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Home My WebLink AboutCLE201400183 Legacy Document 2014-09-22Application for Zoning Clearance OFFICE USE NLY PLEASE REVIEW ALL 3 SHEETS Check # Date: Receipt # Staff. PARCEL INFORM TI n� Tax Map and Parcel: Existing Zoning (' Parcel Owner: Parcel Address: \C�3"\ CoynmGry�a \�4. �C•city C�QI� �y�� State Zip (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? �-O\mo Address : aLO '^ �Oa� �� 7 � '�.� -' �_� City �� State ` –zip -S 03q `1 Office Phone: Cell # ��'c Fax APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: Previous Business on this site Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide Sei vvc2s e� \ - Uo — 5'00_ /a by110 0, r,0, YY\0, 5 cc\y o r e---6 Y'f -& 19 *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signaturc�C� 4\ &C- C6,L0 — �– – -- — APPROVAL INFORMATION [k,,rApproved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x] 17. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date Zoning Official '24 Date — "l Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/1/2011 Page 2 of 3 v ro ntalce to complete the followings Y Is us to LT, H( orPi7IP zoning? I.f sa, give applicant a Certified Engineer's Report (CER) packet. YINt Wil teY -e be food preparation? Ifso, give applicant: a Health Department form. Zoning rcvlew can not begin until we receive approval from Health Dept. FAX DATE Reviewer to complete the followit g Square footage of Use: Y r t O r emitted as: cz, Under Section: 901 • cx Supplementary regulations section: Circle the one that applies Parking formula: Is parcel on private well or public water? _ If private well, provide Health Department form. Zoning review can not begin until we receive approval from Health Required spaces: Dept. FAX DATE Y 0 ^_ Circle the one that appIte. Is parcel on septic public Qetyer? YIN Will you be putting tip a new sign of any kind? If so, obtain proper Sign permit, Permit # Y 16 Will i!�'e be any new pnstruction or renovations? l it so, obtain the proper Permit. i Permit# ......_..._ —_ i1.A 11 LV IV... Jl{+l4 cxry svxx�� x� •x:b. _ Violations: YIN If so, List: 1 l S Proffers: Y N Tf ist; i YIN If so, List: 7 Y� If s , rst; Clearances: Revised 7/1120 11 Page 3 of 3 I Form WW9 Request for Taxpayer (Rev. August 2D13) Identification Number and Certiflcatlon Do 8rb(1eni of the Treasury trtterttal Revenue Servks CV m W W `o m c u a c C z= a „ V m m t� income -turn) �4°CJ�tI/tGt ' `r��WGI ad en0ty name, Irdifterent from above �Y1C Clmk appropriate box for federal tax classification: O IndlvidUaVeole proprlator ❑ C Cwparetbn a S Corporation ❑ partnership ❑ Trust(astate ❑ undted Ilabllity. compuny. Enter Ate tax classtb atton (o-C corporation, S-3 corporutlor, P- parthatullip}► U other (sae tnstructims) ► Address (number, street, and apt. 1$r7aD 33rr City, state, and ZIP rode list name Wye Form to the requester. Do not send to the iRS. Exemptions (see Insbuctlonar. Exempt payee code of airy} Exemption iron FATCA reporting code (a arty) Enter your TIN In the appropriate box, The MN provided must match the name given on the "Name" line �sacnar aecurnry mumoar I re avoid backup sole prieto. For isre arde this is your social security number n page However, fora resident alien, sole proprietor, or disregarded entity, sae the Part I Instructions on pogo 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see Now to got a 77N on page 3. Note. if the account Is In more than one name, see the chart on page 4 for guidelines on whose temptoyar taerlmlcaGon nu� 2 number to enter. F)Po 173 I v 1,51 J 5 Under pertaftles of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am wafting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the (ntemal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified rile that I am no longer subject to backup vtthholding, and 3. t am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out Item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return, For Waal estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured properly, cancellation of debt, contributions to an individual retirement arrangement ORA), and ganwally, payments other flan interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions on page 3. Sign Here (gU 3 aporaon PjG1�r(7`1,ti Dater j -- ,jam General Instructions withholding tax on foreign partners' altara of etfecthrey comxfoted Income, and 4. pertly that FATCA wren o Is err this two (i1 ern} Indicatat8 that you are section references are to trio Internal Revenue Code unless otherwise noted. Co exempt from the FATCA reportbnf), )s correct. . Future developments. The IRS has created a page on IRS.I tov for fnforeurlion Note. it you are a U.S. person and a nx)uaster gives you a {wire other than Form about Faun W -9, at www.frsgoulwg. Ink maflon about any !unite developments W -9 to request your TIN, you must use Me requester's form If It Is substantially afferft Form W -9 (such as leglatallon enacted after we raleass 1t) Will be posted slmtiar to oft Form W -9. an that page. Definition of a U.S. person. For federal tax purposes, you are Considered a U.S. Purpose of Form person If you are: A parson who is required to file an intormailon return with the IRS must obtain your • An Individual who IS a U.S, citlien or U.S. resident alien, correct taxpayer tdentifitation number MN) to report, for example, urcome paid to + A pwInerantp, corporation, wnpany, or assocdailon created or oxganiaed In the yea. payirwrrts Grade to you in -4an( r<gnt of payment wd w4 thlyd party notwork Unttad States or tinder the laws of the United States, trarm000frs, rear estate transactions, mortgage tntelest you paid, acquisition or . An estate (other than a foreign estate), at etrandoxanant of sowred property, cancellation of debt. or carrirlhuttorm you made . A dOmeSUc mist (es donned In Regulations section 301.7701 -7). to an IRA- Use Form W -9 any Ii you are a U.S. person Vncluding a rrsldwd allan), to Special ruins for pmtwrsirfps. P+ulnerships that conduct a traxlo or bustr=s In provide your correct TIN to the parson requesting it (the requester) and, when the United States are genem9y required to pay g Withholding tart surer section 4446 on any forafgr partrners' snare of effectively conrwAad Iwtable income from ap&;ahta, Icy such business. fufttw, in c aruiln cases where a Form W -9 has not been rwelvad, 1. CtrrUfy that the TIN you are is cared (tor yai, are w for a rtmm�ber Y 9> 9 anlsb &a anon, section tthe require rshtl to presume Is a to be j grin lion 144 Th�ore, If youuaare a pay the 2. Certify that you are not subject to backup withholding, or U.S. prxs t is In a partnerWllp corKWIng a tracts or busirrrass In the 3. CruJm exemption from backup wltilriolt9ng tl you are a U.S, exempt payee, if United States, provude Form W -9 to the partnership to establish your U.S. status alit avail section t 446 xfihtroldlttg an yrnu snare at partnership Incottte. app0mble, you are also certifying that as a U.S. person, your allocable share or arty partnership Income from a U.S. trade or busrrim Is not rublect to the Cat. No. 10231X Form w -9 (Rev, 8.2013) Albemarle County Planning Application Community Development Department 401 McIntire Road Charlottesville, VA 22902 -4596 Voice : (434) 296 -5832 Fax: (434) 972 -4126 TMPI 061W0- 03- 00 -021A0 Owner(s): Application # CLE201400183 LINDA BLAKE GAYLE LLC PROPERTY INFORMATION Legal Description ACREAGE VILLAGE GREEN SHOPPING Magisterial Dist. Jack Jouett Land Use Primary Commercial Current AFD Not in A/F District Current Zoning Primary C1 Commercial APPLICATION INFORMATION Street Address 1939 COMMONWEALTH DR CHARLOTTESVILLE, 22901 Entered By Judy Martin Application Type Zoning Clearance 09/15/2014 Project Etcetera Received Date 09/12/14 Received Date Final Submittal Date Total Fees 50 Closing File Date Submittal Date Final Total Paid 50 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicati Comment ContactType. I Name I Address I CityState I Zip I Phone I. PhoneCell; I I Primary Contact : NATIONAL TESTING NETWORK, INC. :18720 33RD AVE. WEST : LYNNWOOD, WA :98037 :42577457001: .. ............................... a.........................................................................................................>............................................... ............................... a ............ ... ............................... a........ ............ ,......., t..................................:.. ..............................1 Signature of Contractor or Authorized Agent Date