HomeMy WebLinkAboutWPO201300079 Preconstruction Form 2015-03-25 Request for Pre-construction Meeting and Grading Permit ;?
from Albemarle County , ,-
Approved Plan Number: WPO- 20 I 0007 43
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Approved Plan Name: E s ��( ,�, � r@v-t�t� `.aGDl�i/�j{�ry,'� �iir�t,,j C �ti"704
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 3 2-6 2.0 l
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: ,�� { ..--------,
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Print Name: r312 f fc 1 �,J • '.---.6 l':. '
State Certi cation Number: 140(0 1 fS
Address 0 i 143
City Al i °t. �et)I.t State CTAg` Zip 302.t 4
Daytime Phone 803L___ _54_1017,e1 E-mail 3o,01-40_6120+ CA.G�
Primary Contractor:
Print Name y+ _ .it: 1/:` _ _ In 1
Address i c 'd b1?4Cs'Y'"'` bie2„
City ��i)St I Stat 4 Zip 302-14
Daytime Pho , s-,— f E-mail iI/ m"n.S Q ets.
Permit Issuance and First Year Maintenance Fees: (Request must incltfde ent
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 I $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2.112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14.Revised: 8/29/14 Page 1 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
Attlee" 4/401 37-&11iA1 S /7- 27/-'77.3 S'
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who^
7/1.'14.Revised: 8.'29//14 Page 2 of 3