16
Gwinnett County Planning Division Change in Conditions Application Last Updated I 2/20 I 5 CHANGE IN CONDITIONS APPLICATION AN APPLICATION TO AMEND THE OFFICIAL ZONING MAP OF GWINNETT COUNTY, GEORGIA APPLICANT INFORMATION PROPERTY OWNER INFORMATION* NAME: Bret Skirvin - Site Enhancement Services NAME: Hamilton Mill Retail II, LLC ADDREss: 6001 Nimtz Parkway ADDREss: 171 Village Parkway CITY: South Bend CITY: Marietta STATE: IN ZIP: 46601 STATE: GA ZIP: 30067 PHONE: 574-232-7471 PHONE: 770-693-2258 CONTACT PERSON: Bret Skirvin PHONE: 574-232-7471 coNTAcTs E-MAIL: [email protected] APPLICANT IS THE: 1111 OWNER'S AGENT D PROPERTY OWNER D CONTRACT PURCHASER ZONING DISTRICTS(S): C-2 PRIOR ZONING CASE: RZC-05-054 PARCEL NUMBER(S): 1001-032 ACREAGE: _0_.9_8_7 ___ _ ADDREss oF PROPERTY: 2744 Hamilton Mill Rd., Buford, GA 30519 PROPOSED CHANGE IN CONDITIONS: ReViSe SeCtion 3(0)(0.1) RESIDENTIAL DEVELOPMENT: NON-RESIDENTIAL DEVELOPMENT: NO. OF LOTS/DWELLING UNITS: _N_/_A __ _ NO. OF BUILDINGS/LOTS: 1 bldg/1 lot DWELLING UNIT SIZE (Sq. Ft.): N/A 42993.72(.987 acres) TOTAL GROSS SQUARE FEET: ____ _ GROSS DENSITY: N/A DENSITY: .987 acres/lot ------------- NET DENSITY: N/A --------- PLEASE ATTACH A LETTER OF INTENT EXPLAINING WHAT IS PROPOSED CEIVED BY CIC ) 16 02 5 2 u J 0 9 2016 PI nning & Development

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Gwinnett County Planning Division Change in Conditions Application

Last Updated I 2/20 I 5

CHANGE IN CONDITIONS APPLICATION AN APPLICATION TO AMEND THE OFFICIAL ZONING MAP OF GWINNETT COUNTY, GEORGIA

APPLICANT INFORMATION PROPERTY OWNER INFORMATION*

NAME: Bret Skirvin - Site Enhancement Services NAME: Hamilton Mill Retail II, LLC

ADDREss: 6001 Nimtz Parkway ADDREss: 171 Village Parkway

CITY: South Bend CITY: Marietta

STATE: IN ZIP: 46601 STATE: GA ZIP: 30067

PHONE: 574-232-7471 PHONE: 770-693-2258

CONTACT PERSON: Bret Skirvin PHONE: 574-232-7471

coNTAcTs E-MAIL: [email protected]

APPLICANT IS THE:

1111 OWNER'S AGENT D PROPERTY OWNER D CONTRACT PURCHASER

ZONING DISTRICTS(S): C-2 PRIOR ZONING CASE: RZC-05-054

PARCEL NUMBER(S): 1001-032 ACREAGE: _0_.9_8_7 ___ _

ADDREss oF PROPERTY: 2744 Hamilton Mill Rd., Buford, GA 30519

PROPOSED CHANGE IN CONDITIONS: ReViSe SeCtion 3(0)(0.1)

RESIDENTIAL DEVELOPMENT: NON-RESIDENTIAL DEVELOPMENT:

NO. OF LOTS/DWELLING UNITS: _N_/_A __ _ NO. OF BUILDINGS/LOTS: 1 bldg/1 lot

DWELLING UNIT SIZE (Sq. Ft.): N/A 42993.72(.987 acres) TOTAL GROSS SQUARE FEET: ____ _

GROSS DENSITY: N/ A DENSITY: .987 acres/lot -------------

NET DENSITY: N/ A ---------

PLEASE ATTACH A LETTER OF INTENT EXPLAINING WHAT IS PROPOSED

CEIVED BY CIC )16 02 5 2 u J 0 9 2016

PI nning & Development

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. ·- Planning & Development

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ALTAIACSM LAND TITLE SURVEY FOR:

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27« HAMIL TON MILL ROAD BUFORD, GEORGIA 3051g

GWINNETT COUNTY 1397thG.M.D.

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Gwinnett County Planning Division Change in Conditions Application

Last Updated I 2/20 I 5

CHANGE IN CONDITIONS APPLICANT'S RESPONSE STANDARDS GOVERNING THE EXERCISE OF THE ZONING POWER

PURSUANT TO REQUIREMENTS OF THE UNIFIED DEVELOPMENT ORDINANCE, THE BOARD OF COMMISSIONERS FINDS THAT THE FOLLOWING STANDARDS ARE RELEVANT IN BALANCING THE INTEREST IN PROMOTING THE PUBLIC HEALTH, SAFETY, MORALITY OR GENERAL WELFARE AGAINST THE RIGHT TO THE UNRESTRICTED USE OF PROPERTY AND SHALL GOVERN THE EXERCISE OF THE ZONING POWER.

PLEASE RESPOND TO THE FOLLOWING STANDARDS IN THE SPACE PROVIDED OR USE AN ATTACHMENT AS NECESSARY:

(A) WHETHER A PROPOSED CHANGE IN CONDITIONS WILL PERMIT A USE THAT IS SUITABLE IN VIEW OF THE USE AND DEVELOPMENT OF ADJACENT AND NEARBY PROPERTY:

See attachment

(B) WHETHER A PROPOSED CHANGE IN CONDITIONS WILL ADVERSELY AFFECT THE EXISTING USE OR USABILITY OF ADJACENT OR NEARBY PROPERTY: See attachment

(C) WHETHER THE PROPERTY TO BE AFFECTED BY A PROPOSED CHANGE IN CONDITIONS HAS REASONABLE ECONOMIC USE AS CURRENTLY ZONED: See attachment

(D) WHETHER THE PROPOSED CHANGE IN CONDITIONS WILL RESULT IN A USE WHICH WILL OR COULD CAUSE AN EXCESSIVE OR BURDENSOME USE OF EXISTING STREETS, TRANSPORTATION FACILITIES, UTILITIES, OR SCHOOLS: See attachment

(E) WHETHER THE PROPOSED CHANGE IN CONDITIONS IS IN CONFORMITY WITH THE POLICY AND INTENT OF THE LAND USE PLAN: See attachment

(F) WHETHER THERE ARE OTHER EXISTING OR CHANGING CONDITIONS AFFECTING THE USE AND DEVELOPMENT OF THE PROPERTY WHICH GIVE SUPPORTING GROUNDS FOR EITHER APPROVAL OR DISAPPROVAL OF THE PROPOSED CHANGE IN CONDITIONS:

See attachment

CiC '16 0 2 5

3

RECEIVED BY

AU 0 9 201

Pla i g & eve\ pment

1 August 2016

Advance Auto Parts 2744 Hamilton Mill Road

Buford, GA - Gwinnett County

Use Permit Analysis

Pursuant to Section 3(D)(D.1) of the Conditions of the Zoning Map amendment case RZC-05 -054, dated October 25, 2005, th e sizes and amount ofsignage shall not exceed the requirements of the Sign Ordinance, Advance Auto Parts is seeking approval for a Change In Conditions to allow signage to exceed the requirements of the Sign Ordinance when a sign variance is granted by the Board of Appeals.

Existing condition: Except as contained herein, sizes and amount of signage shall not exceed the requirements of the Sign Ordinance.

Proposed change: Except as contained herein, sizes and amount of signage shall not exceed the requirements of the Sign Ordinance unless a sign variance is applied for and granted by the Gwinnett County Board of Adjustments.

These are the standards that must be upheld in order for the Board of Commissioners to approve this request.

(A) Whether a proposed change in conditions will permit a use that is suitable in view of the use and development of adjacent and nearby property: The proposed CIC will permit a use that suitable to the use and development of adjacent and

nearby property. The condition that is proposed to change was put in place when this property was rezoned from RA-200 (Agriculture-Residence District) to its current zoning of C-2 (General Business). This rezoning was applied for in order to accommodate future commercial developments, which resulted in Advance Auto Parts electing to develop the property for auto­retail. It is the expectancy of motorists to see and utilize signs for wayfinding in corridors that have a cornn1ercial presence. Conm1ercial businesses need to be able to provide advance notification of their property to motorists traveling the corridor in order to attract business and promote safe .wayfinding. The proposed CIC would allow businesses to apply for relief from the sign ordinance when unique circumstances arise from property characteristics. Gwinnett County has an established process for this, and allows the Board of Adjustments to make determinations on requests that exceed the sign ordinance when the applicant otherwise would face hardships. This is standard practice for Cot1lli1ercially zoned properties, and the existing conditions limit future commercial developments to be afforded the same process, which could eventually effect the use and development of the property in an adverse way.

(B) Whether a proposed change in conditions will adversely affect the existing use or usability of adjacent or nearby property:

RECElVED BY CiC '16 02 5

9 2016

6 0 0 1 N I 11 T Z P ~-\ R K \\1 A Y, S 0 U T H BEND , INDI AN A 4 6 6 2 8 \an \ng & eve\opment TEL. 1.800.599 .8 121 F .AX 5 7 4.23 7 .6166

If approved, the proposed CIC will have no adverse effect on the existing use or usability of adjacent or nearby property. The CIC would in fact allow a use that is already allowed by nearby properties. By approving the proposed CIC, the Board of Commissioners would be granting businesses that utilize this property the right to apply for a sign variance. This would have no effect on the use or usability of nearby property. It allows the business effected by these conditions the ability to propose signage above the code allowance, but only if the Board of Adjustments determines that the request meets all the necessary criteria that prove code compliant signage would result in unnecessary hardships, and would have no detrimental effects on the surrounding area. Denying a commercial business the right to apply for this process can only do the business harm. The Board of Adjustments was put in place to allow necessary signage when it ' s deemed necessary, and when the benefits outweigh the negatives. If they determine that the proposal would be of any detriment to neighboring business, then the request would be denied. Prohibiting a business from pursing this process altogether could potentially compromise traffic safety due to inadequate signage.

(C) Whether the property to be affected by a proposed change in conditions has reasonable economic use as currently zoned: As cunently zoned, the property in question does not have the ability to utilize the variance

process for signs. This effects the property's reasonable economic use, as insufficient signage can negatively impact a business. The ability to apply for a variance is a legal process that all conm1ercial properties are entitled to , except where specific conditions prohibit it. In this particular case, this is a condition that was put in place back in 2005 , and hasn ' t been addressed since because no problem has arisen that could potentially be resolved through a sign variance until more recent development of the property.

(D) Whether the proposed change in conditions will result in a use which will or could cause an excessive or burdensome use of existing streets, transportation facilities, utilities, or schools: The proposed CIC will in no way result in a use that will or could cause an excessive or

burdensome use of existing streets, transportation facilities , utilities or schools. The CIC would only enable a business to apply for a variance for signage, which (signage) is already pennitted by the existing conditions subject to the Sign Ordinance. Signage helps facilitate the use of streets and promote traffic safety, but would not cause excessive or burdensome use of the streets.

(E) Whether the proposed change in conditions is in conformity with the policy and intent of the land use plan. The proposed CIC is in confonnity with the policy and intent of the land use plan. Approving

the proposed ere will not allow anything that is not already allowed within commercial districts throughout the county. Allowing a business to variance for a sign does not allow a business to install excessive signage that would not be in conformity with the policy and intent of the land use plan. This only allows a business to install appropriate signage when the Board of Adjustment determines that a variance request is in line with the policy and intent of the land use plan.

(F) Whether there are other existing or changing conditions affecting the use and development of the property which give supporting grounds for either approval or disapproval of the proposed change in conditions: All of the other conditions under condition 3(D)(D.2-D.5) support the approval of the

changing of condition 3(D)(D.l). Conditions D.3-D.5 specifically regulate signage beyond the Sign Ordinance allowance. These additional limitations imposed by the existing (and unchanging) conditions could potentially increase the likelihood of a businesses need for a sign variance. Amending condition D. I to allow for a variance enables a business to address signage issues while still satisfying all of the other conditions that were originally put in place.

RECEIVED Y CIC ,16 02

2

lan 1inQ & Oevelopmen1

08/02/2016

Gwinnett County 7 5 Langley Drive Lawrenceville, GA 30045

RE: Request for a Change in Conditions of case number RZC-05-054 on behalf of Hamilton I\Jfill Retail II, LLC.

To whon1 it may concern:

This proposed Change In Conditions application is being submitted to amend the conditions of the previous resolution, which was adopted October 25th of 2005. The only condition that is proposed to change is Condition 3, subsection D.1 under signage. The existing language reads as follows: Except as contained herein, sizes and amount rif signage shall not exceed t!Je requirements rif the Sign Ordinance. The proposed Change In Conditions application is requesting the addition of the following language to be added to the end of the aforetnentioned condition: ... z111less a sign variance is applied for and granted 0; the Gu;innett Coun!JI Board rif Acij.ustments.

This packet contains the items discussed with staff as necessary for a complete submittal. If there is anything else needed in order for a complete application, please let me know and I will get it to you promptly. Our intention is to be on the October agenda for the Board of Cotnmissioners.

Bret Skirvin Site Enhancement Service (T) 574.232.7471 1 (F) 574.229.4532 Email: [email protected]

CIC l16 0 2 5

CEIVED Y

AUG ~ 9 2016

Planning Development

6001 NIMTZ PARI<WAY, SOUTH BEND, INDIANA 46628 TEL. 1.800.599 .8121 FAX 574 .237 .6166

Gwinnett County Planning Division Change in Condit ions Application

Last Updated 12/20 IS

CHANGE IN CONDITIONS APPLICANT'S CERTIFICATION

THE UNDERSIGNED BELOW IS AUTHORIZED TO MAKE TH IS APPLICATION. THE UNDERSIGNED IS AWARE THAT NO APPLICATION OR REAPPLICATION AFFECTING THE SAME LAND SHALL BE ACTED UPON W ITH IN 12 MONTHS FROM THE DATE OF LAST ACTION BY THE BOARD OF COMMISSIONERS UNLESS WAIVED BY THE BOARD OF COMMISSIONERS. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION BE ACTED UPON IN LESS THAN SIX (6) MONTHS FROM THE DATE OF LAST ACTION BY THE BOARD OF COMMISSIONERS.

Signature of Applicant

Bret Skirvin as agent to property owner Type or Print Name and Title

4

8/2/2016 Date

Notary Seal

CIC '16 0 2 5

RECEIVED BY

Plan ing & evel pment

Gwinnett County Planning Division Change in Conditions Application

Last Updated 12/201 5

CHANGE IN CONDITIONS PROPERTY OWNER'S CERTIFICATION

THE UNDERSIGNED BELOW, OR AS ATTACHED, IS THE OWNER OF THE PROPERTY CONSIDERED IN THIS APPLICATION. THE UNDERSIGNED IS AWARE THAT NO APPLICATION OR REAPPLICATION AFFECTING THE SAME LAND SHALL BE ACTED UPON WITHIN 12 MONTHS FROM THE DATE OF LAST ACTION BY THE BOARD OF COMMISSIONERS UNLESS WAIVED BY THE BOARD OF COMMISSIONERS. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION BE ACTED UPON IN LESS THAN SIX (6) MONTHS FROM THE DATE OF LAST ACTION BY THE BOARD OF COMMISSIONERS.

Date

Type or Print Name and Title

CEIVE BY CIC ~16 0 2 5

/\ tl b 9 201 5

Gwinnett County Planning Division Change in Conditions Application

Last Updated 12/20 I 5

CONFLICT OF INTEREST CERTIFICATION FOR CHANGE IN CONDITIONS

The undersigned below, making application for a change in conditions, has complied with the Official Code of Georgia Section 36-67 A - I, et. seq, Conflict of Interest in Z oning Actions, and has submitted or attached the required information on the forms provided.

·;?/ Signature of Applicant

Signature of Applicant's Attorney or Representative

\,~~·

8/2/1 6 Date

Date

Bret Skirvin - agent to property owner

Type of Print Name and Title

Type or Print Name and Title

1~-------J,+-~-~'--~.Lt-7'---""'--+------'~~-+-----------------

Signatl:ile of Np tary Public Notary Seal

~

D ISCLOSURE OF CAMPAIGN CONTRIBUTIONS

Have you, within the two years immediately preceding the filing of this application, made campaign contributions aggregating $250.00 or more to a member of the Board of Commissioners or a member of the Gwinnett County Planning Commission?

DYES 0No Bret Ski rvin Your Name

If the answer is yes, please complete the following section:

NAME AND OFFICAL CONTRIBUTIONS DATE CONTRIBUTION POSITION OF (List all which aggregate WAS MADE

GOVERNMENT OFFICIAL to $250 or More) (Within last two years)

N/A

N/A

N/A

Attach additional sheets if necessary to disclose or describe all contributions. REC IVE

CIC 116 0 2 5 Allh ~ 9 201

6 Plan ing De e\ pment

Gwinnett County Planning Division Change in Conditions Application

Last Updated 12/20 I 5

VERIFICATION OF CURRENT PAID PROPERTY TAXES FOR CHANGE IN CONDITIONS

THE UNDERSIGNED CERTIFIES THAT ALL GWINNETT COUNTY PROPERTY TAXES BILLED TO DATE FOR THE PARCEL LISTED BELOW HAVE BEEN PAID IN FULL TO THE TAX COMMISSIONER OF GWINNETT COUNTY, GEORGIA. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION FOR REZONING BE PROCESSED WITHOUT SUCH PROPERTY VERIFICATION.

*NOTE: A SEPARATE VERIFICATION FORM MUST BE COMPLETED FOR EACH TAX PARCEL INCLUDED IN THE REZONING REQUEST.

PARCEL I.D. NUMBER: (Map Reference Number)

Signature of Applicant

1 001 District Land Lot

Bret Skirvin as agent to property owner Type or Print Name and Title

032 Parcel

8/2/2016 Date

***PLEASE TAKE THIS FORM TO THE TAX COMMISSIONERS OFFICE AT THE GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE, FOR THEIR APPROVAL BELOW.***

TAX COMMISSIONERS USE ONLY

(PAYMENT OF ALL PROPERTY TAXES BILLED TO DATE FOR THE ABOVE RE RENCED PARCEL HAVE BEEN VERIFIED AS PAID CURRENT AND CONFIRMED BY HE Sl ATU BELOW)

DATE RECEIVED BY

CIC '16 02 5 AUG ~ 9 2016

7 Planning & Development

Gwinnett County Planning Division Change in Conditions Application

Last Updated 12/20 I 5

VERIFICATION OF CURRENT PAID PROPERTY TAXES FOR CHANGE IN CONDITIONS

THE UNDERSIGNED CERTIFIES THAT ALL GWINNETT COUNTY PROPERTY TAXES BILLED TO DATE FOR THE PARCEL LISTED BELOW HAVE BEEN PAID IN FULL TO THE TAX COMMISSIONER OF GWINNETT COUNTY, GEORGIA. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION FOR REZONING BE PROCESSED WITHOUT SUCH PROPERTY VERIFICATION.

*NOTE: A SEPARATE VERIFICATION FORM MUST BE COMPLETED FOR EACH TAX PARCEL INCLUDED IN THE REZONING REQUEST.

PARCEL I.D. NUMBER: (Map Reference Number)

Signature of Applicant

1 001 District Land Lot

Bret Skirvin as agent to property owner Type or Print Name and Title

024A Parcel

8/2/2016 Date

***PLEASE TAKE THIS FORM TO THE TAX COMMISSIONERS OFFICE AT THE GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE, FOR THEIR APPROVAL BELOW.***

TAX COMMISSIONERS USE ONLY

(PAYMENT OF ALL PROPERTY TAXES BILLED TO DATE FOR THE ABOVE R RENCED PARCEL HAVE BEEN VERIFIED AS PAID CURRENT AND CONFIRMED B THE SIG UR ELOW)

51 NAME

sJ llo DATE

R CEIVED BY

!\ \ Jlj (1) 9 2 0 16

7 Planning & Development

Gwinnett County Planning Division Change in Conditions Application

Last Updated 12/20 15

VERIFICATION OF CURRENT PAID PROPERTY TAXES FOR CHANGE IN CONDITIONS

THE UNDERSIGNED CERTIFI ES THAT ALL GWINNETT COUNTY PROPERTY TAXES BILLED TO DATE FOR THE PARCEL LISTED BELOW HAVE BEEN PAID IN FULL TO THE TAX COMMISSIONER OF GWINNETT COUNTY, GEORGIA. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION FOR REZONING BE PROCESSED WITHOUT SUCH PROPERTY VERIFICATION.

*NOTE: A SEPARATE VERIFICATION FORM MUST BE COMPLETED FOR EACH TAX PARCEL INCLUDED IN THE REZONING REQUEST.

PARCEL I.D. NUMBER: (Map Reference Number)

Signature of Applicant

1 001 District Land Lot

856 Parcel

8/2/2016 Date

Bret Skirvin as agent to property owner Type or Print Name and Title

***PLEASE TAKE THIS FORM TO THE TAX COMMISSIONERS OFFICE AT THE GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE, FOR THEIR APPROVAL BELOW.***

TAX COMMISSIONERS USE ONLY

(PAYMENT OF ALL PROPERTY TAXES BILLED TO DATE FOR THE ABOVE REF ENCED PARCEL HAVE BE N VERIFIED AS PAID CURRENT AND CONFIRMED BY E SIG ATU I BELO

DATE

7

Oc,~ vc ?,fh \ M ~-0vV'tG( Ass u Ct6-Av TITLE

RECEIVED Y

C!C '16 0 2 5 Planning & Development

Gwinnett County Planning Division Change in Conditions Application

Last Updated I 2/20 I 5

VERIFICATION OF CURRENT PAID PROPERTY TAXES FOR CHANGE IN CONDITIONS

THE UNDERSIGNED CERTIFIES THAT ALL GWINNETT COUNTY PROPERTY TAXES BILLED TO DATE FOR THE PARCEL LISTED BELOW HAVE BEEN PAID IN FULL TO THE TAX COMMISSIONER OF GWINNETT COUNTY, GEORGIA. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION FOR REZONING BE PROCESSED WITHOUT SUCH PROPERTY VERIFICATION.

*NOTE: A SEPARATE VERIFICATION FORM MUST BE COMPLETED FOR EACH TAX PARCEL INCLUDED IN THE REZONING REQUEST.

PARCEL I.D. NUMBER: (Map Reference Number)

Signature of Applicant

1 001 District Land Lot

Bret Skirvin as agent to property owner Type or Print Name and Title

857 Parcel

8/2/2016 Date

***PLEASE TAKE THIS FORM TO THE TAX COMMISSIONERS OFFICE AT THE GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE, FOR THEIR APPROVAL BELOW.***

TAX COMMISSIONERS USE ONLY

(PAYMENT OF ALL PROPERTY TAXES BILLED TO DATE FOR THE ABOVE REFERENCED PARCEL HAVE BEEN VERIFI ED AS PAID CURRENT AND CONFIRMED BY E SIGt;J TU BELOW)

NAME TITLE

11 'SJ ~~ DATE y

C!C '16 02 5 7 Plan ing Development

Gwinnett County Planning Division Change in Condit ions Application

Last Updated I 2/20 I 5

VERIFICATION OF CURRENT PAID PROPERTY TAXES FOR CHANGE IN CONDITIONS

THE UNDERSIGNED CERTIFI ES THAT ALL GWINNETT COUNTY PROPERTY TAXES BILLED TO DATE FOR THE PARCEL LISTED BELOW HAVE BEEN PAID IN FULL TO THE TAX COMMISSIONER OF GWINNETT COUNTY, GEORGIA. IN NO CASE SHALL AN APPLICATION OR REAPPLICATION FOR REZONING BE PROCESSED WITHOUT SUCH PROPERTY VERIFICATION.

*NOTE: A SEPARATE VERIFICATION FORM MUST BE COMPLETED FOR EACH TAX PARCEL INCLUDED IN THE REZONING REQUEST.

PARCEL I.D. NUMBER: (Map Reference Number)

Signature of Applicant

1 001 District Land Lot

Bret Skirvin as agent to property owner Type or Print Name and Tit le

773 Parcel

8/2/2016 Date

***PLEASE TAKE THIS FORM TO THE TAX COMMISSIONERS OFFICE AT THE GWINNETT JUSTICE AND ADMINISTRATION CENTER, 75 LANGLEY DRIVE, FOR THEIR APPROVAL BELOW.***

TAX COMMISSIONERS USE ONLY

(PAYMENT OF ALL PROPERTY TAXES BILLED TO DATE FOR THE ABOVE REF RENCED PARCEL HAVE BEEN VERIFI ED AS PAID CURRENT AND CONFIRMED BY E SIG A-TURE B LOW)

NJ\ME

g{CS/II.o DATE

CFIVED Y

2016

CIC '16 02 5 lr:\n ling . [ evelnomenl 7