1 Track 2. Department of Planning and Development Review Permit No. Division of ZOnIng Administration Room 110 City Hall CertIfICate of Z. 900 E. Broad Street Reviewer Richmond, Virginia 23219 ZOnIng Compliance Phone (804) 646-4169. Fax (804) 646-6948 Application This is an application only. It is not authorization for use of premise. No use shall start until a CertIfICate is issued. b Property Address (Street & Number) c Floor/Room No. d Property Owner's Name (Print Clearly). Owner's Information e Property Owner's Address/Zip f Property Owner's or authorized agent Signature g Property Owner's Daytime Telephone No. h Describe Current Structure Use (In detail) If currently vacant, indicate last use & year it was last used.
2 I Describe Proposed Structure Use (In detail). j Ownership . Change Tenant Change Home Occupation Name Change Other (Specify). M M M M M. M One family M Bank/Loan Office M Parking Area, Lot or Deck M Two Family M Beauty/Barber Shop M Pawn Shop/Payday/Auto Loans Commercial /Industrial Uses M Three or More Family M Clinic (Medical/ Dental) M Pet Shop/Veterinary Clinic No. of Units_____ M Contractor Shop/Storage M Repair Shop Residential Uses M Condo Unit M Furniture Store What Type_ _____. Unit_____ M Grocery/Convenience Store M Retail Store/Shop M Baby Sitting M W/Fuel Service M Shopping Center M Hardware or Appliance Store M Travel Agency M Laundry/Laundromat/dry Cleaner M Warehouse /Storage Facility M Manufacturing Facility No.
3 Of Employees_____. No. of Employees_____ No. of Company Vehicles_____. 1). M Motor Vehicle Repair/Sales/Service M Other (Specify):_____. M Office _____. 1! What Type_ _____. 1@ Square Footage to be used 1# Are Floor Plans Attached? 1$ No. of on-site parking spaces 1% Are parking spaces leased off-site? Information Property M Yes M No M Yes M No _____ Square Feet Is a Site Plan Attached? _____ Parking Spaces If yes, attach lease & Site Plan M Yes M No _____ Parking Spaces 1^ Applicant's Name (Print Clearly) 1& Business and/or Trade Name 1* Applicant's Address Zip code contact Information 1( Applicant's Daytime Phone No. 2) Applicant's Fax No. 2!
4 Applicant's Email 2@ Applicant's . Signature 2# Contact person (If Different than Applicant) 2$ Contact Person daytime Phone No. 2% Contact person Address Zip code 2^ Do . you want to be called to pick up Permit when issued? M Yes Name Phone No. M No Arts District Historical District Violation on Property Case Number Corresponding CO. M Yes M No M Yes M No M Yes M No Delinquent Taxes Due? Amount Owed $ Tax Map No. Date Paid M Yes M No Existing Use Group Proposed ZOnIng Use District Group ZOnIng District Office Use Only Permit Fee Fee Received Receipt No. M Cash M check M Credit Card Application approved On Date Application Disapproved On Date ZOnIng Administrator ZOnIng Administrator Conditions Reason for Denial This application is not a CertIfICate of Occupancy.
5 This application only certifies compliance with ZOnIng regulations as required by section 114-1020 of the city code. DCD02Z (Rev. 07/12). 112038-7. Home $ Multi-family dwelling (11-50 units).. $ Two-family detached or attached $ Multi-family dwelling (more than 50 units).. $ Private elementary and secondary $ Commercial or industrial use (equal to or less than 5,000 sq. ft.).. $ Church and other place of $ Commercial or industrial use (greater than 5,000 sq. ft.).. $ Day nursery & Adult day care $ Adult care residence or lodging $ Multi-family dwelling (3-10 units).. $ Uses not $ Record of actual final on-site conditions Agency Review Approval Action Reviewer Agency Comments Item Description Number Taken & Date District/SUP/CUP/.
6 Masterplan/ ZOnIng Nonconforming Plan of Land use For Office Use Only Development Historic Approval/. comprehensive Urban Design Road Access DPW. Chesapeake Bay P&ES. Fire marshall Fire Other ZOnIng Use(S). Parking INSTRUCTIONS ON COMPLETING A CertIfICate OF ZOnIng COMPLIANCE (CZC) APPLICATION. At the top right hand corner of the application is a capital Z . In this space your Permit number will be hand-written by intake personnel after you have paid the application fee. (NOTE: You can check the status of your application on our automated Permit system ( SPANLINK ). Just dial 646- 0770 and follow the prompts!). Box #1 - Provide the address (number & Box #10-11 - Check the appropriate box Box #19 - Provide the applicant's daytime street name) for the location of the use or that most closely indicates the use, including phone number in order that they may be business.
7 Any additional information ( no. of units, contacted, if necessary. Box #2 - Provide the space within the no. of seats, type, etc.) requested. Box #20 - Provide the applicant's facsimile building where the use or business is (FAX) number (if exists) in order that they Box #12 - Provide the size of the space (in going to be located. (NOTE: To be used may be contacted, if necessary. square feet) being used/occupied by the on applications where more than a single applicant. Box #21 - Provide the applicant's E-mail tenant/space/apt. exists.) address (if exists) in order that they may be Box #13 - Check the appropriate box contacted, if necessary.
8 Box #3 - Provide the name of the owner indicating if floor or site plans are provided, Box #22 - Provide the applicant's, or of the property. (NOTE: This may require as applicable. applicant's authorized agent's signature. the submittal of a recorded deed from the Circuit Court record room for newly Box #14 - Provide the number of parking Box #23 - Provide the contact person's purchased property. spaces existing ON the site. (NOTE: Do not name, if different than the applicant. Box #4 - Provide the property owner's include spaces provided off of the site, either Box #24 - Provide the contact person's address, including zip code. on-the-street spaces or leased spaces.))
9 Daytime phone number, if different than the Box #15 - Check the appropriate box, as applicant. Box #5 - Provide the property owner's, or owner's authorized agent's signature applicable, regarding leased parking spaces Box #25 - Provide the contact person's and include a lease and site plan for the complete address and zip code, if different certifying the applicant's request is leased spaces. than the applicant. authorized. Box #26 - Check the appropriate box Box #6 - Provide the property owner's Box #16 - Provide the applicant's name whether or not you would like to be called to daytime telephone number. requesting the Permit . pick up the Permit upon completion.
10 If you Box #7 - Indicate the current/existing Box #17 - Provide the business or trade check, yes , provide the name and daytime use(s) of the property ( - office, 2-family, name, if applicable. (NOTE: This may phone number for the person wanting to restaurant, single-family, etc.) pick-up the Permit . require the filing of a trade name approval Box #8 - Indicate the proposed use(s) of the with the Circuit Court.) Fees for the CZC application are provided at the top of the page. If your proposed property ( - office, 2-family, restaurant, Box #18 - Provide the address of the use is not listed, or if you are unsure single-family, etc.) applicant(s) where the Permit is to be as to the fee, please contact the ZOnIng Box #9 - OFFICE USE ONLY mailed.