Fill and Sign the Spare Parts Transmittal Form Br Projects

Print Form Louisville Metro Planning & Design Services Standard Application For staff use only: Case # _____________ Date: _____________ Intake Staff: ______ Amount $: ______ Project Information Type of Application(s) (e.g., Waiver, Variance, Conditional Use Permit, etc.): Section of the Code Book that applies (if applicable): Project description (e.g., retail center and office development, waiver for design standards, etc.): Primary Project Address: Additional Address(es): Primary Parcel ID(s): Additional Parcel ID(s): Estimated Project Cost: $ Projected Infrastructure Improvement Cost: $ If the property, or any portion thereof, has been the subject of a previous proposal in this office, please list the docket/case number(s). Examples include, but are not limited to, Variances, Appeals, Conditional Use Permits, Minor Plats, etc. See list of resources attached to this application to obtain the below information. Docket/Case #: Docket/Case #: Docket/Case #: Docket/Case #: Proposed Use: Existing Zoning District: Existing Use: Existing Form District: Council District: Fire Protection District: Deed Book(s)/ Page Numbers: The subject Property contains sf / acres Number of Adjoining Property Owners (APO's): Louisville Metro Planning & Design Services | 444 South 5th Street, Suite 300 | Louisville, KY 40202 Phone: (502)574-6230 | Fax: (502)574-8129 | www.louisvilleky.gov/planningdesign Page 1 of 4 Revised 6/03/2011 Louisville Metro Planning & Design Services Standard Application Contact Information Owner(s) Information & Signature(s): Required for all applications (except Landscape Plans, and Minor Plats). The application will not be accepted without it. Please add additional sheets as needed. Any additional required reviews, or approvals, must be obtained by the owner, or owner's representative, prior to the issuance of any building permit. It is the responsibility of the owner, or owner's representative, to verify that all Metro Land Development Code requirements are being followed. Please attach any additional owners, or contact information, to this application. The Certification Statement must be completed, if someone other than the owner(s) will be representing this case at Planning & Design Services (i.e., Surveyor, Engineer, Planner, Attorney, signing authority for a company, etc.) Primary Owner: check if primary contact Secondary Owner: Name: Name: Signature: Signature: Company: Company: Address: check if primary contact Address: City: State: Zip: City: Primary Phone: Alternate Phone: Email:* Zip: Primary Phone: Alternate Phone: State: Email:* Applicant: check if primary contact Professional: Name: Name: Signature: Signature: Company: Company: Address: check if primary contact Address: City: State: Zip: City: Primary Phone: Alternate Phone: Email:* Zip: Primary Phone: Alternate Phone: State: Email:* Louisville Metro Planning & Design Services | 444 South 5th Street, Suite 300 | Louisville, KY 40202 Phone: (502)574-6230 | Fax: (502)574-8129 | www.louisvilleky.gov/planningdesign Page 2 of 4 Revised 6/03/2011 Louisville Metro Planning & Design Services Standard Application Certification Statement A Certification Statement must be submitted with any application in which the owner(s) of the subject property is (are) a limited liability company, corporation, partnership, association, trustee, etc., or if someone other than the owner(s) of record sign(s) the application. I, in my capacity as Owner Representative Authorized Agent Other: hereby certify that is (are) the (owner / LLC / corporation / partnership / association / trustee / etc.) owner(s) of the property located at which is the subject of this application, and that I, owner / representative / authorized agent / other am authorized to sign this application on behalf of the owner(s). Print Name: Signature: Title: Address: City: State: Zip: Primary Phone: Alternate Phone: Email:* I understand that knowingly providing false information on this application may result in any action taken hereon being declared null and void. I further understand that pursuant to KRS 523.010 et seq. knowingly making a material false statement, or otherwise providing false information, with the intent to mislead a public servant in the performance of his/her duty is punishable as a Class B misdemeanor. Louisville Metro Planning & Design Services | 444 South 5th Street, Suite 300 | Louisville, KY 40202 Phone: (502)574-6230 | Fax: (502)574-8129 | www.louisvilleky.gov/planningdesign Page 3 of 4 Revised 6/03/2011 Louisville Metro Planning & Design Services Standard Application Resource List 1. Planning & Design Services homepage: http://www.louisvilleky.gov/PlanningDesign/ 2. Property Valuation Administration (PVA): FiscalCourtBuilding 531 Court Place,Suite504 Louisville,KY40202-3393 (502) 574-6380 Instructions for obtaining property owner information for mailing labels: a. Go to http://jeffersonpva.ky.gov/ b. Use the property search tool at the top right hand corner of the page to find property owner names c. Look up property owners' addresses using phone book Or a.Visit the PVA office in the Fiscal Court Buildingat 531 Court Place, Suite 504 to obtain full owner and owner address information 3.Louisville & JeffersonCountyInformation Consortium (LOJIC): Metropolitan Sewer District (MSD) 700 West Liberty Street Louisville,KY40203-1911 http://www.lojic.org/ Instructions for obtaining a Development Information Sheet: a. Go to http://www.lojic.org/ b. Place the cursor over “Interactive Map” in the menu at the left c. Wait for the pop-up menu to appear and click on “Standard Information” d. Search for the property by address, parcel, or intersection e. On the toolbar at the left, click the green circle with an “i” in it f. Click on the property and wait for the Development Information Sheet to appear at the right g. Click “Export to PDF” and then print 4.Jefferson County Clerk's Office 2nd Floor of Metro Hall 527 West Jefferson Street Louisville,KY40202 (502) 574-6220 http://www.jeffersoncountyclerk.org/ Many deeds, plats and other records are available online at: http://www.landrecords.jcc.ky.gov/records/S0Search.html Louisville Metro Planning & Design Services | 444 South 5th Street, Suite 300 | Louisville, KY 40202 Phone: (502)574-6230 | Fax: (502)574-8129 | www.louisvilleky.gov/planningdesign Page 4 of 4 Revised 6/03/2011