HomeMy WebLinkAboutSDP198800034 Application Letter of Revision 1 2022-10-31Application for
Letter of Revision
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❑ Letter of Revision - $118.86 + $4.75 Technology Fee = $123.61
This application may require additional review by the Fire Marshal. Fees in addition to those shown on this
application may be required as required by the Fire Prevention Code Fee Schedule. A copy of the schedule is
available from the Fire Marshal.
A completed application and aft supplemental documents should be submitted via the Community Development 4ppir for oaee. Ifpaper is the only option,
then one copy of a completed application and all supplemental documents may d. be provided.
Final Site Plan Name and Number: � ; O /I
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Contact (who should we contact about this project) F—U S K'tl e—
Street Addd�re`ss 30—7 C s k iZ � (Z
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City ' S�taattee r Zip Code V (
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Phone Number`C39— 1 (o o� l f0 / Email h/OTs�ye��/o uk (Ood��, cO
Owner of Recor�d7 R1 ,o (rJ2s t i -PJCi � S ht �
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Street Address '30 (NC c -- Z+
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City C l�tt� d&� State up, Zip Codey /
Phone Number �3�-�73-f Email GHA-4-00 s-�WpiP'ICMT,co
Applicant P',;o Wcs� L u^ni �c,� PAn.ktierLSki
Street Address Zeo LA. �p-% c c'k
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City C V''. V Zip Code f
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SUBMITTAL REOUIREMENTS:
❑ The appropriate fee,
❑ The site plan number that the change applies to,
❑ A request letter describing the proposed changes from the owner or authorized agent,
❑ 4 copies of the plan that shows the proposed changes,
Changes must be shown on the sheet or sheets from the approved final Site Alan. or on an I F A 17" copy of that portion of the aDDroved
final Site plan.
Owner/Applicant -N1ust Read and Sign
I hereby certify that the information provided on this application and accompanying information is accurate, true and correct to the best
of my knowledge and bAief d
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Signature of Owner, Agen Date
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Print Naive Daytime phone number of Signatory
FOR OFFICE USE ONLY LOR #
Fee Amount $ Daze Paid By who? Receipt k Ck5 By: _
Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126
REVISED 8/15/2022 Page 1 of 1
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