HomeMy WebLinkAboutCLE201600049 Application 2016-04-01Application fo Zonin iearan
CLE #n _ }
OMCE
PLEASE REVIEW ALL 3 SHEETS Check #
PARCEL INFORMATION
Tax Map and Parcel:
Parcel Owner. 5th Street Station Ventures LLC
Date:
Staff:
Existing Zoning -PD -MC -_
Parcel Address: 415 Merchant Walk Square, Bldg. 1900City Charlottesville
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address : 5 SW Broad Street, Suite 8
City Fairburn
State Virginia Zip 22902
State Georgia Zip 30213
Office Phone: (770 } 692-8300 Cell # (4 34) 245-4909 Fax # _(770) 692$302 E-mail dan(.sicallinsent.com
APPLICANT INFORMATION — - - - --
Check any that apply: Change of ownership Change of use Change of name x - Ne -,v business
Business NamelType: Mattress Warehouse (Suite 1901)
Previous Business on this site mostly undeveloped 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: This 7,145 square foot Mattress Warehouse (mercantile)
business has
This 2,802 square foot ABC Liquor (mercantile) business has
' This C.learmce mall 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
Cleamuu will be required.
1 hereby certify that I own or have the owners permission to use the space indicated on this apptication. I also certify that the information provided
is true and accurate to est of my knowledge. I have read the conditions of approval, and i understand them, and that I will abide by them.
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signature v J'!� Printed)
—�JtSn.T�iY 4�-. G6! r LA !
APPROVAL IRFORMATION
$ij Approved as proposed [ ) Approved with conditions [ ] Denied
[ J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117_
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of comphauce with the existing
site plan.
[ j This site complies with the site plan as of this date.
Notes:
Building Official ` Date
Zoning Official K Date 416 y
Other Official _ Date
Count), of Albermarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fart: (434) 972-4126
Revised 7/1/201 ) Page 2 of 3
Intake to complete the following:
Reviewer to complete the following:
Y /� I Square footage of Use: 71y�
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet. O 1 N
Permitted as; f' 111
Y /
Will there be food preparation? Under Section; � • �-
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health Supplementary regulations section:
Dept. FAX DATE
Circle the one that applies
Is parcel on private well ou 1c w r?
If private well, provide Hea ent form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that apjies
Is parcel on septic o publics ?
YIN
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Q
I N
ll there be any new construction or renovations?
If so, obtain the proper P }rmit.
Permit #.r
Zoning to complete the following:
Parking formula: [�
Required spaces:
YI
Items to be verified in the field:
Inspector:
Notes:
Date:
Violaions:
IfI
If sa, sst:
Proffers:
(h1N
IT so, List: q
Variance:
Y/�
If so, ist:
SP's:
Y/
If so, ist:
Clearances:
SDP's
Revised 11/1/2015 Page 3 bf 3