HomeMy WebLinkAboutApplication APPLICANT 11/10/2020 (2)City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
SPRINGFIELD
(City Staff completes form)
Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: X
City: X
Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ❑
Project Information
Applicant Name: Jeremy Kwit
Phone:?
Company:
Cell:
Address: 70 SW Century Drive, Ste.
110-113, Bend, OR 97702
Property Owner: Olympic Street Pro erties
Phone:
Company:
Celh
Address: PO Box 26125 Eugene, OR
97402
ASSESSOR'S MAP NO: 17032541
TAX LOT NOS : 1101
Property Address: 2329 Olympic Street
Description of Proposal:
OLCC LUCS for Marijuana Retail Facility
Record Information
Record NoAl—A-6 6 1 "If
Date Received: 11/ 10/20
Application Fee: $343
Technical Fee: $17.15
TOTAL FEES: $360.15
Assigned Planner:L. Miller
Revised 11.2.11 kl
Site Location:
❑ Inside city limits ❑ Inside UGB ❑ Outside UGB
Name of Jurisdiction:
Property Zoning of
Proposed Premises:
❑ The proposed land use has been reviewed and is prohibited.
❑ The proposed land use has been reviewed and is not prohibited.
If the proposed land use is allowable only as a conditional use, permits are required as noted below.
co.MenM
Name of Reviewing Local Official (print):
Title:
Date:
Email:
Phone:
Signature:
Check this box if there are attachments to this form
REMINDER: Local jurisdictions are NOT required to begin processing
LUCS forms until January 4. 2016 at 8:30 AM
Submitted
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rpplication M andne dcensing rystern and
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Received
OLCC LKense MvesGgomrrecelies
applba[be and begMsreview.
Local Government
LOM Use CorrpIXblay Statement aM local
� op[-ou[reuiewedforprMibiteduse. �
Completeness Review
License MvesngotorondAppFmn[colla[all
addidenal neeessary bforma[bn.
Application Review
license Mvesdgomr resiewsa(plba[bn
to
\determine ifsuhmiaed infmma[ion
meets requiremen s.
Premises Inspection
O¢Chspectcr visits sae to determine
corrpFmce\ uiah phySiod requirements: scanty, opem[IOIIs, HC /
Approved
6 ocet Rrequirements ofappdwUM
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Denied
House Bi1134OOprohibds the OLCC
from issuing a recreational
marijuana license if the propos
use is prohibited by the local
governmgbody.
Possible Denial
bThe OL ¢ m ust reviewfor colrp lion ce
Ow.admneco ivemks and Oregon
w. In sonecases, o {aRn[bl deniol
nt may be o wrearne if the applicant can
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Possible Denial
nt
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does notmeet securag aperu[bml, o!
otherreyulrenents. An opportari
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1
failed inspecdon may,su tin appbmdon
denid.
License
Issued
r
License Fee Due ! :. _.. . All Fees Paid
1\\ The bcense is issued and can be
Applicant
printed ptheapplicant.It must be
pays [helbersirgfeein the entire ryslem. displayed prominm[ly at the location.