HomeMy WebLinkAboutCLE201700200 Application 2017-08-29Application for Zoning Clearance
OFFICE U N I'
PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel �� Existing Zoning PD-MC
Parcel Owner: 5th Street Station Ventures, LLC
435 Merchant Walk Ave., BLDG 900 Suite 200
Parcel Address: City Charlottesville State Virginia Zip 22902
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Dan Tucker
Address : 5 SW Broad Street, Suite B City Fairburn State Georgia Zip 30213
Office Phone: 7( 70) 692-8300 Cell # (434) 245-4909 Fax # (770) 692-8302 E-ma❑ danOslcollinsent.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name x New business
Business Name/Type. IFIXIT / Mercantile
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 1,201 square foot Suite 200 (M)
*This Ciearance 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.
Signature Printed
APPROVAL INFORMATION
MApproved as proposed [ ] Approved with conditions [ ] Denied
L J Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x117.
[ ] 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 Date „PZ-2-%U
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
Intake to complete the following:
Y/N
Is i LI, HI or PDIP zoning?
Engineer's Report (CER) packet.
If so, give applicant a Certified
Y
Rill ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well r blic water?
If private well, provide a meat form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o public sewer?;
Y/N
Will you be putting up a new sign of any kind?
Sign l!errmt.
Permit �Ol
a I
If so, obtain proper I
Y/N
'ill there be any new construction or re3iovations7
If so, obt ' e r er. er
PermitIfe
#!
Zoning to complete the following:
Reviewer to complete the follotiiring:
Square footage of Use: iu i — Fi
utted as: f eiQ►
Under Section:
Supplementary regulations section:
.zS.2. i
Parking formula:
Li.SIt1000
Required spaces: 5
Y/N
Ile s to be verified in the field:
Inspector
Notes:
Date:
vro ns:
Y/N
If so, ist:
offers:
Y N
so List:
'VA A,I) q —
-- _.I
va ce:
/
YN, is
If t:
Sp1
Y//
If sa I ist:
Clearances:
SDP's
ZU i1 — Z
Revised 7/1/201 l Page 3 of 3