additions to ARB-approved buildings No Fee Minor amendments to site or architectural plans No Fee Building permits where the change is 50%or less of the altered elevation No Fee NOTE: For SIGNS, use the combined APPLICATION AND CHEKLIST FOR SIGNS. FOR OFFICE USE ONLY BP# ARB# Fee Amount$ Date Paid By who? Receipt# Check# By County of Albemarle Dept of Community Development,401 McIntire Rd,Charlottesville,VA 22902 Voice:(434)296-5832 Fax:(434)972-4126 11/2010 Page 1 oft OVER-> Part C: Description of Proposal Describe your proposal.Attach a separate sheet if necessary. key nor,"\: c \ el � a �.r� 4 f C\\" cA,c e- b M k! hId i l ko9 kwr' k t\ J— Y- 1.• 1)1\ Part D: Applicant Agreement Applicant must read and sign j, • Each application package must contain(8)folded copies of all plans and documents being submitted. Only (1)set of building material samples is required. All submittal items, including building material samples, become the property of Albemarle County. Applicants are encouraged to maintain duplicate copies of all submittal items in their own files. • Only complete application packages will be scheduled for ARB review. The application package is not complete without the appropriate checklist, completed, signed, and included with the required submittal materials indicated on the checklist. I hereby certify that I own the subject property or have the legal power to act on behalf of the owner in filing this application. *See submittal requirements below. I also certify that the information provided on this application and accompanying information is accurate, true, and correct to the best of my knowledge, and that the attached plans contain . • • u ati n r- , by the appropriate checklist. . 5 I /7 Signature of owner, owner's representative Date or contract purchaser oss L . O SL() ga 6-26g Printed name,Title Daytime phone number of Signatory *Ownership Information: • If ownership of the property is in the name of any type of legal entity or organization including, but not limited to, the name of a corporation, partnership or association, or in the name of a trust, or in a fictitious name, a document acceptable to the County must be submitted certifying that the person signing above has the authority to do so. • If the applicant is a contract purchaser, a document acceptable to the County must be submitted containing the owner's written consent to the application. • If the applicant is the agent of the owner, a document acceptable to the County must be submitted that is evidence of the existence and scope of the agency. Attach the owner's written consent. 11/2010 Page 2 of 2 OVER—>